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Objective:The characteristics of bacteriology and the change of drug resistance in PICU of our hospital during recent 5 years were analyzed to guide clinical rational drug use.Methods:All positive results of bacterial culture in PICU from January 2016 to December 2020 were retrospectively analyzed, and were classified according to the sample source, strain type and drug sensitivity results.The bacterial etiology spectrum and drug resistance in PICU were summarized.Results:A total of 800 pathogenic bacteria were isolated from the specimens collected from the PICU from January 2016 to December 2020, including 476 Gram-negative bacteria, 292 Gram-positive bacteria, and 32 fungi, accounting for 59.50%, 36.50%, and 4.00%, respectively.The top 9 bacteria were: Staphylococcus aureus 134(16.75%), Haemophilusinfluenzae 79(9.88%), Klebsiellapneumoniae 78(9.75%), Streptococcus pneumoniae 74(9.25%), Escherichia coli 56(7.00%), Acinetobacterbaumannii 51(6.38%), Moraxella catarrhalis 48(6.00%), Enterobacter cloacae 26(3.25%), Pseudomonas aeruginosa 25(3.13%). Drug sensitivity results showed that 27(48.21%, 27/56)strains of EScherichia coli and 42(53.85%, 42/78) strains of Klebsiella pneumoniae were positive for ultrawide spectrum β-lactamase, and a total of 24(17.91%, 24/134)strains of methicillin-resistant Staphylococcus aureus were detected.Staphylococcus aureus was almost 100% resistant to penicillin G and ampicillin, and had high resistance rates to clindamycin and erythromycin(72.70% and 72.30%, respectively). It was 100% sensitive to minocycline, teicoranin, vancomycin, linezolid, and dattomycin.The drug resistance rates of Streptococcus pneumoniae to erythromycin and clindamycin were 98.60% and 98.50%, respectively.The drug resistance rates to azithromycin were 96.80%, the drug resistance rates to penicillin G, cefotaxime and ceftriaxone were 12.30%, 5.40% and 1.50%, respectively, and the drug resistance rates to moxifloxacin, linezolid and vancomycin were 100% sensitive.Conclusion:During the past five years, the etiology of the PICU in our hospital is mainly Gram-negative bacteria, and the most common pathogenic bacteria is Staphylococcus aureus.Klebsiella pneumoniae and Escherichia coli infections remain a great challenge.Bacterial resistance moitoring should be strengthened to provide evidence for the rational use of antibiotics.
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Purpose@#To evaluate the proportion of bevacizumab and the reason for its usage in wet age-related macular degeneration (AMD). @*Methods@#Retrospective analysis of medical records was performed for 1,541 patients who received ranibizumab, aflibercept, or bevacizumab injection to treat wet AMD. The proportion of bevacizumab among the entire set of injections was identified. The reason for selecting bevacizumab was additionally identified. @*Results@#During the study period, a total of 2,929 anti-vascular endothelial growth factor (anti-VEGF) injections were performed; 2,236 (76.3%) were ranibizumab or aflibercept injections and 693 (23.7%) were bevacizumab injections. The most common reason for bevacizumab usage was ‘having a 0.1 or worse best-corrected visual acuity or being unable to assure reimbursement due to the development of extensive scarring or geographic atrophy’ (297 bevacizumab injections, 42.9%). The second most common reason was ‘the inability to assure reimbursement such as extrafoveal choroidal neovascularization (CNV) or early CNV without definite fluid in the foveal region’ (201 bevacizumab injections, 29.0%). @*Conclusions@#Bevacizumab was used in 23.7% of the anti-VEGF injections to treat wet AMD. When analyzing patients’ treatment burden and financial impact, the results of the present study may provide useful information. Further multi-center studies are required to evaluate more precisely the usage of anti-VEGF drugs.
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Purpose@#We compared clinical outcomes between combined laser-assisted subepithelial keratomileusis and accelerated collagen cross-linking (Avedro-LASEK), and LASEK alone. @*Methods@#This retrospective study analyzed 38 eyes of 19 patients who had undergone Avedro-LASEK, and 34 eyes of 17 patients who received LASEK alone. Uncorrected distance visual acuity (UDVA), spherical equivalent (SE), keratometry, and corneal inflammation were evaluated preoperatively, and at 1 week, 1, 3, and 6 months, and 1 and 2 years after surgery. @*Results@#The Avedro-LASEK group had a higher preoperative SE (p < 0.05) and thinner central cornea compared with the control group (p < 0.05). There was no significant difference in UDVA, SE stability or keratometry between the two groups during the 2-year follow-up period. At the 2-year follow-up, the SE was ± 0.25 diopter (D) in 92% of the Avedro-LASEK patients and ± 0.5 D in 90.2% of the LASEK patients. Both groups showed high levels of refractive predictability. There was no significant difference between the flat K (p = 0.38) and steep K (p = 0.56) rates over time between the two groups. Corneal haze was observed in 21% of eyes in the Avedro-LASEK group, but neither decreased vision nor ectasia was observed during the follow-up period. @*Conclusions@#During the 2-year follow-up period, there were no significant differences in any parameters between the Avedro-LASEK and LASEK patients, and both procedures are considered effective for myopia correction because of their stability and effectiveness.
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Purpose@#To evaluate the proportion of bevacizumab and the reason for its usage in wet age-related macular degeneration (AMD). @*Methods@#Retrospective analysis of medical records was performed for 1,541 patients who received ranibizumab, aflibercept, or bevacizumab injection to treat wet AMD. The proportion of bevacizumab among the entire set of injections was identified. The reason for selecting bevacizumab was additionally identified. @*Results@#During the study period, a total of 2,929 anti-vascular endothelial growth factor (anti-VEGF) injections were performed; 2,236 (76.3%) were ranibizumab or aflibercept injections and 693 (23.7%) were bevacizumab injections. The most common reason for bevacizumab usage was ‘having a 0.1 or worse best-corrected visual acuity or being unable to assure reimbursement due to the development of extensive scarring or geographic atrophy’ (297 bevacizumab injections, 42.9%). The second most common reason was ‘the inability to assure reimbursement such as extrafoveal choroidal neovascularization (CNV) or early CNV without definite fluid in the foveal region’ (201 bevacizumab injections, 29.0%). @*Conclusions@#Bevacizumab was used in 23.7% of the anti-VEGF injections to treat wet AMD. When analyzing patients’ treatment burden and financial impact, the results of the present study may provide useful information. Further multi-center studies are required to evaluate more precisely the usage of anti-VEGF drugs.
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Purpose@#We compared clinical outcomes between combined laser-assisted subepithelial keratomileusis and accelerated collagen cross-linking (Avedro-LASEK), and LASEK alone. @*Methods@#This retrospective study analyzed 38 eyes of 19 patients who had undergone Avedro-LASEK, and 34 eyes of 17 patients who received LASEK alone. Uncorrected distance visual acuity (UDVA), spherical equivalent (SE), keratometry, and corneal inflammation were evaluated preoperatively, and at 1 week, 1, 3, and 6 months, and 1 and 2 years after surgery. @*Results@#The Avedro-LASEK group had a higher preoperative SE (p < 0.05) and thinner central cornea compared with the control group (p < 0.05). There was no significant difference in UDVA, SE stability or keratometry between the two groups during the 2-year follow-up period. At the 2-year follow-up, the SE was ± 0.25 diopter (D) in 92% of the Avedro-LASEK patients and ± 0.5 D in 90.2% of the LASEK patients. Both groups showed high levels of refractive predictability. There was no significant difference between the flat K (p = 0.38) and steep K (p = 0.56) rates over time between the two groups. Corneal haze was observed in 21% of eyes in the Avedro-LASEK group, but neither decreased vision nor ectasia was observed during the follow-up period. @*Conclusions@#During the 2-year follow-up period, there were no significant differences in any parameters between the Avedro-LASEK and LASEK patients, and both procedures are considered effective for myopia correction because of their stability and effectiveness.
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Purpose@#This study aimed to investigate the surgical outcomes of nonadjustable Harada-Ito surgery under general anesthesia. @*Methods@#Twenty-two patients who underwent nonadjustable modified Harada-Ito surgery under general anesthesia were reviewed retrospectively. Among them, 21 out of the 22 patients who were followed up for 6 months after surgery were included in this study. Subjective cyclotorsion (double Maddox rod test) and objective cyclotorsions (fundus photography) were measured. Success of the surgery was defined as follows: success (the patients do not acknowledge diplopia at any direction), partial (the patients feel diplopia at a specific direction, but they do not feel discomfort in routine life), and fail (the patients feel diplopia in primary gaze, hence requiring a thorough investigation). @*Results@#The mean age of the patients (18 male and 3 female) was 56.5 years (range, 40–77 years). Based on the alternate prism cover test, the patients had 4.2 ± 3.0 prism diopters of vertical deviation. The corrected amounts of cyclotorsion based on the double Maddox rod test and fundus photography were 14.8° ± 7.5° and 9.8° ± 7.9°, respectively, and were significantly different between the two methods (p = 0.006). After the surgery, 20 out of the 21 patients (95.2%) completely recovered from diplopia in the primary gaze. However, among the 20 patients, seven complained of diplopia in the secondary gaze (down gaze, four patients; head tilt gaze, three patients). The success group had a smaller preoperative subjective excyclotorsion than the partial and fail groups (12.6° ± 2.5° and 21.0° ± 8.9°, respectively; p = 0.046). @*Conclusions@#Nonadjustable modified Harada-Ito surgery under general anesthesia has favorable success rate, and preoperative subjective excyclotorsion can be a prognostic factor in patients with bilateral superior oblique palsy.
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Natural Cordyceps sinensis(Dongchongxiacao) is an insect-fungi complex containing multiple Ophiocordyceps sinensis(≡Cordyceps sinensis) fungi and dead body of larva of the family of Hepialidae. But natural C. sinensis and O. sinensis fungi use the same Latin name, resulting in uncertainty of the specific meaning, even disturbing the formulation and implementation of governmental policies and regulations, and influencing consumer psychology onthe market. This paper reviews the history and current status of the indiscriminate use of the Latin name O. sinensis for both the natural insect-fungi complex C. sinensis and O. sinensis fungi and lists the rename suggetions. Some scholars suggested using the term O. sinensis for the fungi and renaming the natural C. sinensis "Chinese cordyceps". Others suggested renaming the natural C. sinensis "Ophiocordyceps & Hepialidae". Both suggestions have not reached general consensus due to various academic concerns. This paper also reviews the exacerbation of the academic uncertainties when forcing implementing the 2011 Amsterdam Declaration "One Fungus=One Name" under the academic debate. Joint efforts of mycological, zoological and botany-TCM taxonomists and properly initiating the dispute systems offered by International Mycology Association may solve the debate on the indiscriminate use of the Latin name O.sinensis for the natural insect-fungi complex,the teleomorph and anamorph(s) of O. sinensis fungi.
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A recently identified protein, FAN1 (FANCD2-associated nuclease 1, previously known as KIAA1018), is a novel nuclease associated with monoubiquitinated FANCD2 that is required for cellular resistance against DNA interstrand crosslinking (ICL) agents. The mechanisms of FAN1 regulation have not yet been explored. Here, we provide evidence that FAN1 is degraded during mitotic exit, suggesting that FAN1 may be a mitotic substrate of the anaphase-promoting cyclosome complex (APC/C). Indeed, Cdh1, but not Cdc20, was capable of regulating the protein level of FAN1 through the KEN box and the D-box. Moreover, the up- and down-regulation of FAN1 affected the progression to mitotic exit. Collectively, these data suggest that FAN1 may be a new mitotic substrate of APC/CCdh1 that plays a key role during mitotic exit.
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Humans , Anaphase-Promoting Complex-Cyclosome , Bone Neoplasms , Metabolism , Pathology , Cadherins , Genetics , Metabolism , Cdc20 Proteins , Cell Cycle Proteins , Genetics , Metabolism , Cell Line, Tumor , Exodeoxyribonucleases , Genetics , Metabolism , HEK293 Cells , Mitosis , Osteosarcoma , Metabolism , Pathology , Ubiquitin-Protein Ligase Complexes , Genetics , MetabolismABSTRACT
PURPOSE: This study was undertaken to investigate preventable trauma death and trauma care errors contributing to death on Jeju Island. METHODS: A retrospective study was conducted on all trauma deaths between January 2008 and May 2010 at five emergency departments (ED) in Jeju. Of the 165 deaths, 101 patients included for study after excluding death within one hour or after one week. Injury severity was scored according to the Injury Severity Score (ISS) and survival probability (Ps) was calculated. Trauma care errors were coded to six categories: pre-hospital, ED, operating room, intensive care unit, general ward, and inter-hospital transfer. In addition, system inadequacy, problems in treatment, diagnosis, and procedures were analyzed. Patient records were reviewed independently and preventability was determined by agreement. RESULTS: The preventable death rate was 35.6%, and the mean ISS was 25.25+/-10.78. Of all 149 inappropriate cares, 66.4% contributed to death. Of the 121 treatment-related problems, 88 problems occurred in the ED. Of the 18 system-related problems, 12 were in the pre-hospital phase. Seventy of the 96 problems associated with deaths occurred in the ED, and 12 of 29 problems in the pre-hospital phase. CONCLUSION: The preventable death rate was high. Inappropriate care rendered in the treatment process in the ED and system-related errors in the pre-hospital phase were major contributors to preventable trauma deaths. To reduce preventable deaths, more efforts are required on organizing trauma team management and improving care errors during the pre-hospital and inter-hospital transfer.
Subject(s)
Humans , Emergencies , Injury Severity Score , Intensive Care Units , Operating Rooms , Patients' Rooms , Republic of Korea , Retrospective StudiesABSTRACT
Objective To explore the pathological changes by CT scan on localized thermochemotherapy dur- ing and after the operation of human gliomas.Methods Retrospective analysis was given to the CT scan of 37 pa- tients receiving thermochemotherapy during and after the operation,and the relation of the tumorous cells and mi- crovessels and CT density by EM were analyzed.Changes of tumorous cells and microvessels after localized ther- mochemotherapy on C_6 gliomas in rat were analyzed.Results When the tumor was low dense on CT pattern,less cellular number with increasing the amount of fluid between the cells was demonstrated pathologically.On EM,a lower cellular electron density was observed.The amount of fluid in cytoplasm was increased,the cytoplasm was porous,swelling denaturation was chiefly seen in organelle.If the tumor had mixed density on CT,cellular number was more,the amount of fluid was less.On EM,cellular electron density increased correspondingly,the fluid in cyto- plasm decreased,organdie was aggregated.After thermochemotherapy,the tumor reduced,liquefied,and vanished by CT scan.It could be observed that the tumorous cell become smaller,concentrated and cataclased,finally formed apoprotic bodies and separated from the cell in C_6 gliomas in EM.The tumorous vessels was less,smaller and thinker. Some vessels only could see the base membrane and no endothelioid cells.Conclusion The remaining tumors is van- ished by CT scan.The mechanisms of tumors disappearance proposes to explain that thermochemotherapy can dam- age C_6 glioma cells and microvessels,decrease microvessels density and induce tumor ceils apoptosis.That inhibits tu- morous angiogenesis and proliferation.
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PURPOSE: To solve the problems of overcrowding in the emergency department (ED), the Korean government adopted the new emergency fee schedule into National Health Institute (NHI) as of April 2000. The purpose of this system was to determine non-emergent patients from visiting the ED. However, there have been no studies regarding the decision criteria for what constitute an 'emergency'. For that reason, we compared the concordance between the criteria used at the Asan Medical Center since 1998 to designate an emergency with those used by the government to improve the system. METHODS: We performed a retrospective study by collecting the data from 107,097 patients who visited Asan Medical Center from January 1st, 2001, to December 21st, 2002. The criteria on emergency in NHI consist of 36 items, while the criteria at Asan Medical Center are decided by emergency physician and nurse when the patient arrived at the ED. Based on laboratory and radiologic data, a secondary decision is made when the patient is moved from triage to the adult resuscitation room or transferred to an other medical center or discharged. RESULTS: The number of patients who were classified as emergent by both criteria was 22,452 (21%), the number of patients who were classified as non-emergent by both criteria was 39,657 (37%), and the number of patients who were classified in the same way by both criteria was 62,109 (58%). The number of patients for whom the two sets of criteria gave different classification was 44,988 (42%). The Kappa value was 0.138 (p < 0.005). CONCILUSION: There was high discordance between the criteria used by Asan Medical Center and NHI. Further studies and improvements are required.
Subject(s)
Adult , Humans , Classification , Emergencies , Emergency Service, Hospital , Fee Schedules , Fees and Charges , National Health Programs , Resuscitation , Retrospective Studies , TriageABSTRACT
PURPOSE: This study was conducted to solve the problems due to overcrowding of emergency medical centers (EMC) and to help EMCs to improve their financial status. Korean government has implemented a new emergency fee schedule into National Health Insurance (NHI). This policy is aimed at reducing non-emergent visits to EMCs. METHOD: This study was conducted to analyze the impact of the new policy by using a before-after comparison of the patterns of patients' visit to an EMC, Asan Medical Center (AMC). Data electronically recorded at the EMC of AMC were reviewed retrospectively. RESULT: The new emergency fee schedule reduced the rate of increase of non-emergent visit to EMC. CONCLUSION: However, this policy could not succeed in limiting total number of EMC visits. It means that this pricing policy made a partial success in solving the problem of overcrowding of EMCs.