Antibiotics use patterns in end-of-life cancer patients and medical staff’s perception of antimicrobial stewardship programs

Background/Aims@#While most cancer patients with end-of-life (EOL) care receive antibiotic treatments, antibiotic use should be decided appropriately considering the benefits, side effects, resistance, and cost effects. Antimicrobial stewardship programs (ASP) are important for patients with EOL care, but there is limited study analyzing actual antibiotic use in EOL care and the perceptions of Korean medical staff. @*Methods@#Electronic medical records of 149 deceased cancer patients hospitalized in the medical hospitalist units at Asan Medical Center in Seoul from May 2019 to September 2021 were reviewed. Basic information, antibiotic use, duration, and changes were investigated. We surveyed medical staff’s perceptions of antibiotics in cancer patients with EOL. @*Results@#Of the 149 cancer patients with EOL care, 146 (98.0%) agreed with physician orders for life-sustaining treatment (POLST). In total, 143 (95.9%) received antibiotics, 110 (76.9%) received combination antibiotic treatment, and 116 (81.1%) were given antibiotics until the day of death. In a survey of 60 medical staff, 42 (70.0%) did not know about ASP, and 24 (40.0%) thought ASP was important in EOL care. Nineteen doctors (31.7%) discussed the use or discontinuation of antibiotics with patients or caregivers when writing POLST, but only 8 patients (5.6%) stopped antibiotics after POLST. @*Conclusions@#Most cancer patients with EOL care continue to receive antibiotics until just before their death. A careful approach is needed, considering the benefits and side effects of antibiotic use, and the patient’s right to self-decision. It is necessary to actively improve awareness of ASP and its importance for medical staff.

Orthodontic intrusion treatment of mandibular anterior teeth in a periodontal patient with hyperdivergent skeletal pattern: 8-year follow-up

Patients who have extruded anterior teeth and deep bite with pathologic tooth migration, it is necessary not only periodontal treat-ment for reduce inflammation, but also orthodontic treatment for intrusion of anterior teeth. However, it is difficult to place the orthodontic brackets due to the deep bite, and there is a problem that the extrusion of the posterior teeth occurs more easily than the intrusion of the anterior teeth biomechanically. In particular, in patients with long face, relative intrusion of the anterior teeth by extrusion of the posterior teeth causes the clockwise rotation of the mandible and makes the facial profile worse. Therefore the biomechanical consideration and appliance design that can block these problems are required from the treatment plan. This is a patient who had a deep overbite with extruded anterior teeth, treated by treatment and intrusion of mandibular anterior teeth using cute brackes and miniscrews, and resulted in favorable maintenance during 8-year retention.

Temporary replacement of congenital missing incisors on mandible using temporary anchorage devices in growing patient: 2-year follow-up

Agenesis of permanent tooth in adolescent patients can be treated either by orthodontic treatment for space closure or by main-taining the space until implant restoration can be carried out in adult. However, gradual atrophy of alveolar bone width makes it dif-ficult to restore the prosthesis in the future or may cause unaesthetic results. Therefore, maintaining of not only the missing space but also the alveolar bone width should be considered. This case is a treatment whereby a temporary replacement of missing 2mandibular incisors in adolescent patient was carried out using 2 temporary anchorage devices (TADs). Two TADs were placed hori-zontally 2 - 3 mm below the top of alveolar ridge, and fixed with artificial teeth by stainless steel wires extended. During the 2 year follow-up, neither gingival inflammation nor loss of the TADs have occurred. In the radiographic evaluation, the growth of the adja-cent alveolar bone was not inhibited, and the width of the alveolar bone was maintained.

Temporary replacement of congenital missing incisors on mandible using temporary anchorage devices in growing patient: 2-year follow-up

Agenesis of permanent tooth in adolescent patients can be treated either by orthodontic treatment for space closure or by main-taining the space until implant restoration can be carried out in adult. However, gradual atrophy of alveolar bone width makes it dif-ficult to restore the prosthesis in the future or may cause unaesthetic results. Therefore, maintaining of not only the missing space but also the alveolar bone width should be considered. This case is a treatment whereby a temporary replacement of missing 2mandibular incisors in adolescent patient was carried out using 2 temporary anchorage devices (TADs). Two TADs were placed hori-zontally 2 - 3 mm below the top of alveolar ridge, and fixed with artificial teeth by stainless steel wires extended. During the 2 year follow-up, neither gingival inflammation nor loss of the TADs have occurred. In the radiographic evaluation, the growth of the adja-cent alveolar bone was not inhibited, and the width of the alveolar bone was maintained.

Influence of Stress, Social Support and Lifestyle on Health-related Quality of Life in Middle Aged Women

PURPOSE: Purpose of this study was to investigate the effects of stress, social support, and lifestyle on health-related quality of life among middle-aged women. METHODS: One hundred forty three-middle aged women were recruited and completed questionnaires regarding their stress, social support, lifestyle and health-related quality of life. Data was analyzed by using descriptive statistics, t-test, ANOVA, and multiple regression. RESULTS: Regression model was statistically significant (F=24.80, p<.001) with 46% of adjusted R2. Stress showed to be a major factor influencing health-related quality of life in middle-aged women (p<.001) and the presence of chronic illness (p=.011) was noted as next in the result of a multiple regression analysis. CONCLUSION: The results suggest that nursing professionals should include strategies to reduce stress and to consider helping women with chronic illness when developing a health promotion program to increase health related quality of life for middle-aged women.

Neurocysticercosis: Clinical Characteristics and Changes from 26 Years of Experience in an University Hospital in Korea

The prevalence of human taeniasis has decreased in Korea. The stool egg positive proportion decreased from 1.9% in 1971 to 0% in 2004 in nationwide surveys. The neurocysticercosis (NCC) is also presumed to decrease. However, detailed information regarding the recent status of NCC in Korea is lacking. We retrospectively reviewed NCC cases from 1990 to 2016 at Asan Medical Center, a 2700-bed tertiary referral hospital in Korea. We identified patients based on clinical symptoms, brain imaging, pathology and serological assay. The cases were classified as parenchymal, extraparenchymal, and mixed NCC. Eighty-one patients were included in the analysis. The mean age was 54.5 years, and 79.0% were male. The number of NCC cases was highest from 1995 to 1999, and continuously decreased thereafter. Forty (49.4%) patients had parenchymal NCC, while 25 (30.9%) patients had extraparenchymal NCC, and 16 (19.8%) patients had mixed NCC. The seizure and headache were most common symptom of parenchymal NCC and extraparenchymal NCC respectively. Hydrocephalus was more common in extraparenchymal NCC, and patients with extraparenchymal NCC were more likely to require a ventriculoperitoneal shunt. Cases of NCC are decreasing accordingly with human taeniasis and lesion location was the most important determinant of clinical presentation and outcome of NCC in Korea.

Age Estimation Based on Pulp Chamber Size of Mandibular First Molars from Intraoral Periapical Radiographs in Korean / 대한법의학회지

The teeth are the hardest structures in the body and can be a biomarker of aging. The aging process and degenerative changes in the teeth are helpful for estimation of age in adults. One of the best-known features of dental aging is a reduction in the size of the pulp chamber as a result of secondary deposition of dentin. In this study, we developed new regression models to estimate chronological age in Korean adults using the mandibular first molars to examine the relationship between age and pulp cavity size on intraoral radiographs. Intraoral periapical digital radiographs of the mandibular first molars were collected from 243 patients (147 male, 96 female) of known age. The radiographic images were analyzed by using the Adobe Photoshop CS5 image editing program. The pulp chamber height ratio (PCHR), pulp chamber width ratio (PCWR) were calculated and found to have a significant negative correlation with age. The correlation was consistently higher for PCHR than for PCWR. The strongest correlation was found for PCHR in female patients (r=−0.824). Multiple regression models were derived using the PCHR and PCWR. The determination coefficients (R²) of the models ranged from 0.660 to 0.730. Our results indicate that the measurement of pulp chamber height and width in the mandibular first molar is a practical, simple and reliable method for estimation of age in Korean adults.

A Case of Behçet's Disease Mimicking Vertebral Invasion of a Mycotic Aneurysm / 대한내과학회지

Behçet's disease is a systemic vasculitis of unknown etiology characterized by recurrent oral and genital ulcers and uveitis. The vascular involvement of Behçet's disease affects arteries, veins, and blood vessels of all sizes, and it can include venous or arterial thrombosis and arterial aneurysms. There are only a few reports of an aortic aneurysm invading a vertebral body in a patient with Behçet's disease. Here, we report the case of a 45-year-old man who was initially diagnosed with vertebral invasion of a mycotic aneurysm. He underwent vascular surgery and received empirical antibiotics, but all cultures were negative. However, he had persistent, recurrent deep vein thrombosis and elevated inflammatory markers. After reviewing the pathology, a final diagnosis of Behçet's disease was made. He was successfully treated with corticosteroids. This report presents a rare case of Behçet's disease mimicking vertebral invasion of a mycotic aneurysm.

A case of ulcerative colitis presenting with cerebral venous thrombosis

Patients with inflammatory bowel disease (IBD) have been reported to have an increased risk of thromboembolism. Cerebral venous thrombosis (CVT) is a rare but serious extraintestinal manifestation of IBD. Due to its highly variable manifestation and low incidence, CVT is not usually readily recognized by physicians. Herein, we report a case of a 35-year-old male presenting with CVT associated with ulcerative colitis (UC). The patient was admitted with chief complaints of bloody diarrhea that had started 3 days prior. Sigmoidoscopy showed hyperemic and edematous mucosa, friability, and shallow ulcers from the sigmoid colon to the rectum suggestive of IBD. Three days later, the patient started complaining of a headache, and gradually developed a decreased level of consciousness. Magnetic resonance imaging of the brain revealed CVT with hemorrhagic infarctions. An angiogram was obtained to evaluate the extent of CVT, and anticoagulation therapy was initiated with intravenous heparin. During hospitalization, he was diagnosed with UC and treated with 5-aminosalicylic acid. After discharge, the patient was recovered without neurological deficit, and remission of UC was also obtained. The presence of headache or acute worsening of neurological status in a patient with IBD should alert the health professionals about the possibility of CVT.

Age Estimation Based on Pulp Chamber Size of Mandibular First Molars from Intraoral Periapical Radiographs in Korean / 대한법의학회지

The teeth are the hardest structures in the body and can be a biomarker of aging. The aging process and degenerative changes in the teeth are helpful for estimation of age in adults. One of the best-known features of dental aging is a reduction in the size of the pulp chamber as a result of secondary deposition of dentin. In this study, we developed new regression models to estimate chronological age in Korean adults using the mandibular first molars to examine the relationship between age and pulp cavity size on intraoral radiographs. Intraoral periapical digital radiographs of the mandibular first molars were collected from 243 patients (147 male, 96 female) of known age. The radiographic images were analyzed by using the Adobe Photoshop CS5 image editing program. The pulp chamber height ratio (PCHR), pulp chamber width ratio (PCWR) were calculated and found to have a significant negative correlation with age. The correlation was consistently higher for PCHR than for PCWR. The strongest correlation was found for PCHR in female patients (r=−0.824). Multiple regression models were derived using the PCHR and PCWR. The determination coefficients (R²) of the models ranged from 0.660 to 0.730. Our results indicate that the measurement of pulp chamber height and width in the mandibular first molar is a practical, simple and reliable method for estimation of age in Korean adults.

Autoimmune Pancreatitis Featuring a Pseudocyst Requiring Drainage despite Steroid Therapy / 대한내과학회지

Autoimmune pancreatitis (AIP) is rarely associated with pancreatic pseudocysts. AIP-associated pseudocysts requiring drainage despite steroid therapy are rather rare. We report a case of AIP with an infected pseudocyst requiring drainage despite steroid therapy. A 68-year-old male was diagnosed with AIP via pancreatic imaging, a high serum immunoglobulin G4 level, and steroid responsiveness. The AIP was accompanied by a pancreatic pseudocyst. Steroid therapy was prescribed, but the pancreatic pseudocyst became aggravated during steroid tapering. Endoscopic ultrasonography-guided cyst drainage was required; the pseudocyst then became completely resolved.

An Assessment of Radiological Age Estimation Method Using Mandibular First Molars in Korean Adults / 대한법의학회지

Age estimation is important in the practice of forensic science to establish the identity of human remains, as well as with living persons. Particularly in Korea, age estimation in adults has been increase in the demand for incorrect birth records in order to be entitled to civil liability, social benefits, employment. The reduction of pulp cavity size as a result of secondary dentin deposit with increasing age could be used to estimate age. This regressive change can be analyzed using radiological techniques; thus, a variety of methods for dental age estimation based on this approach have been proposed. The purpose of this study is to evaluate the concurrence between the Drusini's method and the Jeon's method using the mandibular first molar on orthopantomographs (OPGs) in Korean adults. A total of 232 OPGs (91 females and 141 males) of Korean individuals with ages ranging from 20 to 69 years were analyzed using Drusini's method and Jeon's method. Our results revealed that the correlation of the two methods with age was statistically significant (r=0.501). Both Drusini's method and Jeon's method showed significant correlation with chronological age, and Jeon's method showed a greater correlation with chronological age (r=0.738) than Drusini's method (r=0.586). The mean absolute error was 7.99 years for Jeon's method and 9.79 years for Drusini's method. Our results demonstrate that Jeon's method using the mandibular first molar on OPGs is a practical and suitable method for age estimation in Korean adults.

IgG4-Related Sclerosing Cholangitis Showing Natural Course of Progression to Decompensated Liver Cirrhosis / 대한췌담도학회지

Immunoglobulin G4-related disease (IgG4-RD) is characterized by extensive IgG4-positive plasma cells infiltration resulting in inflammation and fibrosis of the affected organs. Patient with IgG4-RD shows an excellent response to glucocorticoid therapy especially when given at early onset stages. IgG4-related sclerosing cholangitis (IgG4-SC) is considered biliary manifestation of IgG4-RD. The natural history and long-term prognosis of IgG4-SC is not well defined and most of the previous case series have reported short duration of follow-up. We present the case of development of decompensated liver cirrhosis from IgG4-related sclerosing cholangitis with a 6-year natural clinical course.

Adenovirus-mediated Foxp3 expression in lung epithelial cells reduces airway inflammation in ovalbumin and cockroach-induced asthma model

Foxp3 is a master regulator of CD4⁺CD25⁺ regulatory T-cell (Treg) function and is also a suppressor of SKP2 and HER2/ErbB2. There are an increasing number of reports describing the functions of Foxp3 in cell types other than Tregs. In this context, we evaluated the functions of Foxp3 in ovalbumin- and cockroach-induced asthma models. Foxp3-EGFP-expressing adenovirus or EGFP control adenovirus was administered intratracheally (i.t.), followed by challenge with ovalbumin (OVA) or cockroach extract to induce asthma. Th2 cytokine and immune cell profiles of bronchoalveolar lavage fluid (BALF), as well as serum IgE levels, were analyzed. Histological analyses were also conducted to demonstrate the effects of Foxp3 expression on airway remodeling, goblet cell hyperplasia and inflammatory responses in the lung. Adenoviral Foxp3 was expressed only in lung epithelial cells, and not in CD4⁺ or CD8⁺ cells. BALF from Foxp3 gene-delivered mice showed significantly reduced numbers of total immune cells, eosinophils, neutrophils, macrophages and lymphocytes in response to cockroach allergen or OVA. In addition, Foxp3 expression in the lung reduced the levels of Th2 cytokines and IgE in BALF and serum, respectively. Moreover, histopathological analysis also showed that Foxp3 expression substantially inhibited eosinophil infiltration into the airways, goblet cell hyperplasia and smooth muscle cell hypertrophy. Furthermore, when Tregs were depleted by diphtheria toxin in Foxp3DTR mice, the anti-asthmatic functions of Foxp3 were not altered in OVA-challenged asthma models. In this study, our results suggest that Foxp3 expression in lung epithelial cells, and not in Tregs, inhibited OVA- and cockroach extract-induced asthma.

Microarray Analysis of Gene Expression in Rat Glioma after Ethanol Treatment

Objetives: Identification of target genes for ethanol in neurons is important for understanding its molecular and cellular mechanism of action and the neuropathological changes seen in alcoholics. The purpose of this study is to identify of altered gene expression after acute treatmet of ethanol in rat gliom cells. METHODS: We used high density cDNA microarray chip to measure the expression patterns of multiple genes in cultured rat glioma cells. DNA microarrays allow for the simultaneous measurement of the expression of several hundreds of genes. RESULTS: After comparing hybridized signals between control and ethanol treated groups, we found that treatment with ethanol increased the expression of 15 genes and decreased the expression of 12 genes. Upregulated genes included Orthodenticle(Drosophila) homolog 1, procollagen type II, adenosine A2a receptor, GATA-bindning protein 2. Downregulated genes included diacylglycerol kinase beta, PRKC, Protein phosphatase 1, clathrin-associated protein 17, nucleoporin p58, proteasome. CONCLUSION: The gene changes noted were those related to the regulation of transcription, signal transduction, second messenger systems. modulation of ischemic brain injury, and neurodengeneration.Although some of the genes were previously known to be ethanol responsive, we have for the most part identified novel genes involved in the brain response to ethanol.

Rapidly Growing Mature Teratoma in the Anterior Mediastinum: Case Report

Mature teratoma is a benign tumor composed of a number of different types of well-differentiated tissues. Mature teratomas of the mediastinum usually grow slowly and are commonly asymptomatic. We report a case of mediastinal mature teratoma with rapid growth resulting in rupture

Intraosseous Neurilemmoma of the Sternum: A Case Report

Intraosseous neurilemmoma is a rare benign neoplasm that accounts for less than 1% of all primary bone tumors. The most frequent site of involvement is the mandible. We report a case of intraosseous neurilemmoma of the sternum which was discovered incidentally.

The Effect of Exercise on the Conversion Rate of Ingested Glucose to Glycogen in the Hindlimb Skeletal Muscles in Rats / 영남의대학술지

In the present study the effect of exercise on the conversion rate of ingested glucose to glycogen in the different types of hindlimb skeletal muscles in Sprague-Dawley male rats was studied. The amounts of synthetized glycogen from ingested glucose of fast-twitch white (WV), fast-twitch red (RV), mixed type of fast-twitch white and red (EDL), and slow-twitch (SOL) muscles were determined at 30 and 90 min. after ingestion of 25% glucose solution which contained 14C-glucose(2 ml(luCi)/100gm B.W.) in control and exercise loaded rats. The result was summarized as follows: The about 55% at 30 min. and 70% at 90 min. after glucose ingestion were absorbed from gastrointestinal tract. This result shows no effects of exercise on absorption rate from gastrointestinal tract. The amount of synthetized glycogen of SOL from ingested glucose at 30 and 90 min. after glucose ingestion were highest, whether WV were lowest in hindlimb skeletal muscles in control and exercise loaded rats. In the exercise loaded rats, the amounts of synthetized glycogen of SOL, RV, and EDL at 90 min. after glucose ingestion was much higher than control rats, but not different in WV between exercise-loaded and control rats. At 30 min. after glucose ingestion, only SOL of exercise loaded rats was higher than control rats. In the control rat, the synthesis of glycogen was almost completed during initial 30 minutes. On the other hand, in the exercise loaded rat, except WV was opposite result of control rats, i.e., amounts of synthetized glycogen were major during late period. The amount of synthetized glycogen of liver at 30 and 90 min. after glucose ingestion in exercise loaded rats was higher than control rats. The rate of glycogen synthesis in control and exercise loaded rats were higher between 30-90 minute than initial 30 minutes.

A case of Renal Vein Thorombosis Associated with Nephrotic Syndrome / 영남의대학술지

Renal vein thrombosis is usually a complication of multiple underlying renal disease rather than primary process. High incidence of renal vein thrombosis in patients with nephritic syndrome, which suggest the nephrotic syndrome play a paramount role in the genesis of renal vein thrombosis or thromboembolic phenomena. But these are likely to relationship of “egg and chicken”, and then we cannot determine what is primary of these. Recently authors experienced a case that was questioned renal vein thrombosis with nephrotic-syndrome clinically, laboratory and preliminary radiologically, and this case in confirmed by selective left renal venography. Here we report a case of renal vein thrombosis with nephrotic syndrome which successfully managed with oral anticoagulants and reviewed literatures.