Alterations in lung and gut microbiota reduce diversity in patients with nontuberculous mycobacterial pulmonary disease

Background/Aims@#Although the incidence of nontuberculous mycobacteria pulmonary disease (NTM-PD), a chronic infectious disease, is increasing, lung and gut microbiota dysbiosis in NTM patients has rarely been studied and was therefore the focus of this study. @*Methods@#We analyzed the microbiota diversity in sputum and stool samples from 10 healthy subjects and 10 patients with NTM-PD through sequencing of the V3 and V4 regions of the 16S rRNA gene. In NTM-PD patients, we comparatively evaluated the microbiota diversity according to the body mass index (BMI), with BMI ≤ 18.5 kg/m2 defined as “underweight” and BMI > 18.5 kg/m2 as “others.” @*Results@#The sputum microbiota from NTM-PD patients tended to have lower index values of amplicon sequence variant richness, Shannon evenness, and beta diversity than those from the control group. Furthermore, NTM-PD patients with a low BMI had a lower microbiota diversity than patients with high BMI. Fecal samples from NTM-PD patients also significantly differed in alpha and beta diversity compared with the control group and exhibited a diversity pattern similar to that found in sputum samples. @*Conclusions@#Our results reveal that the lung and gut microbiota of patients with NTM-PD exhibit an altered distribution and reduced richness and diversity.

Evaluation of Iodine Status among Korean Patients with Papillary Thyroid Cancer Using Dietary and Urinary Iodine

Background@#Concerns have been raised regarding thyroid disorders caused by excessive iodine in Koreans, who have iodine-rich diets. This study evaluated iodine status using dietary iodine intake and urinary iodine in papillary thyroid cancer (PTC) patients. @*Methods@#Dietary data of PTC patients were assessed using a 24-hour recall and food frequency questionnaire (FFQ), and urinary iodine concentrations (UICs) were also obtained. To compare the iodine status of PTC patients, Korean adults with or without thyroid disease from the Korea National Health and Nutrition Examination Survey, which had 24-hour recall data and urinary iodine measurements, were analyzed. @*Results@#The median daily iodine intake by 24-hour recall was 341.7 μg/day in PTC patients, similar to the levels of other Korean adults. Based on UICs, the prevalence of excessive iodine was 54.4% in PTC patients, which was similar to the prevalence among subjects with thyroid disease (55.4%) but slightly higher than that in subjects without thyroid disease (47.7%). Based on dietary iodine by 24-hour recall, the prevalence of excessive iodine intake was 7.2%, which was higher than that among subjects with (4.4%) or without (3.9%) thyroid disease. The dietary iodine intake based on 24-hour recall was closely correlated with the UIC (r=0.4826) in PTC patients, but dietary iodine by FFQ was not significantly correlated with either 24-hour recall or UIC-based dietary iodine. @*Conclusion@#Excessive iodine intake was more common in PTC patients than in subjects without thyroid disease. Further longitudinal research is necessary to elucidate the role of dietary iodine in PTC.

Evaluation of Iodine Status among Korean Patients with Papillary Thyroid Cancer Using Dietary and Urinary Iodine

Background@#Concerns have been raised regarding thyroid disorders caused by excessive iodine in Koreans, who have iodine-rich diets. This study evaluated iodine status using dietary iodine intake and urinary iodine in papillary thyroid cancer (PTC) patients. @*Methods@#Dietary data of PTC patients were assessed using a 24-hour recall and food frequency questionnaire (FFQ), and urinary iodine concentrations (UICs) were also obtained. To compare the iodine status of PTC patients, Korean adults with or without thyroid disease from the Korea National Health and Nutrition Examination Survey, which had 24-hour recall data and urinary iodine measurements, were analyzed. @*Results@#The median daily iodine intake by 24-hour recall was 341.7 μg/day in PTC patients, similar to the levels of other Korean adults. Based on UICs, the prevalence of excessive iodine was 54.4% in PTC patients, which was similar to the prevalence among subjects with thyroid disease (55.4%) but slightly higher than that in subjects without thyroid disease (47.7%). Based on dietary iodine by 24-hour recall, the prevalence of excessive iodine intake was 7.2%, which was higher than that among subjects with (4.4%) or without (3.9%) thyroid disease. The dietary iodine intake based on 24-hour recall was closely correlated with the UIC (r=0.4826) in PTC patients, but dietary iodine by FFQ was not significantly correlated with either 24-hour recall or UIC-based dietary iodine. @*Conclusion@#Excessive iodine intake was more common in PTC patients than in subjects without thyroid disease. Further longitudinal research is necessary to elucidate the role of dietary iodine in PTC.

Clinical Outcomes of Early Extubation Strategy in Patients Undergoing Extracorporeal Membrane Oxygenation as a Bridge to Heart Transplantation

Background@#Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) might be considered a bridge therapy in patients who are expected to have short waiting times for heart transplantation. We investigated the clinical outcomes of patients who underwent VA-ECMO as a bridge to heart transplantation and whether the deployment of an early extubation ECMO strategy is beneficial. @*Methods@#Between November 2006 and December 2018, we studied 102 patients who received VA-ECMO as a bridge to heart transplantation. We classified these patients into an early extubation ECMO group (n = 24) and a deferred extubation ECMO group (n = 78) based on the length of the intubated period on VA-ECMO (≤ 48 hours or > 48 hours). The primary outcome was in-hospital mortality. @*Results@#The median duration of early extubation VA-ECMO was 10.0 (4.3–17.3) days.The most common cause for patients to be put on ECMO was dilated cardiomyopathy (65.7%) followed by ischemic cardiomyopathy (11.8%). In-hospital mortality rates for the deferred extubation and early extubation groups, respectively, were 24.4% and 8.3% (P = 0.147). During the study period, in the deferred extubation group, 60 (76.9%) underwent transplantation, while 22 (91.7%) underwent transplantation in the early extubation group.Delirium occurred in 83.3% and 33.3% of patients from the deferred extubation and early extubation groups (P < 0.001) and microbiologically confirmed infection was identified in 64.1% and 41.7% of patients from the two groups (P = 0.051), respectively. @*Conclusion@#VA-ECMO as a bridge therapy seems to be feasible for deployment in patients with a short waiting time for heart transplantation. Deployment of the early extubation ECMO strategy was associated with reductions in delirium and infection in this population.

Psychological Impact of Quarantine on Caregivers at a Children's Hospital for Contact with Case of COVID-19

Quarantine often provokes negative psychological consequences. Thus, we aimed to identify the psychological and behavioral responses and stressors of caregivers quarantined with young patients after a close contact to a coronavirus disease 2019 case at a children's hospital. More than 90% of the caregivers reported feelings of worry and nervousness, while some of them reported suicidal ideations (4.2%), and/or homicidal ideations (1.4%). Fear of infection of the patient (91.7%) and/or oneself (86.1%) were most frequently reported stressors. A multidisciplinary team including infection control team, pediatrician, psychiatrist, nursing staff and legal department provided supplies and services to reduce caregiver's psychological distress. Psychotropic medication was needed in five (6.9%), one of whom was admitted to the psychiatry department due to suicidality. Quarantine at a children's hospital makes notable psychological impacts on the caregivers and a multidisciplinary approach is required.

Revision of an iodine database for Korean foods and evaluation of dietary iodine and urinary iodine in Korean adults using 2013–2015 Korea National Health and Nutrition Examination Survey / 한국영양학회지

Purpose@#Variations in the iodine contents of foods is critical for estimating the iodine intake. This study aimed to update the iodine database of common Korean foods and evaluated the iodine intake in Korean adults. @*Methods@#A list of 855 Korean foods was selected for the updated iodine database. The updated database was established with Version 1 and 2 by applying an average or minimum value for the imputed values. The iodine intake was estimated in 5,927 Korean adults using the data from the 2013–2015 Korea National Health and Nutrition Examination Survey. @*Results@#The analytical values in the updated database were 166 (19.4%), followed in order by 318 (37.2%), 247 (28.9%), and 124 (14.5%) for the adapted, imputed, and missing values, respectively. The median of dietary iodine intake was 352.1 μg/day (± 2,166.1) and 343.4 μg/day (± 2,161.9) in Version 1 and 2 among the total population. The contribution rates of each food group to the iodine intake were 55.7% for seaweeds, which showed a similar trend in Version 2. When subjects were divided by consumption of seaweeds, the median iodine intake was 495.7 μg in the consumer group, which was almost double (241.2 μg) that of the non-consumer group. The proportion of subjects who consumed below the Estimated Average Requirement of iodine was 11.0% in the non-consumer group. In contrast, 11.6% in the consumer group of seaweed consumed above the Upper Level of iodine. When the dietary iodine and urinary iodine were examined, the regression coefficient was 0.11718 in Version 1 and 0.11512 in Version 2 after adjusting for age and sex. @*Conclusion@#This study presented the variation of iodine intake in Korean adults by applying different versions of the iodine database. As the iodine intake can vary due to the highly variable concentrations in the major food sources, an iodine database is necessary to be monitored, and caution should be taken when the database is used in research.

Factors Influencing Self-leadership of Nursing Students according to Locus of Control / 간호행정학회지

PURPOSE: The purpose was to identify factors which affect nursing students' self-leadership according to their locus of control. METHODS: This study was a descriptive research. Participants were 600 D city junior and senior nursing students who had completed clinical training. RESULTS: Results showed the following characteristics of students who had high self-leadership: For students with external locus of control the following correlations with self-leadership were found:, general creativity (r=.46), social support (r=.48), academic self-efficacy (r=.29), and communication competence (r=.49). For students with internal locus of control, self-leadership was correlated with general creativity (r=.46), social support (r=.41), academic self-efficacy(r=.36), and communication competence (r=.48). For the nursing students with external locus of control, age (β=−.24, p=.010), satisfaction with campus life (β=.16, p=.027), general creativity (β=−.20, p=.017), and social support (β=−.20, p=.028) had significant effects on their self-leadership: explanatory power of 44% (F=6.53, p < .001). For students with internal locus of control, self-leadership was effected by general creativity (β=.20, p=.011) and social support (β=.19, p=.012): explanatory power was 42%(F=5.96, p < .001). CONCLUSION: Applying these findings to the curriculum of nursing students would improve their self-leadership and increase the efficiency of organizational culture and contribute to goal achievement in nursing organizations.

Inhibitory Effect of Carnosol on Phthalic Anhydride-Induced Atopic Dermatitis via Inhibition of STAT3

Carnosol is a phenolic antioxidant present in rosemary (Rosmarinus officinalis). It is known for anti-inflammatory effects, analgesic activity and anti-cancer effects. However, no study has been dedicated yet to its effect on atopic dermatitis (AD). Here, we show that carnosol effectively inhibited LPS-induced nitric oxide (NO) generation and expression of inflammatory marker proteins (iNOS and COX-2) in RAW 264.7 cells. In addition, carnosol effectively inhibits the phosphorylation of STAT3 and DNA binding activity in RAW 264.7 cells. Pull down assay and docking model analysis showed that carnosol directly binds to the DNA binding domain (DBD) of STAT3. We next examined the anti-atopic activity of carnosol (0.05 μg/cm²) using 5% Phthalic anhydride (PA)-induced AD model in HR1 mice. Carnosol treatment significantly reduced 5% PA-induced AD like skin inflammation in skin tissues compared with control mice. Moreover, carnosol treatment inhibits the expression of iNOS and COX-2 in skin tissue. In addition, the levels of TNF-α, IL-1β, and Immunoglobulin-E in blood serum was significantly decreased in carnosol treated mice compared with those of 5% PA treated group. Furthermore, the activation of STAT3 in skin tissue was decreased in carnosol treated mice compared with control mice. In conclusion, these findings suggest that carnosol exhibited a potential anti-AD activity by inhibiting pro-inflammatory mediators through suppression of STAT3 activation via direct binding to DBD of STAT3.

Acquired Pure Red Cell Aplasia following Autoimmune Hemolytic Anemia in Systemic Lupus Erythematosus / 대한내과학회지

Pure red cell aplasia (PRCA) is a rare hematological disorder characterized by severe normochromic normocytic anemia and reticulocytopenia due to erythroid progenitor depletion in an otherwise normal bone marrow. Autoimmune hemolytic anemia (AIHA) is caused by autoantibodies directed against red blood cells with normocytic or macrocytic anemia with reticulocytosis. Both diseases can develop in conjunction with various underlying diseases, such as immunological disorders. Although rare, there have been a few cases of AIHA followed by PRCA. Here, we report a patient who developed PRCA following AIHA and was later diagnosed with systemic lupus erythematosus.

HPLC analysis of Phenolic Substances and Anti-Alzheimer's Activity of Korean Quercus Species

This study aimed to establish the quantitative method to analyze the content of peroxynitrite-scavengers belonging to polyphenols in six Korean Quercus species (Quercus mongolica, Q. dentata, Q. acutissima, Q. alienta, Q. serrata, and Q. variabilis) by HPLC. The twelve peroxynitrite-scavengers, flavanols (catechins: (+)-catechin, (−)-epicatechin, and (−)-epigallocatechin), flavonols (kaempferol and quercetin), flavonol glycosides (astragalin, quercitrin, and isoquercitrin), flavonol acylated glycosides (astragalin 6″-gallate and isoquercitrin 6″-gallate), gallic acid and its dimer (ellagic acid) were analyzed by HPLC. Further, anti-Alzheimer's activity was assayed in a passive avoidance testusing mice by measuring the retention latency (sec), the concentration of acetylcholine (ACh), and acetylcholinesterase (AChE) activity. Simultaneous analysis of the extracts of the six Quercus leaves was achieved on a Capcell C18 column (5 µm, 250 mm × 4.6 mm i.d.) with a gradient elution of 0.05% HAc and 0.05% HAc in CH₃CN. In the extract of Q. mongolica leaves, the content of gallic acid (32.53 mg/g), (+)-catechin (28.78 mg/g), (−)-epicatehin (22.03 mg/g), astragalin 6″-gallate (20.94 mg/g), and isoquercitrin 6″-gallate (44.11 mg/g) and peroxynitrite-scavenging activity (IC₅₀, 0.831 µg/ml) were high. This extract delayed the retention latency and inhibited acetylcholinesterase activity in scopolamine-induced memory impairment of mice, suggesting that it has anti-Alzheimer's activity.

Clinical risk factors associated with the development of wheezing in children less than 2 years of age who required hospitalization for viral lower respiratory tract infections / 소아과

PURPOSE: Wheezing following viral lower respiratory tract infections (LRTIs) in children <2 years of age is an important risk factor for the development of asthma later in life; however, not all children with viral LRTIs develop wheezing. This study investigated risk factors for the development of wheezing during viral LRTIs requiring hospitalization. METHODS: The study included 142 children <2 years of age hospitalized for LRTIs with at least one virus identified as the cause and classified them into children diagnosed with LRTIs with wheezing (n=70) and those diagnosed with LRTIs without wheezing (n=72). RESULTS: There were no significant differences in the viruses detected between the two groups. Multivariate logistic regression analysis showed that, after adjusting for potentially confounding variables including sex and age, the development of wheezing was strongly associated with parental history of allergic diseases (adjusted odds ratio [aOR], 20.19; 95% confidence interval [CI], 3.22-126.48), past history of allergic diseases (aOR, 13.95; 95% CI, 1.34-145.06), past history of hospitalization for respiratory illnesses (aOR, 21.36; 95% CI, 3.77-120.88), exposure to secondhand smoke at home (aOR, 14.45; 95% CI, 4.74-44.07), and total eosinophil count (aOR, 1.01; 95% CI, 1.01-1.02). CONCLUSION: Past and parental history of allergic diseases, past history of hospitalization for respiratory illnesses, exposure to secondhand smoke at home, and total eosinophil count were closely associated with the development of wheezing in children <2 years of age who required hospitalization for viral LRTIs. Clinicians should take these factors into consideration when treating, counseling, and monitoring young children admitted for viral LRTIs.

Management of a 25-day-old Male Presenting with a First Episode of Acute Pyelonephritis, and Persistent Hyperkalemia with Normal Serum Aldosterone

Hyperkalemia is often detected in young infants, particularly in association with acute pyelonephritis or a urinary tract anomaly. Cases of hyperkalemia in this population may also be due to transient pseudohypoaldosteronism, or immaturity of renal tubules in handling potassium excretion. Symptoms of hyperkalemia are non-specific, but are predominantly related to skeletal or cardiac muscle dysfunction, and can be fatal. Therefore, treatment has to be initiated immediately. Administration of fludrocortisone for hyperkalemia is appropriate in cases with hypoaldosteronism, but is challenging in young infants with hyperkalemia due to renal tubular immaturity, without pseudohypoaldosteronism. We report the case of a 25-day-old male presenting with persistent hyperkalemia with normal serum aldosterone, who was admitted with a first episode of pyelonephritis and unilateral high-grade vesicoureteral reflux. The patient was treated successfully with fludrocortisone.

The Most Important Factors for Retinopathy of Prematurity in Preterm Infants / 대한주산의학회잡지

PURPOSE: There are many known risk factors for a retinopathy of prematurity (ROP). We analyzed the most important risk factors and predictors of ROP among them. METHODS: We retrospectively reviewed the medical records of all premature infants admitted to the neonatal intensive care unit (NICU), between January 2010 and December 2012 at Gangnam CHA Medical Center, Seoul. . All infants (n=185) were hospitalized for more than 28 days, received eye examination for ROP and showed one of the following criteria: birth weight (BW) below 1,500 g, gestational age (GA) below 32 weeks, or oxygen treatment (> or =40% oxygen for more than 3 days). We divided the infants into the Non-ROP group (n=162) and the ROP group (n=23, more than stage 1) and analyzed group comparisons, risk factors and the importance of each factor of ROP by SPSS 13.0. RESULTS: Risk factors were duration of oxygen uses [Odds ratio (OR): 1.064, 95% confidence interval (CI): 1.007-1.125, P=0.028] and intravenous (IV) steroid (OR: 1.234, 95% CI: 1.000-1.523, P=0.049) by multi-factor adjustment. The most important factor was oxygenation duration. The following factors were time to full enteral feedings, and IV steroid duration. CONCLUSION: The incidence of ROP will be decreased if we can reduce the length of oxygen uses, IV steroid use and advance the full feeding achievement.

Effects of Empowerment and Job Satisfaction on Nursing Performance of Clinical Nurses / 간호행정학회지

PURPOSE: This study was conducted to identify factors that affect nursing performance; Those factors are personal characteristics, sub-categories of empowerment and job satisfaction of clinical nurses. METHODS: Data were collected from November 24, 2012 to March 11, 2013, and participants were 451 hospital nurses in 6 hospitals. Descriptive statistics, t-test, one-way ANOVA, Pearson correlation coefficient, and stepwise multiple regression were used for data analysis. RESULTS: Nurses who were older, married, highly educated, in the position of charge nurse, and with longer clinical careers showed relatively higher empowerment, higher job satisfaction, and higher nursing performance than others. Also, there were strong correlations between nursing performance and empowerment (r=.576)/job satisfaction (r=.617). Factors predicted nursing performance were relationship with coworkers (beta=.398), duty (beta=.181), promotion system (beta=.134), and turnover intention (beta=-.109). Factors predicting job satisfaction were competency of empowerment (beta=.249), and clinical career (beta=.151). These 6 factors explained 55.2% of the variance in nursing performance (F=93.37, <.001). CONCLUSION: Regarding human resource management, relationship with co-workers is a changeable factor. Therefore nursing organizations should apply these factors in human resource management to enhance nursing performance and achieve organizational goals.

Active Surveillance of Pertussis in Infants Under 6 Months of Age: A Single Center Experience from 2011 to 2013 / 소아감염

PURPOSE: The objective of this study was to assess and investigate the epidemiology of pertussis in infants under 6 months of age. METHODS: A prospective study was conducted between October 1, 2011 and April 30, 2013 in CHA Bundang Medical Center, Seongnam, South Korea. Polymerase chain reaction (PCR) or culture was used to detect Bordetella pertussis in nasopharyngeal aspirates from case patients who were hospitalized for acute lower respiratory tract infection (LRTI). In addition, multiplex real-time PCR assays were also performed to detect 6 etiologic viruses, including adenovirus, human metapeumovirus, influenza virus, parainfluenza virus, respiratory syncytial virus and rhinovirus. RESULTS: Of the 79 enrolled case patients, whose median age was 2 months of age, the most common diagnoses uncovered in this study were acute bronchiolitis (60%) and pneumonia (28%). B. pertussis infection was found in 13 cases (16%), in which 7 (53%) was coinfected with respiratory syncytial virus and 1 (7%) with influenza A virus. Of the 13 patients with B. pertussis infection, 6 (46%) were not vaccinated with the diphtheria, tetanus toxoid, and acellular pertussis vaccine, while 6 (46%) received 1 dose, and 1 (8%) received 2 doses. CONCLUSION: B. pertussis infection was present in 16% of under 6 month-old infants, who were hospitalized for acute LRTI. Therefore, a nationwide epidemiological surveillance of pertussis, including institutions that cater to infants under 6 months of age is necessary and needed.

Risk Factors of Suicide Attempt in Male Patients with Alcohol Dependence / 신경정신의학

OBJECTIVES: The aim of this study was to evaluate the risk factors of suicide attempt in patients with alcohol dependence. METHODS: A total of 68 patients admitted to the hospital for alcohol dependence were divided into two groups according to history of suicide attempt. In this study, sociodemographic variables, characteristics of alcohol drinking, and clinical scales were compared between the two groups. RESULTS: Regarding sociodemographic and clinical features, the alcoholic group with history of suicide attempt included more patients with no spouse, using medical aid in social security, and history of depressive disorder. Regarding characteristics of alcohol drinking, ages of first alcohol problems and first admission for alcohol problems were significantly younger in the attempter group. Patients in the attempter group had been drinking more and had higher frequency of delirium tremens and psychiatric admission. Regarding clinical scales, significantly higher scores for suicide ideation, depression, anxiety, and impulsiveness were observed in the attempter group. Among the scores for Temperament and character inventory, the score for persistence was significantly lower in the attempter group. After controlling for other compounding factors, depressive disorder [p=0.006, odds ratio (OR)=32.2] and suicide ideation (p=0.029, OR=1.2) were significant factors showing correlation with suicide attempt. CONCLUSION: Results of this study suggest that assessment and management of the depressive disorder and suicide ideation are necessary for suicide prevention in patients with alcohol dependence.

Psychiatric Disorders of North Korean Defectors in South Korea : Four Case Report / 신경정신의학

OBJECTIVES: Cases of psychiatric disorders are reported with a review of literature on mental health problems in North Korean defectors in South Korea. METHODS: Four patients who were admitted to a psychiatric hospital with major depression, schizophrenia, bipolar affective disorder, or mixed disorder of conduct and emotions of adolescent were studied. RESULTS: The most common precipitating factor was the separation from close persons they had been dependent on. Defector-specific stress included unfamiliar culture of South Korea, lack of ability to adapt to South Korean society, uselessness of past education and professional skills, stress with regard to being identified or discriminated as a North Korean defector, and guilt feeling for leaving their family behind in North Korea. North Korean defector-specific clinical findings were noted; these included reluctance to expose themselves as North Koreans, negative emotional reaction to discrimination of South Korean neighbors, submissive and passive attitude, loneliness, anxiety for the future related to refugee status, and strong stigma related to psychiatry. CONCLUSION: This case report suggests that an individualized or tailored treatment that considers their unique psychosocial situation, which especially focuses on discrimination and social support, is needed for North Korean defectors with mental disorders.

Clinical study on survival rate of osseointegrated implants

Immunologic Response to Cryoablation of Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cryoablation has been recognized as a potential tool in the treatment of cancer. Beside its ability to cause local destruction of the primary tumor, cryoablation has been claimed to induce a systemic anti-tumor immune response. We compared cryoimmunologic responses between cryoablation and surgical excision in a murine model of squamous cell carcinoma (SCC). MATERIALS AND METHOD: Six-to 8-weeks-old female mice (total n=30) were used for this study. Tumors were established at the flank of C3H mice with the SCCVII cell line, which is an immunogenic murine SCC of spontaneous origin in the C3H/HeJ mice. The mice underwent surgical excision or cryoablation, when the tumors were between 0.3 and 0.6 cm in the largest dimension. Successfully treated mice were re-challenged with the murine bladder cancer cells, namely, SCCVII cell line or MBT-2 cells at the contralateral flank. One week later, secondary tumor growth was estimated. Spleens were harvested from the mice that had no tumor after re-challenge. Effector splenocytes were added to the target SCCVII cells prelabeled with 3H thymidine. Cytotoxicity was investigated by measuring 3H thymidine releases from target cells. RESULTS: After re-challenging the SCCVII cell line, tumors were developed in 33% (1/3) of the mice treated by surgical excision, compared to 0% (0/4) of mice treated by cryoablation. In the cytotoxicity assay, there were no significant differences between the excision and cryoablation group. CONCLUSION: These results suggest that the anti-tumor immunologic effect of cryoablation in the murine SCC model is not better than that of surgical excision.

Comparison of a Closed with an Open Endotracheal Suction: Costs and the Incidence of Ventilator-associated Pneumonia / 결핵및호흡기질환

BACKGROUND: Tracheobronchial suctioning using the closed suctioning system has physiological benefits for critically ill patients. Despite these benefits, there are concerns about increased colonization of tracheobronchial tree by pathogenic organisms. The cost is another hinder to the introduction of closed suction system. The aim of this study was to evaluate the incidence of colonization and ventilator associated pneumonia and the cost-effectiveness of closed suction compared with open suction. METHODS: During separated one month period, patients admitted MICU were cared by multiple-use, open suction, single-use, open suction and multiple-use, closed suction method, consecutively. Costs, colonization of tracheobronchial tree by MRSA and the incidence of ventilator-associated pneumonia (VAP) were analyzed. RESULTS: One-hundred and six patients were enrolled. Twenty patients were treated with multiple-use, open suction, while 42 and 44 patients were cared with single-use, open catheter and multiple-use, closed catheter, respectively. Colonization by MRSA and the incidence of VAP were not different among three ways of suctioning. The overall costs per patient per day for suctioning were 10.58 dollars for multiple-use, open suction, 28.27 dollars for single-use, open suction and 23.76 dollars for multiple-use, closed suction. CONCLUSION: Multiple-use, closed suctioning, when suction catheters were changed every 48 hrs, has the similar incidence of colonization of MRSA and occurrence of VAP and is a cost-efficient way of endotracheal suction.