Difference of Microbial Community in the Stream Adjacent to the Mixed Antibiotic Effluent Source.

Released antibiotics from source to stream can influence bacterial communities and potentially alter the ecosystem. This research provides a comprehensive examination of the sources, distribution, and bacterial community dynamics associated with varied antibiotic release sources adjacent to the stream. The residual of antibiotics from different sources was determined, and the bacterial community structure was examined to reveal the differences in the bacteria community in the stream. The residual of antibiotics was quantified with liquid chromatography-tandem mass spectrometry (LC-MS/MS), and the Illumina MiSeq platform was utilized to sequence bacterial 16S rRNA genes, providing comprehensive insights into the bacterial community structure in the sediment across five different sites. Results indicated that the presence and distribution of antibiotics were significantly influenced by released sources. In the case of the bacterial community, the Proteobacteria and Firmicutes were the most dominant phyla in the sediment, and especially, the Firmicutes showed higher abundance in sites mostly affected by livestock sources. Additionally, livestock gut bacteria such as Clostridium saudiense, Proteiniclasticum ruminis, and Turicibacter sanguinis were prevalent in antibiotic-contaminated sites adjacent to livestock facilities. Overall, this study provides critical insights into the effect of antibiotic contamination by verifying the relationship between the occurrence of antibiotic residuals and the alteration in the bacterial community in the stream.

Bioaccumulation and Mass Balance Analysis of Veterinary Antibiotics in an Agricultural Environment.

Veterinary antibiotics (VAs) released into the environment are a concern because of the possibility for increasing antibiotic-resistance genes. The concentrations of six VAs, chlortetracycline, oxytetracycline, tetracycline, sulfamethazine, sulfamethoxazole, and sulfathiazole, in manure-based compost, soil, and crops were measured using liquid chromatography-tandem mass spectrometry. Mass balance analysis was conducted based on the measured antibiotic concentration, cultivation area, and amount of manure-based compost applied. The result showed that the detected mean concentration of VAs ranges was 3.52~234.19 µg/kg, 0.52~13.08 µg/kg, and 1.05~39.57 µg/kg in manure-based compost, soil, and crops, respectively, and the substance of VAs detected in different media was also varied. Mass balance analysis showed that the VAs released from the manure-based compost can remain in soil (at rates of 26% to 100%), be taken up by crops (at rates of 0.4% to 3.7%), or dissipated (at rates of 9% to 73%) during the cultivation period. Among the six VAs, chlortetracycline and oxytetracycline mainly remained in the soil, whereas sulfamethoxazole and sulfathiazole were mainly dissipated. Although we did not verify the exact mechanism of the fate and distribution of VAs in this study, our results showed that these can vary depending on the different characteristics of VAs and the soil properties.

Sex difference of mortality by age and body mass index in gastric cancer.

Mortality difference by age, sex, body mass index (BMI) in gastric cancer (GC) has been controversial. We evaluated sex-specific mortality by age and BMI. A total of 5961 patients diagnosed with GC from 2005 to 2013 in a single tertiary center were included and were followed until December 2017. The plot in goodness-of-fit-test by sex was crossed, so we performed sex-specific analysis. Overall mortality was lower in women than in men (adjusted hazard ratio [aHR], 0.72). Favor outcomes in women compared to men were observed among patients older than 60 yr (aHR, 0.64; 95% CI, 0.56-0.74), a BMI less than 25 kg/m2 (aHR, 0.69; 95% CI, 0.61-0.79), and stage I (aHR, 0.46; 95% CI, 0.38-0.56). In sex-specific analysis, mortality increased in age older than 60 yr in men, whereas it increased in both extreme ages (<40 yr and ≥ 70 yr) in women. Mortality by BMI was lowest at BMI of 25-29.9 kg/m2 and gradually increased according to decrease of BMI in men; aHR, 1.24 (23-24.9 kg/m2), 1.44 (18.5-22.9 kg/m2), and 2.54 (BMI<18.5 kg/m2). However, mortality decreased in patients with BMI ≥ 30 kg/m2 (aHR, 0.46) in women. The sex discrepancies in GC mortality by age and BMI suggest the need for sex-specific approaches to prognostic prediction.

Personal exposure to fine particulate air pollutants impacts blood pressure and heart rate variability.

Air pollution has increasingly been recognized as a major healthcare concern. Air pollution, particularly fine particulate matter (≤ 2.5 µm in aerodynamic diameter [PM2.5]) has demonstrated an increase in adverse cardiovascular events. This study aimed to assess the cardiovascular response to personal exposure to different levels of PM2.5. This prospective cohort study enrolled healthy volunteers aged ≥ 18 years with no cardiovascular disease. Study subjects carried personal exposure monitor of PM2.5, digital thermo-hygrometer for temperature and humidity, 24-h blood pressure monitor, and continuous electrocardiogram monitor. Measurements were repeated twice with an interval of 6-12 months. Statistical models consisted of generalized estimation equations to various repeated measures of each subject. A total of 22 subjects were enrolled in this study between July 2018 and January 2019. Measurement was performed twice in all participants, and a total of 36 data were collected except for insufficient data collection. The mean age of the study population was 41.6 years, and 95% of the subjects were females. No study subjects had hypertension or other cardiovascular diseases. The average systolic blood pressure increased with higher PM2.5 levels with marginal significance (0.22 mmHg [95% confidential intervals - 0.04 to 0.48 mmHg] per 10 µg/m3 of PM2.5). All parameters for heart rate variability significantly decreased with a higher level of PM2.5. In this study, we measured individual personal exposure to PM2.5 by using a portable device. We found that 24-h exposure to high levels of PM2.5 was associated with a significant decrease in heart rate variability, suggesting impaired autonomous nervous function.

Association of short- and long-term exposure to air pollution with atrial fibrillation.

BACKGROUND: Atrial fibrillation is a common cardiac arrhythmia and an important risk factor for stroke and cardiovascular morbidity. However, there is limited evidence regarding the association of air pollution with atrial fibrillation. This study aimed to compare the short-term and long-term effects of air pollution on atrial fibrillation. DESIGN: A nationwide cohort from the Korean general population. METHODS: Different analytical approaches were used for short-term and long-term effects. For the analysis of short-term effects, the daily incidence of emergency admissions for atrial fibrillation was identified. The relationship of atrial fibrillation with air pollutants, including PM2.5 (particulate matter ≤ 2.5 µm in aerodynamic diameter), PM10, carbon monoxide, sulphur dioxide, nitrogen dioxide and ozone, was analysed using a time-series analysis. The long-term effects of air pollution were analysed for subjects aged ≥30 years who resided in Seoul between 2007 and 2015 and had no history of atrial fibrillation. RESULTS: During the study period, 1137 emergency visits were identified in Seoul as being associated with atrial fibrillation. A 10-µg/m3 increase in ambient PM2.5 was shown to significantly increase emergency admissions by 4.5% at lag day 3 (p = 0.038). No other pollutants showed a significant relationship with emergency atrial fibrillation admission. Among 124,010 residents in Seoul, 1903 developed atrial fibrillation at a median follow-up of 9.5 years (1.95 per 1000 person-years). Long-term exposure to air pollution had no significant impact on atrial fibrillation occurrence (p = 0.830 for PM2.5). CONCLUSION: This study suggests that short-term exposure to PM2.5 triggers atrial fibrillation. However, we found no evidence linking atrial fibrillation with long-term exposure to air pollution.

A feasibility study of laparoscopic total gastrectomy for clinical stage I gastric cancer: a prospective multi-center phase II clinical trial, KLASS 03.

BACKGROUND: With improved short-term surgical outcomes, laparoscopic distal gastrectomy has rapidly gained popularity. However, the safety and feasibility of laparoscopic total gastrectomy (LTG) has not yet been proven due to the difficulty of the technique. This single-arm prospective multi-center study was conducted to evaluate the use of LTG for clinical stage I gastric cancer. METHODS: Between October 2012 and January 2014, 170 patients with pathologically proven, clinical stage I gastric adenocarcinoma located at the proximal stomach were enrolled. Twenty-two experienced surgeons from 19 institutions participated in this clinical trial. The primary end point was the incidence of postoperative morbidity and mortality at postoperative 30 days. The severity of postoperative complications was categorized according to Clavien-Dindo classification, and the incidence of postoperative morbidity and mortality was compared with that in a historical control. RESULTS: Of the enrolled patients, 160 met criteria for inclusion in the full analysis set. Postoperative morbidity and mortality rates reached 20.6% (33/160) and 0.6% (1/160), respectively. Fifteen patients (9.4%) had grade III or higher complications, and three reoperations (1.9%) were performed. The incidence of morbidity after LTG in this trial did not significantly differ from that reported in a previous study for open total gastrectomy (18%). CONCLUSIONS: LTG performed by experienced surgeons showed acceptable postoperative morbidity and mortality for patients with clinical stage I gastric cancer.

Occurrence of microplastics in municipal sewage treatment plants: a review.

Municipal sewage treatment plants (STPs) are thought to be important point sources of microplastics in freshwater systems and many peer-reviewed articles have been published on this issue since mid-2010s. In this review, we summarize existing literature on the occurrence of microplastics in STPs and experimental methods used for isolation and identification of microplastics. The number concentrations of microplastics in STP influents were 15.1-640 L-1 , whereas those in the STP effluents were highly variable and ranged from not detectable to 65 L-1 . For most of cases, conventional STPs are removing microplastics very effectively. Fragments and fibers are dominant shapes of microplastics. Thermoplastics (polyethylene and polypropylene) and polyester are the predominant materials recovered. Although further research is needed, size distribution of microplastics in STPs is likely to follow a power law, implying that different studies using different size cutoffs may be compared after establishing a power law relationship.

Preoperative Quality of Life in Patients with Gastric Cancer.

PURPOSE: We evaluated the socio-personal and clinical factors that can affect preoperative quality of life to determine how to improve preoperative quality of life in patients with gastric cancer. MATERIALS AND METHODS: The preoperative quality of life data of 200 patients (68 females and 132 males; mean age 58.9±12.6 years) with gastric cancer were analyzed according to socio-personal and clinical factors. The Korean versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core (QLQ) 30 and the EORTC QLQ-STO22, a gastric cancer-specific module, were used to assess quality of life. Patients were asked to complete the questionnaire preoperatively by themselves. RESULTS: Patients with a higher academic background and stage I disease tended to have higher global health status scores. Highly educated younger men had better physical functioning scores. Highly educated and well-nourished patients with stage I cancer had higher role functioning scores. Married patients had better emotional scores. The symptom scales were affected by sex, age, education level, nutrition, and cancer stage. CONCLUSIONS: Preoperative quality of life in patients with gastric cancer can be improved by nutritional support and treatment of symptoms caused by disease progression. Psychological support may be helpful for patients with a poor quality of life.

Drug susceptibility to etravirine and darunavir among Human Immunodeficiency Virus Type 1-derived pseudoviruses in treatment-experienced patients with HIV/AIDS in South Korea.

BACKGROUND: In South Korea, about 20 types of antiretroviral drugs are used in the treatment of patients with human immunodeficiency virus/acquired immune deficiency syndrome. Since 2010, raltegravir, etravirine, and darunavir have been spotlighted as new drugs for highly active antiretroviral therapy (HAART)-experienced adults with resistant HIV-1 in South Korea. In this study, we investigated potential susceptibility of pseudoviruses derived from treatment-experienced Korean patients to etravirine vs efavirenz and to darunavir vs amprenavir and indinavir using a modified single-round assay. METHODS: Pseudoviruses derived from nine treatment-experienced patients infected with HIV-1 were investigated by comparison with the wild-type strain pNL4-3. The 50% inhibitory concentration (IC50) values were calculated and drug susceptibility was compared. The intensity of genotypic drug resistance was classified based on the 'SIR' interpretation of the Stanford data base. RESULTS: Drug susceptibility was generally higher for etravirine and darunavir compared with efavirenz, amprenavir, and indinavir in pseudoviruses derived from treatment-experienced patients. Pseudoviruses derived from patients KRB4025 and KRB8014, who exhibited long-term use of protease inhibitors, showed an outside of tested drug concentration, especially for amprenavir and indinavir. However, they exhibited a lower fold-change in resistance to darunavir. CONCLUSIONS: Etravirine and darunavir have been used in HAART since 2010 in South Korea. Therefore, these antiretroviral drugs together with other newly introduced antiretroviral drugs are interesting for the optimal treatment of patients with treatment failure. This study may help to find a more effective HAART in the case of HIV-1 infected patients that have difficulty being treated.

Two cases of gastrocolocutaneous fistula with a long asymptomatic period after percutaneous endoscopic gastrostomy.

Gastrocolocutaneous fistula is a rare complication of the percutaneous endoscopic gastrostomy (PEG) procedure. Typical symptoms usually occur in the first few months. We recently encountered 2 patients with 8- and 33-month asymptomatic periods. A 74-year-old man presented with watery diarrhea for 1 month. He had undergone PEG 9 months earlier. During workup, an upper endoscopy and abdominal CT scan revealed the migration of the feeding tube into the transverse colon. He was discharged with a nasogastric tube after treatment. A 77-year-old man presented with sudden loosening of his PEG tube with a duration over 3 days. He had undergone PEG procedure three times until that time. During workup, a gastrocolocutaneous fistula was diagnosed. However, when previous studies were reviewed, an abdominal CT scan, which was done 6 months ago before the third PEG, showed the fistula already existed at that time, suggesting that it was created about 33 months earlier when he underwent the second PEG procedure. The patient died of pneumonia aggravation despite conservative treatment. Both a high index of suspicion and the careful inspection of the upper endoscopy are very important for early diagnosis regardless of symptoms.

The prevalence of antiretroviral multidrug resistance in highly active antiretroviral therapy-treated patients with HIV/AIDS between 2004 and 2009 in South Korea.

BACKGROUND: Highly active antiretroviral therapy (HAART) including protease inhibitors (PIs) has been used in South Korea since 1997. Currently, more than 20 types of antiretroviral drugs are used in the treatment of human immunodeficiency virus-infected/acquired immune deficiency syndrome patients in South Korea. Despite the rapid development of various antiretroviral drugs, many drug-resistant variants have been reported after initiating HAART, and the efficiency of HAART is limited by these variants. OBJECTIVES: To investigate and estimate the annual antiretroviral drug resistance and prevalence of antiretroviral multi-class drug resistance in Korean patients with experience of treatment. STUDY DESIGN: The amplified HIV-1 pol gene in 535 patients requested for genotypic drug resistance testing from 2004 to 2009 by the Korea Centers for Disease Control and Prevention was sequenced and analyzed annually and totally. The prevalence of antiretroviral drug resistance was estimated based on "SIR" interpretation of the Stanford sequence database. RESULTS: Of viruses derived from 787 specimens, 380 samples (48.3%) showed at least one drug class-related resistance. Predicted NRTI drug resistance was highest at 41.9%. NNRTI showed 27.2% resistance with 23.3% for PI. The percent of annual drug resistance showed similar pattern and slightly declined except 2004 and 2005. The prevalence of multi-class drug resistance against each drug class was: NRTI/NNRTI/PI, 9.8%; NRTI/PI, 21.9%; NNRTI/PI, 10.4%; and NRTI/NNRTI, 21.5%. CONCLUSIONS: About 50% and less than 10% of patients infected with HIV-1 have multidrug and multiclass resistance linked to 16 antiretroviral drugs, respectively. The significance of this study lies in its larger-scale examination of the prevalence of drug-resistant variants and multidrug resistance in HAART-experienced patients in South Korea.

Invasive pulmonary aspergillosis after influenza a infection in an immunocompetent patient.

Invasive aspergillosis has emerged as a major cause of life-threatening infections in immunocompromised patients. Recently, patients with chronic obstructive pulmonary disease, who have been receiving corticosteroids for a long period, and immunocompetent patients in the intensive care unit have been identified as nontraditional hosts at risk for invasive aspergillosis. Here, we report a case of invasive pulmonary aspergillosis after influenza in an immunocompetent patient. The patient's symptoms were nonspecific, and the patient was unresponsive to treatments for pulmonary bacterial infection. Bronchoscopy revealed mucosa hyperemia, and wide, raised and cream-colored plaques throughout the trachea and both the main bronchi. Histologic examination revealed aspergillosis. The patient recovered quickly when treated systemically with voriconazole, although the reported mortality rates for aspergillosis are extremely high. This study showed that invasive aspergillosis should be considered in immunocompetent patients who are unresponsive to antibiotic treatments; further, early extensive use of all available diagnostic tools, especially bronchoscopy, is mandatory.

Changes of quality of life after gastric cancer surgery.

PURPOSE: The aim of this study was to evaluate chronological change of quality of life after surgery in patients with gastric cancer during one year postoperatively. MATERIALS AND METHODS: Quality of life data were obtained from 272 gastric cancer patients who underwent curative gastrectomy between September 2008 and February 2011 at the Kyungpook National University Hospital. The Korean versions of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core (QLQ) 30 with gastric cancer-specific module, the EORTC QLQ-STO22 were used to assess quality of life. All patients had no evidence of recurrence or metastasis during the first postoperative year. Patients were asked to complete the questionnaire, by themselves preoperatively, 3-, 6-, 9-, and 12-months postoperatively. RESULTS: Physical functioning score and role functioning score significantly decreased at first 3 months after surgery and the significant differences were noticed until 12 months after surgery. Emotional functioning score started with the lowest score before surgery and significant improvement was shown 6 months after surgery. Most symptom scores and STO-22 scores were highest at 3 months after surgery and gradually decreased, thereafter. Eating restriction, anxiety, taste, body image scores was highest at 3 months after surgery without significant decrease afterwards. CONCLUSIONS: Most scales worsened after surgery and gradually recovered afterwards with some differences in rate of recovery. However the scales did not fully recover by 1 year period. Further follow-up after 1 year would be helpful in determining which scales are permanently damaged and which are just taking longer time to recover.

Drug susceptibility of human immunodeficiency virus type 1-derived pseudoviruses from treatment-experienced patients to protease inhibitors and reverse transcriptase inhibitors, using a modified single-round assay.

BACKGROUND: Genotypic drug resistance assay has been the only method available to provide information related to drug resistance in South Korea since 1999. Phenotypic assay is also a useful method to predict a patient's state related to antiretroviral drug resistance. However, commercial systems and methods for phenotyping have not been introduced into South Korea. OBJECTIVES: To establish and apply modified phenotypic drug susceptibility assay using treatment-experienced patients' derived HIV-1 in South Korea. STUDY DESIGN: The genotypic drug resistance and phenotypic drug susceptibility of two different methods, Stanford HIV Drug Resistance Database (Stanford DB) and modified phenotypic drug susceptibility assay were compared especially focused on the HIV-1 protease (PR) and reverse transcriptase (RT) sequences. RESULTS: There was some discordance in comparing drug susceptibility results (a modified drug susceptibility assay) with the predicted genotypic drug resistance (Stanford DB). Phenotypic drug resistance showed the following order for pseudoviruses from treatment-experienced patients infected with HIV/AIDS: Efavirenz (EFV, 21 to 1,319-fold change), Lamivudine (3TC, 31 to >189-fold change), Indinavir sulfate (IDV, 26 to 63-fold change), Amprenavir (APV, 4 to 35-fold change) and Zidovudine (AZT, 20 to 634-fold change). For patient KRC3221, the AZT-related phenotypic drug resistance was the greatest, with 634-fold change compared with the wild type. CONCLUSIONS: Application of this modified phenotypic drug susceptibility assay is expected to help in predicting drug resistance as a guideline for clinicians to obtain a combined interpretation among genotyping, phenotyping and effective clinical treatments.

A pulse wave simulator for palpation in the oriental medicine.

Pulse diagnosis, which is one of methods of diagnosis, is an important factor in oriental medicine. However, a problem in diagnosis with the pulse is that there is no objective standard. Therefore, the practitioners pass on the skill and students learn about pulse diagnosis as a method that depends on speech. In this study, the electronic pulse wave reproduction apparatus, which is an objective and accurate means for measuring the pulse, was developed. The previous model reproduced the pulse wave in one part of the point, but it was made by using three pairs of voice coil motors (VCM) in order to similarly express the three parts of the pulse: Cun, Guan and Chi. To evaluate this system, the output of the pulse wave was confirmed in order to reproduce the pulse wave with these settings. Consequently, the targets for slow pulse and rapid pulse have a 7 ms standard deviation, which is within the error tolerance. A voltage value of H(1), utilized to verify vacuous pulse and the replete pulse, has a standard deviation range of 4.7-5.4 mV. This system, which is similar to a person's pulse diagnosis, can be used to educate others in pulse diagnosis both quantitatively and scientifically.

Infectivity of Homologous Recombinant HIV-1 Pseudo-virus with Reverse Transcriptase Inhibitor-related Mutations from Highly Active Antiretroviral Therapy Experienced Patients.

OBJECTIVES: In this study, the viral fitness of pseudo-viruses with a drug-resistant site in the reverse transcriptase (RT) region of the genome was investigated. The pseudo-viruses were derived from highly active antiretroviral therapy (HAART)-experienced HIV/AIDS patients. METHODS: HIV-1 RNA was extracted from the plasma of HAART-experienced (KRB9149, KRB7021, KRC1097) and HAART-naïve (KRC5180, KRC5123) HIV-1 patients. The RT gene from the extracted viral RNA was amplified and the polymerase chain reaction product was cloned from the pHXB2Δ2-261 RT vector. C8166 and TZM-bl cell lines were used as the HIV-1 replication capacity measurement system. To quantify the infectivity of homologous recombinant HIV-1, the infectivity derived from each pseudo-virus was compared with the infectivity of the reference strain HXB2. RESULTS: Patient-derived HIV-1 was cotransfected into C8166 cells and the expression level of the p24 antigen was measured. The expression was high in the HIV-1 isolates from patients KRC5180 and KRB9149 and low in patients KRB7021, KRC5123, and KRC1097, when compared with the reference strain. The infectivity of the pseudo-virus measured in TZM-bl cells decreased in the order, reference strain HXB2 > KRC5180 > KRC5123 > KRB9149 > KRB7021 > KRC1097. CONCLUSION: In this study, HIV-1 infectivity of the drug-resistant strain isolated from HAART-experienced patients with HIV/AIDS was found to be lower than the infectivity of the reference strain HXB2. This study provides useful data for the phenotypic susceptibility assay in HAART-experienced patients infected with HIV-1.

Evaluation of the NucliSens EasyQ HIV-1 v1.1 and RealTime HIV-1 kits for quantitation of HIV-1 RNA in plasma.

Human immunodeficiency virus type-1 (HIV-1) RNA viral load is an important biomarker to evaluate the therapeutic efficacy of antiretroviral drugs and to monitor disease progression in HIV-infected individuals. We compared HIV-1 RNA quantitation between two different kits, the NucliSens EasyQ HIV-1 v1.1 (EasyQ, bioMérieux) and RealTime HIV-1 (RealTime, Abbott), using HIV-1 RNA quality control (QC) materials, cell-cultivated viruses, and the plasma samples of 104 patients with HIV. Correlation between the two kits for HIV RNA-1 quantitation with clinical samples was high (R=0.91). Based on results obtained with quality control standards, the reproducibility of the RealTime kit was higher than the EasyQ kit: the viral load value and coefficient of variation of each kit was 4.11+/-0.136 and 3.3% for EasyQ and 3.55+/-0.042 and 1.2% for RealTime, respectively (P<0.002). This is the first comparative analysis of the detection limit and reproducibility of two different quantitation kits using clinical plasma samples from Korean HIV-1-infected patients. It will serve a useful reference to determine correction values for each HIV-1 RNA quantitation kits and to choose an appropriate assay kit for each laboratory.