Publications by authors named "Seok Jeong"

470 Publications

Impact of High-Flow Nasal Cannula Oxygenation on the Prevention of Hypoxia During Endoscopic Retrograde Cholangiopancreatography in Elderly Patients: A Randomized Clinical Trial.

Dig Dis Sci 2021 Nov 2. Epub 2021 Nov 2.

Division of Gastroenterology, Department of Internal Medicine, Inha University College of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, Republic of Korea.

Background: Hypoxia is the most frequently occurring adverse effect during endoscopic retrograde cholangiopancreatography (ERCP) under sedation; thus, oxygen must be properly supplied to prevent a reduction of oxygen saturation. In this study, we intend to verify the preventive effect for hypoxia during ERCP, using a high-flow nasal cannula (HFNC), in elderly patients.

Methods: As a multicenter prospective randomized trial, patients who underwent ERCP with propofol-based sedation were randomly assigned into two groups: Patients in the HFNC group were supplied with oxygen via an HFNC, and those in the standard nasal cannula group were supplied with oxygen via a low-flow nasal cannula. The co-primary end points were the lowest oxygen saturation rate and hypoxia during the overall procedure.

Results: A total of 187 patients (HFNC group: 95; standard nasal cannula group: 92) were included in the analysis. Unexpected hypoxia events were more frequently observed among patients in the standard nasal cannula group than among patients in the HFNC group (13% vs. 4%, odds ratio 3.41, 95% confidence interval 1.06-11.00, p = 0.031). The mean of the lowest oxygen saturation rate during ERCP was significantly lower in the standard nasal cannula group than in the HFNC group (95% vs. 97%, p = 0.002).

Conclusion: Oxygen supplementation with an HFNC can prevent oxygen desaturation and hypoxia events in patients undergoing ERCP under sedation. Trial registration Clinical Research Information Service (CRIS; KCT0004960).
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http://dx.doi.org/10.1007/s10620-021-07272-zDOI Listing
November 2021

Serotype Distribution and Antimicrobial Resistance of Isolates in Korea between 2016 and 2017.

Ann Lab Med 2022 Mar;42(2):268-273

Department of Laboratory Medicine, Inje University College of Medicine, Busan, Korea.

is one of the major causes of food-borne infections. We investigated the serotype distribution and antimicrobial resistance of isolates collected in Korea between January 2016 and December 2017. In total, 669 isolates were collected from clinical specimens at 19 university hospitals. Serotyping was performed according to the Kauffmann-White scheme, and antimicrobial susceptibility was tested using Sensititre EUVSEC plates or disk diffusion. Among the strains, C (39.8%) and B (36.6%) were the most prevalent serogroups. In total, 51 serotypes were identified, and common serotypes were . enterica serovar I 4,[5],12:i:- (16.7%), . Enteritidis (16.1%), . Bareilly (14.6%), . Typhimurium (9.9%), and . Infantis (6.9%). The resistance rates to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole were 32.6%, 12.1%, and 8.4%, respectively. The resistance rates to cefotaxime and ciprofloxacin were 8.1% and 3.0%, respectively, while 5.4% were multidrug-resistant. serovar I 4,[5],12:i:- and . Enteritidis were highly prevalent, and there was an increase in rare serotypes. Multidrug resistance and ciprofloxacin resistance were highly prevalent. Periodic investigations of serotypes and antimicrobial resistance are needed.
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http://dx.doi.org/10.3343/alm.2022.42.2.268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8548255PMC
March 2022

Trajectory of genetic alterations associated with colistin resistance in Acinetobacter baumannii during an in-hospital outbreak of infection.

J Antimicrob Chemother 2021 Oct 5. Epub 2021 Oct 5.

Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, South Korea.

Background: As carbapenem-resistant Acinetobacter baumannii is dominant in clinical settings, the old polymyxin antibiotic colistin has been revived as a therapeutic option. The development of colistin resistance during treatment is becoming a growing concern.

Objectives: To access low- to mid-level colistin-resistant A. baumannii blood isolates recovered from an outbreak in a tertiary care hospital from a national antimicrobial surveillance study.

Methods: The entire bacterial genome was sequenced through long-read sequencing methodology. Quantitative RT-PCR was carried out to determine the level of gene expression. Relative growth rates were determined to estimate fitness costs of each isolate caused by the genetic alterations.

Results: The A. baumannii isolates belonged to global clone 2 harbouring two intrinsic phosphoethanolamine transferases. Cumulative alterations continuing the colistin resistance were observed. PmrC overproduction caused by the PmrBA226T alteration was identified in A. baumannii isolates with low-level colistin resistance and an additional PmrCR109H substitution led to mid-level colistin resistance. Truncation of the PmrC enzyme by insertion of ISAba59 was compensated by ISAba10-mediated overproduction of EptA and, in the last isolate, the complete PmrAB two-component regulatory system was eliminated to restore the biological cost of the bacterial host.

Conclusions: During the in-hospital outbreak, a trajectory of genetic modification in colistin-resistant A. baumannii isolates was observed for survival in the harsh conditions imposed by life-threatening drugs with the clear purpose of maintaining drug resistance above a certain level with a reasonable fitness cost.
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http://dx.doi.org/10.1093/jac/dkab363DOI Listing
October 2021

Performance assessment of ASTA MicroIDSys, a new matrix assisted laser desorption ionization-time of flight mass spectrometry system, for identification of viridans group streptococci.

Microbiol Immunol 2021 Sep 13. Epub 2021 Sep 13.

Department of Laboratory Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea.

The performance of the ASTA MicroIDSys system (ASTA), a new matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) system, was evaluated for the identification of viridans group streptococci (VGS) and compared with the results obtained with the Bruker Biotyper system (Bruker Daltonics). A total of 106 Streptococcus reference strains belonging to 24 species from the bacterial strain bank was analyzed using the two MALDI-TOF MS systems. Of the 106 reference strains tested, ASTA MicroIDSys and Bruker Biotyper correctly identified 84.9% and 81.1% at the species level, 100% and 97.2% at the group level and 100% and 98.1% at the genus level, respectively. The difference between the two systems was not statistically significant (P = 0.289). Out of 24 species, 13 species were accurately identified to the species level with 100% accurate identification rates with both systems. The accurate identification rates at the species level of ASTA MicroIDSys and Bruker Biotyper were 100% and 87.5% for the S. anginosus group; 78.4% and 73.5% for the S. mitis group; 91.7% and 91.7% for the S. mutans group; and 100% and 100% for the S. salivarius group, respectively. The ASTA MicroIDSys showed an identification performance equivalent to that of the Bruker Biotyper for VGS. Therefore, it would be useful for the identification of VGS strains in clinical microbiology laboratories.
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http://dx.doi.org/10.1111/1348-0421.12942DOI Listing
September 2021

[Effects of Second Victim Experiences after Patient Safety Incidents on Nursing Practice Changes in Korean Clinical Nurses: The Mediating Effects of Coping Behaviors].

J Korean Acad Nurs 2021 Aug;51(4):489-504

College of Nursing · Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Korea.

Purpose: This study was investigated the mediating effect of coping behaviors in the relationship between the second victim experiences after patient safety incidents and the nursing practice changes.

Methods: A cross-sectional survey was performed using structured questionnaires. Participants were 218 clinical nurses in general tertiary hospitals in South Korea. Data were collected through an online survey and snowball sampling from August 11 to September 6 2020. Data were analyzed using SPSS 23.0 program. A mediation analysis was performed using multiple regression and a simple mediation model applying the PROCESS macro with 95% bias-corrected bootstrap confidence interval.

Results: The mean scores of second victim experiences was 3.41/5. Approach coping (β = .55, < .001) and the avoidant coping (β = - .23, = .001) showed mediation effects in the relationship between second victim experiences and constructive change in nursing practice. Avoidant coping (β = .29, < .001) showed a mediation effect in the relationship between second victim experiences and defensive change in nursing practice.

Conclusion: Coping behaviors has a mediating effect on the relationship between second victim experiences and nursing practice changes. To ensure that nurses do not experience second victim, medical institutions should have a culture of patient safety that employs a systematic approach rather than blame individuals. They also need to develop strategies that enhance approach coping and reducing avoidant coping to induce nurses' constructive practice changes in clinical nurses in experiencing second victims due to patient safety incidents.
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http://dx.doi.org/10.4040/jkan.21089DOI Listing
August 2021

Generation of wavelength-tunable optical vortices using an off-axis spiral phase mirror.

Opt Lett 2021 Sep;46(17):4216-4219

Wavelength-tunable optical vortices with a topological charge equal to =1 of orbital angular momentum (OAM) were experimentally realized using a single off-axis spiral phase mirror (OSPM) with lasers of various visible-light wavelengths. Using an OSPM designed for 561 nm and an incidence angle of 45°, circular doughnut-shaped =1 optical vortices were obtained at 561, 473, and 660 nm by rotating the OSPM to modify the laser incidence angle. Wavelength-tunable =1 optical vortices were obtained at the respective incidence angles of 45°, 53.4°, and 33.7°, because the effective geometrical thickness of the OSPM, which determines the order of OAM, was identical at each wavelength. This flexible OSPM which operates over a wide wavelength range will provide continuously wavelength-tunable optical vortices for applications in the fields of advanced optics and photonics in which optical vortices with wide wavelength tunability are in demand.
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http://dx.doi.org/10.1364/OL.432413DOI Listing
September 2021

Endoscopic ultrasound (EUS)-guided cylindrical interstitial laser ablation (CILA) on porcine pancreas.

Biomed Opt Express 2021 Jul 24;12(7):4423-4437. Epub 2021 Jun 24.

Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan, Republic of Korea.

This study aims to demonstrate the feasibility of cylindrical interstitial laser ablation (CILA) in porcine pancreatic tissue to develop a EUS-guided PC ablation technique with enhanced safety. A diffusing applicator created a uniformly symmetrical laser ablation in pancreatic tissue. tests presented that both ablation thickness and volume increased linearly with the applied power (R = 0.96 and 0.90, respectively) without carbonization and fiber degradation. The numerical simulations matched well with the experimental results in terms of temperature development and thermal damage (deviation of ≤ 15%). tests with EUS confirmed easy insertion and high durability of the diffusing applicator. EUS-guided CILA warranted a feasible therapeutic capacity of ablating pancreatic tissue. The proposed EUS-guided CILA can be a feasible therapeutic approach to treat PC with predictable thermal ablation and enhanced safety.
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http://dx.doi.org/10.1364/BOE.427379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8367258PMC
July 2021

MALDI-TOF Mass Spectrometry Technology as a Tool for the Rapid Diagnosis of Antimicrobial Resistance in Bacteria.

Antibiotics (Basel) 2021 Aug 14;10(8). Epub 2021 Aug 14.

Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul 06273, Korea.

Species identification by using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) is a routine diagnostic process for infectious diseases in current clinical settings. The rapid, low-cost, and simple to conduct methodology is expanding its application in clinical microbiology laboratories to diagnose the antimicrobial resistance (AMR) in microorganisms. Primarily, antimicrobial susceptibility testing is able to be carried out either by comparing the area under curve of MALDI spectra of bacteria grown in media with antimicrobial drugs or by identifying the shift peaks of bacteria grown in media including C isotope with antimicrobial drugs. Secondly, the antimicrobial resistance is able to be determined through identifying (i) the antimicrobial-resistant clonal groups based on the fingerprints of the clone, (ii) the shift peak of the modified antimicrobial drug, which is inactivated by the resistance determinant, (iii) the shift peak of the modified antimicrobial target, (iv) the peak specific for the antimicrobial determinant, and (v) the biomarkers that are coproduced proteins with AMR determinants. This review aims to present the current usage of the MALDI-TOF MS technique for diagnosing antimicrobial resistance in bacteria, varied approaches for AMR diagnostics using the methodology, and the future applications of the methods for the accurate and rapid identification of AMR in infection-causing bacterial pathogens.
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http://dx.doi.org/10.3390/antibiotics10080982DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8388893PMC
August 2021

Dynamics and Predictors of Mortality Due to Candidemia Caused by Different Species: Comparison of Intensive Care Unit-Associated Candidemia (ICUAC) and Non-ICUAC.

J Fungi (Basel) 2021 Jul 24;7(8). Epub 2021 Jul 24.

Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju 61469, Korea.

We investigated mortality and predictors of mortality due to intensive care unit-associated candidemia (ICUAC) versus non-ICUAC by species. This study included all candidemia cases in 11 hospitals from 2017 to 2018 in South Korea. The all-cause mortality rates in all 370 patients with ICUAC were approximately twofold higher than those in all 437 patients with non-ICUAC at 7 days (2.3-fold, 31.1%/13.3%), 30 days (1.9-fold, 49.5%/25.4%), and 90 days (1.9-fold, 57.8%/30.9%). Significant species-specific associations with 7- and 30-day ICUAC-associated mortality were not observed. Multivariate analysis revealed that ICU admission was an independent predictor of (OR, 2.07-2.48) and -associated mortality (OR, 6.06-11.54). Fluconazole resistance was a predictor of -associated mortality (OR, 2.80-5.14). Lack (less than 3 days) of antifungal therapy was the strongest predictor of 7-day mortality due to ICUAC caused by (OR, 18.33), (OR, 10.52), and (OR, 21.30) compared with 30- and 90-day mortality (OR, 2.72-6.90). ICUAC had a stronger association with lack of antifungal therapy (55.2%) than ICUAC caused by other species (30.6-36.7%, all < 0.05). Most predictors of mortality associated with ICUAC were distinct from those associated with non-ICUAC and were mediated by species.
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http://dx.doi.org/10.3390/jof7080597DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397010PMC
July 2021

Safe-Harboring based novel genetic toolkit for Nannochloropsis salina CCMP1776: Efficient overexpression of transgene via CRISPR/Cas9-Mediated Knock-in at the transcriptional hotspot.

Bioresour Technol 2021 Nov 29;340:125676. Epub 2021 Jul 29.

Department of Chemical and Biomolecular Engineering, KAIST, 291 Daehak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea; Institute for the BioCentury, KAIST, 291 Daehak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea. Electronic address:

Transgene expression in microalgae can be hampered by transgene silencing and unstable expression due to position effects. To overcome this, "safe harboring" transgene expression system was established for Nannochloropsis. Initially, transformants were obtained expressing a sfGFP reporter, followed by screening for high expression of sfGFP with fluorescence-activated cell sorter (FACS). 'T1' transcriptional hotspot was identified from a mutant showing best expression of sfGFP, but did not affect growth or lipid contents. By using a Cas9 editor strain, FAD12 gene, encoding Δ12-fatty acid desaturase (FAD12), was successfully knocked-in at the T1 locus, resulting in significantly higher expression of FAD12 than those of random integration. Importantly, the "safe harbored" FAD12 transformants showed four-fold higher production of linoleic acid (LA), the product of FAD12, leading to 1.5-fold increase in eicosapentaenoic acid (EPA). This safe harboring principle provide excellent proof of the concept for successful genetic/metabolic engineering of microalgae and other organisms.
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http://dx.doi.org/10.1016/j.biortech.2021.125676DOI Listing
November 2021

Molecular epidemiology and clinical risk factors for rifaximin-non-susceptible Clostridioides difficile infection in South Korea: a prospective, multicentre, observational study.

J Glob Antimicrob Resist 2021 Jul 25;27:46-50. Epub 2021 Jul 25.

Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea. Electronic address:

Objectives: This study was designed to investigate the molecular epidemiology of Clostridioides difficile isolates in South Korea and to evaluate risk factors for rifaximin-non-susceptible C. difficile infection (CDI).

Methods: A total of 413 patients with CDI from two sentinel hospitals in South Korea were enrolled in this study. Putative clinical risk factors for CDI were identified using digital medical records of the patients. Pathogen profiles, including antimicrobial susceptibility, toxin production and ribotype, were evaluated for each of the causative C. difficile isolates.

Results: Of the 413 C. difficile isolates, 81 (19.6%) were shown to be rifaximin-non-susceptible, with the most common ribotypes being 018 (56.8%; 46/81), 017 (16.0%; 13/81) and 027 (6.2%; 5/81). Rifaximin-non-susceptible C. difficile isolates exhibited higher non-susceptibility rates to most of the other drugs tested in this study compared with rifaximin-susceptible isolates. Previous history of pulmonary tuberculosis and prior rifaximin treatment were shown to be associated with the occurrence of rifaximin-non-susceptible CDI compared with susceptible CDI.

Conclusion: Non-susceptibility rates to rifaximin for the C. difficile isolates identified in this study were reasonably high with most of the resistant strains belonging to either ribotype 018 or 017. Widespread dissemination of these clones may be the result of antimicrobial selection pressure introduced by the widespread use of rifaximin. These results suggest that a sustainable surveillance programme for CDI and C. difficile resistance is needed in order to better control CDIs and to improve therapeutic efficacy.
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http://dx.doi.org/10.1016/j.jgar.2021.07.009DOI Listing
July 2021

Biologically produced sulfur as a novel adsorbent to remove Cd from aqueous solutions.

J Hazard Mater 2021 10 24;419:126470. Epub 2021 Jun 24.

Department of Biological Environment, Kangwon National University, Chuncheon 24341, Republic of Korea. Electronic address:

Biological desulfurization processes of landfill gas yield an enormous amount of biologically produced S (BPS) as a byproduct. Capability of BPS to remove Cd from aqueous solutions was tested and its removal efficiency was compared to that of granular activated carbon (GAC). Kinetics of Cd removal by BPS was a two-stage process with an initial rapid adsorption showing 45% of initial Cd was removed within 5 min, followed by a slower adsorption. Cadmium adsorption onto the BPS fitted the Langmuir isotherm model and maximum adsorption capacity of the BPS (63.3 mg g) was 1.8 times higher than that of GAC (36.1 mg g). Thermodynamic parameters showed that Cd adsorption by BPS was favorable and endothermic. Data from XPS proved the main adsorption mechanism to be complexation of Cd with sulfides in the BPS. Results demonstrated that BPS can be recycled as a novel adsorbent for Cd removal from wastewater.
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http://dx.doi.org/10.1016/j.jhazmat.2021.126470DOI Listing
October 2021

Primary Needle-Knife Sphincterotomy for Biliary Access in Patients at High Risk of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis.

Gastroenterol Res Pract 2021 18;2021:6662000. Epub 2021 May 18.

Division of Gastroenterology, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon, Republic of Korea.

Methods: Forty patients with one or more risk factors for PEP were prospectively enrolled between June 2018 and November 2019. The cannulation was conducted in all patients using NKS as the primary cannulation technique. Success rate of biliary cannulation, biliary cannulation time, and adverse event rate were assessed.

Results: Of the 40 patients enrolled, 34 patients underwent primary NKS after the screening. Nine patients had 1 risk factor for PEP, 7 had 2, 8 had 3, 7 had 4, and 3 had 5. The success rate of biliary access by NKS was 94.1% (32/34). The median procedure time for NKS and the total procedure time for stone removal or biliary drainage were 4.1 minutes (range, 0.5-25.2) and 11.3 minutes (range, 3.8-40.4), respectively. Adverse events occurred in two patients (minor bleeding, = 1; hyperamylasemia, = 1). No patient experienced PEP or perforation.

Conclusion: NKS might be feasible as a primary cannulation procedure in patients at high risk of PEP. This trial is registered with KCT0004886 (03/06/2018).
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http://dx.doi.org/10.1155/2021/6662000DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8149254PMC
May 2021

Clinical utility of methionyl-tRNA synthetase 1 immunostaining in cytologic brushings of indeterminate biliary strictures: a multicenter prospective study.

Gastrointest Endosc 2021 10 6;94(4):733-741.e4. Epub 2021 May 6.

Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.

Background And Aims: Endobiliary brushings are routinely used in the diagnosis, treatment, and prognostication of biliary strictures. However, standard Papanicolaou (Pap) staining has a low sensitivity in this setting, and the accuracy of brush cytology has not been established for indeterminate strictures. We therefore evaluated the diagnostic merit of methionyl-transfer RNA synthetase 1 (MARS1) immunofluorescence (IF) staining in such cytologic specimens.

Methods: During ERCP, endobiliary brushings were obtained from patients with extrahepatic biliary strictures prospectively enrolled at 6 tertiary hospitals. Using liquid-based cytologic preparations of these samples, we performed Pap and MARS1 IF staining.

Results: In total, 240 patients were eligible; of these, we compared the Pap and MARS1 IF staining results of 218 (malignant, 157; benign, 61). By conventional Pap staining, the diagnoses were distributed as follows: malignant, 55; suspicious of malignancy, 60; atypical, 45; negative for malignancy, 58. MARS1 IF staining was strongly positive in malignant biliary stricture but not so in specimens negative for malignancy. The diagnostic parameters (sensitivity, specificity, positive predictive value, negative predictive value, and accuracy) of the MARS1 IF (93.6%, 96.7%, 98.7%, 85.5%, and 94.5%, respectively) and conventional Pap (73.2%, 100%, 100%, 59.2%, and 80.7%, respectively) staining methods differed significantly (P < .0001).

Conclusions: The high sensitivity and accuracy of MARS1 IF staining enabled the detection of malignancy in patients with biliary strictures. Further prospective studies are needed to validate our findings. (Clinical trial registration number: NCT03708445.).
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http://dx.doi.org/10.1016/j.gie.2021.04.026DOI Listing
October 2021

Superprotonic Conductivity of MOF-808 Achieved by Controlling the Binding Mode of Grafted Sulfamate.

Angew Chem Int Ed Engl 2021 06 6;60(26):14334-14338. Epub 2021 May 6.

Department of Chemistry, Ulsan National Institute of Science and Technology (UNIST), Ulsan, 44919, Republic of Korea.

A metal-organic framework (MOF) having superprotonic conductivity, MOF-808, is prepared by modulating the binding mode of the sulfamate (SA) moieties grafted onto the metal clusters. The activation of the SA-grafted MOF-808 at 150 °C changes the binding mode of the grafted SA from monodentate to bridging bidentate, thus converting the neutral amido (-S-NH ) moiety of the grafted SA to the more acidic cationic sulfiliminium (-S=NH ) moiety. Further, the acidic sulfiliminium moiety of MOF-808-4SA-150 results in more efficient proton conduction than the amido moiety of MOF-808-4SA-60. At 60 °C and 95 % relative humidity, MOF-808-4SA-150 is found to have a proton conductivity of 7.89×10  S cm , which is more than 30-times higher than that of MOF-808-4SA-60. Moreover, this superprotonic conductivity is well maintained over 1000 cycles of conductivity measurements and for similar cyclic measurements each day for seven days.
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http://dx.doi.org/10.1002/anie.202103191DOI Listing
June 2021

Conventional-Dose CT Versus 2-mSv CT for Right Colonic Diverticulitis as an Alternate Diagnosis of Appendicitis: Secondary Analysis of Large Pragmatic Randomized Trial Data.

AJR Am J Roentgenol 2021 11 7;217(5):1113-1121. Epub 2021 Apr 7.

Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea.

Adoption of low-dose CT for the diagnosis of appendicitis has been slow in children and in adults, partly because of concern about missing alternative diagnoses including right colonic diverticulitis. The purpose of our study was to retrospectively compare the diagnostic performance of IV contrast-enhanced 2-mSv and conventional-dose CT (CDCT) for the diagnosis of right colonic diverticulitis in adolescents and young adults with suspected appendicitis. This post hoc analysis of a prospective randomized controlled trial included 3074 patients (1672 female patients and 1402 male patients) ranging in age from 15 to 44 years old (mean ± SD, 28 ± 9 years) from 20 hospitals. From December 2013 to August 2016, patients were randomized to either the 2-mSv CT group ( = 1535 patients) or the CDCT (median, 7 mSv) group ( = 1539 patients). A total of 161 radiologists prospectively issued CT reports in which they suggested alternative diagnoses for 976 (2-mSv CT) and 924 (CDCT) patients. Seven independent assessors adjudicated final diagnoses on the basis of clinical and CT findings. Endpoints of test-positives, test-negatives, sensitivity, and specificity for right colonic diverticulitis were compared using chi-square and Mann-Whitney tests. Characteristics and disposition of patients with test-positive results were assessed. Four readers retrospectively reviewed CT images of 400 patients selected from the trial (113 and 108 patients with diverticulitis from 2-mSv CT and CDCT groups, respectively) to evaluate interobserver agreement for right colonic diverticulitis in terms of Gwet coefficients. Between-group differences were minute for most endpoints related to right colonic diverticulitis: test-positives (difference, 0.2% [95% CI, -1.8% to 2.1%]; 7.8% [119/1535 patients] vs 7.6% [117/1539 patients]; = .93), test-negatives (0.5% [95% CI, -1.5% to 2.5%]; 91.7% [1407/1535] vs 91.2% [1403/1539]; = .67), sensitivity (0% [95% CI, -6% to 6%]; 95% [110/116] vs 95% [105/111]; .99), and specificity (0.3% [95% CI, -0.5% to 0.9%]; 99.4% [1401/1410] vs 99.1% [1397/1409]; = .66). The characteristics and disposition of test-positive patients were similar between the two groups. Gwet coefficients were high and comparable between the two groups (2-mSv CT vs CDCT, 0.849 vs 0.889; = .20). Two-millisievert CT is comparable to conventional-dose CT for the diagnosis of right colonic diverticulitis. By mitigating concern about a missed diagnosis of right colonic diverticulitis, the results further support the use of low-dose CT in patients with suspected appendicitis. ClinicalTrials.gov NCT01925014.
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http://dx.doi.org/10.2214/AJR.21.25584DOI Listing
November 2021

Risk Factors for Extended-Spectrum-β-Lactamase-Producing in Community-Onset Bloodstream Infection: Impact on Long-Term Care Hospitals in Korea.

Ann Lab Med 2021 Sep;41(5):455-462

Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Background: The prevalence of extended-spectrum β-lactamase-producing (ESBL-EC) in the community has increased worldwide due to multifactorial reasons. ESBL-EC bloodstream infection (BSI) complicates the decision for proper antimicrobial administration. In this multicenter study, we investigated the prevalence, risk factors, and molecular background of community-onset (CO) ESBL-EC BSI.

Methods: We included data for all episodes of ESBL-EC BSI of community origin from May 2016 to April 2017 obtained from the Korean national antimicrobial resistance surveillance system, which comprises six sentinel hospitals. Data, including previous history of admission and use of antimicrobials and medical devices before BSI, were collected, along with microbiological analysis results.

Results: Among 1,189 patients with CO BSI caused by , 316 (27%) were identified as ESBL producers. History of admission, especially to a long-term care hospital (LTCH), and previous use of β-lactams/β-lactamase inhibitors, carbapenem, lincosamide, aminoglycoside, and extended-spectrum cephalosporin were independent risk factors for CO ESBL-EC BSI; admission to an LTCH showed the highest odds ratio (3.8, 95% confidence interval 2.3-6.1). The most common genotype was CTX-M-15 (N=131, 41%), followed by CTX-M-14 (N=86, 27%). ST131 was the most common sequence type among ESBL-EC groups (57%).

Conclusions: In Korea, 27% of CO BSI were caused by ESBL producers. From perspectives of empirical treatment and infection control, history of admission to an LTCH and antimicrobial use should be noted.
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http://dx.doi.org/10.3343/alm.2021.41.5.455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041596PMC
September 2021

Association between Polymorphism and Depressive Symptoms in Patients Newly Diagnosed with Type 2 Diabetes Mellitus.

Yonsei Med J 2021 Apr;62(4):359-365

Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea.

Purpose: Little is known about the relationship between brain-derived neurotrophic factor () gene polymorphisms and psychiatric symptoms in diabetes patients. We investigated the effects of Val/66/Met polymorphism, glucose status, psychological susceptibility, and resilience on anxiety and depression symptoms in patients newly diagnosed with type 2 diabetes mellitus (T2DM).

Materials And Methods: We examined biochemical factors and polymorphism in 89 patients who were newly diagnosed with T2DM. Psychiatric symptoms were investigated with the Hospital Anxiety and Depression Scale (HADS), and the Connor-Davidson Resilience Scale (CD-RISC) and Impact of Event Scale (IES) were used to assess psychological resilience and susceptibility to psychological distress, respectively. Logistic regression analyses were conducted to investigate factors associated with psychiatric symptoms.

Results: We determined that 62 patients (70%) were Met-carriers. No significant differences were found between the Val/Val homozygous and Met-carrier groups regarding age, sex, body mass index, and clinical factors related to glycemic control and lipid profiles. HADS-anxiety and HADS-depression scores and IES factor scores were higher in the Met-carrier than the Val/Val homozygous group. Hemoglobin A1c (HbA1c) level was significantly inversely correlated with the severity of depressive symptoms. Resilience factors showed significant inverse correlations, and IES factors showed positive correlations with depressive symptom severity. In the logistic regression analysis model, depressive symptoms were significantly associated with HbA1c and polymorphism, whereas only the hyperarousal factor of the IES scale was associated with anxiety.

Conclusion: Depressive symptoms are associated with the presence of the Met-carriers and lower HbA1c in patients newly diagnosed with T2DM.
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http://dx.doi.org/10.3349/ymj.2021.62.4.359DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007434PMC
April 2021

[Large Animal Models in Pancreas and Biliary Disease].

Korean J Gastroenterol 2021 03;77(3):99-103

Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea.

Rodent models, which have played important roles in preclinical research of pancreas and biliary diseases, have some limitations to translating data from rodent models to human diseases. Large animal models have recently been developed to overcome these limitations and perform translational research of medical devices and drugs in pancreas and biliary diseases. Preclinical studies using large animal models are necessary before clinical application, especially for the research and development of equipment, instrumentation, and techniques in pancreato-biliary diseases. As long as the endoscope used in humans can enter an organ, there appears to be no limitation in terms of species or organ for endoscopic experiments of large animal models. Investigators have mainly used swine for pancreas and biliary endoscopic experiments. Until now, unique swine models that investigators have been established include the normal bile duct model, bile duct dilation model, bile duct dilation+direct peroral cholangioscopy model, benign biliary stricture model, hilar biliary obstruction model, and acute pancreatitis (post-ERCP pancreatitis) model. Many preclinical studies have been performed using these established endoscopy-based large animal models to develop novel medical devices. Furthermore, porcine pancreatic cancer models induced by a transgenic or orthotopic method are currently under development. These models appear to be available for general use in the future and will have multiple potential preclinical and clinical applications.
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http://dx.doi.org/10.4166/kjg.2021.031DOI Listing
March 2021

Prediction of urine culture results by automated urinalysis with digital flow morphology analysis.

Sci Rep 2021 03 16;11(1):6033. Epub 2021 Mar 16.

Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro Gangnam-gu, Seoul, 06273, South Korea.

To investigate the association between the results of urinalysis and those of concurrent urine cultures, and to construct a prediction model for the results of urine culture. A total of 42,713 patients were included in this study. Patients were divided into two independent groups including training and test datasets. A novel prediction algorithm, designated the UTOPIA value, was constructed with the training dataset, based on an association between the results of urinalysis and those of concurrent urine culture. The diagnostic performance of the UTOPIA value was validated with the test dataset. Six variables were selected for the equation of the UTOPIA value: age of higher UTI risk [odds ratio (OR), 2.069125], female (OR, 1.400648), nitrite (per 1 grade; OR, 3.765457), leukocyte esterase (per 1 grade; OR, 1.701586), the number of WBCs (per 1 × 10/L; OR, 1.000121), and the number of bacteria (per 1 × 10/L; OR, 1.004195). The UTOPIA value exhibited an area under the curve value of 0.837 when validated with the independent test dataset. The UTOPIA value displayed good diagnostic performance for predicting urine culture results, which would help to reduce unnecessary culture. Different cutoffs can be used according to the clinical indication.
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http://dx.doi.org/10.1038/s41598-021-85404-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7966378PMC
March 2021

Mobile Carbapenemase Genes in .

Front Microbiol 2021 18;12:614058. Epub 2021 Feb 18.

Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea.

Carbapenem-resistant is one of the major concerns in clinical settings impelling a great challenge to antimicrobial therapy for patients with infections caused by the pathogen. While membrane permeability, together with derepression of the intrinsic beta-lactamase gene, is the global prevailing mechanism of carbapenem resistance in , the acquired genes for carbapenemases need special attention because horizontal gene transfer through mobile genetic elements, such as integrons, transposons, plasmids, and integrative and conjugative elements, could accelerate the dissemination of the carbapenem-resistant . This review aimed to illustrate epidemiologically the carbapenem resistance in , including the resistance rates worldwide and the carbapenemase-encoding genes along with the mobile genetic elements responsible for the horizontal dissemination of the drug resistance determinants. Moreover, the modular mobile elements including the carbapenemase-encoding gene, also known as the resistance islands, are scrutinized mostly for their structures.
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http://dx.doi.org/10.3389/fmicb.2021.614058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930500PMC
February 2021

Amine-Tagged Fragmented Ligand Installation for Covalent Modification of MOF-74.

Angew Chem Int Ed Engl 2021 Apr 5;60(17):9296-9300. Epub 2021 Mar 5.

Department of Chemistry, Ulsan National Institute of Science and Technology (UNIST), Ulsan, 44919, Republic of Korea.

MOF-74 is one of the most explored metal-organic frameworks (MOFs), but its functionalization is limited to the dative post-synthetic modification (PSM) of the monodentate solvent site. Owing to the nature of the organic ligand and framework structure of MOF-74, the covalent PSM of MOF-74 is very demanding. Herein, we report, for the first time, the covalent PSM of amine-tagged defective Ni-MOF-74, which is prepared by de novo solvothermal synthesis by using aminosalicylic acid as a functionalized fragmented organic ligand. The covalent PSM of the amino group generates metal binding sites, and subsequent post-synthetic metalation with Pd ions affords the Pd -incorporated Ni-MOF-74 catalyst. This catalyst exhibits highly efficient, size-selective, and recyclable catalytic activity for the Suzuki-Miyaura cross-coupling reaction. This strategy is also useful for the covalent modification of amine-tagged defective Ni (DOBPDC), an expanded analogue of MOF-74.
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http://dx.doi.org/10.1002/anie.202100456DOI Listing
April 2021

First Identification of IMP-1 Metallo-β-Lactamase in Strain CRS1243 Isolated From a Clinical Specimen.

Ann Lab Med 2021 Jul;41(4):436-438

Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea.

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http://dx.doi.org/10.3343/alm.2021.41.4.436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884188PMC
July 2021

Concordance of Three Automated Procalcitonin Immunoassays at Medical Decision Points.

Ann Lab Med 2021 Jul;41(4):419-423

Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Procalcitonin (PCT) is a useful bacterial infection biomarker with the potential for guiding antibiotic therapy. We evaluated the concordance of three automated PCT immunoassays: Kryptor (BRAHMS GmbH, Hennigsdorf, Germany), Atellica IM 1600 (Siemens Healthcare Diagnostics, Munich, Germany), and Cobas e801 (Roche Diagnostics, Mannheim, Germany). In 119 serum samples with a PCT concentration <5.00 μg/L, Kryptor (reference assay) was compared with the other two immunoassays by Spearman's rank correlation, regression analysis, and concordance at two antibiotic stewardship medical decision points: 0.25 and 0.50 μg/L. The Atellica IM 1600 and Cobas e801 results showed high correlations with those of Kryptor, with correlation coefficient (ρ) values of 0.97 and 0.99, respectively. However, negative biases were observed in both immunoassays (slope/y-intercept: 0.75/-0.00 for Atellica IM 1600; 0.88/-0.01 for Cobas e801). Atellica IM 1600 and Cobas e801 demonstrated excellent concordance with Kryptor at both medical decision points, with linearly weighted κ values of 0.90 and 0.92, respectively, despite discrepancies, which were more prominent at the 0.25 μg/L medical decision point. Based on these biases and discrepancies, the alternate use of different PCT immunoassays in repeat examinations is inadvisable. Standardization is required before comparing the results of different PCT immunoassays.
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http://dx.doi.org/10.3343/alm.2021.41.4.419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884194PMC
July 2021

Anti-HBc IgG Levels: A Predictor of HBsAg Seroclearance in Chronic Hepatitis B Patients with Nucleos(t)ide Analogue-Induced HBeAg Seroclearance.

Dig Dis Sci 2021 Jan 30. Epub 2021 Jan 30.

Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea.

Background/aims: We investigated the efficiency of the indirect ratio of anti-HBc IgG at predicting HBsAg seroclearance in patients with nucleos(t)ide analogue (NA)-induced HBeAg seroclearance.

Methods: We performed a retrospective study that included 366 chronic hepatitis B patients (March 2007 to December 2016) at a single tertiary hospital. These patients were HBsAg seropositive, and experienced NA-induced HBeAg seroclearance. The indirect ratio of light absorbance of anti-HBc IgG levels were measured with chemiluminescent microparticle immunoassay using the Architect Anti-HBc assay (Abbott Laboratories, IL, USA) as a qualitative method prior to antiviral therapy. We calculated the cumulative incidences of HBsAg seroclearance based on the anti-HBc IgG levels.

Results: After a 10-year follow-up, 48 patients experienced HBsAg seroclearance (13.1%). Thirty-three of 179 patients who had an indirect ratio of light absorbance of anti-HBc IgG < 11 RLU (relative light unit) showed HBsAg seroclearance (18.4%); 15 of 187 patients who had an indirect ratio of light absorbance of anti-HBc IgG ≥ 11 RLU showed HBsAg seroclerance (8.0%) (p = 0.003). In multivariate analysis, age, and ALT at the time of HBeAg seroclearance were predictors of HBsAg seroclearance. Especially, the relative risk of HBsAg seroclearance in patients with baseline anti-HBc IgG levels < 11 RLU was 2.213 (95% CI, 1.220-4.014), compared to that in patients with higher levels of anti-HBc IgG at baseline (p = 0.009).

Conclusion: Using an indirect method for anti-HBc IgG levels, baseline anti-HBc IgG levels (< 11RLU), age (≥ 50 years), and ALT (≥ 40 IU/L) might be associated with HBsAg seroclearance in patients with NA-induced HBeAg seroclearance.
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http://dx.doi.org/10.1007/s10620-021-06845-2DOI Listing
January 2021

[A Meta-Analytic Path Analysis on the Outcome Variables of Nursing Unit Managers' Transformational Leadership: Systemic Review and Meta-Analysis].

J Korean Acad Nurs 2020 Dec;50(6):757-777

College of Nursing, Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Korea.

Purpose: The purpose of this study was to identify the outcome variables of nursing unit managers' transformational leadership and to test a hypothetical model using meta-analytic path analysis.

Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Data analysis, conducted using R version 3.6.2 software, included 49 studies for the meta-analysis and 119 studies for meta-analytic path analysis.

Results: In the meta-analysis, four out of 32 outcome variables were selected. These four variables were empowerment, nursing performance, job satisfaction, and organizational commitment, which showed larger effect sizes than the median and more than five k. The hypothetical model for the meta-analytic path analysis was established by using these four variables and transformational leadership. A total of 22 hypothetical paths including nine direct effects and 13 indirect effects were set and tested. The meta-analytic path analysis showed that transformational leadership had direct effects on the four variables. Finally, eight direct effects, 12 indirect effects, and six mediating effects were statistically significant, and the hypothetical model was verified.

Conclusion: Nursing unit managers can use the transformational leadership to improve empowerment, nursing performance, job satisfaction, and organizational commitment of nurses. This study empirically showed the importance of transformational leadership of nursing managers. This finding will be used as evidence to develop strategies for enhancing transformational leadership, empowerment, nursing performance, job satisfaction, and organizational commitment in nursing science and practice.
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http://dx.doi.org/10.4040/jkan.20205DOI Listing
December 2020

Clinical efficacy of high-flow nasal oxygen in patients undergoing ERCP under sedation.

Sci Rep 2021 01 11;11(1):350. Epub 2021 Jan 11.

Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 400-711, Republic of Korea.

Hypoxemia can occur during endoscopic retrograde cholangiography (ERCP) and it is difficult to achieve adequate ventilation with the prone position. High-flow nasal oxygen (HFNO) has been recommended to be more effectively help ventilation than conventional low flow oxygen. The aim of this study was to evaluate the effect of HFNO during sedated ERCP and to identify predictors of desaturation during ERCP. The investigated variables were age, gender, American Society of Anesthesiologists classes (ASA), duration of exam, and sedative used for midazolam or/and propofol of 262 patients with sedated ERCP. The differences between categorical and continuous variables were analyzed using the Student's t test and the chi-square test. Desaturation (SpO ≤ 90%) occurred in 9(3.4%) patients among 262 patients during sedated ERCP. The variables found to predict desaturation were older age (p < 0.01), higher sedation dose for midazolam or propofol (p < 0.01), and use of midazolam (p < 0.01). Desaturation rate was lower during sedated ERCP with HFNO compared to the preliminary study with conventional low flow nasal oxygen. Patients with older age, higher sedation dose, or the use of midazolam might require close monitoring for desaturation and hypoventilation by nursing staff. The study shows the use of high-flow nasal oxygen reduces the incidence of desaturation during ERCP.
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http://dx.doi.org/10.1038/s41598-020-79798-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801411PMC
January 2021

Class D β-lactamases.

J Antimicrob Chemother 2021 03;76(4):836-864

Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea.

Class D β-lactamases are composed of 14 families and the majority of the member enzymes are included in the OXA family. The genes for class D β-lactamases are frequently identified in the chromosome as an intrinsic resistance determinant in environmental bacteria and a few of these are found in mobile genetic elements carried by clinically significant pathogens. The most dominant OXA family among class D β-lactamases is superheterogeneous and the family needs to have an updated scheme for grouping OXA subfamilies through phylogenetic analysis. The OXA enzymes, even the members within a subfamily, have a diverse spectrum of resistance. Such varied activity could be derived from their active sites, which are distinct from those of the other serine β-lactamases. Their substrate profile is determined according to the size and position of the P-, Ω- and β5-β6 loops, assembling the active-site channel, which is very hydrophobic. Also, amino acid substitutions occurring in critical structures may alter the range of hydrolysed substrates and one subfamily could include members belonging to several functional groups. This review aims to describe the current class D β-lactamases including the functional groups, occurrence types (intrinsic or acquired) and substrate spectra and, focusing on the major OXA family, a new model for subfamily grouping will be presented.
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http://dx.doi.org/10.1093/jac/dkaa513DOI Listing
March 2021

Effects of microvascular invasion on clinical outcomes after resection with curative intent for cholangiocarcinoma.

Medicine (Baltimore) 2020 Dec;99(52):e23668

Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea.

Abstract: Surgery is the only curative treatment for cholangiocarcinoma, but even after surgery, survival rates are unsatisfactory. Recently, several reports have suggested microvascular invasion (MiVi) is associated with poor postoperative prognosis in hepatocellular carcinoma (HCC). We considered that MiVi might be associated with poor clinical outcomes in patients with surgically resectable cholangiocarcinoma.The records of 91 patients who underwent resection with curative intent for cholangiocarcinoma at Inha University Hospital from 2007 to 2017 were comprehensively reviewed for clinicopathological characteristics, DFS, and overall survival (OS) relations between these factors and the presence of MiVi.Forty-nine of the 91 study subjects had MiVi and 42 did not. Median overall survivals were 492 days in the MiVi group and 1008 days in the noMiVi group and median DFSs were 367 days and 760 days, respectively. Cumulative survival ratio and recurrence incidence rates were significantly different in the 2 groups (P = .012). Multivariable analysis showed the presence of MiVi was an independent risk factor of OS (hazard ratio [HR] 3.34; 95% confidence interval [CI], 1.40-7.97; P = .007).Cholangiocarcinoma is known to have a poor prognosis. When microvascular invasion remains after surgery it is associated with poor clinical outcomes.
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http://dx.doi.org/10.1097/MD.0000000000023668DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769315PMC
December 2020
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