Fluoroquinolone resistance in uncomplicated acute pyelonephritis: epidemiology and clinical impact

The objectives of this study were to investigate antibiotic resistance in urinary pathogens from Korean patients with uncomplicated acute pyelonephritis (UAPN), and to determine the effect of fluoroquinolone (FQ) resistance on clinical outcome in those patients with UAPN initially treated with FQ. Clinical and microbiologic data for all the APN patients attending 14 hospitals in South Korea in 2008 were collected retrospectively. Urinary pathogens were identified in 719 cases, and Escherichia coli was the most common pathogen (661/719, 91.9%). Antibiotic susceptibilities to several E. coli antibiotics were as follows: ciprofloxacin, 84.1%; trimethoprim-sulfamethoxazola (TMP-SMX), 67.2%; and extended-spectrum beta-lactamase-negative, 92.4%. FQ was the most frequent antibiotic prescribed for UAPN (45.3% intravenously and 53.9% by mouth). We compared clinical outcomes and hospital days in patients with FQ-resistant (32) and FQ-sensitive E. coli (173) who received FQ as initial empirical therapy. Clinical cure was higher in the FQ-sensitive group (78% vs. 91%, p=0.027), and hospital days were longer in the FQ-resistant group (9.6±5.5 days vs. 7±3.5 days, p=0.001). In conclusion, FQ-sensitivity of E. coli from UAPN was 84.1%. FQ treatment of UAPN caused by FQ-resistant E. coli has a lower cure rate and involves longer hospital stay than FQ treatment of cases caused by FQ-sensitive E. coli.     

Immunogenicity and safety of influenza A (H1N1) 2009 monovalent inactivated split vaccine in Korea

In a pandemic, the development of an effective influenza vaccine is the most important subject from the view of public health. This study was performed to evaluate the immunogenicity and safety of inactivated, monovalent H1N1 2009 vaccine (Green Cross Corporation, Yongin, Korea) among healthy adults aged 19-64 years (Group 1) and the elderly aged ≥65 years (Group 2) in a two-dose regimen, 21 days apart. At baseline, 28 of 454 participants (6.1%) had hemagglutination-inhibition titers of ≥1:40 with no significant difference between age groups (p = 0.27). There was an apparent dose-dependent antibody response; participants receiving the dose of 30 μg hemagglutinin (HA) showed higher geometric mean titers (GMTs) than the 15 μg HA group in both age groups. Despite the rates of seroprotection and seroconversion were significantly higher with 30 μg HA formulation than 15 μg HA formula in Group 2, there was no definite difference in Group 1 irrespective of vaccine formula. Significant GMT elevation after the second dose was not noted in either age group, regardless vaccine formulations. No deaths, vaccine-related serious adverse events, or immediate unsolicited adverse reactions occurred during the study periods.     

Prevalence and risk factors of malnutrition among cancer patients according to tumor location and stage in the National Cancer Center in Korea

ObjectiveAlthough malnutrition is common in cancer patients in Korea, little attention is paid to its risks and consequences. This study was carried out to investigate the prevalence and risk factors of malnutrition in hospitalized cancer patients according to tumor location and stage.MethodsOf 14 972 cancer patients admitted to the National Cancer Center, screening examinations were carried out for 12 112 patients and nutritional status was assessed in 8895 patients. Information on age, sex, length of hospital stay, and tumor location and stage were collected from the electronic medical records system. The nutritional status of each subject was assessed using body mass index, serum albumin, total lymphocyte count, and diet and classified into three groups: high risk, moderate risk, and low risk of malnutrition.ResultsAbout 61% of hospitalized patients were malnourished and the prevalence of malnutrition was higher in male patients with longer hospital stays (60.2%, P = 0.0101) and readmitted patients (66.6%, P < 0.0001). Patients with liver and lung cancer (86.6% and 60.5%, respectively) and patients with advanced cancer stage (60.5%, III or IV) had a higher prevalence of malnutrition than other patients (P < 0.0001). Logistic regression analysis showed that patients with advanced cancer stage and longer hospital stay and readmitted patients were at a higher risk for malnutrition.ConclusionThe prevalence of malnutrition in hospitalized cancer patients was high and varied across tumor location and stage. Early identification of malnutrition status is required for proper nutritional intervention during hospitalization.     

Molecular genetic characteristics of influenza A virus clinically isolated during 2011‐2016 influenza seasons in Korea

Background

The influenza virus is reportedly associated with 3‐5 million cases of severe illness and 250 000‐500 000 deaths annually worldwide.

Objectives

We investigated the variation of influenza A virus in Korea and examined the association with death.

Methods

A total of 13 620 cases were enrolled in the Hospital‐based Influenza Morbidity & Mortality surveillance system in Korea during 2011‐2016. Among these cases, a total of 4725 were diagnosed with influenza using RT‐PCR (influenza A; n = 3696, influenza B; n = 928, co‐infection; n = 101). We used 254 viral sequences from the 3696 influenza A cases for phylogenetic analysis using the BioEdit and MEGA 6.06 programs.

Results

We found that the sequences of A/H3N2 in the 2011‐2012 season belong to subgroup 3C.1, whereas the sequences in the 2012‐2013 season pertain to subgroup 3C.2. The sequences in the 2013‐2014 and 2014‐2015 seasons involve subgroups 3C.3a and 3C.2a. The A/H1N1pdm09 subtype belongs to subgroup 6 and contains two clusters. In addition, sequence analysis confirmed the several substitutions of internal genes and gene substitutions associated with drug resistance (I222V in NA and S31N in M2) in the fatal cases. While statistical analysis found no significant associations between genetic differences in the viruses and mortality, mortality was associated with certain host factors, such as chronic lung disease.

Conclusions

In conclusion, influenza A virus clade changes occurred in Korea during the 2011‐2016 seasons. These data, along with antigenic analysis, can aid in selecting effective vaccine strains. We confirmed that fatality in influenza A cases was related to underlying patient diseases, such as chronic lung disease, and further studies are needed to confirm associations between mortality and viral genetic substitutions.     

A Model Enzymic Extracorporeal Detoxification System

Preliminary studies at the University of Oklahoma have incorporated the use of a continuous, seal-less blood centrifuge as an extracorporeal detoxification unit to aid in the removal of foreign chemicals from the blood. Detoxification is performed by immobilized enzymes in conjunction with a cofactor (NADPH) bound to a water-soluble macromolecule. A drug enters the device with the plasma and then passes across a semipermeable membrane which serves to retain the cofactor. At this point, a combination of the drug, the cofactor and the enzyme react to form the drug-oxide. The oxide then passes back through the membrane into the blood and back into the body. Concurrently, the macro-NADP+ is reduced by G-6-P and G-6-PD in the cofactor regeneration portion of the device. To facilitate detoxification, the centrifuge is employed to provide plasma rich in toxins, but void of potentially interfering blood components such as platelets and whole blood cells. These components tend to dilute the toxins or adhere to the interfacing membrane, decreasing the permeability of these toxins into the detoxification unit. It is felt that the centrifuge-detoxification combination will provide a potentially efficient hepatic assist device.     

鼻咽癌超腔、颅底骨破坏和颅神经损害者放疗疗效分析

目的:分析鼻咽癌超腔、颅底骨破坏和颅神经损害而无颈淋巴结转移的患者放疗效果.方法:1980年9月～1988年9月收治的鼻咽癌原发灶超腔、颅底骨破坏和颅神经损害的患者205例.鼻咽病灶全部用~(60)Co放射,有38例单用耳前野放射,其余以耳前野为主,眶下野、鼻前野为辅野.有颅底骨破坏、前组颅神经损害者加照颅底野,有后组颅神经损害者加照患侧耳后野,肿瘤量60～80GY/W.颈部预防照射~(60)Co切线野40GY加深部X线20GY.结果:总的5年生存率为47.3%,原发灶超腔者、颅底骨破坏者、颅神经损害者和侵犯两项以上者的5年生存率分别是61.7%、72.7%、37.1%和30.2%.鼻咽剂量60Gy、70Gy、80Gy的5年生存率各是32.0%、53.8%、38.0%,P<0.05.体重增加者5年生存率为62.7%;下降者为32.2%.结论:以伴颅底骨质破坏和原发性超腔的鼻咽癌患者放疗效果较好.放射剂量以DT70Gy/7周为宜,营养支持使体重增加有助于提高疗效.     

补充四种营养素对仔鼠脑发育的影响

目的：　探讨补充四种营养素对仔鼠脑发育的影响。方法：　以ＳＤ大鼠为实验动物,自怀孕日起随机将母鼠分为两组：１．补充营养组（补充组,ＳＧ）,母鼠孕期２１ 天至哺乳第２１ 天在对照组标准颗粒饲料的基础上,每百克饲料补充营养素：二十二碳六烯酸（ＤＨＡ）原料药：〔ＤＨＡ３１．７％ ,二十碳五烯酸（ＥＰＡ）４２．３％ 〕１６０ｍ ｇ;牛磺酸０．６ｇ;硫酸锌１２０ｍ ｇ;叶酸１４０μｇ;２．对照组（ＣＧ）：标准颗粒饲料。分别于仔鼠出生后不同时期（新生期、脑生长突发期、断乳期）观察其脑重、体重、精神行为发育,学习记忆能力,自发运动状况,并测定脑内不同脑区（皮层、海马和小脑）的ＤＮＡ、ＲＮＡ 的浓度、蛋白质和微量无素的含量及ＡＬＰ、ＳＯＤ酶活性。　结果：　补充组的仔鼠脑重均较对照组重,两组间存在显著性差异（Ｐ＜ ０．０５）;仔鼠的精神行为发育、吸乳迷津分辨学习（ＡＤＬ）和抑制性回避反应（ＬＡ）学习行为、自发运动等多项指标均优于对照组,脑内ＳＯＤ活性也有明显的增加。结论：　上述变化可能与脑内尤其是皮层、海马等ＤＮＡ、ＲＮＡ合成增加及脑内神经细胞的磷脂代谢改变有关。