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Clinical Usefulness of the Line Probe Assay for Rapid Detection of Rifampicin-resistant Tuberculosis (Line probe assay를 이용한 신속한 rifampicin내성결핵 진단법의 임상적 유용성)

  • Hong, Sang-Bum;Lim, Chae-Man;Lee, Sang-Do;Koh, Youn-Suck;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Shim, Tae-Sun
    • Tuberculosis and Respiratory Diseases
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    • v.50 no.3
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    • pp.334-342
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    • 2001
  • Background : RpoB gene mutations have been found in about 96-98% of rifampicin (RMP)-resistant Mycobacterium tuberculosis. Recent reports confirm that the in laboratory settings a rpoB gene mutation can be used as a surrogate marker for multi-drug resistant tuberculosis. However, its usefulness in clinical applications has not been evaluated. This study was performed to confirm whether mutation analysis of the rpoB gene of M. tuberculosis is useful in clinical settings. Methods : The medical records of 33 patients in whom rpoB gene analysis was conducted using an INNOLiPA Rif. TB assay (LiPA) from June, 1998, to July, 2000, at the Asan Medical Center were retrospectively reviewed in 33 patients. The clinical characteristics in addition to the drug susceptibility and LiPA results were analyzed. The drug susceptibility test was considered as a gold standard method for M. tuberculosis susceptibility and these results were compared with those of the rpoB gene study and sequencing analysis. Sequencing analysis of the rpoB gene was done in cases where there was a discrepancy between the results of the drug susceptibility an d rpoB gene study. Results : The mean age and sex ratio was $42{\pm}18$, and 24:9 (M:F), respectively. There were 19 RMP susceptible (58%) and 14 RMP-resistant cases (42%) according to the rpoB gene study. The mean time from the request to reporting the results of the rpoB gene study was $5.2{\pm}2.6$ days. The mean gap from reporting the rpoB gene study to reporting the susceptibility was $56{\pm}35$ days. Twenty-eight cases (85%) showed identical results compared with the drug susceptibility results, whereas five cases (15%) showed contradictory results. When compared with the sequencing analysis, of the five cases that showed contradictory results, two had LiP A analysis errors and the remaining three were identical to the sequencing results. The rpoB gene study was of assistance in choosing the appropriate drugs in 28 cases (85%). Conclusions : An rpoB gene study using an LiP A assay was useful in rapidly diagnosing RMP-resistant tuberculosis, which enabled a proper choice of the appropriate drugs in clinical practices. However, an LiPA assay always should be performed in conjunction with microscopy, culture, and susceptibility tests.

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Factors Influencing the Meaning of Life for Middle-aged Women (중년여성의 삶의 의미와 영향요인)

  • Park, Geum-Ja
    • Women's Health Nursing
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    • v.8 no.2
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    • pp.232-243
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    • 2002
  • The purpose of this study was to examine factors influencing the meaning of life for middle-aged women. The subjects for the study were 190 middle-aged women who live in Busan. Data were collected from May 25 to June 20, 1999. The instruments for this study were as follows : the meaning of life scale developed by Jung D. R(1978) ; the self-esteem scale developed by Ro, E. Y, Kwon, J. H.(1997) ; the volunteer activity scale developed by Park G. J.(1999), the marital satisfaction scale developed by Choi G. Y.(1999) ; and the health status scale developed by Kim S. Y. (1991). SPSS PC+ was utilized for data analysis. Data were analysed according to frequency and percentage, mean and standard deviation, t-test, ANOVA, Sheffe' s test and Pearson' s correlation coefficients and stepwise multiple regression. The reliability of the tools was tested by Cronbach's $\alpha$ : and it showed reliability scores of 0.88(for the meaning of life tool), 0.81(for the self-esteem tool), 0.94(for the marital satisfaction tool) and 0.78(for the health status tool). The results were as follows: 1) The scores showed that middle-aged women had a moderate level of meaning of life, with a mean of 30.31 and standard deviation of 6.24 (with values ranging from 12.00 to 48.00). The scores showed that middle-aged women had a moderate levels of self-esteem, with a mean of 28.92 and standard deviation of 4.67 (with values ranging from 10.00 to 40.00). The scores showed that middle-aged women had a very low level of volunteer activity, with a mean of 0.87 and standard deviation of 0.93(with values ranging from 0.00 to 1.00). The scores showed that middle-aged women had a moderate level of satisfaction in their marriages, with a mean of 31.99 and standard deviation of 7.84(with values ranging from 12.00 to 48.00). The scores showed that middle-aged women had a moderate level of health status, with a mean of 6.63 and standard deviation of 1.57(with values ranging from 3.00 to 9.00). 2) There was a statistically significant difference of the meaning of life of middle-aged women according to their religion(F=8.930, p=.000), christian ($31.94{\pm}5.96$) had more meaning th life than buddhists ($28.40{\pm}6.23$). 3) There was a statistically significant correlations between the subject' s self-esteem and the her meaning of life(r=0.477, p=0.000), the subject' s level of volunteer activity and meaning of life(r=.428, p=.000), her level of marital satisfaction and meaning of life(r=.417, p=.000), and her level of health status and meaning of life(r=.261, p=.000) among these middle-aged women. 4) Self- esteem was the highest factor influencing the level of meaning of life in middle-aged women. 40.0% of the total variance of levels of meaning of life by was dependent on self-esteem, volunteer activity, marital satisfaction and health status. In conclusion, the higher the self-esteem and levels of volunteer activity, marital satisfaction, and health status of middle-aged women, the higher the meaning of life for them. Therefore, it is necessary to elevate levels of the self-esteem and volunteer activity, marital satisfaction and health status in order to help middle-aged women have more meaning of life.

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Relationships among Violence Experience, Resilience and Job Stress of Nurses Working in Emergency Department (응급실 간호사의 폭력경험, 자아탄력성, 직무스트레스와의 관계연구)

  • Song, Young-Jin;Lee, Hye-Kyung
    • Journal of the Korean Applied Science and Technology
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    • v.37 no.5
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    • pp.1390-1401
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    • 2020
  • This study is a descriptive research to identify the relationship among violence experience, resilience and job stress of nurses working in emergency department. The subjects of this study were 143 nurses with over one year working in emergency departments of 6 hospitals located in D city and C city and collected data through structured questionnaire. It was from November 6th to November 15th. The degree of violent experience of the subjects was 1.26 ± 1.31 out of 4. The average score of resillience was 2.50 ± 0.55 out of 4. The average score of job stress was 3.62 ± 0.49 out of 5. The result of correlation between violence experience, resilience and job stress, among the sub factors, in the correlation among violence experience and job stress sub factors, verbal violence experience was significantly positively correlated with nursing work(r=.194, p=.010), role conflict stress(r=.158, p=.030), and physical threat experience was positively correlated with nursing work(r=.200, p=.008), role conflict(r=.162, p=.027), and conflict with doctor(r=.145, p=.042). In the correlation between resilience and job stress sub factors, nursing work stress is hardness(r=-.189, p=.012), persistence(r=-.165, p=.025), and optimism (r=-.186, p=.013) and there was a negative correlation with the region. Expertise stress is hardness(r=-.230, p=.003), persistence(r=-.195, p=.010), optimistic(r=-.194, p=.010) and there was a negative correlation. Nurse-treated stress was positively correlated with spirituality(r=.154, p=.033). In the subcategory correlations of resilience and violent experience, the hardness had a negative correlation with the physical threat(r=-.150, p=.037) experience. The persistence was negatively correlated with the experience of physical threats(r=-.138, p=.050). The optimism was negatively correlated with the experience of physical violence(r=-.151, p=.036). As a result, it is necessary to create a safe working environment free from violence and to reinforce training on how to deal with violence in order to reduce the job stress of emergency department nurses. In addition, measures to cope with stress according to age and work experience and programs to increase resilience should be developed and mediated to reduce the job stress of emergency department nurses.

Associated-Genes and Virulence Factors of Staphylococcus aureus Isolated from Nasal Cavity of Neonates (신생아 비강에서 분리된 황색포도구균의 병원성 인자와 관련 유전자)

  • Kim, Yung Bu;Moon, Ji Young;Park, Jae Hong
    • Clinical and Experimental Pediatrics
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    • v.46 no.1
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    • pp.24-32
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    • 2003
  • Purpose : Nosocomial infection with Staphylococcus aureus, especially methicillin resistant S. aureus, has become a serious concern in the neonatal intensive care unit. The aim of this study is to investigate the virulence factors, and the relationship between the antibiotic resistance and the associated genes of Staphylococcus aureus isolated from nasal cavity of neonates. Methods : Fifty one isolates of S. aureus were obtained from nasal swab taken in 28 neonates in the NICU and nursery of Pusan National University Hospital between February and May, 2001. They were tested in regard to antibiotic susceptibility, coagulase test and typing, plasmid DNA profile, as well as reactivity to enterotoxin A-E(sea, seb, sec, sed, see) genes and toxic shock syndrome toxin-1(tst) gene by polymerase chain reaction(PCR). Associated genes such as mecA, mecR1, mecI, and femA were also determined by PCR. The origin of MRSA strains was assessed using DNA fingerprinting by arbitrarily-primed polymerase chain reaction(AP-PCR). Results : Twenty three(45.1%) and six(11.8%) isolates were resistant to oxacillin and vancomycin respectively. Multidrug resistance to three or more of the antibiotics tested was observed in 51.0% of the isolates. Forty two isolates were coagulase positive and twenty two isolates had mecA gene. Sixteen isolates had both mecA and femA genes and had type I-III plasmids. 64.7% of isolates carried sec gene, and 80.4% carried tst gene. DNA fingerprinting by AP-PCR for 12 MRSA strains showed 10 distinct patterns, suggesting different origins. Conclusion : We confirmed that the prevalence of nasal carriage of S. aureus and the incidence of antimicrobial-resistant S. aureus, especially vancomycin resistance, is very high in neonates who were admitted in NICU and nursery. It is possible that these pathogens are responsible for serious nosocomial infections in neonates. The need for improved surveillance and continuous control of pathogens is emphasized.

Evaluation of Metal-Amino Acid Chelates and Complexes at Various Levels of Copper and Zinc in Weanling Pigs and Broiler Chicks

  • Lee, S.H.;Choi, S.C.;Chae, B.J.;Lee, J.K.;Acda, S.P.
    • Asian-Australasian Journal of Animal Sciences
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    • v.14 no.12
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    • pp.1734-1740
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    • 2001
  • Feeding trials using weanling pigs and broiler chicks were conducted to evaluate the efficacy of different metal-amino acid chelates and complexes at various levels of copper and zinc on the performance and fecal excretions. A total of 200 weanling pigs (Large White ${\times}$ Yorkshire ${\times}$ Duroc, $11.20{\pm}0.81kg$) were randomly assigned to 5 dietary treatments following a randomized complete block design. Each treatment was replicated 4 times with 10 pigs per pen. The dietary treatments were designated as : A-diet containing 170 ppm Cu from $CuSO_4$ and 120 ppm Zn from $ZnSO_4$, B-diet containing 85 ppm Cu from Cu-amino acid chelate (CAC) and 60 ppm Zn from Zn-amino acid chelate (ZAC), C-diet containing 170 ppm Cu from CAC and 120 ppm Zn from ZAC, D-diet containing 85 ppm Cu from Cu-lysine complex (CL) and 60 ppm Zn from Zn-methionine complex (ZM), and E-diet containing 170 ppm Cu from CL and 120 ppm Zn from ZM. On the other trial, 144 of one day old broiler chicks were randomly distributed to 6 dietary treatments following a completely randomized design. Each treatment was replicated 3 times with 8 chicks per replicate. The dietary treatments were as follows: 1-diet with 60 ppm Cu from $CuSO_4$ and 40 ppm Zn from $ZnSO_4$, 2-diet with 120 ppm Cu from $CuSO_4$ and 80 ppm Zn from $ZnSO_4$, 3-diet with 60 ppm Cu from CAC and 40 ppm Zn from ZAC, 4-diet with 120 ppm Cu from CAC and 80 ppm Zn from ZAC, 5-diet with 60 ppm Cu from CL and 40 ppm Zn from ZM, and 6-diet with 120 ppm Cu from CL and 80 ppm Zn from ZM. In Exp. 1 with pigs, there was no difference on average daily gain and average daily feed intake observed among treatments. There was improvement (p<0.05) on the overall feed conversion ratio (FCR) of pigs fed diet containing 120 ppm Zn and 170 ppm Cu from metal-amino acid chelates relative to those fed diet containing inorganic sources of Cu and Zn but equally efficient as those fed diet containing metal-amino acid complexes. Pigs fed diet containing either metal-amino acid chelates or complexes as sources of Cu and Zn had higher (p<0.05) Cu and Zn concentration in serum and lower (p<0.05) in feces than those receiving diet with inorganic sources. In Exp. 2 with broiler chicks, the overall FCR was not different among treatments. Higher (p<0.05) Cu and Zn concentration in serum was obtained from birds fed diet with 60 ppm Cu and 40 ppm Zn from metal-amino acid chelates compared to those fed diet with inorganic sources of Cu and Zn. Also, the feces collected from birds fed diet with either metal-amino acid chelates or complexes contained generally lower Cu and Zn than those birds fed diet with inorganic sources. The higher the dietary level of Cu and Zn the higher the Cu and Zn concentration in the feces. Based on the results, both metal-amino acid chelates and complexes of Cu and Zn at low levels (Zn 60 ppm, Cu 85 ppm for weanling pigs and Zn 40 ppm, Cu 60 ppm for broiler chicks) are not different from that of high levels of inorganic sources in maintaining growth performance and serum concentration. The fecal excretions for Cu and Zn were greatly reduced when organic sources were used.

Apoptotic Effect of Co-Treatment with Valproic Acid and 17AAG on Human Osteosarcoma Cells (Valproic acid와 17AAG의 병용처리가 사람골육종세포에 미치는 세포자멸사 효과에 대한 연구)

  • Park, Jun-Young;Park, Se-Jin;Kim, In-Ryoung;Park, Bong-Soo;Jeong, Sung-Hee;Ko, Myung-Yun;Ahn, Yong-Woo
    • Journal of Oral Medicine and Pain
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    • v.36 no.1
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    • pp.11-20
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    • 2011
  • Valproic acid (VPA) is a well-known anticonvulsive agent and has been used in the treatment of epilepsy for almost 30 years. VPA emerged in 1997 as an antineoplastic agent. And it is known that antitmor activity of VPA is associated with its targeted at histone deacetylases. 17AAG, Inhibition of HSP90 leads to the proteasome degradation of the HSP90 client proteins, such as Akt, Raf/Ras, Erk, VEGF, cyclin D and p53, and causes potent antitumor activity. It is reported that 17AAG-induced HSP90 inhibition results in prevention of cell proliferation and induction of apoptosis in several types of cancer. This study was undertaken to investigate the synergistic apoptotic effect of co-treatment with the histone deacetylases inhibitor, VPA and the HSP90 inhibitor, 17AAG on human osteosarcoma (HOS) cells. Cell viability was evaluated by trypan-blue exclusion. Induction and augmentation of apoptosis were confirmed by Hoechst staining, flow cytometry (DNA hypoploidy and MMP change), Westen blot analysis and immunofluorescent staining. In this study, HOS cells co-treated with VPA and 17AAG showed several lines of apoptotic manifestation such as nuclear condensations, the reduction of MMP, the decrease of DNA content, the release of cytochrome c into cytosol, the translocation of AIF onto nuclei, and activation of caspase-3, caspase-7 and PARP whereas each single treated HOS cells did not. Although the single treatment of 1 mM VPA or 0.5 ${\mu}M$ 17AAG for 48 h did not induce apoptosis, the co-treatment with them induced prominently apoptosis. Therefore our data in this study provide the possibility that combination therapy with VPA and 17AAG could be considered as a novel therapeutic strategy for human osteosarcoma.

Heat Budget Analysis of Light Thin Layer Green Roof Planted with Zoysia japonica (한국잔디식재 경량박층형 옥상녹화의 열수지 해석)

  • Kim, Se-Chang;Lee, Hyun-Jeong;Park, Bong-Ju
    • Journal of the Korean Institute of Landscape Architecture
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    • v.40 no.6
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    • pp.190-197
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    • 2012
  • The purpose of this study was to evaluate thermal environment and heat budget of light thin layer green roof through an experiment in order to quantify its heat budget. Two concrete model boxes($1.2m(W){\times}1.2m(D){\times}1.0m(H)$) were constructed: One experiment box with Zoysia japonica planted on substrate depth of 10cm and one control box without any plant. Between June 6th and 7th, 2012, outside climatic conditions(air temperature, relative humidity, wind direction, wind speed), evapotranspiration, surface and ceiling temperature, heat flux, and heat budget of the boxes were measured. Daily maximum temperature of those two days was $29.4^{\circ}C$ and $30^{\circ}C$, and daily evapotranspiration was $2,686.1g/m^2$ and $3,312.8g/m^2$, respectively. It was found that evapotranspiration increased as the quantity of solar radiation increased. A surface and ceiling temperature of those two boxes was compared when outside air temperature was the greatest. and control box showed a greater temperature in both cases. Thus it was found that green roof was effective in reducing temperature. As results of heat budget analysis, heat budget of a green roof showed a greater proportion of net radiation and latent heat while heat budget of the control box showed a greater proportion of sensible heat and conduction heat. The significance of this study was to analyze heat budget of green roof temperature reduction. As substrate depth and types, species and seasonal changes may have influences on temperature reduction of green roof, further study is necessary.

Development of Independent Target Approximation by Auto-computation of 3-D Distribution Units for Stereotactic Radiosurgery (정위적 방사선 수술시 3차원적 공간상 단위분포들의 자동계산법에 의한 간접적 병소 근사화 방법의 개발)

  • Choi Kyoung Sik;Oh Seung Jong;Lee Jeong Woo;Kim Jeung Kee;Suh Tae Suk;Choe Bo Young;Kim Moon Chan;Chung Hyun-Tai
    • Progress in Medical Physics
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    • v.16 no.1
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    • pp.24-31
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    • 2005
  • The stereotactic radiosurgery (SRS) describes a method of delivering a high dose of radiation to a small tar-get volume in the brain, generally in a single fraction, while the dose delivered to the surrounding normal tissue should be minimized. To perform automatic plan of the SRS, a new method of multi-isocenter/shot linear accelerator (linac) and gamma knife (GK) radiosurgery treatment plan was developed, based on a physical lattice structure in target. The optimal radiosurgical plan had been constructed by many beam parameters in a linear accelerator or gamma knife-based radiation therapy. In this work, an isocenter/shot was modeled as a sphere, which is equal to the circular collimator/helmet hole size because the dimension of the 50% isodose level in the dose profile is similar to its size. In a computer-aided system, it accomplished first an automatic arrangement of multi-isocenter/shot considering two parameters such as positions and collimator/helmet sizes for each isocenter/shot. Simultaneously, an irregularly shaped target was approximated by cubic structures through computation of voxel units. The treatment planning method by the technique was evaluated as a dose distribution by dose volume histograms, dose conformity, and dose homogeneity to targets. For irregularly shaped targets, the new method performed optimal multi-isocenter packing, and it only took a few seconds in a computer-aided system. The targets were included in a more than 50% isodose curve. The dose conformity was ordinarily acceptable levels and the dose homogeneity was always less than 2.0, satisfying for various targets referred to Radiation Therapy Oncology Group (RTOG) SRS criteria. In conclusion, this approach by physical lattice structure could be a useful radiosurgical plan without restrictions in the various tumor shapes and the different modality techniques such as linac and GK for SRS.

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Effects of Iterative Reconstruction Algorithm, Automatic Exposure Control on Image Quality, and Radiation Dose: Phantom Experiments with Coronary CT Angiography Protocols (반복적 재구성 알고리즘과 관전류 자동 노출 조정 기법의 CT 영상 화질과 선량에 미치는 영향: 관상동맥 CT 조영 영상 프로토콜 기반의 팬텀 실험)

  • Ha, Seongmin;Jung, Sunghee;Chang, Hyuk-Jae;Park, Eun-Ah;Shim, Hackjoon
    • Progress in Medical Physics
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    • v.26 no.1
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    • pp.28-35
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    • 2015
  • In this study, we investigated the effects of an iterative reconstruction algorithm and an automatic exposure control (AEC) technique on image quality and radiation dose through phantom experiments with coronary computed tomography (CT) angiography protocols. We scanned the AAPM CT performance phantom using 320 multi-detector-row CT. At the tube voltages of 80, 100, and 120 kVp, the scanning was repeated with two settings of the AEC technique, i.e., with the target standard deviations (SD) values of 33 (the higher tube current) and 44 (the lower tube current). The scanned projection data were reconstructed also in two ways, with the filtered back projection (FBP) and with the iterative reconstruction technique (AIDR-3D). The image quality was evaluated quantitatively with the noise standard deviation, modulation transfer function, and the contrast to noise ratio (CNR). More specifically, we analyzed the influences of selection of a tube voltage and a reconstruction algorithm on tube current modulation and consequently on radiation dose. Reduction of image noise by the iterative reconstruction algorithm compared with the FBP was revealed eminently, especially with the lower tube current protocols, i.e., it was decreased by 46% and 38%, when the AEC was established with the lower dose (the target SD=44) and the higher dose (the target SD=33), respectively. As a side effect of iterative reconstruction, the spatial resolution was decreased by a degree that could not mar the remarkable gains in terms of noise reduction. Consequently, if coronary CT angiogprahy is scanned and reconstructed using both the automatic exposure control and iterative reconstruction techniques, it is anticipated that, in comparison with a conventional acquisition method, image noise can be reduced significantly with slight decrease in spatial resolution, implying clinical advantages of radiation dose reduction, still being faithful to the ALARA principle.

Voxel-based Investigations of Phase Mask Effects on Susceptibility Weighted Images (화소 간 분석을 이용하여 자화율 가중 영상(SWI)에 나타난 위상 마스킹의 효과 분석)

  • Hwang, Eo-Jin;Kim, Min-Ji;Kim, Hyug-Gi;Ryu, Chang-Woo;Jahng, Geon-Ho
    • Progress in Medical Physics
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    • v.24 no.1
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    • pp.25-34
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    • 2013
  • To investigate effects of phase mask on susceptibility-weighted images (SWI) using voxel-based analyses in normal elderly subjects. A three-dimensional (3D) gradient echo sequence ran to obtain SWIs in 20 healthy elderly subjects. SWIs with two (SWI2) and four (SWI4) phase multiplications were achieved with positive (PSWI) and negative (NSWI) phase masks to investigate phase mask effects. The voxel-based comparisons were performed using paired t-tests between PSWI and NSWI and between SWI2 and SWI4. Differences of signal intensities between magnitude images and SWI4 were larger than those between magnitude images and SWI2s. Differences of signal intensities between magnitude images and PSWIs were larger than those between magnitude images and NSWIs. Moreover, the signal intensities from NSWI2s and NSWI4s were greater than those from PSWI2s and PSWI4s, respectively. More differences of signal intensities between NSWI4 and PSWI4s were found than those between NSWI2s and PSWI2s in the whole brain images. The voxel-based analyses of SWI could be beneficial to investigate susceptibility differences on the entire brain areas. The phase masking method could be chosen to enhance brain tissue contrast rather than to enhance venous blood vessels. Therefore, it is recommended to apply voxel-based analyses of SWI to investigate clinical applications.