A case of adult-onset Still’s disease combined with Sjögren’s syndrome

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Focal nodular hyperplasia-like nodules in a young man with congenital liver cirrhosis

Focal nodular hyperplasia-like nodules (FNH-like nodules) are hypervascular lesions that occur in the cirrhotic liver. Histologically, they are similar to classical FNH in an otherwise normal liver. Radiologically, FNH-like nodules may mimic hepatocellular carcinoma (HCC), and they have been misdiagnosed as HCC based on radiological findings. Their pathogenesis and etiology are unclear, but they may arise from a local hyperplastic response to vascular alterations like classical FNH. Rarely, these nodules transform into malignant tumors and cause complications. We report the case of a 28-year-old man with multiple FNH-like nodules in congenital liver cirrhosis.ope

Cryptococcal Meningitis : 12 Years Experience in a Single Tertiary Health Care Center

BACKGROUND: Cryptococcal infections are frequent in human immunodeficiency virus (HIV)-infected patients. This infection may occur in other immunocompromised patients, and the diagnosis is often delayed in these cases. There are a few reports on cryptococcal meningitis in non-HIV-infected patients in Korea. We reviewed the clinical features and efficacy of antifungal therapy in 33 patients who were treated at a single tertiary health care center of Korea. MATERIALS AND METHODS: The medical records of 33 consecutive patients who were admitted to one tertiary hospital for cryptococcal meningitis between 1995 and 2008 were reviewed retrospectively. Cryptococcal meningitis was confirmed by positive cerebral spinal fluid (CSF) cultures or compatible clinical features plus a positive cryptococcal antigen test of CSF. RESULTS: Of the 33 patients analyzed, 30 cases were non-HIV patients. The outcomes were complete cure in 23 cases, relapse after initial treatment in four cases, and death due to treatment failure in six cases. The main initial manifestations were headache (84.8%), fever (54.5%), and seizure (33.3%). Factors significantly associated with unfavorable outcomes, including mortality and relapse, were afebrile condition, mental change, hearing impairment, initial high opening pressure of CSF (>250 mmH2O), and low initial absolute neutrophil count. On multivariate analysis, afebrile condition was an independent predictor of an unfavorable outcome (odds ratio 17.3; 95% confidence interval 1.0-28.3; P=0.045). CONCLUSIONS: It is necessary to observe closely cryptococcal meningitis patients without fever on admissionope

Serum Retinol-Binding Protein-4 Levels Are Increased in HIV-Infected Subjects with Metabolic Syndrome Receiving Highly Active Antiretroviral Therapy

Metabolic syndrome is an important long term complication in chronic asymptomatic HIV-infected subjects under highly active antiretroviral therapy (HAART), because it can contribute to morbidity and mortality via cardiovascular disease (CVD). Therefore, a predictive marker for early detection of metabolic syndrome may be necessary to prevent CVD in HIV-infected subjects. Retinol-binding protein-4 (RBP-4) has been shown to be associated with metabolic syndrome in various non-HIV-infected populations. We performed a cross-sectional study to evaluate whether serum RBP-4 levels are correlated with metabolic syndrome in HIV-infected subjects receiving HAART. In total, 98 HIV-infected Koreans who had been receiving HAART for at least 6 months were prospectively enrolled. Metabolic syndrome was diagnosed according to the Adult Treatment Panel III criteria, and serum RBP-4 concentrations were measured using human RBP-4 sandwich enzyme-linked immunosorbent assay. Serum RBP-4 levels were significantly higher in HIV-infected subjects receiving HAART with metabolic syndrome (n=33, 33.9±7.7 µg/mL) than in those without it (n=65, 29.9±7.2 µg/mL) (p=0.012). In multivariate linear regression analysis, the number of components of metabolic syndrome presented and waist circumference were independently, significantly correlated with RBP-4 (p=0.018 and 0.030, respectively). In conclusion, we revealed a strong correlation between RBP-4 and the number of components of metabolic syndrome in HIV-infected subjects receiving HAART.ope

Clinical Factors Associated with Acquisition of Resistance to Levofloxacin in Stenotrophomonas maltophilia

PURPOSE: Fluoroquinolones, rapidly gaining prominence in treatment of Stenotrophomonas maltophilia (SMP), are noted for their potency and tolerability. However, SMP may rapidly acquire resistance to fluoroquinolones. We evaluated associations of clinical factors with acquisition of levofloxacin resistance (LFr) in SMP. MATERIALS AND METHODS: Our retrospective cohort study was based on patient data collected between January 2008 and June 2010. Through screening of 1275 patients, we identified 122 patients with data for SMP antibiotic susceptibility testing in ≥3 serial SMP isolates. RESULTS: We assigned the 122 patients to either the SS group (n=54) in which levofloxacin susceptibility was maintained or the SR group (n=31) in which susceptible SMP acquired resistance. In multivariate regression analysis, exposure to levofloxacin for more than 3 weeks [odds ratio (OR) 15.39, 95% confidential interval (CI) 3.08-76.93, p=0.001] and co-infection or co-colonization with Klebsiella pneumoniae resistant to levofloxacin (OR 4.85, 95% CI 1.16-20.24, p=0.030) were independently associated with LFr acquisition in SMP. CONCLUSION: Acquisition of LFr during serial sampling of SMP was related to the levofloxacin exposure.ope

Risk Factors and Prognosis for Persistent Candidemia without Catheter Colonization

BACKGROUND: Candidemia is one of the most common causes of nosocomial bloodstream infection, and increases the morbidity and mortality rate of seriously ill patients. We evaluated the risk factors and outcomes associated with persistent candidemia without catheter colonization (non-catheter related candidemia) and compared them with those of non-persistent candidemia. MATERIALS AND METHODS: A retrospective case-control study was performed to identify risk factors for, and outcomes of, persistent candidemia. All adults who experienced candidemia in a university-affiliated hospital in Korea between January 2005 and December 2009 were included. Patients with catheter colonization were excluded. Persistent candidemia was defined as the occurrence of candidemia in a patient receiving at least 3 days of systemic antifungal agents prior to the second positive blood culture. RESULTS: Of 605 adult patients with candidemia, 104 (17.2%) patients had persistent candidemia and 23 (3.8%) patients were free of catheter colonization. There were no statistically significant differences in baseline characteristics between patients with persistent and non-persistent candidemia. In univariate analysis, less use of metronidazole, glycopeptide, fluoroquinolone, and aminoglycoside, and presence of Candida parapsilosis were significantly associated with persistent candidemia. In multivariate analysis, less use of metronidazole was an independent factor associated with persistent candidemia. The candidemia related mortality was insignificantly (P=0.094) higher in persistent candidemia than non-persistent candidemia. CONCLUSIONS: Persistent candidemia can occur without catheterization. Patterns of antibiotic use could be associated with the occurrence of persistent candidemia, and prognosis of persistent candidemia seems to be worse than non-persistent candidemia. Further studies for persistent candidemia should be performedope

Viral shedding of 2009 pandemic H1N1 and evaluation of quarantine recommendations

Public health authorities recommend that isolation precautions for influenza should be continued for 7 days after illness onset or until 24 h after the resolution of symptoms, whichever event lasts longer. However, little data are available regarding the duration of isolation for patients with 2009 pandemic H1N1 (pH1N1). We recruited patients with confirmed pH1N1 virus infection at a 2,000-bed tertiary care center. Influenza viral loads from oropharyngeal swab specimens were serially determined by reverse transcriptase quantitative polymerase chain reaction every other day, and the risk factors for prolonged viral shedding were investigated. To evaluate the current recommendations for isolation precautions, we measured the intervals between symptom onset and the last viral RNA detection, and that between the last viral RNA detection and the point at which the patient was symptom-free for 24 h. From November 2009 to January 2010, 26 patients were enrolled, and viral RNA was detected in more than half of the eligible patients (10 of 19, 52.6%) for ≥7 days after symptom onset. While evaluating the policy for lifting quarantine, we found that viral RNA was detected in 4 of 15 patients (26.7%) beyond the recommended duration of isolation. In conclusion, viral RNA was detected in a substantial proportion of hospitalized patients even when they fulfilled the recommended conditions for lifting quarantine, and we believe that more prudence is required in this aspect.ope

Recurrent Coccidioidomycosis Manifesting as Osteomyelitis in Korea

Coccidioidomycosis is a fungal infection that results from inhaling the airborne arthroconidia of the Coccidioides species. It is an endemic disease in the southwest part of North America and rarely diagnosed in Korea. As tourism to endemic areas and the number of immunocompromised patients have been increasing, the incidence of this infection has increased in non-endemic areas. Treatment is usually successful with antifungal agents; however, recurrence is common. It is difficult to decide when to discontinue the antifungal treatment especially in non-endemic areas where doctors are not familiar with the disease. We report a case of recurrent coccidioidomycosis manifesting as osteomyelitis after the treatment of the patient for disseminated coccidioidal infection. The complement fixation test was a useful tool for the assessment of patient response and to evaluate suspected recurrenceope

Clinical features of re-emerging hepatitis A: an analysis of patients hospitalized during an urban epidemic in Korea.

From April 2008 to November 2008, many cases of hepatitis A were reported in Seoul and Gyeonggi Province in Korea. Furthermore, the rate of severe or fulminant hepatitis have significantly increased during the latest epidemic (13.4% vs. 5.2%, p=0.044). Therefore, widespread use of vaccine is warranted to reduce the burden of hepatitis A in Korea.ope

The study on empirical exploration of options price calculation of Black : Scholes equation

본 연구는 콜옵션을 계산하는 대표적인 모형인 블랙-숄즈 방정식이 현실적으로 타당한지에 대해 실증 분석을 해보는 것이다. 글로벌 금융 위기의 원인 중의 하나가 파생상품이라는 것이 알려지면서 파생상품에 대한 관심이 급증하였고, 이 파생상품에 대한 관리의 중요성 또한 높아지고 있다. 이러한 시점에서 파생상품 중의 하나인 콜옵션을 계산하는 블랙-숄즈 방정식으로부터 계산되어지는 콜옵션 계산치와 실제 콜옵션 값이 얼마나 잘 일치하는지에 대한 궁금증이 유발되어 실증 분석을 해보게 되었다. 본 연구에서는 첫 번째로, 몇 가지 가정을 충족해야지만 옵션 가격을 계산하는 것이 타당한 블랙-숄즈 방정식에서 통계학적인 관점에서 접근할 수 있는 2가지 가정, 즉, 기초자산의 수익률이 로그정규분포에 따르는지, 기초자산 수익률의 변동이 등분산인지에 대한 가정이 타당한지 알아보았다. 여기에서 가정이 타당하지 않다면 그에 대한 대안도 알아보았다. 두 번째로, 블랙-숄즈 방정식으로 계산한 옵션 가격과 실제 옵션 가격이 차이가 난다면 이 차이를 좁히기 위해 블랙-숄즈 방정식으로 계산하는 데에 필요한 기초자산 수익률 변동의 정확성을 높이기 위한 방안들이 있는지에 대해서도 알아보았다. 이렇게 블랙-숄즈 방정식의 가정을 검토하고, 옵션 가격 계산의 실증적 탐구를 해보았다.;This study is whether Black - Scholes equation which is typical model to calculate Call option is valid for the practical demonstration or not. It became known that derivatives was one of the causes of the global financial crisis, and interest of derivatives was increased, the importance of management of derivatives is also increasing. At the time, I analyze whether Call option price that is calculated from Black - Scholes equation and real Call option price are similar or not. In this study, first, I study whether assumptions are true or not in the Black - Scholes equation. Especially 2 assumptions that is based on statistical point of view, that is, whether asset returns follows a log normal distribution, whether asset returns' variation is same. If assumptions are not reasonable, I will find alternatives. Second, if Call option price that is calculated from Black - Scholes equation and real Call option price are not similar, I will find alternatives to make two prices similar using asset returns' variation. I review Black - Scholes equation's assumptions, and do empirical exploration of options price calculation.Ⅰ. 서론 = 1 A. 연구의 배경 및 목적 = 1 Ⅱ. 본론(이론) = 2 A. 옵션의 정의 = 2 1. 옵션의 개념 = 2 2. 옵션의 종류 = 2 3. 옵션의 특징 = 2 4. 옵션의 가격결정모형 = 3 B. 옵션의 가격결정모델(블랙-숄즈 방정식) = 4 1. 블랙-숄즈 방정식이란 = 4 2. 블랙-숄즈 방정식의 유도 = 4 가. 블랙-숄즈 방정식(전제조건 : 무재정조건, 무차익 거래) = 4 나. 블랙-숄즈 방정식의 유도 = 4 다. Call 옵션 블랙-숄즈 방정식 = 6 라. 블랙-숄즈 방정식의 기본 가정 = 7 C. 옵션의 가격결정모델(블랙-숄즈 방정식)에서의 변동 = 7 1. 블랙-숄즈 방정식에 사용할 σ값 추정 방법 3가지 = 8 가. case1 : 폐장가에 근거한 σ값 추정 = 8 나. case2 : 개장가, 폐장가에 근거한 σ값 추정 = 8 다. case3 : 개장가, 폐장가, 최고가, 최저가에 근거한 σ값 추정 = 8 Ⅲ. 실증분석 = 9 A. 블랙-숄즈 방정식 가정 2가지(수익률 분표, 변동) 확인 = 9 1. 기초자산의 수익률이 로그정규분포를 따르는가(블랙-숄즈 방정식 가정 1 검정) = 9 2. 기초자산의 수익률의 변동이 등분산인가(블랙-숄즈 방정식 가정 2 검정) = 11 가. 코스피200 지수 수익률의 자기상관 여부 확인 = 11 나. 코스피200 지수 수익률 제곱의 자기상관 여부 확인 = 13 B. 블랙-숄즈 방정식에서 등분산의 대안에 대한 고찰 (참고사항) = 15 1. 기초가격의 수익률의 변동 - 조건부 이분산 모델 = 15 가. AR(0)-ARCH(1) 모형일 경우 = 15 나. AR(0)-ARCH(2) 모형일 경우 = 16 다. AR(0)-ARCH(3) 모형일 경우 = 17 라. AR(0)-GARCH(1,1) 모형일 경우 = 17 마. AR(0)-IARCH(1,1) 모형일 경우 = 18 C. 블랙-숄즈 방정식의 Call 옵션 가격결정모델로서의 적절성 평가 = 19 1. 변동 추정 방법에 따른 Call 옵션 = 19 가. 변동 추정 방법에 따른 Call 옵션값 = 19 2. 적절한 변동 추정을 위한 기간별 Call 옵션 = 22 Ⅳ. 결론 및 논의 = 28 참고문헌 = 29 ABSTRACT = 3