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

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

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

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

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

A Comparison of the return prediction power between retained earnings to market and book to market according to the size of Intangible return

학위논문(석사)--서울대학교 대학원 :경영대학 경영학과,2020. 2. 이관휘.본 논문에서는 무형수익률 크기에 따라 분류한 기업 그룹에서 이익잉여금/시가 비율이 장부가/시가 비율의 설명력을 흡수하는지 알아보고자 하였다. 장부가/시가 비율이 주식 수익률을 예측하는 이유는 장부가를 구성하는 항목인 이익잉여금이 과거 순이익에 대한 누적 정보를 담고 있기 때문이다. 따라서 장부가/시가의 주식 수익률 예측력은 이익잉여금/시가의 예측력에 흡수된다. 본 논문에서는 무형정보를 반영한 수익률인 무형수익률을 계산하여 무형수익률이 큰 그룹과 낮은 그룹에서 이익잉여금/시가 비율이 장부가/시가 비율의 설명력을 흡수하는 것이 어떻게 달라지는지 알아보고자 하였다. 분석 결과 무형수익률이 큰 그룹과 낮은 그룹에서 모두 이익잉여금/시가 비율이 장부가/시가 비율의 주식예측력을 흡수하지 못하는 것으로 나타났다. 구체적으로, 무형수익률이 작은 그룹에서 이익잉여금/시가 비율이 장부가/시가 비율의 예측력을 흡수할 것으로 기대했으나 무형수익률이 큰 그룹과 마찬가지로 이익잉여금/시가의 주식 수익률 설명력은 유의하지 않았다. 이러한 결과를 종합할 때 국내 시장에서는 이익잉여금/시가 비율이 과거 순이익에 대한 누적 정보를 잘 반영하지 못한다는 것을 알 수 있다. 국내 여러 논문에서 지적된 바와 같이 외환위기 이후로 기업의 사내 유보금, 즉 기업이 영업 활동을 통해 벌어들인 이익 중 외부로 유출되지 않은 내부 자본이 급증하였는데 이는 국내 기업들 사이에 이익잉여금을 쌓아두는 경향이 전반적으로 만연하게 되어 이익잉여금이 과거 순이익에 대한 누적 정보를 잘 반영하지 못하는 이유 중 하나라고 생각된다.This paper empirically examined whether retained earnings to market subsume book to market according to the size of intangible return. The book to market strategy is effective because its main component, retained earnings, has the cumulative information about past earnings. However, the result indicated that retained earnings to market have no explanatory power of stock return regardless of the size of intangible return. Specifically, retained earnings to market insignificantly predicted stock return for the low group of intangible return, which did not support the hypothesis. In conclusion, the results showed that retained earnings to market do not reflect accumulated information of past earnings properly in the Korean market. This can be attributed to the overall increase in retained earnings of firms after the financial crisis in 1997.Ⅰ.서론 1 Ⅱ.무형수익률의 계산 4 Ⅲ.자료 및 실증 방법 7 1. 자료 7 2. 실증 방법 7 Ⅳ.실증 결과 10 Ⅴ.결론 13 참고문헌 22 Abstract 24Maste