Impact of Cytomegalovirus Disease on New-Onset Type 2 Diabetes Mellitus: Population-Based Matched Case-Control Cohort Study

BACKGROUND: A latent cytomegalovirus (CMV) cause chronic inflammation through undesirable inflation of cell-mediated immune response. CMV immunoglobulin G has been associated with cardiovascular disease and type 1 diabetes mellitus. We evaluated impact of CMV diseases on new-onset type 2 diabetes mellitus (T2DM). METHODS: From the Korean Health Insurance Review and Assessment Service claim database of entire population with 50 million, we retrieved 576 adult case group with CMV diseases diagnosed with International Statistical Classification of Diseases and Related-Health Problems 10th Revision (ICD-10) B25 code between 2010 and 2014 after exclusion of patients with T2DM to 2006. The 2,880 control patients without T2DM from 2006 to cohort entry point were selected between 2010 and 2014 by age, sex matching with case group. The subjects without new-onset T2DM were followed until 2015. T2DM, hypertension (HTN), dyslipidemia (DYS), and end-stage renal disease (ESRD) were coded as ICD-10. RESULTS: The frequency of new-onset T2DM in case group was significantly higher than that in control (5.6% vs. 2.2%, P<0.001). The group with T2DM (n=95) had higher incidence of CMV diseases than the group without T2DM (n=3,361) (33.7% vs. 16.2%, P<0.001). In multivariate regression model adjusted by age, sex, lower income, HTN, and DYS, the incidence rate (IR) of T2DM in case group was significantly higher than that in the control group (IR per 1,000, 19.0 vs. 7.3; odds ratio, 2.1; 95% confidence interval, 1.3 to 3.2). The co-existence of HTN, DYS, and ESRD with CMV diseases did not influence the IR of T2DM. CONCLUSION: CMV diseases increase the patients' risk of developing T2DM.ope

Efficacy and Gut Dysbiosis of Gentamicin-Intercalated Smectite as a New Therapeutic Agent against Helicobacter pylori in a Mouse Model

Helicobacter pylori eradication rate with conventional standard therapy is decreasing owing to antibiotic resistance, necessitating novel antibacterial strategies against H. pylori. We evaluated the efficacy of a gentamicin-intercalated smectite hybrid (S-GM)-based treatment and analyzed fecal microbiome composition in H. pylori-infected mice. To evaluate anti-H. pylori efficacy, mice were divided into eight groups, and H. pylori eradication was assessed by a Campylobacter-like organism (CLO) test and PCR assay of H. pylori in gastric mucosa. One week after H. pylori eradication, pro-inflammatory cytokine levels and atrophic changes in gastric mucosa were examined. Stool specimens were collected and analyzed for microbiome changes. The S-GM-based triple regimen decreased bacterial burden in vivo, compared with that in untreated mice or mice treated with other regimens. The therapeutic reactions in the CLO test from gastric mucosa were both 90% in the standard triple therapy and S-GM therapy group, respectively. Those of H. pylori PCR in mouse gastric mucosa were significantly lower in standard triple therapy and S-GM therapy groups than in the non-treatment group. Toxicity test results showed that S-GM therapy reduced IL-8 level and atrophic changes in gastric mucosa. Stool microbiome analysis revealed that compared with mice treated with the standard triple therapy, mice treated with the S-GM therapy showed microbiome diversity and abundant microorganisms at the phylum level. Our results suggested that S-GM is a promising and effective therapeutic agent against H. pylori infection.ope

경부 임파선염에서 조기 진단을 위한 임상적, 혈청학적 그리고 영상학적 진단요소

의과대학/석사Cervical lymphadenitis is composed of various different diseases. The treatment and prognosis of each disease is multifarious. So, this study aimed to evaluate different factors among Reactive lymphadenitis (RL), Kikuchi’s disease (KD) and Tuberculous lymphadenitis (TL) which are common cervical lymphadenitis. We reviewed medical records of Gangnam Severance Hospital with cervical lymphadenitis between May 2005 and November 2014, retrospectively. And compared the clinical, laboratory and radiologic factors among three groups (n, RL=80, KD=80, TL=80). The study included 240 Patients with the mean age 36.9. Longer duration of fever, lower level of leukocyte, lower level of Hb, lower level of platelet, lower level of albumin and higher level of AST were significant characteristics of KD than other cervical lymphadenitis. Neck mass was dominant chief complaint in RL and TL whereas it were neck swelling and fever in KD. And fever, weight loss, fatigue and headache were common clinical features in KD. Anatomically dominant areas of lymphadenopathy were level II in RL, however it were level III, IV in KD and TL. Comparing of radiologic features by sonography, discrete, oval shape, regular margin, homogenous lymph nodes are predominant in RL and KD rather than TL. On the contrary, presence of hypoechoic center and intranodal necrosis are distinctive features of TL. By CT images, matted nodes, presence of nodal necrosis, multiple necrosis, perinodal infiltration and calcification were remarkable features of TL. Lastly we made a multivariate analysis among three groups, fever and leukopenia were significant predictive factors for KD comparing with RL. Leukopenia, CRP/albumin ratio and headache were significant predictive factors for RL comparing with TL. Fever, leukopenia and hypoalbuminemia were significant predictive factors for KD comparing with TL. This knowledge about clinico-laboratoric and radiologic perspectives of cervical lymphadenitis will help to detect the disease early.ope

Emergence of Creativity in Mathematically Gifted Students Rebuttal Argumentation: A Case study of Learning Outlier by Peircean Perspective

Creativity education is one of the key themes of mathematically gifted education. However, there have been lack of researches on what learning experiences should be provided to foster creativity of mathematically gifted students, how to prepare and provide opportunities for mathematical creativity and analyze its effects. In this study, we have included rebuttal activities in the statistical argumentation and examined whether this played a positive role in the emergence of creativity. For this purpose, we analyzed mathematical creativity emerged by the rebuttal activity in terms of sign, interpretant and object. The results showed that rebuttal provides opportunities for emergence of creativity in the statistical argumentation of the gifted students.수학 영재교육에 있어서 창의성 교육은 핵심적인 주제 중의 하나이다. 그러나 수학영재들의 창의성 신장을 위해 어떤 학습 경험을 제공해야 하는지, 수학적 창의성 발현의 기회를 어떻게 준비하여 제공하고 그 효과의 분석을 어떻게 해야 하는지에 대한 구체적인 논의는 부족한 실정이다. 본 연구에서는 수학 영재들의 통계적 논증활동에 반박 활동을 포함시키고, 이것이 창의성 발현에 긍정적인 역할을 하는지를 살펴보았다. 이를 위해, 반박 활동에 의한 수학적 창의성의 발현 양상을 기호, 해석체, 대상체의 세 측면에서 살펴보았다. 연구결과, 반박은 수학 영재들의 통계적 논증활동에서 창의성 발현의 기회를 제공하는 것으로 나타났다

Use of antimicrobial agents in actively dying inpatients after suspension of life-sustaining treatments: Suggestion for antimicrobial stewardship

Background: The role of antimicrobial treatment in end-of-life care has been controversial, whether antibiotics have beneficial effects on comfort and prolonged survival or long-term harmful effects on increasing antimicrobial resistance. We assessed the use of antimicrobial agents and factors associated with de-escalation in inpatients who suspended life-sustaining treatments (SLST) and immediately died. Methods: We included 1296 (74.7%) inpatients who died within 7 days after SLST out of 1734 patients who consented to SLST on their own or family's initiative following a decision by two physicians, observing the "Life-sustaining Treatment Decision Act" between January 2020 and December 2020 at two teaching hospitals. De-escalation was defined as changing to narrower spectrum anti-bacterial drugs or stopping ≥ one antibiotic of combined treatment. Results: 90.6% of total patients received anti-bacterial agents, particularly a combination treatment in 60.1% and use of ≥ three drugs in 18.2% of them. Antifungal and antiviral drugs were administered to 12.6% and 3.3% of the patients on SLST, respectively. Antibacterial and antifungal agents were withdrawn in only 8.3% and 1.3% of the patients after SLST, respectively. Anti-bacterial de-escalation was performed in 17.0% of patients, but 43.6% of them received more or broad-spectrum antibiotics after SLST. In multivariate regression, longer hospital stays before SLST, initiation of SLST in the intensive care unit, and cardiovascular diseases were independently associated with anti-bacterial de-escalation after SLST. Conclusions: The intervention for substantial antibiotic use in patients on SLST should be carefully considered as antimicrobial stewardship after decision by the will of the patient and proxy.ope

Validation of the Revised Piper Fatigue Scale in Koreans with Chronic Hepatitis B

PURPOSE: The purpose of the study was to evaluate the construct validity and reliability of the Korean version of the revised Piper Fatigue Scale (PFS) in Koreans with chronic hepatitis B. METHODS: A total of 146 chronic hepatitis B patients completed the Korean version of the revised PFS. A descriptive analysis was performed to determine the subjects' demographic characteristics; the construct validity was examined using exploratory factor analysis; and internal consistency reliability of the scale was estimated for the meaningful total scale and factors. RESULTS: The factor analysis supported the original four-factor structure based on Kaiser Criterion and Minimum Average Partial (MAP): Behavioral/Severity, Affective meaning, Sensory, & Cognitive/Mood. In the 22 items in the original instrument, patient/impatient, relaxed/tense, and exhilarated/depressed were re-identified from the cognitive/mood subscale and sensory subscale. The Cronbach's alpha of the 22-item Korean version of the revised PFS was 0.96 for the total scale, and the range of Cronbach's alpha for subscales was 0.90 to 0.93. CONCLUSIONS: The results of the study revealed that the 22-item Korean version of the revised PFS is valid and reliable in Koreans with chronic hepatitis B. Further studies ascertaining the psychometric properties of the revised PFS need to be performed in Korean patients.ope

Association of cytomegalovirus diseases with newly developed myocardial infarction and congestive heart failure: data from a national population-based cohort

Introduction: Anti-cytomegalovirus (CMV) IgG seropositive and/or titer are associated with a higher risk of cardiovascular diseases (CVD). However, it is not clear whether CMV end-organ disease may have a relation with development of CVD or chronic heart diseases. Material and methods: In matched cohort study, the National Health Insurance Database covering 50 million people was used to identify 667 patients with CMV diseases and aged ≥ 20 years between 2010 and 2014. 6,670 control subjects without CMV diseases were matched by age, sex, type 2 diabetes mellitus (DM), hypertension, dyslipidemia, and cohort entry year. Data on CMV disease and heart disease events of myocardial infarction (MI), congestive heart failure (CHF), and atrial fibrillation (AF) were retrieved. Previous events before CMV disease or cohort entry were excluded until January 2006. Subjects were followed until December 2015 in subjects without events and until date of events in subjects with events. Results: The multivariate regression model adjusted by age, sex, low-income status, type 2 DM, hypertension, dyslipidemia, solid organ transplantation, and hematopoietic stem cell transplantation showed a significantly higher incidence rate of MI (odds ratio (OR) = 2.1, 95% confidence intervals (CI): 1.0-4.5) and CHF (OR = 3.8, 95% CI: 2.1-6.8) but not AF (OR = 1.9, 95% CI: 0.9-4.0) in patients with CMV disease. The age group of 40-64 years with CMV disease had the highest risk for new-onset CHF in this regression model (OR = 9.4, 95% CI: 4.12-21.44, p = 0.029). Conclusions: Symptomatic CMV tissue-invasive diseases were associated with a higher risk of new-onset MI and CHF.ope

PISA 2003에서 한국과 호주의 학생들이 나타낸 수학 성취도의 성차 분석

본 연구는 PISA 2003 에 서 한국과 호주의 학생들이 나타낸 성취도를 성차의 관점에서 분석하는 것을 목표로 한다. 우리나라의 경우， 수학 성취도에서 있어서의 성차 연구가 최근들어 시도되고 있으나， 국제 비교를 심층적으로 시도한 연구는 없었다. 한국과 호주는 교육적 상황， 사회문화적 배경이 다른 만큼 학생들이 보이는 성취도의 남녀 차이도 클 것으로 기대하며， 이를 PISA 2003의 결과 분석을 통해 구체적으로 확인하고자 한다. 이 논문에서는 공개된 평가 문항에 대해 공간과 모양， 변화와 관계， 양， 불확실성의 네 범주로 분류한 문항별 정답률을 비교하여 경향을 비교하고 구체적인 차이점을 도출할 것이다

Is Only Clarithromycin Susceptibility Important for the Successful Eradication of Helicobacter pylori?

Resistance to clarithromycin and other antibiotics included in the eradication regimen, such as amoxicillin and metronidazole, is important for Helicobacter pylori (H. pylori) eradication. The aim of this study was to investigate the correlation between the results of antimicrobial susceptibility testing and the eradication rate, as well as to understand the importance of antimicrobial susceptibility testing in H. pylori eradication. We retrospectively reviewed the electronic medical records of 1862 patients who underwent gastric biopsy for the culture of H. pylori during upper endoscopy from March 2015 to June 2019. We tried to find a correlation between the results of the antimicrobial susceptibility testing and the eradication rate in patients who received standard triple or concomitant therapy. A total of 247 patients exhibited positive results for culture and underwent antimicrobial susceptibility testing. Of these, 146 received eradication therapy, with follow-up tests after treatment. In the standard triple therapy, patients who were susceptible to both clarithromycin and amoxicillin exhibited significantly higher eradication rates (85.9%) than those susceptible to clarithromycin and resistant to amoxicillin (75.0%) or those resistant to clarithromycin and susceptible to amoxicillin (44.4%) (p = 0.013). In the concomitant therapy, patients who were susceptible to both clarithromycin and metronidazole had significantly higher eradication rates (96.3%) than those susceptible to clarithromycin and resistant to metronidazole (88.9%) or those resistant to clarithromycin and susceptible to metronidazole (50.0%) (p = 0.016). There was a correlation between the results of antimicrobial susceptibility testing and the eradication rate for H. pylori. In addition to clarithromycin, susceptibility to amoxicillin and metronidazole is also important for the successful eradication of H. pylori.ope

Acquisition of Carbapenemase-Producing Enterobacteriaceae in Solid Organ Transplantation Recipients

BACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) can lead to life-threatening outcomes with rapid spread of the carbapenemase gene in solid organ transplantation (SOT) recipients because of limitations of available antibiotics. We examined the characteristics and importance of CPE acquisition in SOT recipients with large numbers of CPE isolates. METHODS: Between November 2015 and October 2016, 584 CPE isolates were found in 37 recipients and verified by carbapenemase gene multiplex polymerase chain reaction (PCR). One hundred recipients with at least 2 negative results in carbapenemase PCR for stool surveillance and no CPE isolates in clinical samples were retrospectively included. RESULTS: Most CPE isolates were Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (546, 93.5%). The most frequent transplantation organ was lung (43.3%), and the most common sample with CPE isolates other than stool was respiratory tract (22.6%). The median time between SOT and first CPE acquisition was 7 days. All-cause mortality was significantly higher in recipients with CPE than in those without CPE (24.3% vs 10.0%; P = .03). In multivariate regression analysis, stool colonization of vancomycin-resistant Enterococci and/or Clostridium difficile during 30 days before SOT (odds ratio [OR], 3.28; 95% CI, 1.24-8.68; P = .02), lung transplantation (OR, 4.50; 95% CI, 1.19-17.03; P = .03), and intensive care unit stay ≥2 weeks (OR, 6.21; 95% CI, 1.72-22.45; P = .005) were associated with acquisition of CPE. CONCLUSIONS: Early posttransplantation CPE acquisition may affect the clinical outcome of SOT recipients. Careful screening for CPE during the early posttransplantation period would be meaningful in recipients with risk factors.ope