Early catheter removal improves patient survival in peritoneal dialysis patients with fungal peritonitis: results of ninety-four episodes of fungal peritonitis at a single center

BACKGROUND: Fungal peritonitis (FP) is an uncommon but serious complication of peritoneal dialysis (PD) and is associated with high morbidity and mortality. Although previous studies have demonstrated that abdominal pain and catheter in situ are associated with mortality in FP patients, the effect of early catheter removal on mortality remains largely unexplored. In this study, therefore, we not only determine the risk factors for mortality but also investigate the effect of immediate catheter removal on mortality in PD patients with FP. PATIENTS AND METHODS: This retrospective study was conducted on 94 episodes of FP in 1926 patients that underwent PD at Yonsei University Health System from January 1992 to December 2008. Data including demographic characteristics, laboratory and clinical findings, management, and outcome were collected from medical records. RESULTS: Among a total of 2361 episodes of peritonitis, there were 94 episodes of FP in 92 patients, which accounted for 4.0% of all peritonitis episodes and occurred in 4.8% of patients. Mean age of patients was 52.1 years and mean duration of PD before contracting FP was 46.1 months. The presenting symptoms included turbid dialysate (93.6%), abdominal pain (84.0%), and fever (66.0%). Intestinal obstruction was complicated in 39 episodes (41.5%). 75% of FP was caused by Candida species, among which Candida albicans was the most common pathogen, accounting for 41.5% of all episodes of FP. The PD catheter was removed within 24 hours in 39 patients (41.5%), whereas catheter removal was performed between 2 and 9 days after the diagnosis of FP in 42 patients (44.7%). 27 patients (28.7%) died as a result of FP, 59 patients (62.8%) required a change to hemodialysis, and PD was resumed in 8 episodes (8.5%). In addition, the mortality rate was significantly higher in patients with delayed catheter removal (13/41, 31.7%) compared to patients with catheter removal within 24 hours (5/39, 12.8%) (p < 0.01). Multivariate logistic regression analysis revealed that delayed catheter removal, the presence of intestinal obstruction, and higher white blood cell counts in the blood and in the PD effluent were independently associated with mortality in FP patients. CONCLUSION: These results suggest that immediate catheter removal (i.e., within 24 hours after the diagnosis of FP) is mandatory in PD patients with FP.ope

High peritoneal transport status is not an independent risk factor for high mortality in patients treated with automated peritoneal dialysis

We undertook this study to elucidate whether baseline peritoneal membrane transport characteristics are associated with high mortality in incident automated peritoneal dialysis (APD) patients. This retrospective study includes 117 patients who started APD at Yonsei University Health System from 1996 to 2008 and had a PET within 3 months of APD initiation. High transporters were significantly older and had a higher incidence of cardiovascular disease. Patient survival for years 1, 3, and 5 were 85%, 64%, and 35% for high transporter and 94%, 81%, and 68% for non-high transporter group (P<0.01). Multivariate analysis revealed that age, diabetes, cardiovascular disease, serum albumin level, and residual renal function were independently associated with high mortality in APD patients. In contrast, high transport status was not a significant predictor for mortality in this population when the other covariates were included. Even though high transport was significantly associated with mortality in the univariate analysis, its role seemed to be influenced by other comorbid conditions. These findings suggest that the proper management of these comorbid conditions, as well as appropriate ultrafiltration by use of APD and/or icodextrin, must be considered as protective strategies to improve survival in peritoneal dialysis patients with high transport.ope

Prediction of the retention factors in micellar electrokinetic chromatography using a density functional theory and a semi-empirical method

Thesis (master`s)--서울대학교 대학원 :화학부 분석화학전공,2004.Maste

(The)Study on recognition of physical education subject matter and it`s teachers perceived by general teachers in a selected secondary school

학위논문(석사)--서울대학교 대학원 :체육교육과,2005.Maste

hnRNP L binds to CA repeats in the 3'UTR of bcl-2 mRNA

We previously reported that the CA-repeat sequence in the 3'-untranslated region (3'UTR) of bcl-2 mRNA is involved in the decay of bcl-2 mRNA. However, the trans-acting factor for the CA element in bcl-2 mRNA remains unidentified. the heterogeneous nuclear ribonucleoprotein L (hnRNP L), an intron splicing factor, has been reported to bind to CA repeats and CA clusters in the 3'UTR of several genes. We reported herein that the CA repeats of bcl-2 mRNA have the potential to form a distinct ribonuclear protein complex in cytoplasmic extracts of MCF-7 cells, as evidenced by RNA electrophoretic mobility shift assays (REMSA). A super-shift assay using the hnRNP L antibody completely shifted the complex. Immunoprecipitation with the hnRNP L antibody and MCF-7 cells followed by RT-PCR revealed that hnRNP L interacts with endogenous bcl-2 mRNA in vivo. Furthermore, the suppression of hnRNP L in MCF-7 cells by the transfection of siRNA for hnRNP L resulted in a delay in the degradation of RNA transcripts including CA repeats of bcl-2 mRNA in vitro, suggesting that the interaction between hnRNPL and CA repeats of bcl-2 mRNA participates in destabilizing bcl-2 mRNA.ope

Subtype Differences of Social Withdrawal in Emotional Maladjustment and Subjective Happiness in Emerging Adulthood

본 논문은 윤미설(2017)의 부산대학교 석사학위논문을 수정보완하여 작성되었음본 연구는 성인진입기에 있는 대학생 749명을 대상으로 사회적 위축의 주요 하위유형(수줍음형 및 비사교형)에 따라 정서적 부적응의 지표들(즉, 우울, 사회적 불안, 특성분노, 외로움) 및 주관적 행복감에서 어떠한 차이를 보이는지 성별을 고려하여 살펴보았다. 수집된 자료에 대한 성차 분석 결과, 여자대학생이 남자대학생에 비해 수줍음 및 비사교성, 우울, 사회적 불안, 특성분노가 높은 것으로 나타났다. 상관분석 결과, 수줍음은 모든 정서적 부적응 지표들과 정적 상관을, 주관적 행복감과는 부적 상관을 보인 반면, 비사교성은 사회적 불안과 정적상관을, 주관적 행복감과는 부적 상관을 보였다. 그러나 중다회귀분석 결과에서 성별을 통제한 후 비사교성은 수줍음과 공유하는 변량 외에는 주관적 행복감에 대한 고유한 설명력을 갖지 못하였으며, 특성분노에 오히려 부적 영향을 미치는 것으로 나타났다. Nelson(2013)의 대상자 중심 분석방법에 따라 사회적 위축의 하위유형 집단을 구분하였을 때, 정서적 부적응 및 주관적 행복감에서 유의한 집단 간 차이와 성차가 나타났으며, 구체적으로 수줍음형 집단은 비사교형 및 비위축 집단에 비해 모든 정서적 부적응 지표에서 유의하게 높았고, 주관적 행복감은 가장 낮은 수준을 보였다. 반면, 비사교형 집단은 사회적 불안을 제외한 모든 종속변인에서 비위축 집단과 유의한 차이가 없었으며, 수줍음형 집단보다는 낮지만 비위축 집단보다는 높은 사회적 불안을 나타내었다. 이러한 결과는 사회적 위축의 적응적 함의가 구체적인 하위유형에 따라 다르다는 기존의 청소년 대상의 연구 결과들을 지지하며, 사회적 위축 하위유형의 개념이 성인진입기에도 유용함을 보여준다. 또한 비사교형 위축의 경우 청소년기에 비해 성인진입기에 그 부정적 영향이 더욱 감소함을 시사한다.This study compared two subtypes of social withdrawal (i.e., shyness and unsociability) on several indices of emotional maladjustment (i.e., depression, social anxiety, trait anger, and loneliness) and subjective happiness among 749 college students in emerging adulthood in consideration of possible gender differences. T-tests revealed that female students reported higher levels of shyness, unsociability, depression, social anxiety, and trait anger than male students. Correlational analyses indicated that shyness was correlated positively with all indices of emotional maladjustment and negatively with subjective happiness, while unsociability was correlated positively only with social anxiety and negatively with subjective happiness; however, controlling for the effects of gender and shyness, unsociability did not have a unique contribution to subjective happiness and negatively contributed to trait anger in multiple regression analyses. Moreover, according to findings from person-centered analyses(Nelson, 2013), the shy-withdrawn group demonstrated the highest level of emotional maladjustment in terms of depression, social anxiety, trait anger, and loneliness and the lowest level of subjective happiness, compared to unsociable-withdrawn or non-withdrawn groups. In contrast, the unsociable-withdrawn group was no significantly different from the non-withdrawn group on all dependent variables, except for social anxiety, in which the unsociable-withdrawn group had a lower level than the shy-withdrawn group, but a higher level than the non-withdrawn group. Our findings support the utility of the concept of social withdrawal subtypes and extend previously findings, in which adjustment outcomes of social withdrawal in adolescence significantly vary depending on its subtypes, to emerging adulthood with an implication that the negative impacts of unsociability appear to be greatly decreased in emerging adulthood

Congenital absence of inferior vena cava as a rare cause of pulmonary thromboembolism

Interruption of the inferior vena cava IVC) with azygos continuation is an uncommon vascular anomaly that results from aberrant development during embryogenesis. We report a rare case of this anomaly, presenting with massive pulmonary embolism. Subsequent evaluation with abdominal CT scan revealed the congenital absence of retrohepatic IVC. The patient was successfully treated with anticoagulation. When deep venous thrombosis (DVT) develops in patients with no apparent risk factors, the presence of congenital IVC anomalies should be considered.ope