Objective To evaluate the clinical significance of various vital signs in women referred for postpartum hemorrhage (PPH). Methods This retrospective study included patients with primary PPH who were referred to Korea University Medical Center, Ansan, between January 1, 2004, and December 31, 2016. We analyzed data for systolic and diastolic blood pressure, heart rate, and shock index (heart rate divided by systolic blood pressure) at time of arrival. Significant morbidity, such as massive transfusion, invasive procedures, and admission to the intensive care unit were reviewed. We used the area under the receiver operating characteristic curve (AUROC) for each vital sign to predict adverse maternal  outcomes. Sensitivity, specificity, and negative and positive predictive values were assessed. Results 118 women with PPH were identified. The shock index had the highest AUROC to predict massive transfusion (0.815, 95% confidence interval [CI] 0.727–0.883). A shock index greater than 0.9 had 93.8% (95% CI 69.8–99.8) sensitivity and 51.2% (35.1–67.1) specificity for prediction of massive transfusion, and 93.6% (78.6–99.2) sensitivity and 31.0% (15.3–50.8) specificity for prediction of invasive procedures. Conclusion The shock index has significant ability to predict adverse outcomes of PPH compared with other initial vital signs when patients are referred.

This study aimed to investigate the overall prescription pattern for patients with bipolar disorders in Korea and its relevance to the practice guidelines. Prescription records from all patients with bipolar I and II disorders who have been admitted or who started the outpatient treatment during the year of 2009 in 10 academic setting hospitals were reviewed. A total of 1447 patients with bipolar I and II disorders were included in this study. Longitudinal prescription patterns of inpatients and outpatients were analyzed by episode types and compared with the clinical practice guideline algorithms. In all phases, polypharmacy was chosen as an initial treatment strategy (>80%). The combination of mood stabilizer and atypical antipsychotics was the most favored. Antipsychotics were prescribed in more than 80% of subjects across all phases. The rate of antidepressant use ranged from 15% to 40%, and it was more frequently used in acute treatment and bipolar II subjects. The concordance rate of prescriptions for manic inpatients to the guidelines was higher and relatively more consistent (43.8%-48.7%) compared with that for depressive inpatients (18.6%-46.9%). Polypharmacy was the most common reason for nonconcordance. In Korean psychiatric academic setting, polypharmacy and atypical antipsychotics were prominently favored in the treatment of bipolar disorder, even with the lack of evidence of its superiority. More evidence is needed to establish suitable treatment strategies. In particular, the treatment strategy for acute bipolar depression awaits more consensuses.

No abstract

An in situ experiment was conducted to find out whether Tween 80 improves rice straw digestion through increased adhesion of major fibrolytic bacteria. Rice straw was sprayed with various levels of Tween 80 non-ionic surfactant or SDS ionic surfactant 24 h before incubation in the rumen of Holstein steers. Dry matter (DM) disappearance and adhesion of F. succinogenes, R. flavefaciens and R. albus on rice straw after in situ incubation were measured by real-time PCR. Application of Tween 80 increased DM disappearance, which was more noticeable at an application level of 1% compared to lower application levels. Application of SDS resulted in an opposite response in DM disappearance with highest reduction in DM disappearance at 1% level. In a subsequent in situ experiment, higher Tween 80 was applied to rice straw in an attempt to find the optimum application level. Tween 80 at 2.5% gave better DM disappearance than 1% with a similar result at 5%. Therefore, an adhesion study was carried out using rice straw treated with 2.5% Tween 80. Our results indicated that Tween 80 reduced adhesion of all three major rumen fibrolytic bacteria to rice straw. Present data clearly show that improved DM disappearance by Tween 80 is not due to increased bacterial adhesion onto substrates.

Efficiency of viral promoters and various cell lines in directing high-level expression of human erythropoietin (Epo) was investigated. To investigate the effects of various viral promoters and cell lines on the Epo expression level, genomic Epo with the 5' and 3' untranslated regions (UTRs) deleted was cloned next to the simian virus 40 early promoter, cytomegalovirus early promoter or SRalpha promoter. These expression vectors were transfected into COS-7, BHK-21 and Chinese hamster ovary (CHO)/dhfr(-) cells, respectively. The COS-7 cells transfected with the vector containing the SRalpha promoter showed the highest expression level ( approximately 103 IU/ml) at 72 h post-transfection. For the development of Epo-producing stable cell lines, BHK-21 and CHO/dhfr(-) cells transfected with the 5',3'-UTR-deleted genomic Epo under the control of the SRalpha promoter were cultured with media containing zeocin. Several clones of zeocin-resistant BHK-21 and CHO/dhfr(-) cells were cultured in the presence of methotrexate (MTX). A BHK-21 clone selected in the presence of 500 nM MTX expressed and secreted approximately 490 IU/ml Epo into the medium. A CHO/dhfr(-) clone selected in the presence of 20 nM MTX expressed and secreted approximately 45 IU/ml Epo into the medium. Southern-blot analysis indicated that enhancement of Epo expression in the MTX-resistant stable cells might be related to the amplification of gene copy number.