Postoperative Complications of Esophageal Atresia and Role of Endoscopic Balloon Dilatation in Anastomotic Strictures / 대한소아소화기영양학회지

Purpose@#Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is a congenital anomaly that can cause frequent digestive and nutritional problems, even after repair. The most common complication is anastomotic stricture, for which reoperation or balloon dilatation is performed. This study aimed to evaluate the postoperative complications of EA and the role of endoscopic balloon dilatation (EBD) in cases of anastomotic stricture. @*Methods@#We retrospectively analyzed patients diagnosed with EA with or without TEF between January 2000 and February 2021. Patients’ baseline characteristics, associated anomalies, and postoperative complications were reviewed. @*Results@#Among 26 patients, 14 (53.8%) were male, 12 (46.2%) had coexisting anomalies, and the median follow-up was 6.1 years (range, 1.2–15.7 years). In univariate analysis, prematurity, low birth weight, and long-gap EA were associated with postoperative complications in 12 (46.2%) patients. Among the 10 (38.5%) patients with anastomotic stricture, nine (90.0%) required EBD. Regarding the first EBD, it was performed at a median of 3.3 months (range, 1.2–7.6 months) post-repair, while the average patient weight was 4.6 kg. The mean diameter ranged from 3.3 to 9.1 mm without major complications. In univariate analysis, long-gap EA alone was significantly associated with EBD. @*Conclusion@#Approximately half of the patients experienced complications after EA repair.In particular, patients with a long-gap EA had a significantly increased risk of complications, such as anastomotic strictures. EBD can be safely used, even in infants.

Experience of Violence and Hospital Violence Attitude according to Gender and Gender-Role Identity of Clinical Nurses / 한국직업건강간호학회지

Purpose@#This study aims to examine differences in experiences of violence and hospital violence attitude according to gender and gender-role identity of clinical nurses. @*Methods@#The quota sampling method, was used to select the research subjects. They were divided into two groups male and female nurses who worked for three general hospitals or higher level-hospitals in Incheon and Gyeongbuk. The data of 219 subjects was used for final analysis. The IBM SPSS 22.0 was used to analyze the data t-test and ANOVA. @*Results@#According to gender, the hospital violence experience of female nurses was oserved frequently when the verbal violence came from guardians, and when the physical threats came from others. For male nurses, the experiences of hospital violence was obserbed. According to gender, the hospital violence attitude revealed significant differences in female nurses that the negative attitude was higher (t=-4.69, p<.001). According to gender-role identity, the undifferentiated and femininity showed significant differences (F=4.86 p=.003). @*Conclusion@#The differentiated strategies of coping measures and violence preventive education considering the gender and gender-role identity of clinical nurses would help formulate measures for the effective management of hospital violence.

The first Korean case of 2p15p16.1 microdeletion syndrome, characterized by facial dysmorphism, developmental delay, and congenital hypothyroidism

The microdeletion syndrome of chromosome 2p15p16.1 (MIM: 612513) is an extremely rare contiguous gene deletion syndrome. Microdeletions of varying sizes in the 2p15-16.1 region are associated with developmental delay, intellectual disability, autism spectrum disorder, hypotonia, and craniofacial dysmorphism. Previous studies have identified two critical regions: the proximal 2p15 and distal 2p16.1 regions. BCL11A, PAPOLG, and REL genes play crucial roles in patients with 2p16.1 microdeletion. To our knowledge, only 39 patients have been reported as having 2p15p16.1 microdeletion syndrome. Here, we present another patient with 2p15p16.1 microdeletion syndrome. A nine-month-old boy was referred to our clinic for the psychomotor delay, facial dysmorphism, and congenital hypothyroidism. During his follow-up visits, he was diagnosed with global developmental delay, intellectual disability, abnormal behavior, hypotonia, microcephaly, and abnormal electroencephalography. Using a chromosomal microarray for genetic analysis, a novel, de novo, 622 kb microdeletion of 2p16.1 was identified as one of the critical regions of the 2p15p16.1 microdeletion syndrome. This is the first case of its kind in Korea. We have discussed our case and literature reviews to clarify the relationship between the genes involved and clinical phenotypes in 2p15p16.1 microdeletion syndrome.

The Role of Thymic Stromal Lymphopoietin (TSLP) in Glomerulonephritis

Thymic stromal lymphopoietin (TSLP) is an interleukin-7-like cytokine that is an important trigger and initiator of many allergic diseases. TSLP promotes a T-helper type 2 (Th2) cytokine response that can be pathological. A relationship is formed both at the induction phase of the Th2 response through polarization of dendritic cells to drive Th2 cell differentiation and at the effector phase of the response, by promoting the expansion of activated T cells and their secretion of Th2 cytokines and TSLP. In transgenic mice with TSLP overexpression, it has been reported that TSLP leads to the development of mixed cryoglobulinemic membranoproliferative glomerulonephritis. In addition, TSLP can play an important role in the pathogenesis of IgA nephropathy and systemic lupus erythematosus-related nephritis. From our knowledge of the role of TSLP in the kidney, further studies including the discovery of new therapies need to be considered based on the relationship between TSLP and glomerulonephritis.

Awareness of Hospital Safety Culture and Safety Activities of Workers in a Tertiary Care Hospital / 한국간호교육학회지

PURPOSE: The purpose of this study was to identify awareness of hospital safety culture (AHSC) and safety activities (SA) of workers in a tertiary care hospital, and the factors influencing safety activities. METHODS: 303 Participants from the tertiary care hospital in Seoul were invited. Collected data were analyzed using SPSS 18.0. RESULTS: The level of AHSC and SA was 3.61 and 4.17, respectively. There were differences between AHSC and SA according to gender, religion, employment status, job class, working period, safety education, need for safety education, and number of safety accident reports. There was a positive relationship between AHSC and SA. The factors influencing SA were communication and process, employment status, and safety accident reports. CONCLUSION: AHSC and SA are important factors to improve hospital safety, as well as increasing chances to receive hospital accreditation.

Subjective View of and Attitude toward Multiculturalism in First-year Undergraduate Nursing Students after Completing a Multicultural Subject

PURPOSE: Individuals' view of multiculturalism can be varied. The purpose of this study was to survey subjective view of and attitude toward multiculturalism in first-year undergraduate nursing students who had completed a multicultural subject. METHODS: The Q methodology, which integrates quantitative andqualitative methods, was used. Forty one Q-statements selected from each of the 40 participants were classified into theshape of normal distribution using a nine-point scale. The collected data were analyzed using the QUANL program. RESULTS: Two types of view of multiculturalism were identified: 'domestic type-constructive view' and 'global type-advanced view.' CONCLUSION: The findings show how nursing students think about multiculturalism and provide a basis for further research and education.

Analysis of Knowledge About, Attitude Toward, and Educational Needs for Dementia in Certified Caregivers / 한국간호교육학회지

PURPOSE: The purpose of this study was first to identify knowledge about, attitude toward, and educational needs for dementia in certified caregivers; secondly, to understand the relationships among those variables; and thirdly, to provide base-line data for education program development. METHODS: The participants in this study were 670 certified caregivers who were working in nursing homes or care hospitals throughout the whole of the country and engaged in education programs for improvement of their professional abilities. Collected data were analyzed using t-tests, ANOVA, Duncan, and Pearson's correlation coefficients with the SPSS 18.0 for Windows Program. RESULTS: The scores for knowledge about, attitude toward, and educational needs for dementia were 14.12+/-2.83 out of 20, 42.27+/-5.54 out of 50 (item mean 4.22), and 121.51+/-22.13 out of 160 (item mean 3.79) respectively. There were statistically significant positive correlations between knowledge and attitude (r=.238, p<.001), educational needs (r=.083, p=.032), and attitude and educational needs (r=.244, p<.001). CONCLUSION: Tailored and continuous educational programs for certified caregivers that can improve knowledge about the causes and symptoms of dementia should be developed. Nurses and professors who are experts in dementia should be on the front lines of education for caregivers.

Comparison of Learning Effects using High-fidelity and Multi-mode Simulation: An Application of Emergency Care for a Patient with Cardiac Arrest

PURPOSE: Simulation-based learning has become a powerful method to improve the quality of care and help students meet the challenges of increasingly complex clinical practice settings. The purpose of this study was to identify the learning effects using high-fidelity SimMan and multi-mode simulation. METHODS: Participants in this study were 38 students who were enrolled in an intensive course for a major in nursing at R college. Collected data were analyzed using Chi-square, t-test, and independent t-test with the SPSS 18.0 for Windows Program. RESULTS: There were no statistically significant differences in learning effects between high-fidelity SimMan and multi-mode simulation group. However, skills in clinical performance in the high-fidelity SimMan group were higher than in the multi-mode group (p=.014), communication in clinical performance in multi-mode simulation group was higher than in the high-fidelity SimMan group (p<.001). CONCLUSION: Multi-mode simulation with a standardized patient is an effective learning method in many ways compared to a high-fidelity simulator. These results suggest that multi-mode simulation be offered to students in nursing colleges which cannot afford to purchase a high-fidelity simulator, or offered as an alternative.

Platelet count and mean platelet volume in low birth weight infants (< or =2,000 g) with sepsis / 소아과

PURPOSE: Sepsis is a common complication in Neonatal Intensive Care Units (NICU), seen especially in low birth weight (LBW) infants. A recent study showed that fungal or gram-negative sepsis is associated with a greater degree of thrombocytopenia than is seen with gram-positive sepsis. So, this study was undertaken to examine the platelet counts and platelet indices in LBW infants during episodes of sepsis. METHODS: We analyzed 36 cases with culture-proven sepsis on chart review in LBW infants admitted to the NICU at Wonkwang University Hospital from January 2001 to June 2006. RESULTS: Patients were grouped by organism type: gram-positive bacteria (1,521+/-309 g, 31.3+/-2.9 wk, 15/36), gram-negative bacteria (1,467+/-290 g, 30.6+/-3.6 wk, 17/36), and fungi (1,287+/-205 g, 30.0+/-3.9 wk, 4/36). The most common organism was Staphylococcus epidermis and the incidence of thrombocytopenia was 88.9%. When compared with infants with gram-positive sepsis, those with gram- negative sepsis had significantly higher incidences of thrombocytopenia, lower initial platelet count, lower platelet nadir, and greater mean percentage decrease in platelet count from before the onset of sepsis. Those with fungal infections were similar to gram-negative sepsis, but they were not significant because of the small number of patients. And mean platelet volume (MPV) in sepsis was increased more significantly in time of platelet nadir than before the onset of sepsis. CONCLUSION: We conclude that decrease in platelet count was significantly greater in gram-negative sepsis than gram-positive sepsis, and also greater than fungal sepsis-which was insignificant because of the small number of patients-in LBW infants. And elevation in MPV will be helpful in the diagnosis and treatment of sepsis in LBW infants.

The study on cytotoxicity of cytokines produced by the activated human NKT cells on neuroblastoma / 소아과

PURPOSE: alpha-Galactosylceramide (alpha-GalCer)-stimulated human Valpha24 natural killer T (NKT) cells exert antitumor activity against some leukemia in a CD1d dependent and TCR-mediated manner, but could not kill CD1d-negative neuroblastoma (NB) cells. There are few reports about the direct antitumor effect of highly secreted cytokines by these cells on activation. In this study, using a cell-free supernatant (SPN) collected from plate bound hCD1d/alphaGalCer tetramers-stimulated NKT cells, we examined whether they could be helpful in the immunotherapeutic treatment of NB. METHODS: Cells were cultured in IMDM. The cytokines produced by NKT cells were measured with Cytometric Bead Array (CBA) analysis. Cell viability was evaluated by calcein-AM fluorescence with digital image microscopy scanning (DIMSCAN). The percentage of specific apoptosis was calculated by flow cytometric detection of apoptosis using annexin V and 7-AAD. RESULTS: The activated NKT cells secreted high levels of IL-2, INF-gamma, TNF-alpha. The SPN was significantly cytotoxic against four out of eight tested NB cell lines, through mainly apoptosis as evidenced by annexin-V staining and inhibition with the pretreatment of pancaspase blocker. This apoptosis was significantly inhibited when anti-TNF-alpha and anti-IFN-gamma neutralizing mAbs were used separately and it was completely abolished when the two mAbs were combined. CONCLUSION: IFN-gamma and TNF-alpha produced by NKT cells could exert synergistically direct anti-tumor activity through apoptosis on some NB cell lines.

A Case of Periventricular Leukomalacia and Necrotizing Enterocolitis in a Surviving Twin after Intrauterine Fetal Death in Twin Pregnancy / 대한주산의학회잡지

Single fetal death in the late second or the third trimester in twin pregnancy is associated with high mortality and morbidity of surviving co-twin. Monochorionic twins have an increased risk of intrauterine fetal death, its prognosis is poor, and assoiated with neurological damage in the surviving co-twin. And renal, cutaneous, pulmonary, gastrointestinal complications are also reported. Especially, survivals with twin-to-twin transfusion are at risk for development of renal insufficiency, periventricular leukomalaca, and necrotizing enterocolitis. In this report, we present a case of surviving co-twin complicated with periventricular leukomalacia and necrotizing enterocolitis delivered after intrauterine single death in twin pregnancy.

Relationship between CO-CR discrepancy and facial skeletal type / 대한치과교정학회지

The present study was performed to prove the relationship between CO-CR discrepancy and facial skeletal type. In this study, 242 subjects were randomly selected and devided into 9 groups(devided into class I, Il, 111 by ANB and each one devided into dolicho-, brachy mesofacial skeleton by Ricketts' vertical index). Lateral cephalometric radiographs with the mandible in centric occlusion were taken and measured and CO and CR bites were registered on all subjects. Diagnostic casts were mounted on Panadent articulator using an estimated face-bow and centric relation bite registration. The amount and direction of CO-CR discrepancy present was recorded using a Condylar Position Indicator(CPI) and a centric occlusion wax bite registration. CPI measurements and cephalometric measurements were statistically analyzed. The finding of this study can be summerized as follows: 1. There is little correlation between right and left sides for magnitude or direction. of CO-CR discrepancies. The correlation between the magnitude of CO-CR discrepancy of left A-P and right A-P is higher than that of left S-I and right S-I. 2. Correlation of Class H malocclusion group was higher than that of the other groups between the magnitude of CO-CR discrepancy of left CPI and right CPL 3. There is no difference between the pattern of CO-CR discrepancy of 9 malocclusion groups. 4. There is very little, if any, correlation between Skeletofacial measurements and CO-CR discrepancy. 5. In Class II brachyfacial skeleton and Class IIl mesofacial skeleton there was Lateral cephalometric measurements by that we predict CPI measurements was detected. That was overbite, overjet, upper gonial angle, lower gonial angle, saddle angle, articular angle, convexity of point A, ANS-Me/Na-Me, PCBL/I3H, Posterior FH/anterior FR

Hydroxyl radical-mediated commitment of HL-60 cells to differentiation: Modulation of differentiation process by phosphodiesterase inhibitors

Ms report shows that hydroxyl radical, generated by a Fenton reaction involving adenosine 5'-diphosphate/Fe2+ complex (5-15 micrometer) and H2O2 (2 micrometer), induced differentiation of HL-60 cells in a dose- and time-dependent manner. This is evidenced by the increases in 12-O-tetradecanoylphorbol 13-acetate- and fMLP-stimulated superoxide production capability. The cells exposed to hydroxyl radical for defined periods (24~96 hr) continued to differentiate even after the hydroxyl radical generating system had been removed. The differentiated cells displayed fMLP-stimulated calcium mobilization and increased expression of myeloid-specific antigen CD11b and CD14. The extent of the differentiation was markedly reduced by desferrioxamine (100micrometer), dimethylthiourea (5 mM), N,N'-diphenyl-1,4-phenylenediamine (2 micrometer), and N-acetyl-L-cysteine (5 mM). The induction of differentiation by hydroxyl radical was enhanced by 3-isobutyl-1-methylxanthine (200 micrometer) and Ro-20-1724 (8 micrometer), and inhibited by dipyridamole (2 micrometer). These results suggest that hydroxyl radicals may induce commitment of HL-60 cells to differentiate into more mature cells of myelomonocytic lineage through specific signal-transduction pathway that is modulated by phosphodiesterase inhibitors.