Explanatory Power and Prognostic Implications of Factors Associated with Troponin Elevation in Acute Ischemic Stroke / 대한뇌졸중학회지

Background@#and Purpose We investigated the impact of comorbidity burden on troponin elevation, with separate consideration of neurological conditions, in patients with acute ischemic stroke (AIS). @*Methods@#This prospective, observational cohort study consecutively enrolled patients with AIS for 2 years. Serum cardiac troponin I was repeatedly measured, and disease-related biomarkers were collected for diagnosis of preassigned comorbidities, including atrial fibrillation (AF), ischemic heart disease (IHD), myocardial hypertrophy (MH), heart failure (HF), renal insufficiency (RI), and active cancer. The severity of neurological deficits and insular cortical ischemic lesions were assessed as neurological conditions. Adjusted associations between these factors and troponin elevation were determined using a multivariate ordinal logistic regression model and area under the receiver operating characteristic curve (AUC). Cox proportional hazards model was used to determine the prognostic significance of comorbidity beyond neurological conditions. @*Results@#Among 1,092 patients (66.5±12.4 years, 63.3% male), 145 (13.3%) and 335 (30.7%) had elevated (≥0.040 ng/mL) and minimally-elevated (0.040–0.010 ng/mL) troponin, respectively. In the adjusted analysis, AF, MH, HF, RI, active cancer, and neurological deficits were associated with troponin elevation. The multivariate model with six comorbidities and two neurological conditions exhibited an AUC of 0.729 (95% confidence interval [CI], 0.698–0.759). In Cox regression, AF, IHD, and HF were associated with adverse cardio-cerebrovascular events, whereas HF and active cancer were associated with mortality. @*Conclusion@#Troponin elevation in patients with AIS can be explained by the burden of comorbidities in combination with neurological status, which explains the prognostic significance of troponin assay.

Phubbing as a Millennials’ New Addiction and Relating Factors Among Nursing Students

Objective@#This study investigated phubbing (the act of ignoring one’s companion or companions to pay attention to one’s smartphone) and examined the factors affecting phubbing among nursing students in South Korea. @*Methods@#A cross-sectional survey design was adopted, and a self-reported questionnaire was used. Data were collected from 200 nursing students in two cities. Self-administered questionnaires included demographic data, smartphone addiction, media multitasking motivation, interpersonal competency, and phubbing. @*Results@#Phubbing was positively correlated with smartphone addiction (r=0.41, p<0.001) and media multitasking motivation (r=0.16, p<0.05), and negatively correlated with interpersonal competence (r=-0.51, p<0.001). Factors influencing nursing students’ phubbing were interpersonal competency (β=-0.59, p<0.001), media multitasking motivation (β=0.24, p<0.001), smartphone addiction (β=0.19, p<0.01) and interpersonal relationships (β=0.14, p<0.05). The model including these variables accounted for 43% of variance in phubbing. @*Conclusion@#Nursing students showed a moderate level of phubbing, and interpersonal competency was an important factor for reducing their phubbing of nursing students. Since phubbing occurs frequently among nursing students, educators in nursing are required to develop and implement active interventional measures to help nursing students avoid phubbing and improve their interpersonal relationships by increasing their empathic ability and communication skills.

The Influence of Personality Characteristics, Self-leadership and Positive Psychological Capital on Learning Flow of Nursing Students / 한국간호교육학회지

PURPOSE: This study aims to investigate the influence of personality type, self-leadership, and positive psychological capital on the flow of learning of nursing students.METHODS: The sample consisted of 179 nursing students. Data were analyzed using frequency, percentage, mean, standard deviation, t-test, ANOVA, Scheffé's test, Pearson's correlation coefficient analysis, and Hierarchical multiple regression.RESULTS: Upon analysis, the relative influence of the variables that can improve learning flow, the influencing variables, were identified as self-leadership and self-efficacy.CONCLUSION: To increase the learning flow, supportive measures and strategies that increase positive psychological capital should be developed, successful cases of self-leadership be shared, and be incorporated into a culture that promotes learning flow. And to promote the learning flow, it needs political and environmental improvement, and institutional support of at the college level.

Multidisciplinary Approach to Decrease In-Hospital Delay for Stroke Thrombolysis / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Decreasing the time delay for thrombolysis, including intravenous thrombolysis (IVT) with tissue plasminogen activator and intra-arterial thrombectomy (IAT), is critical for decreasing the morbidity and mortality of patients experiencing acute stroke. We aimed to decrease the in-hospital delay for both IVT and IAT through a multidisciplinary approach that is feasible 24 h/day. METHODS: We implemented the Stroke Alert Team (SAT) on May 2, 2016, which introduced hospital-initiated ambulance prenotification and reorganized in-hospital processes. We compared the patient characteristics, time for each step of the evaluation and thrombolysis, thrombolysis rate, and post-thrombolysis intracranial hemorrhage from January 2014 to August 2016. RESULTS: A total of 245 patients received thrombolysis (198 before SAT; 47 after SAT). The median door-to-CT, door-to-MRI, and door-to-laboratory times decreased to 13 min, 37.5 min, and 8 min, respectively, after SAT implementation (P<0.001). The median door-to-IVT time decreased from 46 min (interquartile range [IQR] 36–57 min) to 20.5 min (IQR 15.8–32.5 min; P<0.001). The median door-to-IAT time decreased from 156 min (IQR 124.5–212.5 min) to 86.5 min (IQR 67.5–102.3 min; P<0.001). The thrombolysis rate increased from 9.8% (198/2,012) to 15.8% (47/297; P=0.002), and the post-thrombolysis radiological intracranial hemorrhage rate decreased from 12.6% (25/198) to 2.1% (1/47; P=0.035). CONCLUSIONS: SAT significantly decreased the in-hospital delay for thrombolysis, increased thrombolysis rate, and decreased post-thrombolysis intracranial hemorrhage. Time benefits of SAT were observed for both IVT and IAT and during office hours and after-hours.

Effects of Workplace Bullying, Job Stress, Self-esteem, and Burnout on the Intention of University Hospital Nurses to Keep Nursing Job / 간호행정학회지

PURPOSE: Medical institutions and their patients benefit from continued employment of nurses. In this study an assessment was done of important factors that influence nurses' intention to leaving their jobs. METHODS: The sample consisted of 229 university hospital nurses. Data were analyzed using frequency, percentage, mean, standard deviation, t-test, ANOVA, Scheffé, Pearson's Correlation Analysis, and Hierarchical Multiple Regression. RESULTS: The control variables, including age, current position, and health status explained 18% (F=16.37, p<.001) of variance in retention intention. The control variables, bullying, job stress, self-esteem, and burnout collectively explained 27% of variance in retention intention. CONCLUSION: The findings indicate that the factors influencing retention intention are age, current position, and health status, while self-esteem and burnout in work places are new and more recent factors that impact retention intention. These findings can be utilized to develop strategies to increase self-esteem and retention intention.

Adapting Oral Health Care Guidelines for Nursing Home Residents in South Korea / 재활간호학회지

PURPOSE: This study attempted to adapt evidence-based oral health care guidelines for nursing home residents in South Korea. METHODS: The manual for guideline adaptation, version 2.0, developed by the Korean National Evidence-based Healthcare Collaborating Agency was applied. On the basis of a comprehensive literature review of current research and multidisciplinary panel discussion on adapting such guidelines, we developed evidence-based guidelines for oral health at nursing homes. RESULTS: The guidelines have three domains: oral assessment, oral hygiene care, and support and facilities. Oral assessment includes recommendations on the frequency of and tools for conducting oral health assessment. Oral hygiene care involves recommendations for care of natural teeth, denture care, xerostomia, and behavioral problems. Support and facilities refer to six components of the support system provided by facilities to encourage oral hygiene care among nursing home residents. CONCLUSION: These adapted guidelines could be an effective method to improve oral hygiene among nursing home residents.

Factors Influencing Chinese Customers' Loyalty to Korean Medical and Tourism Services / 간호행정학회지

PURPOSE: The purpose of this study was to identify factors related to the loyalty of Chinese customers who use Korean medical and tourism services. METHODS: Participants were 158 Chinese who visited plastic surgery clinics in Korea. Data were analyzed using descriptive statistics, One-way ANOVA, Scheffe? test, Pearson Correlation and Hierachical Multiple Regression. RESULTS: Medical service quality, tourism service quality and medical and service satisfaction were positively correlated with customer loyalty. Medical service quality and medical and tourism service satisfaction had significant influence on customer loyalty. The explained variance for customer loyalty was 84.9%. CONCLUSION: These results suggest the need to improve the tourism service and medical and tourism service satisfaction to retain loyal customers.

Factors Associated With Oral Health Related-quality of Life in Elderly Persons: Applying Andersen's Model / 기본간호학회지

PURPOSE: This study was done to apply Andersen's behavioral model to identify factors that determine oral health-related quality of life in elderly persons. METHODS: Participants were 257 people ages 65 years or older. Data were analyzed using frequency, percentage, mean and hierarchical multiple regression. RESULTS: The variables in the behavioral model, predisposing factors, enabling factors and need factors, explained 31% (F=12.7, p<.001) of variance in oral health-related quality of life. The predisposing factors, enabling factors, need factors and health behavior collectively explained 35% (F=9.22, p<.001) of variance in oral health-related quality of life. Factors influencing oral health-related quality of life in older adults were ADL and IADL, self-reported oral health status, xerostomia and dental care in last 12 months. CONCLUSIONS: The analysis results showed that the need factor had the highest level of relative importance of the three factors. The model used for this study can be used to predict oral health-related quality of life.

Gender Differences in Oral Health Literacy related Factors among Elderly People

PURPOSE: This study is to measure oral health literacy levels and to identify oral health literacy related factors in elders. METHODS: The research design for this study was a descriptive survey design using convenience samples. Data collection was done by using a self-report questionnaire with 321 elders from three welfare centers for the aged and two senior centers located in three cities. Data were analyzed by using percentage, mean, standard deviation, t-test, ANOVA, Scheffe, Pearson's Correlation Analysis and hierarchical multiple regression with the SPSS Win 18.0 Program. RESULTS: The oral health literacy scores of male elders were higher than those of female elders (t=9.73, p=.002). In hierarchical multiple regression analysis, education levels, smoking and oral health statuses were significant predictors and accounted for 29.8% of the male elders' oral health literacy. For female elders, education levels, health statuses and oral health statuses were significant predictors and accounted for 47.7%. CONCLUSION: These results suggest that interventions for improving oral health literacy are necessary to enhance elders' ability of self-care management. Also, these results could be used in developing oral health literacy programs.

An Empirical Study on Burnout in Clinical Nurses: Focused on Bullying and Negative Affectivity / 간호행정학회지

PURPOSE: The purpose of this study was to identify the effects of bullying, negative affectivity and burnout in the nurses. METHODS: The sample consisted of 389 nurses. Data were analyzed using frequency, percentage, mean, standard deviation, t-test, ANOVA, Scheffe, Pearson Correlation Analysis and Hierarchical Multiple Regression. RESULTS: The control variables of age, marital status, education level, current position, health status and work unit explained 30.2%(F=28.9, p<.001) of variance in burnout. The control variables, bullying and negative affectivity collectively explained 49.7% of variance in burnout. CONCLUSION: The results indicate that the demographic factors influencing burnout are age, education level, health status, work unit, while bullying and negative affectivity in the work places are factors that influence burnout. These findings can be utilized to develop strategies to reduce bullying and negative affectivity.

Effects of perceived health status, leisure satisfaction and loneliness on life satisfaction for elderly people / 기본간호학회지

PURPOSE: This study was done to identify the relationship of perceived health status, leisure satisfaction, loneliness and life satisfaction and to identify predictors of life satisfaction for elders. METHOD: The research design for this study was a descriptive survey design using a convenience sample. Data collection was done using self-report questionnaires with 297 elders from 6 community health practitioner posts. Data were analyzed using ANOVA, t-test, Pearson correlation coefficients and hierarchical multiple regression with the SPSS Win 18.0 Program. RESULTS: Life satisfaction had significant negative correlations with age (r=-.31, p<.001) and loneliness (r=-.73, p<.001), and positive correlations with monthly spending money (r=.44, p<.001), health status (r=.63, p<.001), and leisure satisfaction (r=.62, p<.001). The explained variance for life satisfaction was 72%. Variables of monthly spending money, health status, leisure satisfaction, and loneliness significantly predicted the degree on life satisfaction of these elders. CONCLUSION: Findings of this study provide a comprehensive understanding of life satisfaction and related factors for elders in Korea. However, further studies with a larger random sample and more detailed research design are necessary.

Effects of eating habits, activities of daily living and health behaviors on oral health related-quality of life in elderly persons / 기본간호학회지

PURPOSE: The purpose of this study was to identify the effects of eating habits, activities of daily living and health behaviors on oral health related-quality of life in elders. METHODS: The sample consisted of 246 people 65 years or older. Data were analyzed using frequency, percentage, average standard deviation, t-test, ANOVA, Scheffe, Pearson Correlation Analysis and Hierarchical Multiple Regression. RESULTS: The control variables such as gender, presence of a spouse, subjective health status, presence of chronic disease and existing number of teeth explained 14% (F=7.76, p<.001) of variance in oral health related-quality of life. The control variables, eating habits, activities of daily living and health behaviors collectively explained 20% of variance in oral health related quality of life. CONCLUSIONS: The factors that influence oral health related quality of life were presence of spouse presence factor, existing number of teeth and health behavior. Therefore, oral health related quality of life of elders requires the development of programs to boost the quality of life, and help the elderly people to maintain existing number of teeth by focusing on the variety of characteristics.

Hypoglycemic effects of Welsh onion in an animal model of diabetes mellitus

Tight control of blood glucose is the most important strategy for the treatment of diabetes mellitus. Here, we investigated the beneficial effects of Welsh onion on fasting and postprandial hyperglycemia. Inhibitory activities of hot water extracts from the green stalk and white bulb, which are the edible portions of the Welsh onion, and the fibrous root extract against yeast alpha-glucosidase were measured in vitro. To study the effects of Welsh onion on postprandial hyperglycemia, a starch solution (1 g/kg) with and without Welsh onion fibrous root extract (500 mg/kg) or acarbose (50 mg/kg) was administered to streptozotocin-induced diabetic rats after an overnight fast. Postprandial plasma glucose levels were measured and incremental areas under the response curve were calculated. To study the hypoglycemic effects of chronic feeding of Welsh onion, five-week-old db/db mice were fed an AIN-93G diet or a diet containing either Welsh onion fibrous root extract at 0.5% or acarbose at 0.05% for 7 weeks after 1 week of adaptation. Fasting plasma glucose and blood glycated hemoglobin were measured. Compared to the extract from the edible portions of Welsh onion, the fibrous root extract showed stronger inhibition against yeast alpha-glucosidase, with an IC50 of 239 microg/mL. Oral administration of Welsh onion fibrous root extract (500 mg/kg) and acarbose (50 mg/kg) significantly decreased incremental plasma glucose levels 30-120 min after oral ingestion of starch as well as the area under the postprandial glucose response curve, compared to the control group (P < 0.01). The plasma glucose and blood glycated hemoglobin levels of the Welsh onion group were significantly lower than those of the control group (P < 0.01), and were not significantly different from those fed acarbose. Thus, we conclude that the fibrous root of Welsh onion is effective in controlling hyperglycemia in animal models of diabetes mellitus.

Adipokine Concentrations in Pregnant Korean Women with Normal Glucose Tolerance and Gestational Diabetes Mellitus / 당뇨병

BACKGROUND: The aims of this study were to compare adipokine concentrations of pregnant women in the 24th~28th weeks of gestation to those of non-pregnant women. We compared the concentrations of adipokines in women with gestational diabetes mellitus (GDM), gestational impaired glucose tolerance (GIGT) and normal glucose tolerance (NGT). We also investigated the role of adipokines in the development of gestational glucose intolerance. METHODS: We surveyed 129 pregnant women who underwent a 100 g oral glucose tolerance test (OGTT) during the 24th~28th weeks of gestation. Participants were classified into three groups: (1) NGT (n = 40), (2) GIGT (n = 45), and (3) GDM (n = 44). Pregnant subjects with NGT were matched to non-pregnant controls for BMI and age (n = 41). RESULTS: Pregnant women with NGT exhibited significantly decreased adiponectin levels and elevated leptin levels compared to non-pregnant controls. Mean plasma resistin levels were significantly higher in women with GDM and GIGT than in women with NGT. Resistin and fasting glucose were significant predictors for the development of gestational glucose intolerance. CONCLUSION: Plasma adiponectin levels were decreased and leptin levels were increased in pregnant subjects with NGT compared to BMI and age matched non-pregnant controls. Women with GDM and GIGT exhibit significantly elevated concentrations of resistin compared with women with NGT. Increased resistin levels were also associated with the development of gestational glucose intolerance. Resistin may play an important role on the development of gestational glucose intolerance in Korean women.

Mutation analysis of the KAL Gene in Female Patients with Gonadotropin-Releasing Hormone Deficiency

Isolated gonadotropin-releasing hormone (GnRH) deficiency, including Kallmann's syndrome (KS) and idiopathic hypogonadotropic hypogonadism (IHH), is a congenital disorder, which is characterized by a functional deficit in hypothalamic GnRH secretion. Despite recent advances in the understanding of the pathogenesis of the X-linked form of KS as the identification of the KAL gene (Xp22.3), the genetic basis of the sporadic form in female patients remains unclear. Although most searches for mutations in X chromosome have been reported in males, the newly recognized phenomenon of inheritance, such as genomic imprinting and uniparental disomy, raises the possibility of a female phenotype in the X- linked genetic defect. Here, the molecular study of the coding region of the KAL gene (exon 5 to 14) in 10 unrelated females with KS (n=6) or IHH (n=4) is reported. None of the subjects had familial histories of delayed puberty or hypogonadism. Samples from 4 healthy, unrelated female volunteers were used for identification of polymorphisms. PCR of the 10 exons of the KAL gene was performed on genomic DNA. The PCR products of the 10 exons were subject to single strand conformation polymorphism (SSCP) analysis to identify possible mutations. In an SSCP analysis of the amplified fragments (fragment size: 147 to 302bp), no mutations or polymorphisms were found in any of the 10 patients and 4 controls. In conclusion, it is unlikely that KAL gene mutations are a clinically significant cause of sporadic GnRH deficiency in female patients, indicating the existence of defects in unidentified genes that result in the expression of the phenotypes in females.

Percutaneous Ethanol Injection in Autonomous Functioning Thyroid Nodules and Complex Cysts: Five Years' Experience / 대한내분비학회지

BACKGROUND: Percutaneous ethanol injection therapy (PEI) performed with ultrasonography guidance has recently been used in cases of autonomous functioning thyroid nodules (AFTN) and benign complex cysts. We performed this study to analyze the effects of PEI on AFTN and benign complex cysts. METHEODS: From September 1995 to September 2000, we performed PEI on 456 outpatients (47 men and 409 women, mean age 42.4+/-11.8 years) with AFTN or benign complex cysts. All cases were subjected to fine needle aspirations (FNA) by ultrasonography-guidance if necessary. FNA was performed at least twice with results of colloid nodule in cases of complex cysts. For AFTN, cases with FNA results of follicular neoplasm were also included. After PEI on AFTN, patients were classified into three response groups: complete response as judged by our new criteria (CR, normalization of TSH and free T4, disappearance of hot nodule on thyroid scan) along with the old criteria of previous studies (normalization of TSH and free T4, recovery of suppressed extranodular tissue on thyroid scan), partial response (PR, normalized free T4 but suppressed TSH, persistent hot nodule despite recovery in suppressed extranodular tissue) and no response (no change of hot nodule). Complex cysts were classified into three groups in accordance with volume reduction after PEI: complete response (CR, above 90% of volume reduction), partial response (PR, 50~89%) and no response (below 50%). RESULTS: Overall pre-treatment volumes were 15.3+/-12.1 mL and post-treatment volumes were 2.8+/-2.9 mL, with 66.4+/-19.9% of volume reductions in AFTN and complex cysts. Volume reductions were 71.5+/-18.0% in AFTN, and 66.1+/-15.0% in complex cysts. In 24 cases of AFTN, responses satisfying the previous criteria were 14 (58.3%) of CR, 6 (25.0%) of PR, and 4 (16.7%) of no response. However, by the new criteria there were 1 (4.2%) of CR, 10 (41.6%) of PR, and 13 (54.2%) of no response. In 432 cases of complex cysts, CR was observed in 82 (19.0%), PR in 261 (60.4%) and no response in 89 (20.6%). The volume reductions in complex cysts with pre-treatment volume larger than 15 mL were higher than those of groups with smaller volumes (p<0.001). Pre-treatment volumes were not correlated with post-treatment volumes, nor with volume reductions. Volume reductions were not correlated with the amounts of injected ethanol. Mild and transient complications were observed in 41 cases (9.0%) during PEI, consisting of transient neck pain (n=36, 7.9%), transient unilateral vocal cord palsy (n=3, 0.7%), intracavitary hemorrhage (n=1, 0.2%), and transient hypotension (n=1, 0.2%). CONCLUSION: Our data suggest that the efficacy of PEI on AFTN is temporary and does not usually induce long-term complete remissions. In complex cysts, however, PEI may have potential as an additive treatment modality to thyroid hormone suppressive therapy

The Association of Abdominal Fat with Serum Insulin and Atherogenic Index for Obese Females

BACKGROUND: The purpose of this study was to find an independent relationship between waist circumference/waist-to-hip ratio which estimates abdominal fat and fasting insulin/atherogenic index which is a predictor of coronary heart disease in obese women. METHODS: The subjects were 80 obese (BMI > or = 25 kg/m2) women. Whole body fat was estimated by body fat mass, % body fat using bioelectrical impedence, and by BMI. Abdominal fat was measured by waist circumference (WC) and waist-to-hip ratio. Fasting insulin was examined and atherogenic index was defined asthe ratio of serum total cholesterol to HDL-cholesterol. Independent association between abdominal fat and insulin/AI was analyzed using partial correlation, multiple regression and Hotelling t-test. RESULTS: Among subjects, 85.7% of obese women had WC greater or equal to 80 cm. The mean BMI was 30.3 kg/m2. The partial correlations between whole body fat and insulin/AI were not significantly different from the partial correlations between abdominal fat and insulin/AI. When age and height were adjusted, partial correlations between abdominal fat and insulin were 0.38 and 0.39. The partial correlations were reduced to 0.15-0.29 after further adjusting for whole body fat. Age and height-adjusted partial correlations between abdominal fat and AI were 0.34 and 0.36. The partial correlations were reduced to 0.11-0.17 when whole body fat was additionally adjusted. Whole body fat explained 9.9-13.7% for variability of insulin; abdominal fat explained 14.2% and 15.9%. Whole body fat explained 12.5-12.8% for variability of AI and abdominal fat explained 11.9%. CONCLUSION: Most of the obese women showed abdominal obesity. Abdominal fat did not seem to be independently associated with fasting insulin and atherogenic index.

Lanreotide Therapy in Graves' Ophthalmopathy / 대한내분비학회지

BACKGROUND: Graves' ophthalmopathy (GO) is an autoimmune process that affects the orbital tissues. Patients with GO are usually treated with high doses of corticosteroids, retrobulbar irradiation, or by surgical decompression, however, those have some adverse effect. Recently, a synthetic somatostatin analogue has been reported for the treatment of GO. This study was performed prospectively to evaluate the therapeutic effects of lanreotide, a potent long acting synthetic somatostatin analogue, in patients that have GO. METHODS: Eight patients with moderate to severe GO (M:F=1:7, age 39.0+/-11.8 years) were included. Patients who had been treated with other modalities than GO, or had a systemic illness such as diabetes were excluded. Eight patients were given lanreotide, 40mg IM every 2 weeks over a period of 8 weeks. Their therapeutic responses were evaluated using an orbital CT or MRI and by ophthalmologic examinations. RESULTS: After 8 weeks' of lanreotide treatment, 4 patients showed decreased scores in the NOSPECS classification (p=0.059) as well as 5 patients in their clinical activity scores(p=0.109). All of the 8 patients showed improvements according to clinical evaluation criteria (p=0.008). Significant changes in the thickness of both the lateral rectus and superior rectus muscles were observed (p<0.05). No patient showed serious adverse effects related to lanreotide therapy during the follow-up periods. CONCLUSION: We conclude that lanreotide therapy has clinical benefits and show radiologic improvements in GO. Considering the minimal side-effects of lanreotide compared to those of corticosteroid, lanreotide therapy should be considered for use in selected patients that have Graves' ophthalmopathy

The Analysis of SHP (Small Heterodimer Partner) Gene Mutation in Infertile Patients with Polycystic Ovary Syndrome (PCOS) in Korea / 대한불임학회지

OBJECTIVE: We inversigated Small Heterodimer Partner (SHP) gene mutation in Korean Polycystic Ovarian Syndrome (PCOS) patients. SHP protein regulates the activity of nuclear receptors which regulate the cellular development and differentiation. Recently, the mutation of SHP gene was found in the obesity and diabetes patients in Japanese group, and suggested that its mutation may involved in pathogenic mechanism of PCOS. METHODS: This study was performed in 20 PCOS patients and 20 normal women. The DNAs were extracted from the peripheral bloods, and amplified at each exon (1 and 2) of SHP gene by PCR method. Subsequently, each PCR product was digested with the restriction enzyme indicated below for studying restriction fragment length polymorphism (RFLP). After enzyme digestion, the results of RFLP were compared PCOS patients with control women to find any sequence variation. RESULTS: We examined 9 regions of exon 1 with Msp I, Pvu II, Dde I and 3 regions of exon 2 with Pst I, Dde I. There is no heterozygous or homozygous mutation in patients and control women at these restriction sites. CONCLUSION: The genetic analysis at our restriction sites in the SHP gene did not show any genetic variation in Korean PCOS patients. Our PCR-RFLP analysis was not covered the entire SHP gene (68 bp/ 1,006 bp), we need to further analysis of the entire SHP gene.

Differential Diagnostic Value of TSH Receptor Antibody Measurements in Thyrotoxic Postpartum Patients with History of Graves' Disease / 대한내분비학회지

BACKGROUND: It is known that pregnancy markedly influences the clinical course of autoimmune thyroid diseases. In the postpartum period, various kinds of autoimmune thyroid dysfunctions can be observed. Thyroid dysfunction is found in 5.5-7.1% of postpartum women in the general population. Among those who show thyroid dysfunction after delivery, some will develop Graves' disease and others will develop postpartum thyroiditis. It is also known that patients with Graves' disease may manifest thyrotoxicosis in the postpartum period because of postpartum thyroiditis or relapse of the Graves' disease itself. We evaluated the clinical features of postpartum thyrotoxicosis in Graves' disease patients to find diagnostic indices that could be used in differentiating between postpartum thyroiditis and relapse of Graves' disease. METHOD: We reviewed the cases with postpartum thyrotoxicosis in patients that had a history of Graves' disease between 1995 and 2000. The diagnosis of postpartum thyroiditis had been made by means of a 99mTc thyroid scan or by the observation of a typical triphasic thyroid function change, in cases where a 99mTc thyroid scan was not possible because of breast feeding. We measured the serum TSH, free T4, free T3, TSH binding inhibiting immunoglobulin (TBII), anti-thyroid peroxidase (TPO) antibody, and anti- thyroglobulin (Tg) antibody serially from the time of the diagnosis of Graves' disease to the time of postpartum thyroid dysfunction. RESULTS: Eleven patients, 5 patients in the postpartum thyroiditis (PPT group) and 6 patients with relapse of the Graves' disease (GD group), were identified. The mean values of TBII of two groups at the time of diagnosis of Graves' disease were 40.9+/-4.8 IU/mL (PPT group), 58.9+/-23.5 IU/mL (GD group) respectively, which were insignificant. The mean values of TBII of the two groups at early pregnancy were 3.2+/-1.9 IU/mL (PPT group), 41.6+/-22.6 IU/mL (GD group) and this difference was statistically significant (p=0.009). The mean values of TBII of the two groups at the time of postpartum thyrotoxicosis were 1.9+/-1.6 IU/mL (PPT group), 51.5+/-23.2 IU/mL (GD group) which were also statistically significant (p=0.003). The mean values of anti-TPO antibody, anti-Tg antibody, disease duration, and treatment duration between the two groups were not significantly different. The onsets of thyroid dysfunction after delivery in the two groups were 2.6+/-2.0 (PPT group), 4.0+/-3.9 (GD group) months which were statistically insignificant. CONCLUSION: These data suggest that the measurement of TBII at the time of the postpartum thyrotoxic period, could help to differentiate postpartum thyroiditis from a relapse of Graves' disease in those patients that have a history of Graves' disease especially when thyroid scan is not possible because of breast feeding.