Nursing Hours and Nurse Staffing according to Korean Triage Acuity Scale and Patient Dependency / 임상간호연구

Purpose@#The purpose of this study was to analyze nurse staffing according to patients' acuity and dependency by measuring nursing hours. @*Methods@#The study sample included patients who visited the adult emergency departments (EDs) of three tertiary referral hospitals and nurses who worked on shifts for 48 hours from October 24 to 26, 2019. Hourly patient census and nurse staffing were analyzed. Patient acuity was measured using the Korean Triage and Acuity Scale (KTAS), ranging from Level 1 (highest) to Level 5 (lowest). Patient dependency was measured using six items (e.g., clinical attention and communication) and classified into four groups. Nursing activities were observed every 10 minutes and nursing hours per patient and nurse staffing were analyzed according to acuity and dependency. @*Results@#Nurse-to-patient ratio ranged from 1:1.8 to 1:4.2 during the 48 hours of observation. The average work hours of nurses, excluding breaks and meals, was 8.57 hours; 42.5% of which was spent providing direct care. Higher acuity and dependency were associated with higher nursing hours and staffing level. Patients with KTAS Level 1 were provided 74.3 minutes per hour, 5.02 times higher than Level 5 (14.8 minutes). Patients in the highest dependency group were provided 87.4 minutes per hour, 5.75 times higher than the lowest group (15.2 minutes). Newly arrived patients received more nursing hours than continuously stayed patients within the same KTAS Levels. @*Conclusion@#Large variations were found in hourly patient census, acuity, and dependency. Nurse staffing in EDs should be determined based on patient acuity and dependency.

Nursing Hours and Nurse Staffing according to Korean Triage Acuity Scale and Patient Dependency / 임상간호연구

Purpose@#The purpose of this study was to analyze nurse staffing according to patients' acuity and dependency by measuring nursing hours. @*Methods@#The study sample included patients who visited the adult emergency departments (EDs) of three tertiary referral hospitals and nurses who worked on shifts for 48 hours from October 24 to 26, 2019. Hourly patient census and nurse staffing were analyzed. Patient acuity was measured using the Korean Triage and Acuity Scale (KTAS), ranging from Level 1 (highest) to Level 5 (lowest). Patient dependency was measured using six items (e.g., clinical attention and communication) and classified into four groups. Nursing activities were observed every 10 minutes and nursing hours per patient and nurse staffing were analyzed according to acuity and dependency. @*Results@#Nurse-to-patient ratio ranged from 1:1.8 to 1:4.2 during the 48 hours of observation. The average work hours of nurses, excluding breaks and meals, was 8.57 hours; 42.5% of which was spent providing direct care. Higher acuity and dependency were associated with higher nursing hours and staffing level. Patients with KTAS Level 1 were provided 74.3 minutes per hour, 5.02 times higher than Level 5 (14.8 minutes). Patients in the highest dependency group were provided 87.4 minutes per hour, 5.75 times higher than the lowest group (15.2 minutes). Newly arrived patients received more nursing hours than continuously stayed patients within the same KTAS Levels. @*Conclusion@#Large variations were found in hourly patient census, acuity, and dependency. Nurse staffing in EDs should be determined based on patient acuity and dependency.

A Case of Neuroblastoma in Old Age / 대한내과학회지

Neuroblastoma originates in the sympathetic division of the autonomic nervous system, and is the most common extracranial solid malignancy in children; rarely developing in adults. Generally this primitive neuronal malignancy develops during fetal development or in early childhood. However, we have cared for one elderly patient with neuroblastoma. The 84-year-old woman suffered from several symptoms, such as general weakness, weight loss, and hematuria. Her abdominopelvic computed tomography showed an 8.5 x 8 cm mass, which originated from the right kidney. Pathological examination by explorative laparotomy indicated neuroblastoma. She was treated by radical nephrectomy. One year later, there has been no recurrence or solid organ metastasis, and the patient has been in good clinical condition.

Effects of laser-irradiated dentin on shear bond strength of composite resin / 대한치과보철학회지

PURPOSE: This study was conducted to evaluate the shear bond strength of composite resin to dentin when etched with laser instead of phosphoric acid. MATERIAL AND METHODS: Recently extracted forty molars, completely free of dental caries, were embedded into acrylic resin. After exposing dentin with diamond saw, teeth surface were polished with a series of SiC paper. The teeth were divided into four groups composed of 10 specimens each; 1) no surface treated group as a control 2) acid-etched with 35 percent-phosphoric acid 3) Er:YAG laser treated 4) Er,Cr:YSGG laser treated. A dentin bonding agent (Adapter Single Bond2, 3M/ESPE) was applied to the specimens and then transparent plastic tubes (3 mm of height and diameter) were placed on each dentin. The composite resin was inserted into the tubes and cured. All the specimens were stored in distilled water at 37degree C for 24 hours and the shear bond strength was measured using a universal testing machine (Z020, Zwick, Germany). The data of tensile bond strength were statistically analyzed by one-way ANOVA and Duncan's test at alpha = 0.05. RESULTS: The bond strengths of Er:YAG laser-treated group was 3.98 +/- 0.88 MPa and Er,Cr:YSGG laser-treated group showed 3.70 +/- 1.55 MPa. There were no significant differences between two laser groups. The control group showed the lowest bond strength, 1.52 +/- 0.42 MPa and the highest shear bond strength was presented in acid-etched group, 7.10 +/- 1.86 MPa (P < .05). CONCLUSION: Laser- etched group exhibited significantly higer bond strength than that of control group, while still weaker than that of the phosphoric acid-etched group.

PLC-gamma1 for Differentiating Adenocarcinoma from Reactive Mesothelial Cells in Effusions / 대한세포병리학회지

Cytologic diagnosis of reactive or malignant effusion is sometimes difficult. Espe- cially, differentiation of benign reactive mesothelial cells from malignant cells in body effusion is more difficult. Recently, immunohistochemistry has been used to diagnose difficult cases. Phospholipase C(PLC)-gamma 1 is one of the isoenzyme of the PLC which plays central role in signal transduction involving cellular growth, differentiation and transformation by phosphorylating many protein component. Increased expression of PLC-gamma 1 in human breast carcinoma, colorectal carcinoma and stomach cancers are reported. To evaluate the efficacy of positive PLC-gamma 1 immunostaining in the diagnosis of malignancy in effusions, paraffin-embedded cell blocks of pleural fluid and ascites from 10 patients(5 metastatic adenocarcinomas, and 5 reactive mesothelial cells) were immunostained with a monoclonal antibody to PLC-gamma 1. PLC-gamma 1 immuostained all the adenocarcinomas in cell block(5/5) with intense membrane pattern, however, none of the reactive mesothelial proliferations stained with the diagnostic membrane pattern. Thus, our study strongly supports the conclusion that PLC-gamma 1 immunopositivity is likely to become a useful adjunct for the diagnosis of malignancy in effusions.

The Expression of phospholipase C-lambda1 and p53 in Endometrial Carcinoma / 대한부인종양콜포스코피학회잡지

PLC-gamma1 plays a central role in the signal transduction for cellular activity, such as proliferation and differentiation. However, the significance of their expressions in endometrial cancer is yet to be determined. The current study examined the expression prevalence of phospholipase C-gamma1(PLC-gamma1) , and studied its relationship with p53 expression in endometrial carcinomas of varying stages and grades. Expressions of PLC-gamma1 and p53 were determined using immunohistochemical taining of paraffin embedded tissues from 21 endometrial specimens; Specimens included 10 cases of grade I, 8 cases of grade II, and 3 cases of grade III lesions. While there were few PLC-gamma1 expressions in the control group, 60% (6/10) of grade I carcinomas showed obvious PLC-gamma1 expression, 50%, and 30% of Grade II and III cases did respectively. In addition, PLC-gamma1 expression was restricted to the tumor lesions and the intensity of the PLC-lambda1 was the strongest in well differentiated cancers. P53 expression was identified in 7 of 21 (33%) cases, and there was no relationship between PLC-gamma1 expression and p53 overexpression. Our studies revealed that levels of PLC-gamma1 play important roles in the occurrence of ndometrial carcinomas, though factors that might influence them still remain obscure. And also further studies about correlation between PLC-gamma1 and p53 are needed to elucidate that in tumorigenesis.

Histiocytic Necrotizing Lymphadenitis(Kikuchi's Disease) A clinicopathologic study of 1 cases

The Kikuchi's disease is a distinctive type of histiocytic necrotizing lymphadenitis that affects primarily the cervical lymphadenites of young adults and has a self-limited clinical course. Authors report the case of a 77-year old patient who presented with axillary and cervical, tender lymphadenopathy and who was diagnosed as having Kikuchi's disease upon excisional biopsy.

Tumor Angiogenesis As a Predictor of Prognosis in Gastric Carcinoma / 대한암학회지

PURPOSE: Angiogenesis is an essential component of tumor growth and proven to be a prognostic factor in breast, cervix, prostate carcinoma and melanoma. This study was designed to define the relationship of microvessel density with overall survival, clinicopathologic data and with other reported prognostic factors in gastric carcinoma. METHODS: We studied resected tumor specimens from thirty-two patients with gastric carcinoma who underwent gastrectomy at Ewha Women's University Hospital from January, 1989 to December, 1991. Specimens were investigated by staining with a monoclonal antibody aganist factor VIII-related antigen, which was localized to vascular endothelium. Correlation between the microvessel count (X200), various clinicopathologic factors, EGFR and p53 were studied. RESULTS: The microvessel count was increased with higher histologic staging. The microvessel count was significantly higher in group with lymph node metastasis than in those without lymph node metastasis (60.7 vs 27.4, p=0.02). In patients with high microvessel count (> or =30), overall survival time was shorter than in those with low count (0.05). The microvessel count was higher in group with recurrence than in those without recurrence (48.1 vs 33.2, p=0.05). CONCLUSION: Microvessel count may be a prognostic indicator in gastric carcinoma but larger scale study should be followed.

Subendocardial Ischemic Necrosis in Hypertrophied Rabbit Heart Induced by Chronic Aoric

BACKGROUND: Cardiac hypertrophy is the compensatory response of the myocadium to increased workload. Compensatory mechanisms come into play when the hypertrophied heart can no longer accommodate the increased demand or persistent stimuli. Although it has been reported that the molecular changes in hypertrophied hearts that initially mediate enhanced function may contribute to the development of heart failure, the structural/biochemical/molecular basis for myocardial contractile failure is still obscure. This study was aimed to clarify the structural basis for relation between hypertrophy and failure. METHOD: Nine pairs of rabbits were sacrificed at 8,12,24,48 hours and 1,2,4,6,8 weeks after experiment aortic constriction. There hearts were studied with routine histopathology. Each heart was weighed and compared with total body weight. Multiple sections were embedded in paraffin, sectioned at 5um, and stained with hematoxylin and cosin and Masson's trichrome and analysed. RESULTS: The heart weight to body weight ratio(g/Kg) increased progressively with time after aortic banding. Banding of the aorta in the rabbit resulted in multifocal areas of myofiber degeneration, necrosis and fibrosis through the wall of the left ventricle, in the papillary muscles of the left ventricle and in the left ventricular portions of the interventricular septum in rabbit of 6 and 8 weeks after aortic banding. By 4 weeks after banding, the foci of necrosis were not observed. CONCLUSION: There findings suggest that the increased necrosis, fibrosis in animals with cardiac hypertrophy induced by banding the aorta may play a role in progression to heart failure.

Proliferating Cell Nuclear Antigen Expression in Cervical Intraepithelial Neoplasia / 대한부인종양콜포스코피학회잡지

In comparison with normal cervix, mitosis occur more frequently in cervical intraepithelial neoplasia(CIN) and are seen at high levels, suggesting that CIN may be associated with a progressive dysfunction in proliferative activity of cervical cells. This study aims that expression of proliferative cell nuclear antigen(PCNA) was examined to determine proliferative activity at the cell of CIN. Sixty four colposcopic biopsies from patients with cytologically and/or colposcopically dtagnosed condyloma and CIN. The cases were classified as follows ; 19 as normal cervix and condyloma, 15 as CIN I, 16 as CIN II and 14 as CIN III. Immunohistochemical detection of PCNA was performed on paraffin sections by the streptavidin-biotin peroxidase method using the monoclonal antibody PC10. There was a statisically significant correlation between the CIN grade and the PCNA grade(p<0.05). In addition, the PCNA grade showed significant correlation with mitotic grade(p<0.05) and the CIN grade was also observed(p<0.05). This study suggests that the cell proliferation index as detected immunohistochemically using PCNA may be a useful adjunct to histopathological diagnosis of various grades of CIN.

Expressions of Matrix Metalloproteinase-9 and Tissue Inhibitor of Metalloproteinase-2 with Changes of Interleukin-6 and Interleukin-18 in Atherosclerotic Lesions of Hypercholesterolemic Rabbits / 대한흉부외과학회지

BACKGROUND: Atherosclerosis is a chronic inflammatory disease of the arterial wall characterized by progressive accumulation of lipids,cells,and extracellular matrix.Matrix metalloproteinases(MMPs)and tissue inhibitor of metalloproteinases(TIMPs)contribute to vascular matrix remodeling in atherosclerosis,and some cytokines may play role in the synthesis or activation of MMPs or TIMPs. MATERIALS AND METHOD: We produced experimental atherosclerotic plaques in 9 rabbits by atherogenic hypercholesterol diet for 12 weeks,and 10 other rabbits were used as control group with standard laboratory chow.At that time,19 rabbits were sacrificed and aorta,coronary arteries and blood specimens were prepared.The expressions of MMP-9,TIMP-2 and interleukin(IL)-18,and the bioactivity of IL-6 were investigated with H&E stain,immunohistochemical stain,immunoblotting(Western blot analysis),and bioassay. RESULT: Serum cholesterol in the experimental group increased up to 1258 +/-262 mg/dL(control group:41 +/-7 mg/dL).All experimental group showed well developed atherosclerotic plaques in aorta and coronary artery.The expression of MMP-9 in aorta and coronary artery of the experimental group showed significant increase than that of the control group by immunohistochemistry.Among the experimental group, complicated lesions with intimal rupture or complete luminal occlusion,demonstrated stronger expression of MMP-9.Interestingly,there was no difference in expression of TIMP-2 between the experimental and the control group.These findings were confirmed by Western blot analysis.The bioassay revealed significant up-regulation of serum bioactivity of IL-6 in the experimental group(4819.60 +/-2021.25 IU/ml)compared to that of IL-6 in the control group(27.20 +/-12.19 IU/ml).IL-18 was expressed in all atherosclerotic plaques, whereas little or no expression was detected in the control group. CONCLUSION: The increased MMP-9 expression along with the unchanged TIMP-2 expression seem to be contributory factors in extracellular matrix degradation in atherosclerosis.Focal overexpression of MMP-9 may promote plaque destabilization and cause complications of atherosclerotic plaques such as thrombosis with/without acute coronary syndrome.Elevation of IL-6 and IL-18 may be more than just markers of atherosclerosis but actual participants in lesion development.Identification of critical regulatory pathway is important to improve the understanding of the cellular and molecular basis of atherosclerosis and may open the way for novel therapeutic strategies.

Fine Needle Aspiration Cytology of Papillary Renal Cell Carcinoma: A Case Report / 대한세포병리학회지

Papillary renal cell carcinoma(RCC) is an uncommon subtype of RCC that has distinctive gross, histologic, and cytogenetic features. The cytologic features of FNA are abundant papillary clusters and relatively few single cells. The cells are usually small and contain uniform nuclei; numerous macrophages with foamy cytoplasm are often found in the background. We describe a case of papillary renal cell carcinoma evaluated by fine needle aspiration cytology(FNAC) in a 42 year-old man. The smear showed a few papillary clusters and numerous macrophages with foamy cytoplasm in the background. With adequate cellularity, papillary RCC can be distinguished reliably from non-papillary RCC by FNAC.

A Case of Spontaneous Regression of Basaloid Squamous Cell Carcinoma / 대한이비인후과학회지

Basaloid squamous cell carcinoma(BSCC) is a rare distant variant of squamous cell carcinoma of head and neck region, of which about 90 cases was reported in the world. BSCC has aggressive biologic behavior with a high incidence of cervical lymph node metastasis, distant spread, and death from disease. S pontaneous regression has not been previously reported in BSCC. However, we experienced a case of spontaneous regression of BSCC in nasal cavity with characteristic histopathologic and immunologic feature in 53 old male patient. T herefore, we report the first case of spontaneous regression of BSCC.

Application of Epstein-Barr Virus Cell Lines (CCL85 EB-3) in Performing the EBER mRNA In Situ Hybridization as a Positive Control / 대한세포병리학회지

Epstein-Barr virus(EBV) is associated with a wide spectrum of benign and malignant disorders including leukoplakia, Hodgkin's lymphoma, central nervous system lymphoma, peripheral T cell lymphoma and nasopharyngeal undifferentiated carcinoma. There are several distinctive aspects of biology of the virus that are important in investigation of virus in clinical specimens. The abundant expression of the EBER mRNA transcripts makes possible the sensitive detection of latent expression in EBV-associated tumors. Although there has been a dramatic increased interest in the direct characterization of EBV in clinical specimens, there have been few studies about the effective and reliable positive controls in performing in situ hybridization technique for EBV, especially on paraffin-embedded tissue. We applied Burkitts lymphoma cell line as positive control in EBV in hydridization using Oncor Kit. The cell block of Burkitt lymphoma cell line(CCL85 EB-3) showed strong and specific positivity for EBER in situ in nuclei of EBV infected cells.

A case of hepatoma with duodenal metastasis proved by liver aspiration cytology and gastrofiberscopic duodenal biopsy / 대한세포병리학회지

No abstract available.

Significance of Increased Expression of the Tissue Inhibitor of Matrix Metalloproteinase-2 in Human Colorectal Carcinomas

BACKGROUND : Tumor invasion and metastasis are the major causes of morbidity and death for cancer patients. Metastasis is a complex multistep process in which tumor cells must pass through supporting structures. Proteolytic degradation of the structures is an important part of this process, and matrix metalloproteinase (MMP) has been implicated. The activation and the enzymatic activity of MMP is regulated by the tissue inhibitor metalloproteinase (TIMP). Three distinct TIMP molecules have been isolated. Very little is known about the role of TIMP-2 in tumors. The purpose of this study was to examine the expression of TIMP-2 in human colorectal carcinomas. METHODS : The paraffin blocks of 33 colorectal carcinomas were recalled and immunostained with monoclonal antibodies specific for TIMP-2. The rate of stain was estimated, and the relationships between the expression and the stage, the differentiation, and the recurrence were assessed. RESULTS : The expression of TIMP-2 in tumor tissues increased with increasing Dukes's stage (p<0.05) and recurred cases (p<0.05). CONCLUSIONS : Our results suggest that increased expression of TIMP-2 may be useful as a marker of biologic aggressiveness.

A study of Tumor Angiogenesis in Human Lung Cancerby Immunohistochemical Stain / 결핵

Background: Tumor angiogenesis is the growth of new vessels toward and within tumor. It has been demonstrated that the growth of tumor beyond a certain size requires angiogenesis and it is closely involved in tumor progression and metastasis. The finding that intensity of neovascularization correlates independently with metastasis may lead to identification of patients in whom radical surgery should be supplemented by systemic treatment. Method: We have collected paraffin blocks of bronchoscopic biopsy of patients with non-small cell lung cancer. We highlighted the vessel by staining endothelial cell with JC70 monoclonal antibody(to CD31) immunohistochemically and counted microvessels under 200 X field using light microscopy. Results: 1) The mean microvessel count was 32.7+/-20.8 (9-96) in total 29 cases. 2) There were no correlations between microvessel counts and pathologic cell type, T staging, node metastasis(N) and hematogenous metastasis(M) (p>0.05). 3) The median follow-up duration was 15 months(2-46) and there was no correlation between the microvessel counts and survival rate of lung cancer patients (p>0.05). Conclusion: Tumor angiogenesis seems to be an important prognostic factor suggesting the probability of metastasis. But the microvessel count in the bronchoscopic biopsy specimen was inadequate and very limited. There has been no data about angiogenesis of lung cancer in korea yet. So the study of tumor angiogenesis using resected lung tumor specimen would be demanded.

A Case of Pulomonary Lymphomatold Granulomatosis / 대한내과학회지

Lymphomatoid granulomatosis was described by Liebow as a peculiar angiocentric and angiodestructive lymphoreticular proliferative granulomatous disease. Although the lung is most frequently involved, lymphomatoid granulomatosis is also commonly found in the upper respiratory tract, skin, kidneys and central nervous system. Pulmonary infiltrates are histologically polymorphous and show variable degree of cytologic atypic in the lymphoid cells. Infrequent involvement of the bone marrow, spleen and peripheral lymph nodes initially supported the distinction of lymphomatoid granulomatasis from lymphoma. We experienced a rare case of 26-year-old female diagnosed as lymphomatoid granulomatosis by per cutaneous needle aspiration biopsy and transbronchial lung biopsy with symptoms of fever, cough, sputum and right chest pain. After 4th chemotherapy it showed partial remission and chemotherapy is going on.

Malignant Histiocytic Lymphoma Associated with Celiac Disease: A Case Report

The celiac disease is an immunologic disorder, related to dietary gluten and morphologically characterized by a striking loss of villi in the small intestine and, with it, a marked reduction in the absorptive surface area. The authors experienced a rare case of pathologically confirmed malinant histiocytic lymphoma of jejunum, associated with celiac disease which was histologically manifested with ulcerative jejunitis in a 25-year-old Korean female who had suffered from projectile vomiting for 2 months. We report this case with literature review emphasis on the pathogenesis of malignant neoplasm in celiac disease and pathogenetic relationship between ulcerative jejunitis and celiac disease. To our knowledge, this is the first reported case of malignant histiocytic lymphoma complicating celiac disease with ulcerative jejunitis, in Korea.

The Signal Transduction Mechanisms on the Intestinal Mucosa of Rat Following Irradiation / 대한치료방사선과학회지

PURPOSE: Phospholipase C(PLC) isozymes play significant roles in signal transduction mechanism. PLC-gamma1 is one of the key regulatory enzymes in signal transduction for cellular proliferation and differentiation. Ras oncoprotein, EGFR, and PKC are also known to be involved in cell growth. The exact mechanisms of these signal transduction following irradiation, however, were not clearly documented. Thus, this study was planned to determine the biological significance of PLC, ras oncoprotein, EGFR, and PKC in damage and regeneration of rat intestinal mucosa following irradiation. MATERIAL AND METHOD: Sixty Sprague-Dawley rats were irradiated to entire body with a single dose of 8Gy. The rats were divided into 5 groups according to the sacrifice days after irradiation. The expression of PLC, ras oncoprotein, EGFR and PKC in each group were examined by the immunoblotting and immunohistochemistry. The histopathologic findings were observed using HandE stain, and the mitoses for the evidence of regeneration were counted using the light microscopy and PCNA kit. The phosphoinositide(PI) hydrolyzing activity assay was also done for the indirect evaluation of PLC-gamma1 activity. RESULTS: In the immunohistochemistry, the expression of PLC-beta was negative for all groups. The expression of PLC-gamma1 was highest in the group III followed by group II in the proliferative zone of mucosa. The expression of PKC-sigma1 was strongly positive in group I followed by group II in the damaged surface epithelium. The above findings were also confirmed in the immunoblotting study. In the immunoblotting study, the expressions of PLC-beta, PLC-gamma1, and PLC-sigma1 were the same as the results of immunohistochemistry. The expression of ras oncoprotein was weakly positive in groups II, III and IV. The of EGFR was the highest in the group II, III, followed by group IV and the expression of PKC was weakly positive in the group II and III. CONCLUSION: PLC-gamma1 mediated signal transduction including ras oncoprotein, EGFR, and PKC play a significant role in mucosal regeneration after irradiation. PLC-sigma1 mediated signal transduction might have an important role in mucosal damage after irradiation. Further studies will be necessary to confirm the signal transduction mediating the PLC-sigma1.