Preliminary Report of Validity for the Infant Comprehensive Evaluation for Neurodevelopmental Delay, a Newly Developed Inventory for Children Aged 12 to 71 Months

Objectives@#Early detection of developmental issues in infants and necessary intervention are important. To identify the comorbid conditions, a comprehensive evaluation is required. The study’s objectives were to 1) generate scale items by identifying and eliciting concepts relevant to young children (12–71 months) with developmental delays, 2) develop a comprehensive screening tool for developmental delay and comorbid conditions, and 3) assess the tool’s validity and cut-off. @*Methods@#Multidisciplinary experts devised the “Infant Comprehensive Evaluation for Neurodevelopmental Delay (ICEND),” an assessment method that comes in two versions depending on the age of the child: 12–36 months and 37–71 months, through monthly seminars and focused group interviews. The ICEND is composed of three parts: risk factors, resilience factors, and clinical scales. In parts 1 and 2, there were 41 caretakers responded to the questionnaires. Part 3 involved clinicians evaluating ten subscales using 98 and 114 questionnaires for younger and older versions, respectively. The Child Behavior Checklist, Strengths and Difficulties Questionnaire, Infant-Toddler Social Emotional Assessment, and Korean Developmental Screening Test for Infants and Children were employed to analyze concurrent validity with the ICEND. The analyses were performed on both typical and high-risk infants to identify concurrent validity, reliability, and cut-off scores. @*Results@#A total of 296 people participated in the study, with 57 of them being high-risk (19.2%). The Cronbach’s alpha was positive (0.533–0.928). In the majority of domains, the ICEND demonstrated a fair discriminatory ability, with a sensitivity of 0.5–0.7 and specificity 0.7–0.9. @*Conclusion@#The ICEND is reliable and valid, indicating its potential as an auxiliary tool for assessing neurodevelopmental delay and comorbid conditions in children aged 12–36 months and 37–71 months.

Content analysis of real-time simulation video observation records of nursing students-focusing on communication / 의료커뮤니케이션

Background@#: In the case of simulation practice, if the visual information obtained through observation is described in text along with video observation learning, students will be able to reinforce their memory of the acquired content, promote the learning process, and further enhance nursing performance skills. The purpose of this study was to confirm the effectiveness of communication training through observational learning and recording of simulation practice videos and to provide basic data for developing strategies to improve learning effects. @*Methods@#: We conducted a simulation of chronic obstructive pulmonary disease patient nursing with fourth-year students in the department of nursing at University B in A City. The described communication contents while watching a video of a colleague’s team’s implementation in real time, were analyzed by content analysis method. @*Results@#: In this study, nursing students have an opportunity to think critically by recording their judgments on effective or ineffective situations in therapeutic communication with patients, information transfer, and cooperative communication between professionals and used it for reflection and application. @*Conclusion@#: Creating a structured observation sheet while observing the simulation situation of a peer team in real time is a way to reinforce the memory of the learned content by allowing more focus on observational learning and elaborate processing of visual information through recording.

Incidence and Comorbidity of Reactive Attachment Disorder: Based on National Health Insurance Claims Data, 2010–2012 in Korea

OBJECTIVE: We aimed to investigate the current diagnostic incidence, and medical and psychiatric comorbidities of reactive attachment disorder (RAD) using the National Health Insurance Review and Assessment (HIRA) claims data. METHODS: To examine the diagnostic incidence, we selected patients who were under 10-year-old and who had at least one medical claim containing a 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) code for RAD (F94.1 and F94.2) and who had not been diagnosed in the previous 360 days, from 2010 to 2012. In this study, we used the term ‘reactive attachment disorder’ representing for both RAD per se and Disinhibited social engagement disorder. Comorbid disorders were categorized according to ICD-10. RESULTS: Among 14,029,571, the total population under 10-year-old during 2010–2012, incident cases of RAD were 736. The mean diagnostic incidence of RAD was 5.25 per 100,000 annually. Language disorders (F80-84) were the most common psychiatric comorbidities in both boys and girls in age groups 0–3 years and 4–6 years, and attention deficit hyperactivity disorder was the most common in both sex aged 7–9 years. In non-psychiatric comorbidities, diseases of the respiratory system (J00–99) were the commonest in both sex in all age groups, and diseases of the digestive system (K00–99) were the next. CONCLUSION: RAD was very rare in practice and would be disguised as other psychiatric disorders. Children with RAD might have more medical comorbidities than typically developed children.

Influence of Ego-resilience and Stress Coping Styles on College Adaptation in Nursing Students / 간호행정학회지

PURPOSE: The purpose of this study was to investigate the effects of ego-resilience and stress coping styles on college adaptation in nursing students. METHOD: The sample for this study consisted of 1st and 2nd year students from 3 colleges of nursing, one each, in Jeolla, Chungcheong, and Gyeongsang Provinces. The data were collected from November 5 to 22, 2010. The data were analyzed using t-test, ANOVA, Pearson correlation and multiple regression with SPSS 18.0. RESULTS: A positive correlation was found for college adaptation with stress coping styles and ego-resilience. The strongest predictor of college adaptation was an optimistic attitude. In addition optimistic attitude, satisfaction with nursing as a major, confidence, academic scores, age, emotional control, and gender accounted for 63.3% of variance in college adaptation. CONCLUSIONS: The results of this study suggest that development of stress coping and ego-resilience in nursing students is important to college adaptation. Further research in improving ego-resilience and stress coping is warranted.

Critical Thinking Disposition and Clinical Competence in General Hospital Nurses

PURPOSE: This study was done to investigate the relationship between critical thinking disposition and clinical competence among nurses in general hospitals. METHODS: This study was a descriptive-correlational study with a convenience sample of 560 nurses from 5 general hospitals. The data were collected by self-administered questionnaires. Critical thinking disposition was measured using the Critical Thinking Disposition Scale for Nursing Students. Clinical competence was measured using the Standardized Nurse Performance Appraisal Tool. RESULTS: The mean score for critical thinking disposition and clinical competence was 3.37 and 4.10 respectively on a 5 point scale. A statistically significant correlation was found between critical thinking disposition and clinical competence. A regression model explained 72.8% of clinical competence. Prudence is the most significant predictor of clinical competence (R2=.728). CONCLUSION: Study findings suggest that nurses with a higher level of critical thinking disposition would have a higher level of clinical competence. Furthermore, prudence might be the most important predictor of clinical competence. In order to strengthen clinical competence in nurses, the development and enhancement of critical thinking should be emphasized at the college level and nurses should be encouraged to make a clinical decision with greater prudence.

Expression of p53 and p73 Genes in Human Transitional Cell Carcinoma of the Bladder / 대한비뇨기과학회지

PURPOSE: We analyzed the tissue samples of bladder transitional cell carcinoma (TCCa) for both the p53 and p73 gene, and we attempted to elucidate their possible roles in the pathogenesis of bladder TCCa. MATERIALS AND METHODS: After homogenizing 33 samples of bladder TCCa and 3 normal bladder tissues, the genomic DNA was isolated for PCR. The primers used for PCR were exon 5-10 for p53 and exon 8 and 13 for p73. The mutation analysis was performed by an automatic sequencing analyzer. The results were compared to the grade and stage of the bladder cancers. RESULTS: Mutations of p53 and p73 were noted in 18 (54.5%) and 19 samples (57.6%), respectively, out of 33 bladder cancer tissue samples. The frequency of p53 mutation were significantly higher for invasive and high grade cancer (p=0.04). Mutation of p73 show no statistically significant difference according to invasiveness (p=0.224); however, it show a significantly higher incidence in high grade cancer (p=0.026). Simultaneous mutations of p53 and p73 show a significant increase in higher grade cancer (p=0.025) and in the higher cancer stages (p=0.045). Recurrence-free probabilities for patients with superficial bladder cancer were significantly correlated with the p53 and p73 mutation. CONCLUSIONS: Mutation of p73, as well as p53, which is already known as a predictor for the recurrence and progression of bladder cancer, also seems to be related to the pathogenesis and prognostic factors of TCCa of the bladder.

A case of thoracic aortic aneurysm presenting as hoarseness of voice: ortner's syndrome / 대한내과학회지

Ortner's syndrome is a clinical entity with hoarseness due to a left recurrent laryngeal nerve palsy caused by cardiac disease. It is a recognized complication of a number of conditions including, atrial septal defect, patent ductus arteriosus, primary pulmonary hypertension, Eisenmenger's syndrome and aortic aneurysm. A 71-year-old woman with a history of hypertension and diabetes complained hoarseness and hemoptysis for 3 days. Chest X-ray showed a soft tissue mass shadow in the left upper lung field and chest CT scan revealed a thoracic aortic aneurysm. We report a case of left recurrent laryngeal nerve palsy due to a huge thoracic aortic aneurysm in an old woman.

A Patient with Epstein-Barr Virus-associated B-cell Anaplastic Large Cell Lymphoma and Human Immunodeficiency Virus Infection / 대한혈액학회지

Epstein-Barr virus (EBV), a human lymphotropic herpesvirus, is presently the best known viral contributor to the development of human lymphomas and transforms normal resting B cells into immunoblasts. Especially a positive correlation has been found between the EBV- associated lymphadenopathy and the later development of EBV-carrying lymphoma in patients with acquired immune deficiency syndrome. Anaplastic large cell lymphoma(ALCL) is a clinicopathologically distinct category of non-Hodgkin's lymphoma (NHL) and classified as T-/null-cell type lymphomas in the revised European-American Classification of lymphoid neoplasms. We report a patient with EBV- associated B-cell ALCL and HIV positive. EBV-associated ALCL in HIV-positive patient usually has B-cell phenotype, so this lymphoma should be distinguished from the classical ALCL as were defined by the revised European-American Classification of lymphoid neoplasms.

Dissociation between Clearances of Small and Middle Molecules in Incremental Peritoneal Dialysis / 대한신장학회잡지

OBJEVTIVE: To evaluate the peritoneal clearance of the middle molecule compared with that of the small molecule in incremental peritoneal dialysis(PD). METHODS: Peritoneal clearances of the creatinine and beta2-microgloblulin were compared in 57 continuous ambulatory PD patients with full dose 4 times exchange and in 54 incremental PD patients with 2 or 3 times exchange over 24 hours. The clearances were also compared when there were changes in the peritoneal dialysis regimen such as in the number of exchanges and dwelling time. RESULTS: Peritoneal creatinine clearance increased almost linearly along with the increase in the number of exchanges. In contrast, peritoneal clearance of beta2-microglobulin was 9.1+/-3.6 L/week, 8.8+/-4.4 L/ week, and 7.9+/-2.5 L/week respectively with 2, 3 and 4 exchanges per day, not different from each other. Peritoneal clearance of beta2-microglobulin did not change when there was an increase in the number of exchange from 2 to 3 times and 3 to 4 times over a period of 24 hours, whereas the peritoneal clearance of creatinine increased. Peritoneal clearance of beta2-microglobulin almost doubled from 5.4+/-2.7 L/ week with 2 times exchange over 12 hours per day, to 9.5+/-4.4 L/week with 2 times exchange over 24 hours, whereas the creatinine clearance did not change. CONCLUSION: In contrast to peritoneal clearance of small molecule which depends on the number of dialysate exchange, peritoneal clearance of middle molecule depends mainly on the total dwelling hours rather than the number of exchange per day in incremental PD. This can be another advantage of incremental PD since peritoneal clearance of middle molecules in incremental PD over 24 hours is comparable to that in full dose PD.

A Case of Acute Cholestatic Hepatitis Caused By the Seeds of Psoralea-corylifolia / 대한간학회지

The potential hepatotoxicity of herbal remedies is usually ignored in daily life. One such compound, Boh-Gol-Zhee (in Chinese, Bu Ku Zi), appeared to be the cause for acute cholestatic hepatic injury in the following case. Psoralea corylifolia is known to contain a sufficient amount of phyto-estrogen. Some alternative medicine therapists claim that Psoralea corylifolia is effective for the treatment of osteoporosis. So far, at least 35 chemical components in the fruits of Psoralea corylifolia have been identified. High concentrations of phyto-estrogen, such as genistein, have been found in the leaves of Psoralea corylifolia. Phyto-estrogen has structural similarity to estrogen and exhibits beneficial effects on osteoporosis under estrogen-deficient conditions. The authors observed a case of acute cholestatic hepatitis in a post-menopausal woman caused by seeds of Psoralea corylifolia in amounts over 10 times the usual dose. Other possible causes of liver injury were excluded by laboratory tests and imaging studies. After discontinuation of this remedy, elevated liver enzyme and total bilirubin rapidly returned to normal. Liver biopsy showed zone 3 necrosis, degenerating cells, cholestasis and infiltrations with inflammatory cells. This case stresses the need to warn the potential hepatotoxicity of Psoralea corylifolia seeds, especially in a large dose.

A Magnetic Resonance Angiographic Diagnosis and Successful Thrombolytic Therapy in The Thrombosis of Renal Vein Complicated from Nephroitc Syndrome / 대한신장학회잡지

The nephrotic syndrome has been considered a hypercoagulable state since it may be complicated by thromboembolic events of the venous or the arterial circulations. Diverse pathogenetic factors leading to the hypercoagulable state in nephrotic syndrome have been recognized. Renal vein thrombosis is a serious complication, which might lead to either renal failure or to secondary thromboembolic processes like pulmonary thromboembolism. Although it may present acutely with flank pain and macroscopic hematuria, the majority of cases run an indolent course. Until relatively recently, the diagnosis could only be confidently confirmed or excluded with selective renal venography but, more recently, computerized tomography and magnetic resonance imaging have been used. Anticoagulant therapy with heparin and warfarin apparently halts the natural progression of the disease and allowing for slow recovery. The possibility of more rapid and complete resolution with thrombolytic agents warranted their application. We described a case of bilateral renal vein thrombosis diagnosed by the new technique of magnetic resonance angiography and successful treatment by thrombolytic agent.

Effects of Castration on Apoptosis and p53 in the Adult Rat Penis / 대한남성과학회지

PURPOSE: Androgen plays an important role during penile development and is essential for a normal libido in the male, but its role in the regulation of the androgen receptor (AR) and maintenance of the erectile response has been controversial. We investigated the effect of androgen on the AR and apoptosis of the penile erectile tissue after castration. MATERIALS AND METHODS: Adult Sprague-Dawley rats were divided into four groups: sham operation, castration, testosterone and dihydrotestosterone (DHT) replacement after castration. Androgens (testosterone, DHT) were administrated for 7 days at week 1,2,3, and 4 after castration. The AR mRNA expression detected by reverse transcription-PCR and percentage of apoptosis (apoptotic index) were analyzed in the penis. The relation between androgen and p53 was determined by Western blot analysis. RESULTS: Castration induced a progressive decrease in serum testosterone. As serum testosterone decreased, a reduction in AR mRNA expression was noted, along with an increase in apoptosis and p53 expression in the penis. Androgen replacement after castration increased the AR mRNA expression with a decrease in apoptosis and p53. CONCLUSIONS: The adult rat penis was affected by the androgen milieu via AR expression and apoptosis. Therefore, androgens such as testosterone and DHT plays a direct role in the erectile function in adult rat.

Effects of Androgen on Telomerase Activity in the Adult Rat Penis / 대한비뇨기과학회지

PURPOSE: Telomerase functions to maintain telomere length and its activity are generally present in most cancer cells, germ line cells but typically are not present in normal somatic cells. Among few exceptions, telomerase activity is detected in hematopoietic stem cells and in physiologically renewable cell populations. The adult rat penis exhibits the ability to regenerate during androgen replacement after castration, we hypothesized that a pool of cells with regenerating potential is present in the adult rat penis, and therefore assayed for the telomerase activity in the castrated and androgen replaced adult rat penis. MATERIALS AND METHODS: Adult male Sprague Dawley rats were divided into 4 groups; control, castration, and androgen(testosterone, DHT) replacement after castration. Percentage of apoptotic cells assessed by morphological analysis(apoptotic index, TUNEL), and proliferating cells incorporating Ki-67(proliferating index) were analyzed. Telomerase activity was detected by using a PCR-based telomerase assay(Telomeric repeat amplification protocol). RESULTS: Following castration, serum testosterone significantly decreased from day 1. Normal penis was found to be telomerase positive. Since serum testosterone decreased after castration, a significant decrease for the activity of telomerase was noted with a decrease in the proliferating index and an increase in apoptotic index in the penis. Replacement of androgen after castration increased the telomerase activity with an increase in the proliferating index and a decrease in apoptotic index in the penis. CONCLUSIONS: These results provide evidence for the ability of androgen to regulate telomerase activity in the adult rat penis, and the adult rat penis retains throughout life the potential to regenerate in response to androgen replacement following castration-induced apoptotic cell death.

Effect of Androgen Deprivation and Replacement on the Penis and Erectile Function in the Adult Rat / 대한남성과학회지

PURPOSE: Androgen plays an important role during penile development and is essential for libido in the male, but its role in the regulation and maintenance of the erectile response has been controversial. We investigated the effect of castration and androgen replacement on penile erection in the adult rat. MATERIALS AND METHODS: Adult male Spargue-Dawley rats were divided into three groups: control, castration, and androgen replacement after castration. Androgen (testosterone, DHT) was administrated for 7 days at week 1, 2, 3, and 4 after castration. The intracavernosal pressure was recorded after submitting the rats to cavernous nerve stimulation. The percentages of cells in the penis expressing Ki-67 (proliferative index) and of apoptotic cells, assessed by morphologic analysis (apoptotic index), were analyzed. Nitric oxide synthase (NOS) activity was measured by the arginine-citrulline conversion ratio, and expression of nNOS and eNOS was determined by Western blot analysis. RESULT: After castration, a significant increase was noted in the apoptotic index, with a decrease in the expression of nNOS and eNOS. Replacement of androgen increased the proliferative index and the expression of cavernous nerve stimulation; NOS activity and erectile function were restored with androgen replacement. CONCLUSIONS: These results suggested that the penile tissue and NOS activity of the adult rat are affected by the androgen milieu and androgen such as testosterone and DHT play a direct role in the erectile function at the level of the erectile tissue.

Unilateral Absence of Lung Perfusion Caused by Non-thromboembolic Compression in Bronchogenic Carcinoma / 대한내과학회지

Perfusion scintigraphy has proved to be an essential part for the diagnosis of pulmonary thromboembolism. The wedge shaped perfusion defect extending to lung base is a highly probable finding of pulmonary embolism. Occasionally, great perfusion defects could be presented as a false positive finding under the circumstance of nonthromboembolic origin, such as neoplastic compression or invasion of pulmonary artery. We report an unusual case of massive perfusion defect resulting from pulmonary arterial compression by bronchogenic carcinoma. A 71-year-old man visited our hospital because of productive cough and was diagnosed as bronchogenic carcinoma. The perfusion scintigraphy showed unilateral total defect of lung, not accompanied by any clinical evidence of thromboembolism. A contrast enhanced computed tomogram showed heterogeneous mass shadow in left hilum, abutting to the descending aorta and compressing left main pulmonary artery. These findings suggested a nonembolic mechanism of perfusion defects which were produced by the neoplastic compression of pulmonary artery.