Effect of Aromatase Inhibitor (AI) in Polycystic Ovary Syndrome Patients with an Inadequate Response to Clomiphene Citrate / 대한불임학회지

OBJECTIVE: To evaluate the effectiveness of aromatase inhibitor (AI) for ovulation induction in polycystic ovary syndrome (PCOS) patients with thin endometrium, hyper-responsiveness after clomiphene citrate (CC) treatment. MATERIAL AND METHODS: A prospective study was performed in 43 PCOS patients (50 cycles) with ovulatory dysfunction between March 2004 and September 2004. AI group (total 36 cycles) included the patients 1) with thin endometrium below 6 mm on hCG day after CC (n=17), 2) with more than 5 ovulatory follicles after 50mg of CC (n=4), 3) who do not want multiple pregnancy (n=14). Patients were treated with Letrozole 2.5mg for days 3 to 7 of the menstrual cycle. CC group (total 14 cycles) were treated with CC 50~100 mg. RESULTS: In PCOS patients, ovulation was occurred 97.2% after AI use. Between AI group and CC group, there was no significant difference in the mean age, duration of infertility, interval of menstruation, basal FSH, prior treatment cycles, and the day of hCG administration. But, the number of mature follicles (> or =15 mm) was lower in the AI group (1.08+/-0.45 vs. 1.64+/-0.75) (p=0.018), and the thickness of endometrium (mm) was significantly thicker in the AI group (10.35+/-1.74 vs. 9.23+/-1.61) (p=0.044), and E2 (pg/ml) concentration on hCG day was lower in the AI group (116.9+/-75.8 vs. 479.5+/-300.8) (p=0.001). Among the AI group, patients with prior thin endometrium (below 6 mm) during CC treatment showed 10.6+/-1.6 mm in the endometrial thickness and 106.6+/-66.8 pg/ml in E2 concentration. Patients with more than 5 ovulatory follicles after CC showed decreased follicle number (1.25+/-0.5) compared to prior CC cycle. CONCLUSIONS: In PCOS patients, AI group showed significantly thicker endometrium, lesser number of mature follicles, and lower E2 concentration on hCG day than CC group. AI might be useful alternative treatment for ovulation induction in PCOS patients with thin endometrium and hyper-responsiveness after CC treatment.

A Case of Non-immune Hydrops Fetalis due to Intraperitoneal Hemangioma

Hydrops describes the infant who has generalized edema due to accumulation of excess fluid. In severe case, massive edema with ascites and pleural and pericardial effusions are commonly combined. The main etiology of hydrops fetalis has been changed from immune type which is caused by fetomaternal blood group incompatibility to nonimmune type. Although cardiovascular diseases are the most common (23% to 38%) causes for nonimmune hydrops fetalis, fetal tumors still compromise 5% to 7% of the diseases. We report a case of nonimmune hydrops fetalis due to intraperitoneal hemangioma. The newborn infant was managed surgically and had excellent outcome.

Effectiveness of Intravenous Immunoglobulin Therapy in Women with Recurrent Spontaneous Abortions and Elevated Pre-conceptional Peripheral Blood CD56+ Natural Killer Cell Percentage / 대한불임학회지

OBJECTIVE: The aim of present study was to evaluate the effectiveness of low-dose intravenous immunoglobulin (IVIg) therapy in women with recurrent spontaneous abortions (RSA) and elevated pre-conceptional peripheral blood CD56+Natural Killer (NK) cell percentage. STUDY DESIGN: Retrospective case control study. MATERIALS AND METHODS: Thirty three women with RSA and elevated pre-conceptional peripheral blood CD56+NK cell percentage who had received low-dose IVIg therapy (400 mg/kg per day, every 4 week, until 20 gestational weeks) were included in this study. Controls were nine women with RSA and elevated pre-conceptional peripheral blood CD56+ Natural Killer (NK) cell percentage who had not received IVIg therapy were included in this study. Medical records of study and control groups were retrospectively analyzed and we compared the successful pregnancy outcomes between two groups. Successful pregnancy outcome was defined as pregnancy ongoing beyond 25 gestational weeks. RESULTS: Age, number of previous abortions, pre-conceptional CD56+NK cell percentage and type of RSA were not statistically different between two groups. Otherwise, twenty-five women who received IVIg therapy (25/33, 75.8%) but, only three women who had not received (3/9, 33.3%) had a successful pregnancy outcome and the rate difference between two groups was statistically significant. CONCLUSION: Based on our study, low-dose IVIg therapy have a effective role in treatment of RSA patients with elevated pre-conceptional peripheral blood CD56+ Natural Killer (NK) cell percentage, but more larger scaled prospective study is needed for available of conclusive evidence.

The Preconceptional Level of Peripheral Natural Killer Cells which was Expected to Bring Successful Treatment Outcome using Low-dose Intravenous Gamma Immunoglobulin (IVIg) Infusion in Patients with Recurrent Spontaneous Abortion / 대한불임학회지

OBJECTIVES: We aimed to investigate the clinical effect of low-dose intravenous immunoglobulin treatment in unexplained recurrent spontaneous aborters (RSA) with elevated peripheral CD56+ natural killer (NK) cell levels and to determine the pre-conceptional NK cell percentage predictive of subsequent successful pregnancy outcome. MATERIALS AND METHODS: Sixty four cases of unexplained recurrent miscarriage with elevated peripheral NK cells (>15%) were received low dose IVIg infusion at the dosage of 400 mg/Kg/month after confirmation of gestational sac and continued until 20 weeks. The patients were divided into two groups according to the pregnancy outcome: Group I was success of treatment defined as live birth at or after 25 gestational weeks and Group II was failure of treatment. The preconceptional levels of the peripheral blood NK cells were compared between two groups. RESULTS: Fifty-three pregnancies resulted in live births after 25 weeks and 11 resulted in abortion (Overall success rate of IVIG treatment was 82.8%). Preconceptional CD56+ NK cell percentage in group II (27.4+/-1.9%) was higher than those in group I (22.3+/-0.8%). By using ROC curve, optimal discrimination between success and failure of treatment was achieved with < or = 27% of preconceptional NK cell percentage. CONCLUSION: In RSA patients with elevated NK cells, we suggest that preconceptional peripheral blood CD56+ NK cell level could be a useful marker for predicting successful treatment outcome of low-dose IVIg infusion.

Effect of Low-dose Aspirin on Implantation and Pregnancy Rates in Patients Undergoing Frozen-thawed Embryo Transfer / 대한불임학회지

OBJECTIVE: Low-dose aspirin have been proposed to improving endometrial receptivity and pregnancy rate in COH-IVF by increasing endometrial perfusion. However, the effect of low-dose aspirin in COH-IVF could be negligible because there have been large quantity of other important factors responsible for changing endometrial perfusion accompanied by COH procedure. In contrast, in frozen-thawed embryo transfer cycles which were not accompanied by COH procedure, the effects of low-dose aspirin in endometrial blood flow seems to be more certain than in COH-IVF cycles. In this study, we analyzed the effect of low-dose aspirin treatment on implantation and pregnancy rates in patients undergoing frozen-thawed embryo transfer METHODS: From January 2003 to December 2003, total 264 cycles from 264 patients who attended infertility clinic at Samsung Cheil Hospital were enrolled in this study. All cases included in this study, embryos were frozen and thawed at the pronuclear stage and three days after incubation, at least 2 or more good quality embryos were transferred into uterus. In study group, low dose aspirin (100 mg/day) was administrated from the first or second date of menstrual day to 9 days after embryo transfer. On the other hand, control group did not take any medicine except estradiol valerate for endometrial priming. Several variables including implantation and pregnancy rates were compared in both groups. After then, each groups were stratified by endometrial thickness checked at embryo transfer (ET) day such as (28 mm versus 0.05) After we analyzed same variables stratified by endometrial thickness checked at embryo transfer day, we could not found any significant difference between study and control groups. CONCLUSIONS: Low-dose aspirin treatment seems to have no advantage of improving implantation and pregnancy rates in patients undergoing frozen-thawed embryo transfer.

The Comparion of Pregnancy Outcomes between GnRH Agonist and GnRH Antagonist Cycles in Women with Advanced Age / 대한불임학회지

OBJECTIVE: To compare the clinical results and pregnancy outcomes of in vitro fertilization (IVF) between GnRH antagonist cycles and GnRH agonist (GnRH-a) cycles including flare-up and long protocol in women with advanced age. MATERIALS AND METHODS: Retrospective clinical study. From January 2001 to September 2003, IVF cycles of female patient 37 years over were included in this study. GnRH-a long protocol (62 cycles, 61 patients) and GnRH antagonist multi-dose flexible protocol (66 cycles, 51 patients) were compared with the control group of GnRH-a flare-up protocol (151 cycles, 138 patients). IVF cycles for non-obstructive azoospermia (NOA), endometriosis III, IV and polycystic ovarian syndrome (PCOS) were excluded in this study. Clinical results such as total gonadotropin dose, serum E2 on hCG administration, the number of retrieved oocytes and the pregnancy outcomes - clinical pregnancy rate (CPR), implantation rate (IR) and live birth rate (LBR) per embryo transfer - were compared. RESULTS: There were significant differences in the total dose of gonadotropin (GnRH-a flare-up vs. GnRH-a long vs. GnRH-antagonist; 41.8 vs. 54.7 vs. 24.8), serum E2 on hCG administration (1787.2 vs. 1881.6 vs. 788.0), the numbers of retrieved oocytes (8.1 vs. 11.1 vs. 4.5) and endometrial thickness (9.1 vs. 10.4 vs. 8.0) which were significantly lower in GnRH-antagonist cycles. But pregnancy outcomes shows no significant differenced in CPR (25.0% vs. 35.8% vs. 24.5%), IR (11.7% vs. 12.3% vs. 10.1%) and LBR (15.8% vs. 28.3% vs. 15.1%) CONCLUSION: In women with advanced age, GnRH-antagonist cycles can result in comparable pregnancy outcomes to GnRH-a cycles including flare-up and long protocol. GnRH-a long protocol show higher CPR, IR and LBR than GnRH antagonist multi-dose flexible protocol and flare-up protocol without significant differences.

Transcervical embryoscopy in missed abortion / 대한산부인과학회지

OBJECTIVE: Approximately 15-20% of all clinically recognized pregnancies result in spontaneous abortion and 60-70% of these are attributable to detectable chromosome abnormalities. Although the incidence of first trimester losses is high, spontaneous abortion material is often poorly described from a development perspective. The purpose of this study was to determine the usefulness of transcervical embryoscopy in diagnosing localized and generalized defects in the embryonic morphogenesis of missed abortions. The embryoscopic findings are supplemented by the results of cytogenetic analysis in all cases. METHODS: In this study, consisted of 26 women with the final diagnosis of missed abortion between August 1, 2003 and October 31, 2003 in Samsung Cheil Hospital. Prior to the instrumental evacuation of the uterus a rigid hysteroscope was passed transcervically into the amniotic cavity to obtain a detail view of the embryo. Karyotyping was done in all cases included in this study. RESULTS: Visualization of embryo or early fetus was successful in 24 cases. Among 24 examined cases, 21 cases had successful karyotype and as a result 11 (11/21, 52.4%) had abnormal karyotype. Among 21 cases which had successful karyope, 4 (4/21, 19.0%) had normal external features, 10 (10/21, 47.6%) had classified as growth-disorganized and 7 (7/21, 33.3%) had either isolated or multiple defects, including facial dysplasia, delayed limb development, facial fusion to chest, umbilical cyst, brownish discoloration of ventral part and increased nuchal thickness. Of the morphologically normal and growth-disorganized embryo in embryoscopic examination, only 1 and 4 (1/4, 25.0% and 4/10, 40.0%) had a abnormal karyotype. In contrast, of the morphologically abnormal embryo in embryoscopic examination, 5 (5/7, 71.4%) had a abnormal karyotype. CONCLUSION: Transcervical embryoscopy permits visualization of the embryo in utero, unaffected by the damage usually caused by its instrumental evacuation or spontaneous passage. This technique can be a helpful tool for understanding human embryonic malformations and genetic counseling for parents. Futhermore, correlation of morphological and cytogenetic findings in spontaneous abortion specimens could provide the need of further evaluation for future pregnancies in couples which had fear of repeated abortions. But, more larger scaled controlled study is needed for widely use of transcervical embryoscopy in missed abortion.

Obstetrical outcome after oocyte donation in patients with premature ovarian failure / 대한산부인과학회지

OBJECTIVE: The purposes of this study are to evaluate the obstetric outcome in pregnancies resulting from oocyte donation and to assess the factors related to the obstetric complications. METHODS: The obstetric outcome in pregnancies from the oocyte donation (n=37) was compared with that in pregnancies from conventional IVF program (n=137) in our IVF center between January 1995 and December 2000. Control group was selected by age, parity, and order of gestation matched to the study group. Pregnancy induced hypertension (PIH) was defined as blood pressure >140/90 mmHg on two or more occasions at least 6 hours apart with or without proteinuria after 20 weeks of gestation and not associated with chronic hypertension. Small for gestational age (SGA) was defined as birth weight below tenth percentile for gestational weeks. The data was analyzed using the Statistical Package for Social Sciences (SPSS). RESULTS: Early pregnancy loss rates were 37.8% (14/37) and 23.4% (32/137) in study and control group, respectively (P>0.05). PIH related factors such as mean age, parity and order of gestation were not significantly different among the two groups. However, the incidence of PIH in oocyte donation group (30.0%, 6/20) was significantly higher than control group (8.8%,9/102). There was no significant difference in the incidence of SGA between the two groups. When oocyte donation group was stratified by relationship of oocyte donor to infertile patient (sibling versus non-sibling), the incidence of early pregnancy loss and PIH was significantly higher (chi square test, P<0.05) in non-sibling group (42.3%, 11/26; 38.5%, 5/13) than in control group (23.4%, 32/137; 8.8%, 9/102). CONCLUSION: The incidence of PIH was significantly higher in pregnancies after oocyte donation. Notably, the pregnancies from non-sibling oocyte donors had much higher incidence of early pregnancy loss and PIH than pregnancies from sibling oocyte donors or control group. Therefore, the occurrence of early pregnancy loss and PIH may be related to other factors than age, parity or multiple pregnancy.

A Change of Peripheral CD56+Natural Killer Cell Fraction in Recurrent Pregnancy Loss Patients who Successfully Treated with Intravenous Immunoglobulin in Previous Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the change of peripheral blood CD56+NK cell fraction in recurrent pregnancy loss patients who successfully treated with intravenous immunoglobulin (IVIg) in previous pregnancy. METHODS: The study subjects were women with a history of two or more documented consecutive spontaneous pregnancy loss under 20 weeks of gestation and successfully treated with intravenous immunoglobulin (IVIg) in previous pregnancy, excluding any aneuploidy by karyotype analysis, and with no evidence of genetic, endocrine, infections or anatomic factors. We retrospectively analyzed the medical record study subjects of the change of peripheral blood CD56+NK cell fraction before and after successful birth of baby beyond 25 weeks since June, 1998 to September, 2003 in Samsung Cheil Hospital. Healthy women with no history of recurrent pregnancy loss and having one baby with pregnancy ongoing at least 25 weeks selected as a control group and we compare the CD56+NK cell fraction to that of study group. RESULTS: Pre- and after conceptional CD56+NK cell fraction in women with next pregnancy beyond 25 weeks after IVIg treatment (n=16, pre: 24.5 +/- 1.2, after: 22.5 +/- 1.5) were significantly high compared with control group (n=14,8.9 +/- 1.3) (T-test, p<0.05), but the difference between pre- and after conceptional CD56+NK cell fraction was not statistically significant. Among 16 women with IVIg treatment in previous pregnancy, after conceptional CD56+NK cell fraction below 15%, who regarded as have no need of IVIg treatment in next pregnancy were 3 women (3/16, 18.7%), but most of women with IVIg treatment in previous pregnancy (13/16, 81.3%) were regard as need of IVIg treatment in next preganacy. CONCLUSION: For the safety of pregnancy in women with history of recurrent spontaneous abortion and successfully treated with intravenous immunoglobulin (IVIg) in previous pregnancy, IVIg treatment should be considered in consecutive pregnancy.

Intramural Pregnancy after in vitro Fertilization and Embryo Transfer / 대한불임학회지

Intramural pregnancy is an unusual ectopic gestation located within the uterine wall, completely surrounded by myometrium and separate from the uterine cavity, fallopian tube, or round ligament. It is known to be difficult to diagnose, and associated with a high rate of uterine rupture. We report a case of intramural pregnancy in which early diagnosis was made and successful treatment was done by dilatation and curettage. Diagnostic laparoscopy confirmed the absence of uterine rupture during the procedure. Therefore, conservation of fertility can be possible with early diagnosis of intramural pregnancy. To our knowledge, this is the first case report of intramural pregnancy following IVF-ET in Korea.

Spontaneous Uterine Rupture with Placenta Percreta / 대한산부인과학회잡지

Placenta percreta occurs when chorionic villi penetrate through the myometrium up to the serosa. The incidence of placenta percreta is extremely rare (about 1/140000 deliveries) but it is accompanied by life threatening complication of pregnancy due to massive hemorrhage. Antepartum diagnosis and proper management is important to decrease the marternal mortality and morbidity. We present two cases of spontaneous uterine rupture due to placenta percreta with brief review of literature. The one is that a women with a history of previous ceasrean section and placenta previa was treated with cesarean hysterectomy due to the spontaneous uterine rupture with placenta percreta at GA 37(+2) weeks. The other is that a women with a bicornuate uterus had preserved the ruptured uterus with placenta percreta incidentally detected at emergency cesarean section at GA 39(+5) weeks.

Pregnancy Outcome after Exposure of Suspected Teratogens in Early Pregnancy / 대한산부인과학회잡지

OBJECTIVE: To compare the risk of congenital anomaly after exposure to suspected teratogens in early pregnancy with the known baseline risk to the geneneral population. METHODS: From September 1999 to August 2001, we counseled about the teratogenic risk of the fetus by relevant medical literatures after assessment of type, amount, and time of exposure for 302 pregnant women exposed to suspected teratogens such as drugs, radiation, alcohol, and cigarette smoking. We followed up on the pregnancy outcome with the rate of termination of pregnancy and incidence of congenital anomaly. RESULTS: Among a total of 302 cases, 253 pregnant women (83.8%) delivered, 15 (5%) were aborted spontaneously, 34 (11.3%) were terminated. 297 pregnant women (98.3%) were lastly exposed to drugs in mean 5.3 +/- 0.2 gestational weeks. Medicines taken were gastrointestinal drugs (23%), NSAIDs (18.3%), antibiotics (16.2%), antihistamines (10.8%) in the order of frequency. 74 pregnant women (24.5%) were exposed to radiation in mean 5.1 +/- 0.5 gestational weeks. The mean dose was 234.60 mrem. 113 pregnant women (37.3%) lastly drank alcohol in mean 4.5 +/- 0.4 gestational weeks and the mean amount was 1.55 oz. 36 pregnant women (11.9%) lastly smoked in mean 4.4 +/- 0.3 gestational weeks and the mean amount was 7.3 cigarettes/day. We found structural anomalies in 5 cases (Polydactylyl, Ileal agenesis, Both ear mass, Left ectopic kidney, Meningomyelocele) and 1 chromosomal abnormality case (Trisomy18). CONCLUSION: The rate of fetal structural anomaly was 2% in this study and is not more than baseline risk of general population. Therefore, evidence-based teratogenic risk counseling may prevent unnecessary pregnancy termination.

Maternal Anxiety related to Medication during Lactation and the Breast Feeding Rate / 대한주산의학회잡지

OBJECTIVE: To determine the type and frequency of medication taken by breast-feeding women and to evaluate the effects of maternal anxiety related to medication during lactation on the breast-feeding rate. METHODS: From April 15 to May 15 2003, we conducted a survey with a prepared questionnaire on ninety-one mothers who visited the obstetric clinics of Samsung Cheil hospital at eight weeks after delivery. The questionnaire contained information about parity, mode of delivery, whether to feed breast-milk, and the type and frequency of medicinal exposure. We also asked the degree of perceived adverse effects on her baby associated with maternal medication using 10cm visual analogue scale. RESULTS: The mean age of respondents was thirty-one years and the mean number of children born to the respondents was 1.3. At the eighth week after delivery the breast-feeding rate was 65.9%. The breast-feeding rate was not related to maternal age or the number of children but rather, the mode of delivery, which was 76.9% in NSVD, 70.0% in vaginal delivery with labor induction and 50% in cesarean delivery(P<0.05). The frequency of maternal medication intake during lactation was 50%. The most frequent type of medicine was herb medicine (36.7%). The average score of perceived adverse effect on a respondent's baby during breast-feeding was about 49% in total, which was 46.5% in NSVD, 48.9% in vaginal delivery with labor induction, and 51.2% in cesarean delivery. CONCLUSION: Most nursing mothers think that their medications during lactation affect adversely their babies, who, in turn, may be associated with the decrease of breast-feeding rate.

Two Cases of Gastritis Cystica Superficialis without Previous Gastric Surgery / 대한소화기내시경학회지

Gastritis cystica superficialis (GCS) is a rare lesion which is characterized by glandular hyperplasia with regeneration and degeneration in the mucosa and muscularis mucosa. Recently, GCS is revealed as precancerous lesion, but most report has been associated with those found at the site of a gastroenterostomy. So, we report two cases with GCS who had not previous gastric surgery. A 45-year-old woman visited for epigastric discomfort and another 4Q-year-old woman for epigastric pain. They had not undergone any gastric surgery. The gastroscopy discovered one polyp on anterior wall of greater curvature, upper body and another polyp in the center of the fold of greater curvature, lower body. We removed it by snare polypectomy and the histologic finding showed the character of GCS.

Efficacy of 1:1000 Diluted Heparin versus 0.9% Normal Saline for Maintenance of Intermittent Intravenous Locks / 기본간호학회지

The objective of this research was to compare the flushing effects using 1:1,000 diluted heparin or 0.9% normal saline in relation to needle gauge and frequency of IV medications. The comparative categories were clotting, duration of patency, and incidence of phlebitis. The design of research was a Nonequivalent Control group, Post test, Nonsynchrorized Design. The independent variable was 0.9% normal saline flushing the IV locks and the dependent variables were clotting, duration of patency, and incidence of phlebitis. Subjects were medical-surgical inpatients over 15 years old and with peripherally placed IVs who were hospitalized in a university medical center. Exclusion criteria included foreigners and those who were rejected for this research. The final sample for data analysis included 295 IV sites in 194 patients; 154 were in the saline group and 141 were in the heparin group. Subjects were assigned to have IV locks is flushed with 0.9% normal saline in the experimental group and to have IV lock flushed with 1:1,000 diluted heparin(100 units) in the control group. In order to increase reliability, the nurses who were assigned to the units involved in the study received an explanation on the standard method for locking an IV, recording method for observational data and criteria for the detection of phelbitis. Data were collected for a period of 2 weeks, from March 16, 2000 to March 29, 2000. Total duration of IV was defined the time of IV insertion to the time of discontinuation. Phlebitis was defined as the presence of the following : pain, swelling, erythema at the insertion site. Chi-square was used to determine the association between the degree of clotting, duration of patency, and incidence of phlebitis for the diluted heparine or the normal saline and needle gauge and frequency of IV medications. The results are summarized as follows : (a) There was difference in the degree of clotting between two groups(x2=5.882, p=.015). (b) There was no difference in the degree of duration of patency between two groups(x2=2.439, p=.295). (c) There was no difference in the incidence of phlebits between two groups(x2=0.190, p=.663). (d) There was difference in the degree of clotting(x2=6.209, p=.013) and in the degree of duration of patency(x2=6.978, p=.031) according the needle guage between the two groups. (e) There was difference in the incidence of phlebitis(x2=5.008, p=.025) according to the frequencies of IV injection between two groups.

The Effect of Preceptorship on OJT(On the Job Training)of New Nurses / 성인간호학회지

The purpose of this study was to examine the effect of preceptorship on On the Job Training of new nurses. The research design was a retrospective survey and one group pre-post test design. The subjects were 49 entry nurses and 49 preceptors. The data were collected from Feburary 1, 1998 to December 1, 1998. One questionnair applied in this study consisted of general characteristics, the responses of new entry nurses and their preceptors and their qualities. The other questionnair consisted of job satisfaction of new entry nurses and preceptors and their competencies. The data were analyzed for frequencies, mean score, standard deviation, t-test, and ANOVA. The results of the study were as follows: 1) Preceptees's responses were that the nurses' affiliation of unit, cooperation of other nurses, and competencies of nursing skills improved after OJT applied preceptorship. 2) Preceptors's answers were that preceptor- ship had a positive effect on their continuing education. 3) While preceptees's job satisfaction scores were high in interaction, administration, and organization, they were low in autonomy and pay. 4) Pre-competency scores were the same as post-competency scores. 5) After preceptorship, preceptors responded that their nursing skill & communication competency increased, but their nursing administration competency decreased. 6) Finally, preceptorship's other effects were as follows: 1. Checklists for preceptee education at the nursing unit were developed separately. 2. It was proved that 'preceptor interview note' was effective on manage preceptorship. 3. We obtained duty overlap periods; medical- surgical units-1 month, 5 ICU-2 months, operation room-3 months. 4. We prepared a preceptor program based on the study results.

Nurses' Perception of Barriers to Research Utilization / 간호학회지

The present study is a descriptive study to investigate nurses'perception of barriers to research utilization. A total of 274 participants in this study consisted of registered nurses working in a large, urban and academic medical center. A questionnaire packet containing the Barriers Scale, and a demographic profile was distributed to nurses and they were asked to return the packet to a return-box in the Nursing Office after completion. The greatest barrier was insufficient time on the job to implement new ideas. Next was `implications for practice are not made clear'. Also the item of the English language in research articles was considered to be the ninth barrier. The greatest mean score of each of the sub-scales was the communication factor. The were followed by the organization, research, and nurse factors. Compared with the means from other studies, the mean scores of the communication and research factors were higher in this study. Nurses who had not taken a class of research methods found the communication and research factors as a higher barrier than those who did. Also, nurses who did not participate in a conference last year perceived the research factor as higher than those who did. It is recommended that English and research classes should be strengthened in educational nursing programs. The researchers should also describe the section of implication for practice as more detail and clearer for the understanding of nurses; Lastly journals in a libraries or online journal systems should be easily accessible.

The Expression of Bcl-2, Bax, and p53 Developmental Rat Eye

To investigate the tissue-specific and stage-specific expressions of porteins relatedto cell death or survival in development of rat eye, Bcl-2, Bax and p53 as well as PCNA were studied from 14th day of embryonic stage(E14) to 22th day of opstnatal stage(P22) every other day in Spragur-Dawley(SD) rats. Expression of these gene proteins was studied by immunohistochemistry. At E14, Bcl-2, Bax and PCNA were expressed on the surface ectoderm and anterior lens epithelium. p53 was highly expressed in theposterior lens epithelium and in the inner layer of retina. PCNA was highly expressed in the middle layer of retina. In postnatal stage, In the retina, Bax and PCNA were expressed throughout whole layers and p53 was stained in the middle layer, However, Bax, p53 and PCNA disappeared after P14, wherase Bcl-2 still remained by P22. In the lens, p53 expression was detected by P14 and then disappeared. In the iris. Bax and PCNA were highly expressed between P0 and P22. These results indicate that Bcl-2, Bax and p53 may contribute to the development of rat eye. The expressions of Bcl-2, and Bax, p53 are not conducted step by step but overlapped and expressed in different stages depending on ocular tissue.

Immunohistochemical Study of CD4 , CD8 ICAM-1 and LFA-1 in Experimental Uveitis

We have reported an animal model of human anterior uveitis in Lewis rats with bovine melanin associated antigen[BMAA] which has been named as experimental autoimmune anterior uveitis[EAAU]. Immunopathogenesis in this model during different clinical stages was examined by the immunohistochemical detection of CD4 , CD8 , ICAM-1 and LAF-1 which play an important role in immune and inflammatory response. After the separation of eyes, these eyes were sectioned by cryostat at 6micrometer thick sections and stored at -70degreesC. For immunohistochemical study monoclonal antibodies to CD4, CD8, ICAM-1, and LAF-1 were used. An increase of ICAM-1 expression was shown on the epithelial cells of uveal tissues before clinical sign of uveitis and followed by LFA-1 expression. And there was no staining in retinal pigment epithelium and cornea. In conclusion, the immunopathogenesis of EAAU appears to be mediated by T cells and cells expressing ICAM-1, LFA-1.

Expression of GnRH and GnRH-receptor mRNAs in the Human Placenta / 체질인류학회지

Placental GnRH is one of the potential paracrine regulator of hCG secretion from the trophoblasts during pregnancy. However, this paracrine function is not clearly confirmed. The present study was designed to evaluate the possible correlation between the synthesis and cellular distribution of GnRH and GnRH -receptor in the placental villi. 6 to 40 weeks termed twenty five human placental tissues were used in this study. GnRH and GnRH -receptor mRNAs were localized in the placenta by in situ hybridization using the corresponding cRNA probes. GnRH mRNA was present in all cell types of placenta including cytotrophoblasts, syncytiotrophoblasts and stromal cells. The GnRH -receptor mRNA signals were localized in both cytotrophoblasts and syncytiotrophoblasts. The GnRH -receptor mRNA signals were also localized in some stromal cells at the full term placenta. GnRH mRNA signals were detected abundantly at 6 ~7 weeks and the intensities were remarkably increased with the following gestational ages. GnRH -receptor mRNA signals were detected at 6 ~7 weeks, peaked at 9 ~10 weeks, declined at 23 ~24 weeks and focally expressed at full term placenta. The present study demonstrates that GnRH mRNA is expressed in all cell types of the placenta, however GnRH -receptor mRNA is expressed only in the cytoptrophblasts and syncytiotrophoblasts and exhibits parallel change with the time course of hCG secretion during pregnancy. These data provide a morphological understanding that placental GnRH has a paracrine/autocrine role through its receptor from 6 ~7 weeks gestation to term placenta.