The effect of 6% hydroxyethyl starch 130/0.4 preloading on the blood glucose levels in diabetic patients undergoing orthopedic surgery with spinal anesthesia: a randomized pilot study

Background@#Perioperative hyperglycemia can occur in surgical patients and may increase postoperative morbidity and mortality, especially in patients with diabetes. Therefore, we conducted the present study to evaluate whether the administration of 6% hydroxyethyl starch (HES)-130/0.4 increases blood glucose levels in patients with diabetes. @*Methods@#Forty patients undergoing lower limb surgery under spinal anesthesia were randomly allocated into two groups according to the fluids administered 20 min before spinal anesthesia (Group L, lactated Ringer’s solution; Group H, 6% HES-130/0.4). Patient characteristics, intraoperative variables, blood glucose levels, mean blood pressure (MBP), and heart rate (HR) were recorded at five time-points (0, 20, 60, 120, and 240 min). @*Results@#A total of 39 patients were analyzed (Group L, n = 20; Group H, n = 19). The amount of intraoperative fluid was significantly higher in Group L than in Group H (718.2 ml vs. 530.0 ml, P = 0.010). There were no significant differences in the changes in blood glucose levels, HR, or MBP between the two groups (P = 0.737, P = 0.896, and P = 0.141, respectively). Serial changes in mean blood glucose levels from baseline also showed no significant differences between the groups (P = 0.764). @*Conclusions@#There were no significant changes in blood glucose levels when lactated Ringer’s solution or 6% HES-130 was used. When compared to the lactated Ringer’s solution, no evidence that 6% HES-130/0.4 produces hyperglycemia in diabetic patients could be found. Further evaluation of larger populations is needed.

Comparison of Meibomian Gland Loss between Demodex-infested Group and Dry Eye Patients without Demodex Infestation

Purpose@#To compare the degree of meibomian gland drop-out associated with Demodex infestation using non-contact meibography. @*Methods@#We performed noncontact meibography using an infrared digital camera on 24 adult subjects infested by Demodex and 40 without infestation. The right upper and lower lids were scored based on the loss of meibomian glands, and the scores of the upper and lower eyelids were summed to obtain the total meiboscore for each subject. Meiboscores were evaluated according to Demodex infestation and gender in each group. @*Results@#Sixty-four eyes of 64 people were enrolled in this study. The study subjects had an average age of 67.9 years (range, 40-79 years; men, 65.2 years; women, 69.1 years). There was a significant association between Demodex infestation and total meiboscore and upper and lower eyelid meiboscores (p = 0.000, p = 0.002, p = 0.004, respectively). There was no significant difference in the meiboscores between men and women. Age and meiboscore suggested a weak positive correlation; however, the R2 value was low, due to the concentrated age distribution of the study population. @*Conclusions@#Based on noncontact meibography, the authors concluded that the prevalence of changes in the meibomian glands was significantly related to Demodex infestation; however, there was no significant difference between men and women.

Correlation of Serum Inflammatory Cytokine Levels with Clinical Characteristics Including Severity in Korean Patients with Psoriasis / 대한피부과학회지

Background@#Psoriasis is a chronic relapsing inflammatory disease, with several cytokines related to its pathophysiology and clinical manifestations, such as disease activity, severity, and clinical subtype. However, there is limited information regarding Korean psoriasis patients.Objective We investigated the association between serum inflammatory cytokines and clinical characteristics of psoriasis, including treatment modalities. @*Methods@#We evaluated the serum Th17-related cytokine levels of 70 patients diagnosed with psoriasis using a multiplex immunoassay. All clinical information of patients was collected by reviewing electronic medical records and photo documentation in a retrospective manner. @*Results@#The serum IL-23 level was significantly higher in the young age group (＜40 years), and the IL-6, TNFβ, and IL-28A levels were significantly higher in the early onset group (＜40 years). In addition, patients with moderate-to-severe psoriasis (PASI≥10 and body surface area ≥10%) exhibited significantly lower serum IL-28A levels. We observed high serum TNF-α and CCL20 levels in patients with metabolic comorbidities and those with psoriatic arthritis, respectively, and biologics use and systemic treatment modality were also significantly associated with the serum levels of some cytokines. @*Conclusion@#Disease severity, comorbidities, presence of psoriatic arthritis, and treatment responsiveness might affect the inflammatory cytokine levels in psoriasis patients. Therefore, the serum cytokine levels can be used to predict the severity or treatment responsiveness of psoriasis patients.

Antinociceptive effects of intrathecal cimifugin treatment: a preliminary rat study based on formalin test

Background@#Cimifugin is one of the components of the root of Saposhnikovia divaricata. The extract derived from S. divaricata is traditionally used as an analgesic. This study was conducted to evaluate the analgesic effect of intrathecal cimifugin in the formalin test. @*Methods@#Male Sprague–Dawley rats (n = 20) were randomized into four groups for intrathecal administration of 70% dimethylsulfoxide and various doses of cimifugin (100 μg, 300 μg, and 1,000 μg). The typical flinch response after the injection of 5% formalin into the hind paw was assessed in two distinct phases: phase 1 until 10 min, and phase 2 from 10 min to 60 min. ED50 values were calculated via linear regression. @*Results@#Intrathecal cimifugin significantly reduced the flinch response in both phases of the formalin test. Significant antinociceptive effects of cimifugin were found with the dose of 300 μg in phase 1 and the dose of 100 μg in phase 2. The ED50 value (95% confidence intervals) of intrathecal cimifugin was 696.1 (360.8–1,342.8) μg during phase 1 and 1,242.8 (42.0–48,292.5) μg during phase 2. @*Conclusions@#Intrathecal cimifugin has an antinociceptive effect against formalin-induced pain. Cimifugin has an anti-inflammatory effect at low concentrations, and non-inflammatory analgesic effect at higher concentrations.

Rapidly Growing Merkel Cell Carcinoma after Biopsy / 대한피부과학회지

No abstract available.

Influence of Axial Length on Recurrence of Wet Age-related Macular Degeneration after Initial Treatment

PURPOSE: To evaluate the influence of axial length on the recurrence of wet age-related macular degeneration (AMD) after anti-vascular endothelial growth factor therapy. METHODS: A retrospective review of the medical records for 45 eyes of 45 patients, who were diagnosed with neovascular AMD and treated with three ranibizumab injections per month, was performed. Axial length was compared between eyes with (recurrence group) and without (no recurrence group) recurrence of fluid during a 12-month follow-up period. In eyes with recurrence, the association between axial length and the time between the third injection and the first recurrence was also evaluated. RESULTS: The axial length was measured at a mean of 20.6 ± 10.1 months after the diagnosis of neovascular AMD. The mean axial length at that time was 23.33 ± 0.90 mm. The mean axial length was 23.29 ± 0.96 mm in the recurrence group (n = 30) and 23.40 ± 0.79 mm in the no-recurrence group (n = 15). There was no difference in the axial length between the two groups (p = 0.709). In the recurrence group, the period between the third injection and the first recurrence was not associated with axial length (p =0.582). CONCLUSIONS: There was no significant difference in axial length between eyes with and without recurrence after initial treatment for wet AMD. In addition, the time to first recurrence was not significantly associated with axial length. Because the present study was retrospective and the sample size was small, further prospective studies with a better design are needed to more accurately assess the influence of axial length.

Histopathologic Study of Morbilliform Drug Eruption: Differences between Chemotherapeutic Agents and Antibiotics / 대한피부과학회지

BACKGROUND: Cutaneous drug eruption is very common, and its clinical manifestations are variable. Diagnosis of drug eruption is usually based on clinical findings and medication history. To date, few studies have compared the variable histopathologic findings of drug eruption according to medication. OBJECTIVE: We focused on morbilliform eruption among diverse manifestations of drug eruption and investigated the differences in histopathologic findings between antibiotics- and chemotherapeutic-agent-induced morbilliform drug eruption. METHODS: We reviewed medical charts established from March 1998 to August 2016 at our hospital. Inclusion criteria were histopathologically confirmed drug eruptions, clinical demonstrations of typical morbilliform eruptions obtained from medical photographs, and causative drugs identified as chemotherapeutic agents or antibiotics. Immunohistochemical staining was performed and included CD3, CD4, CD8, CD20, CD56, CD68, langerin, CD138, and c-kit. RESULTS: A total of 40 cases (20 cases, chemotherapeutic group; 20 cases, antibiotics group) were included in this study. The most frequent histologic feature of the epidermis was exocytosis (95%) in the chemotherapeutic group and necrotic keratinocytes (100%) in the antibiotics group. Inflammatory infiltration depths were significantly deeper in the antibiotics group than in the chemotherapeutic group. There was no significant difference between the two groups in terms of immunohistochemical staining. CONCLUSION: This study suggested that in patients with morbilliform drug eruption, chemotherapeutic agents cause more superficial inflammation compared to antibiotics. These findings may facilitate the differentiation of the culprit agents of morbilliform drug eruption in cancer patients. Further large, well-designed studies are needed to confirm these findings.

Confluent and Reticulated Papillomatosis Limited to the Forearm / 대한피부과학회지

No abstract available.

Cutaneous Lupus Erythematosus Presenting as Localized Grouped Papules Mimicking Herpes Zoster on the Back

No abstract available.

Conversion and Data Quality Assessment of Electronic Health Record Data at a Korean Tertiary Teaching Hospital to a Common Data Model for Distributed Network Research / 대한의료정보학회지

OBJECTIVES: A distributed research network (DRN) has the advantages of improved statistical power, and it can reveal more significant relationships by increasing sample size. However, differences in data structure constitute a major barrier to integrating data among DRN partners. We describe our experience converting Electronic Health Records (EHR) to the Observational Health Data Sciences and Informatics (OHDSI) Common Data Model (CDM). METHODS: We transformed the EHR of a hospital into Observational Medical Outcomes Partnership (OMOP) CDM ver. 4.0 used in OHDSI. All EHR codes were mapped and converted into the standard vocabulary of the CDM. All data required by the CDM were extracted, transformed, and loaded (ETL) into the CDM structure. To validate and improve the quality of the transformed dataset, the open-source data characterization program ACHILLES was run on the converted data. RESULTS: Patient, drug, condition, procedure, and visit data from 2.07 million patients who visited the subject hospital from July 1994 to November 2014 were transformed into the CDM. The transformed dataset was named the AUSOM. ACHILLES revealed 36 errors and 13 warnings in the AUSOM. We reviewed and corrected 28 errors. The summarized results of the AUSOM processed with ACHILLES are available at http://ami.ajou.ac.kr:8080/. CONCLUSIONS: We successfully converted our EHRs to a CDM and were able to participate as a data partner in an international DRN. Converting local records in this manner will provide various opportunities for researchers and data holders.

Differences of Reasons for Alert Overrides on Contraindicated Co-prescriptions by Admitting Department / 대한의료정보학회지

OBJECTIVES: To reveal differences in drug-drug interaction (DDI) alerts and the reasons for alert overrides between admitting departments. METHODS: A retrospective observational study was performed using longitudinal Electronic Health Record (EHR) data and information from an alert and logging system. Adult patients hospitalized in the emergency department (ED) and general ward (GW) during a 46-month period were included. For qualitative analyses, we manually reviewed all reasons for alert overrides, which were recorded as free text in the EHRs. RESULTS: Among 14,780,519 prescriptions, 51,864 had alerts for DDIs (0.35%; 1.32% in the ED and 0.23% in the GW). The alert override rate was higher in the ED (94.0%) than in the GW (57.0%) (p < 0.001). In an analysis of the study population, including ED and GW patients, 'clinically irrelevant alert' (52.0%) was the most common reason for override, followed by 'benefit assessed to be greater than the risk' (31.1%) and 'others' (17.3%). The frequency of alert overrides was highest for anti-inflammatory and anti-rheumatic drugs (89%). In a sub-analysis of the population, 'clinically irrelevant alert' was the most common reason for alert overrides in the ED (69.3%), and 'benefit assessed to be greater than the risk' was the most common reason in the GW (61.4%). CONCLUSIONS: We confirmed that the DDI alerts and the reasons for alert overrides differed by admitting department. Different strategies may be efficient for each admitting department.

Measurement Properties of Self-report Questionnaires Published in Korean Nursing Journals

PURPOSE: The purpose of this study was to evaluate measurement properties of self-report questionnaires for studies published in Korean nursing journals. METHODS: Of 424 Korean nursing articles initially identified, 168 articles met the inclusion criteria. The methodological quality of the measurements used in the studies and interpretability were assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. It consists of items on internal consistency, reliability, measurement error, content validity, construct validity including structural validity, hypothesis testing, cross-cultural validity, and criterion validity, and responsiveness. For each item of the COSMIN checklist, measurement properties are rated on a four-point scale: excellent, good, fair, and poor. Each measurement property is scored with worst score counts. RESULTS: All articles used the classical test theory for measurement properties. Internal consistency (72.6%), construct validity (56.5%), and content validity (38.2%) were most frequently reported properties being rated as 'excellent' by COSMIN checklist, whereas other measurement properties were rarely reported. CONCLUSION: A systematic review of measurement properties including interpretability of most instruments warrants further research and nursing-focused checklists assessing measurement properties should be developed to facilitate intervention outcomes across Korean studies.

Continuous Renal Replacement Therapy in a 4-year-old Child with Rhabdomyolysis Following Parainfluenza Virus Infection and Hyperammonemia due to Isovaleric Acidemia

Parainfluenza virus infection is one of the causes of fatal rhabdomyolysis. Rhabdomyolysis can be aggravated by mitochondrial fatty acid beta-oxidation disorders during prolonged periods of fasting. Moreover, in patients with late-onset isovaleric acidemia, hyperammonemia may occur following catabolic stress. In the present report, we describe a case of a 4-year-old boy with parainfluenza virus infection and late-onset isovaleric acidemia that rapidly progressed to coma, seizures, and cardiorespiratory collapse. His serum ammonia and creatinine kinase (CK) levels were 385 microMol/L and 23,707 IU/L, respectively. Continuous renal replacement therapy (CRRT) was initiated using continuous venovenous hemodiafiltration, after which the ammonia and CK levels returned to normal. Thus, we recommend the immediate initiation of CRRT in the management of patients with life-threatening rhabdomyolysis and hyperammonemia.

Endobronchial Mycobacterium avium Infection in an Immunocompetent Patient

Although Mycobacterium avium complex (MAC) is the most common pathogen in nontuberculous mycobacterial (NTM) pulmonary diseases, endobronchial lesions caused by MAC infections are very rare even in an immunocompromised host. Herein, we describe the case of a 59-year-old, HIV-negative and non-immunocompromised woman who developed multifocal pulmonary infiltrations with endobronchial lesion caused by M. avium. Bronchoscopic examination revealed white- and yellow-colored irregular mucosal lesions in the bronchus of the left lingular division. M. avium was identified using sputum culture and bronchial washing fluid culture. Following the recommendations of the American Thoracic Society and Infectious Diseases Society of America (ATS/IDSA), the patient was begun on treatment with antimycobacterial drugs. After treatment, pneumonic infiltration decreased.

Prioritization of Research Topics of Korean Oncology Nurses

PURPOSE: The aim of this study was to determine the prioritization of research topics by Korean oncology nurses. METHODS: A descriptive and cross-sectional survey was conducted via the website of the Korean Oncology Nursing Society, with participation sought by email from all of its members. RESULTS: Overall, 'pain' and 'quality of life' were the most important among the 74 topics, 'cancer prevention' was ranked 47th, while 'informatics' and 'telehealth' were ranked 62nd and 72nd, respectively. Korean oncology nursing research needs to be expanded to include community-based cancer prevention. In addition, research on informatics and telehealth in the oncology nursing area is necessary given the current dramatic changes in the implementation of information technology in medical services. CONCLUSION: These findings may contribute toward the development of a Korean oncology nursing research agenda and the provision of information to funding agencies with respect to setting the priorities of oncology nursing research.

Factors Influencing Turnover Intention in Emergency Department Nurses / 기본간호학회지

PURPOSE: The purpose of this study was to identify the factors influencing emergency department (ED) nurses' turnover intention. METHODS: The study was conducted with 241 nurses from ED of 20 general hospitals in Busan. The survey data were collected from May 1 to July 31, 2010 and were analyzed using frequencies, percentages, means, t-test, ANOVA, Pearson correlation coefficient and stepwise multiple regression with the SPSS Win 17.0 program. RESULTS: There were statistically significant differences in turnover intention depending on age, regular change in department, and nursing experiences. A significant positive correlation was found between job stress and turnover intention and a significant negative correlation between organizational commitment and turnover intention. The significant factors influencing turnover intention were regular change in department, job stress, and organizational commitment, which explained about 13.7% of the variance. CONCLUSION: Considering this results, nursing managers should analyze these main factors which affect turnover intention and create ways to decrease turnover intentions, and thus decrease high turnover intention.

Monitoring the Use of Health-Related Quality of Life Measurements in Korean Studies of Patients with Diabetes

PURPOSE: The purpose of this study was to monitor the use of health-related quality of life (HRQOL) instruments in Korean studies of patients with diabetes. METHODS: Of 86 Korean studies initially identified, 17 studies met the inclusion criteria. For each study, a description of the instrument and its psychometric properties were monitored by the Instrument Review Criteria of the Scientific Advisory Committee. These criteria include conceptual definition, attributes, taxonomy, reliability, validity, responsiveness, administrative mode, and language adaptations. RESULTS: Five generic and one diabetes specific type questionnaires were identified from the 17 studies. Of those studies, conceptual definitions with the attributes of multi-dimension and subjectiveness were provided for 11 studies (71%). In the analysis of conceptual taxonomy, only 6 studies were classified as HRQOL, while other studies were done as QOL or health status. In monitoring of psychometric properties, reliability, validity, and responsiveness were reported for 88.2%, 64.7%, and 29.4%, respectively. One generic instrument was developed with a Korean population, while the other instruments were developed for Western countries. However, language adaptations were performed for only a few of the instruments. CONCLUSION: The psychometric properties including responsiveness of most instruments warrants further research, and the development of diabetes-specific HRQOL measurements should be sought to facilitate intervention outcomes across Korean studies of patients with diabetes.

Assessment of Anxiety using Beck's Anxiety Inventory in Patients with Vestibular Neuritis / 대한평형의학회지

BACKGROUND AND OBJECTIVES: The intimate relationship of vertigo and anxiety has been previously recognized. Anxiety may have an important influence on recovery of symptoms in vestibular neuritis (VN). The aim of study was to evaluate subjective anxiety of the pre-VN, at the time of onset of VN, and just after vestibular rehabilitation therapy (VRT) using Beck Anxiety Inventory (BAI) questionnaire, respectively. MATERIALS AND METHODS: Twenty-eight patients with VN were asked to complete the BAI and dizziness handicap inventory (DHI). Each of the BAI and DHI was scored. We also evaluated the relationship between the DHI and BAI scores. RESULTS: The VN patients at the time of attack had significantly more anxiety with vertigo and related symptoms (p<0.05). In most patients, anxiety level decreased following VRT. CONCLUSION: These findings indicate that almost every VN patients can recovery from anxiety as vertigo regressed. However, the emotional support as well as physical and/or functional rehabilitation may be required to provide a more rapid and complete return to normal daily lives for these patients.

Diffuse Alveolar Hemorrhage Subsequently Developed after Recovery from Severe Acute Lung Injury Caused by H1N1 Influenza Infection: A Case Report / 대한구급학회지

Severe acute lung injury (ALI), leading to respiratory failure caused by H1N1 infection, developed in a 34-year-old man during a work-up for non-small cell lung cancer. Although he fully recovered through instant treatment with oseltamivir, mechanical ventilation was required again, 7 days later, due to subsequent diffuse alveolar hemorrhage (DAH). Finally, his condition improved and he was able to move out of the intensive care unit. However, multiple pulmonary metastatic nodules appeared over a period of one month, suggesting the aggressive nature of lung cancer. Although he was discharged after chemotherapy, his prognosis seemed poor, considering the rapidity of growth of the lung cancer. It is important to recognize that DAH can occur after acute lung injury caused by influenza virus.

The Relationship between Job Characteristics and Organizational Commitment, and Turnover Intention in Emergency Department Nurses / 기본간호학회지

PURPOSE: This study was done to identify the relationship of emergency department(ED) nurse's job characteristics, organizational commitment and turnover intention. METHOD: This study was conducted through a survey of 171 nurses from ED in nine general hospitals of B and U cities. The data were collected by self-report questionnaires and analyzed with the SPSS WIN 17.0 program using descriptive statistics, t-test, ANOVA, Pearson correlation coefficient and stepwise multiple regression. RESULTS: The mean score for job characteristics was 3.37. Job characteristics according to position, number days night duty, and monthly income showed significant differences. Turnover intention according to age, total career, and monthly income showed significant differences. A significant positive correlation was found between job characteristics and organizational commitment. Significant negative correlations were found between job characteristics and turnover intention, organizational commitment and turnover intention were found. The significant factors influencing turnover intention were organizational commitment, monthly income, and total career, which explained 27.6% of the variance. CONCLUSION: The findings indicate that nurse managers should analyze the reasons for high turnover intention, focusing on the main factors affecting turnover intention and consider solutions for decreasing turnover intention.