Clinical Efficacy of Lacrimal Syringing under General Anesthesia

Purpose@#To compare the results of lacrimal syringing performed in clinical practice and under general anesthesia, and the clinical efficacy of lacrimal syringing under general anesthesia before endoscopic dacryocystorhinostomy and dacryoscintigraphy. @*Methods@#The study included 148 eyes of 82 patients who underwent endoscopic dacryocystorhinostomy and silicone tube intubation from August 2018 to April 2019. The patients were examined with lacrimal syringing in clinical practice and re‐examined under general anesthesia. Based on the change in lacrimal syringing, the patients were assigned to inconsistent and consistent groups. The inconsistent group was subclassified into complete (‘regurgitation’ of lacrimal syringing changes to a ‘passage’ pattern) and partial improvement groups (the degree of regurgitation improves under general anesthesia). @*Results@#Twenty (13.5%) eyes showed inconsistent results of lacrimal syringing performed in clinical practice and under general anesthesia; all showed improved passage under general anesthesia. The surgical results did not differ significantly (p = 0.336) between the consistent and inconsistent groups, but did between the complete and partial improvement groups (p < 0.01). @*Conclusions@#Lacrimal syringing under general anesthesia may enable an accurate preoperative diagnosis of the degree of obstruction. The combined results of dacryoscintigraphy and lacrimal syringing performed in clinical practice and under general anesthesia allow surgeons to evaluate the lacrimal drainage anatomy precisely and may be useful for predicting the functional success of endoscopic dacryocystorhinostomy.

Externally Monitored Versus Conventional Buried Flaps in Laryngopharyngeal Reconstruction

Objectives@#. To compare the surgical outcomes of externally monitored and conventional buried flaps with the goal of determining the usefulness of external monitoring of buried flaps. @*Methods@#. In this case-control study with propensity score matching, 30 patients were evenly divided into externally monitored buried flap and conventional buried flap groups. The total operative time for free flap reconstruction, the flap survival rate, the length of hospital stay, the initial time of a reliable visual assessment, complications, the final diet achieved, and the duration until diet initiation were compared between the groups. @*Results@#. The mean operative time for reconstruction was 115 minutes (interquartile range, 85–150 minutes) and 142 minutes (interquartile range, 95–180 minutes) in the externally monitored and conventional groups, respectively (P= 0.245). The median length of hospital stay was 24 days (interquartile range, 18–30 days) and 27 days (interquartile range, 20–41 days) in the externally monitored and conventional groups, respectively (P=0.298). The median duration until diet initiation was 15 days (interquartile range, 15–21 days) and 18 days (interquartile range, 15–34 days) in the externally monitored and conventional groups, respectively (P=0.466). The final diet, initial time of a reliable visual assessment, and complications were comparable between the groups, but the external skin paddle provided an excellent visual assessment immediately postoperatively in all cases. @*Conclusion@#. The outcomes were comparable between the groups, indicating that externalization of the cutaneous component of a buried flap may be a straightforward and useful technique for monitoring a buried anterolateral thigh free flap in laryngopharyngeal reconstructions. The salvage and false-positive rates of compromised flaps should be compared in large subject groups in future studies to prove that the use of an external skin paddle improves flap monitoring.

Alteration of MRP2 expression and the graft outcome after liver transplantation

PURPOSE: Multidrug resistance-associated protein (MRP) 2 is a glutathione conjugate in the canalicular membrane of hepatocytes. Early graft damage after liver transplantation (LT) can result in alteration of MRP2 expression. The purpose of this study was to evaluate the relationship between the pattern of MRP2 alteration and graft outcome. METHODS: Forty-one paraffin-embedded liver graft tissues obtained by protocol biopsy within 2 months after LT; these were stained using monoclonal antibodies of MRP2. We selected 15 live donor biopsy samples as a control, that showed homogenous canalicular staining for MRP2. The pattern of canalicular MRP2 staining of graft was classified into 3 types: homogenous (type C0), focal (type C1), and no (type C2,) staining of the canaliculi. RESULTS: In total, 17.1% graft tissues were type C0, 36.6% were type C1, and 46.3% were type C2. The median operation time was longer in patients with type C2 (562.6 minutes) than in patients with type C0 (393.8 minutes) (P = 0.038). The rates of posttransplant complications were higher in patients with type C2 (100%) than in patients with type C0 (42.9%) and C1 (73.3%) (P < 0.001). CONCLUSION: MRP2 expression pattern was altered in 82.9% after LT. The pattern of MRP2 alteration was associated with longer operation time and higher rates of post-LT complications.

A Structural Equation Model on Korean Adolescents' Excessive Use of Smartphones

PURPOSE: Authors develop a unified structural model that defines multirelationships between systematic factors causing excessive use of smartphones and the corresponding results. METHODS: A survey was conducted with adolescents who live in Seoul, Pusan, Gangneung, Donghae, and Samcheok from February to March 2016. Authors used SPSS, version 22.0, and AMOS, version 22.0, to analyze the survey results at a .05 significance level. To investigate demographic characteristics of the participants and their variations, descriptive analysis was used. The maximum likelihood estimate method was adopted to verify the fitness of the hypothetical model and the hypotheses therein. Authors used χ² statistics, goodness-of-fit index, adjusted goodness-of-fit index, comparative fit index, normed fit index, incremental fit index, root mean square residual, and root mean square error of approximation to verify the fitness of our structural model. RESULTS: (1) The proposed structural model demonstrated a fine fitness level. (2) The proposed structural model could describe the excessive use of a smartphone with 88.6% accuracy. (3) The absence of the family function and relationship between friends, impulsiveness, and low self-esteem were confirmed as key factors that cause an excessive use of smartphones. (4) Furthermore, impulsiveness and low self-esteem are closely related to the absence of family functions and relations between friends by 68.3% and 54.4%, respectively. CONCLUSION: Authors suggest that nursing intervention programs from various angles are required to reduce adolescents' excessive use of smartphones. For example, family communication programs would be helpful for both parents and children. Consultant programs about relationships with friends would also be helpful.

Surgery versus Nerve Blocks for Lumbar Disc Herniation : Quantitative Analysis of Radiological Factors as a Predictor for Successful Outcomes

OBJECTIVE: To assess the clinical and radiological factors as predictors for successful outcomes in lumbar disc herniation (LDH) treatment. METHODS: Two groups of patients with single level LDH (L4–5) requiring treatment were retrospectively studied. The surgery group (SG) included 34 patients, and 30 patients who initially refused the surgery were included in the nerve blocks group (NG). A visual analogue scale (VAS) for leg and back pain and motor deficit were initially evaluated before procedures, and repeated at 1, 6, and 12 months. Radiological factors including the disc herniation length, disc herniation area, canal length-occupying ratio, and canal area-occupying ratio were measured and compared. Predicting factors of successful outcomes were determined with multivariate logistic regression analysis after the optimal cut off values were established with a receiver operating characteristic curve. RESULTS: There was no significant demographic difference between two groups. A multivariate logistic regression analysis with radiological and clinical (12 months follow-up) data revealed that the high disc herniation length with cutoff value 6.31 mm [odds ratio (OR) 2.35; confidence interval (CI) 1.21–3.98] was a predictor of successful outcomes of leg pain relief in the SG. The low disc herniation length with cutoff value 6.23 mm (OR 0.05; CI 0.003–0.89) and high baseline VAS leg (OR 12.63; CI 1.64–97.45) were identified as predictors of successful outcomes of leg pain relief in the NG. CONCLUSION: The patients with the disc herniation length larger than 6.31 mm showed successful outcomes with surgery whereas the patients with the disc herniation length less than 6.23 mm showed successful outcomes with nerve block. These results could be considered as a radiological criteria in choosing optimal treatment options for LDH.

Sickness Experiences of Korean Registered Nurses at Work: A Qualitative Study on Presenteeism

PURPOSE: Presenteeism is a relatively new concept in nursing describing the condition within which registered nurses (RNs) come to work while they are sick. The purpose of this study was to explore and describe presenteeism experiences among RNs in South Korea. METHODS: In this constructivist grounded theory study, a focus group interview (FGI) technique was utilized for data collection. A total of 20 RNs at one hospital in Chuncheon city joined in three different FGIs. Semistructured questions were asked in reference to their sickness experience in the workplace. Data analysis was conducted according to the constructivist grounded theory methodology. RESULTS: All participants had experiences of presenteeism. The overriding theme was "having no caring for nurses leads to losing one's nursing mind". The participants reported that due to either their personal preference or peer pressure they showed up to work, but they felt sad and their pride was hurt by the fact that there was no caring for them from other nurses. This emotional exhaustion often led to the loss of compassion and the resignation of nursing staff. CONCLUSIONS: Care for nurses in the workplace is necessary for RNs to make their presenteeism experience positive and even effective.

Safety of reduced dose of mycophenolate mofetil combined with tacrolimus in living-donor liver transplantation

BACKGROUND/AIMS: The dose of mycophenolate mofetil (MMF) has been reduced in Asia due to side effects associated with the conventional fixed dose of 2-3 g/day. We aimed to determine the pharmacokinetics of a reduced dose of MMF and to validate its feasibility in combination with tacrolimus in living-donor liver transplantation (LDLT). METHODS: Two sequential studies were performed in adult LDLT between October 2009 and 2011. First, we performed a prospective pharmacokinetic study in 15 recipients. We measured the area under the curve from 0 to 12 hours (AUC0-12) for mycophenolic acid at postoperative days 7 and 14, and we performed a protocol biopsy before discharge. Second, among 215 recipients, we reviewed 74 patients who were initially administered a reduced dose of MMF (1.0 g/day) with tacrolimus (trough, 8-12 ng/mL during the first month, and 5-8 ng/mL thereafter), with a 1-year follow-up. We performed protocol biopsies at 2 weeks and 1 year post-LDLT. RESULTS: In the first part of study, AUC0-12 was less than 30 mgh/L in 93.3% of cases. In the second, validating study, 41.9% of the recipients needed dose reduction or cessation due to side effects within the first year after LDLT. At 12 months post-LDLT, 17.6% of the recipients were administered a lower dose of MMF (0.5 g/day), and 16.2% needed permanent cessation due to side effects. The 1- and 12-month rejection-free survival rates were 98.6% and 97.3%, respectively. CONCLUSIONS: A reduced dose of MMF was associated with low blood levels compared to the existing recommended therapeutic range. However, reducing the dose of MMF combined with a low level of tacrolimus was feasible clinically, with an excellent short-term outcome in LDLT.

Splenectomy affects the balance between hepatic growth factor and transforming growth factor-beta and its effect on liver regeneration is dependent on the amount of liver resection in rats / 대한외과학회지

PURPOSE: Small-for-size syndrome (SFSS) is a major problem in liver surgery, and splenectomy has been used to prevent SFSS. However, it is unknown whether splenectomy has the same effect on liver regeneration in both standard and marginal hepatectomy. The aim of this study is to see a difference in effect of splenectomy on liver regeneration according to the amount of liver resection. METHODS: Thirty male Sprague-Dawley rats (220 to 260 g) were divided into the following five groups: control (n = 6), 70% hepatectomy (n = 6), 70% hepatectomy with splenectomy (n = 6), 90% hepatectomy (n = 6), and 90% hepatectomy with splenectomy (n = 6). The animals were euthanized 24 hours after surgery and liver specimens were obtained. To assess liver regeneration, we performed immunohistochemistry of liver tissue using 5-bromo-2-deoxyuridine (BrdU) labeling and Western blot analysis of hepatic growth factor (HGF) and transforming growth factor-beta (TGF-beta) in the liver tissue. RESULTS: The splenectomized subgroup had a higher BrdU-positive cell count in the 90% hepatectomy group, but not in the 70% hepatectomy group (P < 0.001). Splenectomy significantly decreased TGF-beta expression (P = 0.005) and increased the HGF to TGF-beta ratio (P = 0.002) in the 90% hepatectomy group, but not in the 70% hepatectomy group. CONCLUSION: The positive effect of splenectomy on liver regeneration was greater in the group with the larger liver resection. This phenomenon may be related to the relative balance between HGF and TGF-beta in the liver.

Changes in Stress Hormone, Lymphocytes, and Neutrophils Related to Examination and Social Support in University Students / 성인간호학회지

PURPOSE: The purpose of the study was to identify levels of anxiety, stress hormone, lymphocytes, and neutrophils of the nursing students before an examination and to examine effects of social support on those variables related to taking examinations. METHODS: Thirty eight healthy nursing students participated. They completed the questionnaire including state anxiety, test anxiety (VAS scale) and social support two weeks before the exam and again just before the exam. Simultaneously, a venous sample for ACTH, cortisol, lymphocytes & neutrophils count was drawn by a trained nurse. Descriptive statistics, paired t-test, student t-test, and Pearson's correlation with SPSS/WIN 14.0 were used to analyze the data. RESULTS: Test anxiety scores and cortisol level on the exam day showed a significant increment compared with those on the non-exam day. The participants with higher levels of total social support scores showed significantly lower state anxiety on the exam day than those with lower levels of total social support scores. CONCLUSION: These data indicate a possible alteration in cortisol responsiveness to academic stress in nursing students. Social support would play an important role in modulation of academic stress.

The Change of HBV DNA Titer after Hepatic Resection in Hepatitis B Patients with Hepatocelluar Carcinoma

PURPOSE: Reactivation of hepatitis B virus (HBV) replication after hepatic resection might be a significant risk factor for prognosis in patients with chronic hepatitis B. The purpose of the present study was to investigate the changing pattern of serum HBV DNA titer after hepatic resection and to assess the incidence of reactivation of HBV replication. METHODS: Among HBV-positive patients who underwent hepatic resection for hepatocellular carcinoma, thirty-six patients with preoperative serum HBV DNA titer > or =3 log(10)copies/mL were enrolled. Serum DNA titers were examined before the operation, on the second and seventh postoperative days, and one month after the operation. RESULTS: The serum DNA titer decreased on the second postoperative day (p=0.078). The DNA level, however, had substantially returned to preoperative values by the seventh postoperative day (p<0.001). For most patients, the postoperative DNA titer reached its zenith on the seventh postoperative day or one month after the operation. The zenith level was higher (by 0.49+/-0.25 log10copies/mL) than preoperative levels although this difference just missed significance (p=0.068). Although postoperative reactivation of HBV replication emerged in 6 patients, only one of those patients developed postoperative hepatitis. Overall, four patients developed postoperative hepatitis and all of them had high postoperative HBV DNA levels (over 6 log(10)copies/mL). CONCLUSION: Although serum HBV DNA titers tended to increase postoperatively, routine antiviral therapy might be unnecessary because of the low incidence of postoperative hepatitis. High postoperative DNA levels, however, might be a risk factor for hepatitis, and postoperative follow-up of serum HBV DNA levels might be necessary in HBV-positive patients with hepatic resection.

Pulmonary Artery Embolotherapy in a Patient with Type I Hepatopulmonary Syndrome after Liver Transplantation

Although liver transplantation (LT) is the only effective treatment option for hepatopulmonary syndrome (HPS), the post-LT morbidity and mortality have been high for patients with severe HPS. We performed post-LT embolotherapy in a 10-year-old boy who had severe type I HPS preoperatively, but he failed to recover early from his hypoxemic symptoms after an LT. Multiple embolizations were then successfully performed on the major branches that formed the abnormal vascular structures. After the embolotherapy, the patient had symptomatic improvement and he was discharged without complications.

Liver Transplantation Using Non-Heart Beating Donor: The First Korean Case Report / 대한이식학회지

A liver originating from Maastricht category 4 non-heart-beating donor (NHBD: cardiac death in a brain death donor) was procured and transplanted. Donor was 46 years old female. She was moved to the operation room after 3 times of cardiopulmonary resuscitation. Arrest occurred 15 minutes after stopping ventilation. After 5 min waiting time, the incision was performed. The interval between incision and initiation of donor perfusion was 5 minutes. Warm ischemic time, which is from the withdrawal of support to perfusion, was 25 minutes. Super-rapid technique was used for the donor procedure. The frozen biopsy of the liver was performed before transplantation and macrovesicular and microvesicular fatty change were less than 5% respectively. The cold ischemic time was 6 hours 22 minutes. Orthotopic liver transplantation was performed with the preservation of the recipient caval vein without venovenous bypass. The recipient was 56 years old female. She suffered from cryptogenic liver cirrhosis with refractory ascites. Postoperatively, the early graft function was good. At the post-operative 10th day, Serum total bilirubin was 1.4 mg/dL and aspartic acid transaminase and alanine aminotransferase was 26 IU/L and 20 IU/L respectively. Post operative 10th day liver biopsy was normal. She stayed at the intensive care unit for 6 days. Post-operatively, Tuberculosis (Tb) peritonitis (by the intra-operative omentum tissue culture) was diagnosed and the patient is under Tb medication. This experience suggests that careful donor selection, minimizing warm and cold ischemic time and utilization of histology provide acceptable results of liver transplantation from NHBD.

Experiences of Interpersonal Relationships among Head Nurses in General Hospital Settings / 성인간호학회지

PURPOSE: The purpose of this study was to understand the experiences of interpersonal relationships of head nurses in interacting with others in general hospital settings. METHODS: The data were collected by individual in-depth interviews from seven head nurses and were analyzed using qualitative content analysis. RESULTS: Five major categories emerged and they represent a major strategy according to five different groups of interacting people. 'Establishing trust' was identified as the key strategy in dealing with patients and family members. 'Embracing with sisterly love' and 'helping with self-defense' were major strategies for subordinate nurses and physicians, respectively. 'Respecting and recognizing' was the main approach for other professionals such as dietitians and 'emphasizing rules and educating' were a major one for non-professionals. Head nurses paid more attention and made efforts in dealing with their subordinate nurses than with other groups of people, because they felt the most difficulty in their relationship with subordinate nurses. CONCLUSION: The results of the study showed that head nurses employ unique strategies in interacting with different groups of people to increase the efficiency of communication. This study would help nurse administrators establish an effective program for improving interpersonal relationships of head nurse.

Incidental Intraductal Papillary Mucinous Neoplasms(IPMN) of the Pancreas after Liver Transplantation

PURPOSE: The incidence and risk of malignancy are elevated in solid organ transplant recipients compared to persons in the general population. Epidemiological data reveal that the length of exposure to immunosuppressive therapy and the intensity of therapy are clearly related to the post-transplant risk of malignancy. The purpose of this study was to investigate the course of incidental intraductal papillary mucinous neoplasms (IPMN) of the pancreas after liver transplantation. METHODS: We retrospectively reviewed the medical records of 17 patients with IPMNs of the pancreas who underwent liver transplantation between January 2000 and December 2006. The mean follow-up duration was 29.6 +/- 22.8 months. RESULTS: The mean patient age was 55.2 +/- 7.2 years, and the male to female ratio was 14:3. All patients had branch duct type IPMNs. The lesions were located principally in the head (64.7%) and body (52.9%) of the pancreas. The mean tumor size was 13.0 +/- 6.2 mm. There were no newly developed symptoms associated with these lesions, and none of the lesions enlarged during the follow-up period. No patients underwent surgical resection of their lesions. CONCLUSION: The course of each of the incidental small IPMNs of the pancreas was uneventful for more than 2 years after liver transplantation. Therefore, patients with incidental small IPMNs of the pancreas are not immediate candidates for surgical pancreas resection. However, a longterm follow-up study with a larger sample size will be required to establish treatment guidelines in immunosuppressed patients.

The Life of Elderly Women Living Alone

PURPOSE: This study aimed to uncover the fundamental nature of living alone in female elderly. METHODS: The phenomenological research approach developed by van Manen was adopted. RESULTS: The theme was 'taking a firm stand alone on the edges of life'. The composition elements of living alone experienced by elderly women were as follows: 1) Corporeality: participants perceived their bodies by their health status. Unhealthy participants were suffering with diseases and dependant on other persons, while healthy participants were free from family responsibility and kept on moving. 2) Spatiality: participants felt both freedom and loneliness while they stayed home. 3) Relationality: participants felt pity and yearning for their bereaved husband and sometimes talked to his picture. According to their children's filial piety, participants were pleased or displeased. However, they incessantly devoted themselves to their children. 4) Temporality: participants considered the rest of their life as extra-time which was proceeding to death, and tried to keep themselves busy before they died. CONCLUSION: A nurse should understand the multifarious aspects of elderly women's life, and then intervene to consolidate their strengths for self-supporting the final years of life.

Melittin-induced Nociceptive Responses are Alleviated by Cyclooxygenase-1 Inhibitor

Melittin-induced pain model has been known to be very useful for the study of pain mechanism. Melittin-induced nociceptive responses are reported to be modulated by the changes in the activity of excitatory amino acid receptor, calcium channel, spinal serotonin receptor and extracellular signaling-regulated kinase. The present study was undertaken to investigate the role of cyclooxygenase (COX) in the melittin-induced nociception. Changes in mechanical threshold, flinchings and paw thickness were measured before and after intraplantar injection of melittin in the rat hind paw. Also studied were the effects of intraperitonealy administered diclofenac (25 mg & 50 mg/kg), piroxicam (10 mg & 20 mg/kg) and meloxicam (10 mg & 20 mg/kg) on the melittin-induced nociceptions. Intraplantar injection of melittin caused marked reduction of mechanical threshold that was dose-dependently attenuated by non-selective COX inhibitor (diclofenac) and selective COX-1 inhibitor (piroxicam), but not by COX-2 inhibitor (meloxicam). Melittin-induced flinchings were strongly suppressed by non-selective COX and COX-1 inhibitor, but not by COX-2 inhibitor. None of the COX inhibitors had inhibitory effects on melittin-induced increase of paw thickness (edema). These experimental findings suggest that COX-1 plays an important role in the melittin-induced nociceptive responses.

Vertebroplasty in the Treatment of Osteoporotic Compression Fracture: More Than 1 Year Follow Up

PURPOSE: To assess the clinical and functional outcome of the patients who underwent percutaneous vertebroplasty with bone cement for the osteoporotic compression fracture and who had been followed up for minimum 1 year. MATERIALS AND METHODS: Among 110 patients who had been undergone percutaneous vertebroplasty with bone cement for osteoporotic compression fracture in Gangneung Asan Hospital from January 2001 to August 2002, 75 patients who had been followed up for more than 1 year were selected. And retrospectively, we analyzed the clinical and radiographic finding of 1 year, 2 year and 3 year follow-up. The patients were divided into 3 groups, the first group who have follow-up period of the from 1 to 2 years had 75 patients, the second group who the from 2 to 3 years, 49 patients, and the third group who the more than 3 years, 20 patients. We graded the clinical results to excellent, good, normal, fair and poor. Also, we assessed the height of vertebral body, the adjacent vertebral body fracture and the leakage of bone cement. RESULTS: 74 patients (98.6%) had the excellent or good results postoperatively. 69 patients (92%) of the first group, 46 patients (93.8%) of the second group and 16 patients (80%) of the third group had excellent or good results at last follow-up. There was no statistical correlation of each groups (p>0.05). In first group, the average height of body was 71.1% preoperatively, 73.5% postoperatively and 73.5% at follow-up. In second group, 71.5%, 75.5%, and 73.1%. In third group, 71.2%, 78.0% and 77.8%. There was no significant statistical correlation of each groups (p>0.05). 47cases (38.8%) had some leakage of cement immediate postoperatively. In 4 cases (7 vertebra), there were adjacent vertebral body fractures. CONCLUSION: Based on the results of our study, percutaneous vertebroplasty is a useful method in the treatment for the osteoporotic compression fracture of vertebra body.