RESUMO
BACKGROUND: Research on next-generation sequencing (NGS)-based HLA typing is active. To resolve the phase ambiguity and long turn-around-time of conventional high resolution HLA typing, this study developed a NGS-based high resolution HLA typing method that can handle large-scale samples within an efficient testing time. METHODS: For HLA NGS, the condition of nucleic acid extraction, library construction, PCR mechanism, and HLA typing with bioinformatics were developed. To confirm the accuracy of the NGS-based HLA typing method, the results of 192 samples HLA typed by SSOP and 28 samples typed by SBT compared to NGS-based HLA-A, -B and -DR typing. RESULTS: DNA library construction through two-step PCR, NGS sequencing with MiSeq (Illumina Inc., San Diego, USA), and the data analysis platform were established. NGS-based HLA typing results were compatible with known HLA types from 220 blood samples. CONCLUSION: The NSG-based HLA typing method could handle large volume samples with high-throughput. Therefore, it would be useful for HLA typing of bone marrow donation volunteers.
Assuntos
Medula Óssea , Biologia Computacional , Biblioteca Gênica , Teste de Histocompatibilidade , Antígenos HLA-A , Métodos , Reação em Cadeia da Polimerase , Estatística como Assunto , VoluntáriosRESUMO
OBJECTIVES: The aim of this study was to develop nursing practice guidelines and algorithms for the pre- and postoperative care of gastric cancer patients. METHODS: The guidelines and algorithms were developed based on a literature review and subject-matter experts' knowledge. The usefulness and applicability of the developed guidelines and algorithms were evaluated by the expert group. RESULTS: The guidelines comprised 64 recommendations and algorithms for admission care, preoperative care on the day before the operation, preoperative care on the operation day, immediate postoperative assessment, postoperative care, and discharge care of gastric cancer patients. After appropriate evaluation, the experts declared the guidelines to be both useful and applicable. CONCLUSIONS: The guidelines developed in this study can be used for patient care and for training nursing students and novice nurses. In addition, these guidelines can be integrated into the electronic nursing record system for clinical decision support in the future. This will improve the quality of clinical nursing and the expertise of nurses.
Assuntos
Humanos , Eletrônica , Elétrons , Registros de Enfermagem , Assistência ao Paciente , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Neoplasias Gástricas , Estudantes de EnfermagemRESUMO
PURPOSE: The aim of this project was to develop a patient safety-focused inservice education program for surgical nurse and to test the effects of this program. METHODS: Methodological designs for instruments development, a pretest-posttest and a posttest design were employed. After the education, nurses' satisfaction, confidence, usefulness and application of 137 nurses were evaluated at 15 surgical units of a tertiary teaching hospital in Seoul, Korea. The education contents are 6 skill areas (infusion pump use, suction, chest tube drainage, oxygen administration, nebulizer use, insulin administration) and medication knowledge. Teaching methods were lecture, instructor demonstration, and 1:1 skill test. Descriptive statistics, Wilcoxon test, Spearman's correlation and Stepwise regression were used. RESULTS: Satisfaction scores for skills and medication education were 4.00-4.21 (out of 5). The more performance frequency in 6 skills, the higher score in confidence as well as in usefulness and application, and the higher satisfaction with the program, the higher score in usefulness, application, confidence, and medication knowledge. Medication knowledge improved after the education (Z=-7.757, p<.001). Significant predictors of skill confidence were application of skills in job performance, medication confidence, and career in present unit. CONCLUSION: The results of this study suggest that systematic and continuous inservice education will improve patient safety by promoting nursing quality.
Assuntos
Humanos , Tubos Torácicos , Drenagem , Hospitais de Ensino , Capacitação em Serviço , Insulina , Coreia (Geográfico) , Nebulizadores e Vaporizadores , Oxigênio , Segurança do Paciente , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Sucção , EnsinoRESUMO
PURPOSE: This study was to identify behaviors preventing the recurrence of breast cancer and the level of quality of life. METHODS: This descriptive study was conducted using a structured questionnaire from November 1, 2006 to December 25, 2006 . One hundred and twenty two women breast cancer survivors were recruited by convenience sampling. RESULTS: The most frequent behavior for preventing recurrence of the breast cancer was dietary treatment (90.9%) and exercise (86.8%) was the second behavior. In addition, most of them perceived these behaviors as 'very effective' (82.8%). The degree of the quality of life of a breast cancer survivor was 5.34 point indicating a 'medium level'. CONCLUSION: Breast cancer survivors pursued various behaviors for preventing recurrence of breast cancer. Therefore, the nursing interventions should be focused on a systematic educational approach considering healthy behaviors to prevent breast cancer recurrence for breast cancer survivors.
Assuntos
Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Adaptação Psicológica , Neoplasias da Mama/prevenção & controle , Interpretação Estatística de Dados , Demografia , Suplementos Nutricionais , Terapia por Exercício , Comportamentos Relacionados com a Saúde , Estilo de Vida , Recidiva Local de Neoplasia/prevenção & controle , Qualidade de Vida , Inquéritos e Questionários , Recidiva , Sobreviventes/psicologiaRESUMO
BACKGROUND: TGF-beta is involved in the pathogenesis of various kidney diseases characterized by glomerulosclerosis and tubulointerstitial fibrosis. It is reported that urinary TGF-beta reflects the grade of interstitial fibrosis in glomerular disease. Here, we evaluated the relationship between the histological findings and beta ig-h3 in IgA nephropathy. METHODS: In patients with IgA nephropathy, we measured blood pressure (BP), serum creatinine, 24-hour urinary protein excretion (UTp), creatinine clearance (Ccr), serum and urine beta ig-h3 levels, and urine TGF-beta levels at the time of renal biopsy. Histologic findings were semiquantitively scored according to the extent of glomerulosclerosis (GG), tubulointerstitial fibrosis (TIG) and hyaline arteriolosclerosis (HA) by the criteria suggested by To. Semiquantitive scoring of immunohistochemistry for beta ig-h3 was done. RESULTS: Mean BP 95.4+/-14.5 mmHg, serum creatinine 1.06+/-0.35 mg/dL, 24-hour UTp 1, 423+/-1, 439 mg/day, and Ccr was 97.84+/-59.73 mL/min. The number of patients that showed GG 3 were 5, GG 2 was 1, GG 1 were 12. And, the number of patients that showed TIG 3 were 2, TIG 2 were 5, TIG 1 were 11. HA was shown in 4 patients. beta ig-h3 immunostaining was observed in glomerular Bowman's capsules and basement membrane of proximal tubules. The degree of beta ig-h3 immunostaining was positively correlated with the degree of glomerulosclerosis (r=0.72, p<0.001), interstitial fibrosis (r=0.91, p<0.001), serum creatinine (r=0.592, p<0.05) and Ccr (r=-0.626, p<0.05), but not with 24-hour UTp. Serum and urine beta ig-h3 levels did not correlate with any of these parameters. CONCLUSION: Renal beta ig-h3 expression in patients with IgA nephropathy may be related to glomerulosclerosis and interstitial fibrosis. However, urinary beta ig-h3 levels did not represent the pathologic changes of IgA nephropathy. Long-term study to measure renal beta ig-h3 expression and urinary beta ig-h3 is required to elucidate the roles of beta ig-h3 in IgA nephropathy.
Assuntos
Humanos , Arteriolosclerose , Membrana Basal , Biópsia , Pressão Sanguínea , Cápsulas , Creatinina , Fibrose , Glomerulonefrite por IGA , Hialina , Imunoglobulina A , Imuno-Histoquímica , Nefropatias , Fator de Crescimento Transformador beta , Uridina TrifosfatoRESUMO
PURPOSE: To investigate audiometery and characteristics related to tinnitus in tinnitus patients. and to understand the relationship between the discomfort of tinnitus and the quality of life. Methods: The subjects were 110 patients with tinnitus. The data were collected using tinnitus handicap questionnaire. quality of life, and pure tone audiometry, which measured hearing level in dB and frequency in Hz matching of tinnitus. RESULTS: Majority of tinnitus patients (75.5%~81.8%) had normal auditory sensation. but 82.7% of patients indicated that they have heard tinnitus frequently. or always, and the major sounds of tinnitus were wing, wung, wang, The matching sounds of tinnitus had various range in hearing level(dB) and frequency(Hz). Tinnitus patients reported moderate levels of the discomfort of tinnitus and the quality of life, and there were negative correlation between the discomfort of tinnitus and the quality of life(r=-.314, p .00l). CONCLUSION: These findings suggest that special attention is needed for tinnitus patients because the physical. psychological. and social impacts of tinnitus could be decrease their quality of life, Specialized nursing intervention considering specific conditions related to tinnitus is required to solve various health problems of tinnitus patients.
Assuntos
Humanos , Audiometria , Audição , Enfermagem , Qualidade de Vida , Inquéritos e Questionários , Sensação , Mudança Social , ZumbidoRESUMO
PURPOSE: This study was conducted to suggest direction and strategy of safety education proper to elementary school children. METHOD: The subject of this survey consisted of 313 3rd-5th grade from 4 elementary schools in Kyungi-Do and Kwangwon-Do. Data were collected from March to May, 2002 using a questionnaire about "safety education needs", "knowledge about injury prevention", "attitude about injury prevention. RESULT: 1. The degree of safety education needs showed averaged 77.50 on the basis of 100 points. 2. The degree of knowledge and attitude about injury prevention showed averaged 72.81 and 81.74 seperately on the basis of 100 points. 3. With the respect to the demographic characteristics, there were stastically significant differences in safety education need according to children's grade(F=8.692, p=.003), sex(t=-2.059, p=.040), family type(t=-2.229, p=.027) and in knowledge & attitude about injury prevention, there statiscally significant difference according to experience of injury prevention education(t=3.058, p=.003; t=5.308, p=.000) each. 4. The level of safety education needs is correlated at signficant level with knowledge and attitude about injury prevention of childrens(r=.166, p=.048; r=.265, p=.001) and between knowledge and attitude about injury prevention, there was significant correlation (r=.427, p=.000). CONCLUSION: From this results, nurses can plan safety education program appropriate to children's needs, level of knowledge and attitude about injury prevention.
Assuntos
Criança , Humanos , Educação , Saúde da Criança , Inquéritos e QuestionáriosRESUMO
A 61-year old female presented with intermittent abdominal pain. Further examination showed an pelvic mass, partially obstructing the sigmoid colon. A search of the past medical records revealed that a primary low-grade ESS of the uterus had been treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy 10 years earlier. Surgical resection was performed under suspicion of recurrent ESS and subsequent pathologic examination of the tumor mass specimen established the recurrent LGSS and free resection margin. Then she has been treated with megestrol acetate and doing well for about 1 year since the surgical resection of the pelvic mass.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Dor Abdominal , Colo Sigmoide , Histerectomia , Prontuários Médicos , Acetato de Megestrol , Recidiva , Sarcoma do Estroma Endometrial , ÚteroRESUMO
Glucagonomas are rare pancreatic tumors of islet ahpha-2 cells. Less than 430 cases have been reported worldwide and 210 cases are malignant tumors. In generally, the tumors typically present with a characteristic constellation of symptoms including necrolytic migratory erythema of the skin, weight loss, non-insulin-dependent diabetes mellitus, anemia, cheliosis, stomatitis, and an increased thrombotic tendency. Since pancreatic glucagonomas are predominantly located in the tail and findings of radiographic or sonographic examination can remain unspecific, patients often present already metastasis when diagnosis is first established, and can be difficult to differentiate from the other pancreatic tumors. We report the case of a 59-year-old woman with an malignant glucagonoma of the pancreas infiltrating already the spleen and presenting metastatic lesion in perirenal lymph nodes, and that the tumor was not assocated with the characteristic skin rash. The pateint with a past history of a diabetes mellitus and hypertension for 9 years was admitted with cramp-like left lower abdominal pain, watery diarrhea, and nausea. A solid tumor of tail of the pancreas revealed by ultrasonography and abdominal computed tomography and distal pancreatectomy, radical nephrectomy, and splenectomy were performed. Immunohistochemial examination of the tumor did show glucagon-reactive tissue and electron microscopy revealed many secretory granules, 180 to 300 nm in diameter in granulated cells. After pancreatic tumor resection, the patient had normalization of plasma glucagon and blood sugar.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Dor Abdominal , Adenoma de Células das Ilhotas Pancreáticas , Anemia , Glicemia , Diabetes Mellitus , Diabetes Mellitus Tipo 2 , Diagnóstico , Diarreia , Exantema , Glucagon , Glucagonoma , Hipertensão , Linfonodos , Microscopia Eletrônica , Náusea , Eritema Migratório Necrolítico , Metástase Neoplásica , Nefrectomia , Pâncreas , Pancreatectomia , Plasma , Vesículas Secretórias , Pele , Baço , Esplenectomia , Estomatite , Cauda , Ultrassonografia , Redução de PesoRESUMO
Cyclosporin A (CsA)-induced hyperkalemia is caused by alterations in transepithelial K(+) secretion resulting from the inhibition of renal tubular Na(+), K(+) -ATPase activity. Thyroxine enhances renal cortical Na(+), K(+) -ATPase activity. This study investigated the effect of thyroxine on CsA-induced hyperkalemia. Sprague-Dawley rats were treated with either CsA, thyroxine, CsA and thyroxine, or olive-oil vehicle. CsA resulted in an increase in BUN and serum K(+), along with a decrease in creatinine clearance, fractional excretion of potassium, and renal cortical Na(+), K(+) -ATPase activity, as compared with oil vehicle administration. Histochemical study showed reduced Na(+), K(+) -ATPase activity in the proximal tubular epithelial cells of the CsA-treated compared with the oil-treated rats. Histologically, isometric intracytoplasmic vacuolation, disruption of the arrangement and swelling of the mitochondria, and a large number of lysosomes in the tubular epithelium were characteristic of the CsA-treated rats. Co-administration of thyroxine prevented CsA-induced hyperkalemia and reduced creatinine clearance, Na(+), K(+) -ATPase activity, and severity of the histologic changes in the renal tubular cells when compared with the CsA-treated rats. Thyroxine increased the fractional excretion of potassium via the preservation of Na(+), K(+) -ATPase activity in the renal tubular cells. Thus, the beneficial effects of thyroxine may be suited to treatment modalities for CsA-induced hyperkalemia.
Assuntos
Animais , Masculino , Ratos , Ciclosporina/antagonistas & inibidores , Hiperpotassemia/induzido quimicamente , Imunossupressores/antagonistas & inibidores , Córtex Renal/efeitos dos fármacos , Microssomos/enzimologia , Potássio/sangue , Ratos Sprague-Dawley , ATPase Trocadora de Sódio-Potássio/metabolismo , Tiroxina/farmacologiaRESUMO
A fifty year old Korean female was admitted with a few months history of general malaise. On admission, positive HBs Ag, negative HBs Ab and HBe Ag was negative. The liver function tests showed AST 274 U/L, ALT 126 U/L, CEA 1.87 ng/ml. With the clinical impression of chronic hepatitis B, abdominal CT and ERCP were performed and demonstrated a narrowing of the distal common bile duct suggesting a malignant etiology. The Whipple's procedure was done. The intraoperative finding revealed neoplastic involvement of the distal 1 cm of the common bile duct with severe narrowing and proximal dilatation. Microscopic findings demonstrated cystically dilated ductular structures and intervening irregular hypertrophic smooth muscle bundles.
Assuntos
Feminino , Humanos , Adenomioma , Colangiopancreatografia Retrógrada Endoscópica , Ducto Colédoco , Dilatação , Hepatite B Crônica , Testes de Função Hepática , Músculo Liso , Tomografia Computadorizada por Raios XRESUMO
Adrenal myelolipomas are rare benign tumors consisting of mature fat and hematopoietic elements resembling bone marrow. Due to the frequent use of ultrasound and computerized tomography their presence is now more frequently discovered. Although these tumors are usually asymptomatic and only found incidentally at autopsy, they can cause local symptomes or hemorrhage requiring surgical excision. We present the case of a large surgically and histologically confirmed, adrenal myelolipoma with retroperitoneal hemorrhage due to spontaneous rupture in a 32-year old man.
Assuntos
Glândulas Suprarrenais , Autopsia , Medula Óssea , Hemorragia , Mielolipoma , Ruptura Espontânea , UltrassonografiaRESUMO
Adrenal myelolipomas are rare benign tumors consisting of mature fat and hematopoietic elements resembling bone marrow. Due to the frequent use of ultrasound and computerized tomography their presence is now more frequently discovered. Although these tumors are usually asymptomatic and only found incidentally at autopsy, they can cause local symptomes or hemorrhage requiring surgical excision. We present the case of a large surgically and histologically confirmed, adrenal myelolipoma with retroperitoneal hemorrhage due to spontaneous rupture in a 32-year old man.
Assuntos
Glândulas Suprarrenais , Autopsia , Medula Óssea , Hemorragia , Mielolipoma , Ruptura Espontânea , UltrassonografiaRESUMO
In diabetic and diabetic renal failure patients on continuous ambulant peritoneal dialysis(CAPD) treatment, the peritoneal membrane and vascular beds are continuously exposed to the high glucose concentration contained in the dialysate and blood. This may lead to the local generation of advanced glycosylated end-products(AGEs), formed from nonenzymatic glycation of proteins and lipids with reducing sugars and have been implicated in many diabetic complications. AGEs is cross linked to the circulating proteins resulting in peritoneal dysfunction and vascular thickening. To elucidate the deposition of AGEs in diabetic rats(n=10) induced by streptozotocin(STZ, 75mg/kg) injection via tail vein and those of age-matched control rats(n=10), peritoneums were examined light microscopically and immunohistochemically with monoclonal antibody specific for AGEs after 5 weeks of disease. Histologically, the peritoneum of the STZ diabetic rats showed mild interstitial fibrosis and no mesothelial alteration, vascular proliferation, compared with age-matched, non-diabetic control group. Immunohistochemical staining with AGEs demonstrated that weakly accumulation in the submesothelial layer, but it was not different from comparison with control group. We speculate that the peritoneum of the STZ-induced diabetic rat did not stain with monoclonal antibody against AGEs after 5 weeks of disease, but long-term experiments may demonstrate significant functional and morphological alterations of peritoneum.
Assuntos
Animais , Humanos , Ratos , Carboidratos , Complicações do Diabetes , Fibrose , Glucose , Membranas , Peritônio , Insuficiência Renal , Estreptozocina , VeiasRESUMO
A spontaneous rupture into the sigmoid colon and peritoneal cavity is a most unusual complication for a mature cystic teratoma of the ovary. A 38-year-old woman with acute lower abdominal pain, presenting as peritonitis, visited our hospital. Physical examination revealed tenderness, rebound tenderness, and vague palpable mass in the right lower quadrant of the abdomen. A pelvic computed tomographic scan demonstrated a right ovarian cystic mass with bone and fat tissue, which had ruptured into the sigmiod colon, and peritoneal fluid collection. During a laparotomy, the ovary tumor was found to be densely adherent to the rectosigmoid junctional wall; also a solid element of the ovary tumor containg hair and skin tissue seemed to be in continuity with colonic lumen, and the ovarian wall was ruptured with spillage of purulent exudate into the peritoneal cavity. En bloc resection of the tumor-bearing segment of the sigmoid colon, together with the adherent right ovary and salpinx was carrried out. The diagnosis of a mature teratoma of the ovary was made by histologic examination of a surgical specimen; the tumor had perforated the sigmoid colon wall, had protruded into the bowel lumen, and had ruptured the intraperitoneal cavity due to inflammation its wall.
Assuntos
Adulto , Feminino , Humanos , Abdome , Dor Abdominal , Líquido Ascítico , Colo , Colo Sigmoide , Diagnóstico , Exsudatos e Transudatos , Tubas Uterinas , Cabelo , Inflamação , Laparotomia , Cistos Ovarianos , Ovário , Cavidade Peritoneal , Peritônio , Peritonite , Exame Físico , Ruptura , Ruptura Espontânea , Pele , TeratomaRESUMO
Cervical large cell neuroendocrine carcinoma is rare. We experienced one case of cervical large cell neuroendocrine carcinoma with invasive mucinous adenocarcinoma in 49 years old woman. So we report the case and brief review of literature.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Adenocarcinoma Mucinoso , Carcinoma Neuroendócrino , Colo do Útero , MucinasRESUMO
Pancreaticobiliary tract strictures are frequent indications for endoscopic retrograde cholangiopancreatography(ERCP). We have investigated the brushing cytology in order to determine its efficacy for diagnosis of pancreaticobiliary malignancies. Brushing cytology during ERCP was evaluated in 56 patients with biliary tract stricture presenting to the Catholic Hospital of Taegu-Hyosung from April 1997 to August 1999. A comparison was made between the cytologic and histologic diagnoses on 32 cases from 30 patients. A diagnosis of malignancy was establishied in 78.1%, benign in 15.6%, and inadequate in 6.3% of the cases. Statistical data on cytologic diagnoses in strictures of the bile duct were as follows; specificity and sensitivity of brushing procedure was 100% & 83.3%, respectively: sensitivity of interpretation was 89.3%: with no false positive cases and 3 false negative cases: predictive value for malignancy was 100% & 100%, respectively: predictive value for benign was 28.6% & 40%, respectively: overall diagnostic efficiency was 84.4%. It is concluded that brush cytology is a diagnostically reliable, highly specific technique for malignant lesions encounted at ERCP, although a negative result does not rule out the diagnosis of malignancy.
Assuntos
Humanos , Ductos Biliares , Sistema Biliar , Colangiopancreatografia Retrógrada Endoscópica , Constrição Patológica , Diagnóstico , Sensibilidade e EspecificidadeRESUMO
We reported a case of subchorionic placental cyst with maternal floor infarction in 32-year-old multigravida. In this case the infant without growth retardation was delivered at fuU term by repeat cesarean section. A 5.8*5cm placental cyst detected prenatally by ultrasound was shown subsequentty to be a subchorionic cyst without thrombohematoma. The cyst was unilocular and attached near the cord insertion, and it contained straw-colored fluid. There was no other placental abnormalities except placental inFarction on matemal floor with fibrin deposition. It is necessary to differentiate placental cystic lesions by ultrasonographic and pathologic examination because placental abnormalities could be associated with perinatal complications.
Assuntos
Adulto , Feminino , Humanos , Lactente , Recesariana , Fibrina , Infarto , Placenta , UltrassonografiaRESUMO
Gastroduodenal Crohn's Disease (CD), which is uncommon in adults, involves the gastric antrum and proximal duodenum in most cases, and results in epigastric pain, weight loss, and gastric outlet obstruction, raising initial suspicion that it may be peptic ulcer disease or a malignancy. On upper endoscopy, aphthous ulcers are typical in the early stages but linear or stellate ulcers with a cobblestone appearance and luminal narrowing can be found in advanced diseases. Multiple mucosal biopsies are helpful for diagnosis despite the fact that granulomas are seen in less than one third of all cases. Gastroduodenal CD requires oral sulfasalazine therapy or systemic corticosteroid therapy in advanced cases. A case of gastroduodenal CD in a 37-year-old man admitted with epigastric pain, anorexia, vomiting and weight loss is herein reported. Malignancy was suspected as a result of the patient's clinical manifestations and endoscopic findings. An endoscopic biopsy revealed an active inflammation in the mucosa and lamina propria. The patient's condition improved with oral sulfasalazine and prednisolone therapy.
Assuntos
Adulto , Humanos , Anorexia , Biópsia , Doença de Crohn , Diagnóstico , Duodeno , Endoscopia , Obstrução da Saída Gástrica , Granuloma , Inflamação , Mucosa , Úlcera Péptica , Fenobarbital , Prednisolona , Antro Pilórico , Estomatite Aftosa , Sulfassalazina , Úlcera , Vômito , Redução de PesoRESUMO
A case of primary malignant fibrous histiocytoma(MFH) of the lung occurring in a 62-year-old man is presented. After preoperative bronchial brushing and washing cytologic diagnosis of poorly differentiated carcinoma, surgical resection and lymph nodes dissection were performed. Subsequent histologic examination revealed a primary MFH. The diagnosis was confirmed by electron microscopic and immunohistochemical examinations. The review of the bronchial brushing and washing cytologic features disclosed many bipolar and a few unipolar spindle tumor cells with a "comet" configuration, mainly single cells, but also forming loose clusters. The nuclei were elongated and hyperchromatic and contained one or more irregular nucleoli. Scattered bizarre, multinucleated tumor giant cells were also present.