Development and Effects of Health Education Program using Flipped Learning for Allergic Rhinitis Patients / 한국간호교육학회지

PURPOSE: This study was conducted to develop and test effects of flipped learning on a health education program for allergic rhinitis patients. METHODS: The study was a nonequivalent control group pretest-posttest design, with 38 participants (experimental group: 19, control group: 19). The education program for allergic rhinitis patients with flipped learning developed for this study was conducted in pre-class, in-class, and post-class stages for a total of 12 weeks. For the in-class stage, a TREAT model suitable for patient education program was developed. Data were analyzed with an independent t-test and repeated measures ANOVA. RESULTS: The experimental group showed significant improvement in knowledge (F=15.029, p<.001), self-efficacy (F=6.814, p<.001) and self-care behavior (F=41.761, p<.001). In addition, subjective symptoms (F=61.453, p<.001) and quality of life (F=52.413, p<.001) improved. CONCLUSION: The results of this study show that flipped learning in an education program is an effective method for those in their twenties persistent moderate-severe allergic rhinitis. Therefore, the education program for allergic rhinitis developed by this study is actively recommended for nurses or health managers at universities to educate subjects in their twenties with allergic rhinitis.

The Effect of the Flipped Learning on Self-efficacy, Critical Thinking Disposition, and Communication Competence of Nursing Students / 한국간호교육학회지

PURPOSE: This study was conducted to test the effects of flipped learning for undergraduate nursing students. METHODS: The study was a nonequivalent control group pretest-posttest design. Participants were 140 nursing students (experimental group=70, control group=70). The flipped learning was provided for 6 times (18 hours). Data were collected between March 7 and May 30, 2016. Data were analyzed using Chi-square, t-test, paired t-test with SPSS/WIN 22.0. RESULTS: The results showed that self-efficacy (t=4.67, p<.001), critical thinking disposition (t=6.55, p<.001), and communication competence (t=3.57, p=.001) were significantly higher than in the experimental group than in the control group. CONCLUSION: The study findings suggest that the flipped learning has proven to be influential educational program for improving the self-efficacy, critical thinking disposition, and communication competence of nursing students. The flipped learning was an effective teaching program for nursing student, and need to develop other nursing major subjects.

A Pregnant Woman with Type 2 Diabetes Unintentionally Exposed to Metformin and Voglibose until the Second Trimester of Pregnancy: A Case Report / 임상당뇨병

Use of oral hypoglycemic agents during pregnant women with type 2 diabetes is controversial due to safety issues. Recently, randomized controlled trials support short-term safety of glyburide and metformin for the treatment of gestational diabetes mellitus. However, long-term safety data are not available. Moreover, use of oral hypoglycemic agents, except for metformin and glyburide, during pregnancy were limited to a few case reports. We report the case of a pregnant woman with type 2 diabetes unintentionally exposed to metformin and voglibose in addition to lercanidipine and bisoprolol during fetal organogenesis. The patient was continuously exposed to oral agents because we were not aware of her pregnancy until 22 weeks of gestation. After pregnancy was confirmed, we replaced oral hypoglycemic agents with insulin and discontinue betablockers. Delivery occurred without maternal or fetal complications.

Roots extracts of Adenophora triphylla var. japonica improve obesity in 3T3-L1 adipocytes and high-fat diet-induced obese mice

Objective: To investigate the anti-obesity activity and the action mechanism of the roots of Adenophora triphylla var. japonica extract (ATE) in high-fat diet (HFD)-induced obese mice and 3T3-L1 adipocytes. Methods: The roots of Adenophora triphylla were extracted with 70% ethanol. To demonstrate the compounds, linoleic acid was analyzed by using gas chromatography; and the anti-obesity effects and possible mechanisms of ATE were examined in 3T3-L1 adipocytes and HFD-induced obese mice. Results: Treatment with ATE inhibited the lipid accumulation without cytotoxicity in 3T3-L1 adipocytes. Furthermore, 200 and 400 mg/kg ATE treatment significantly decreased the body weight gain, white adipose tissues (WATs) weight and plasma triglyceride level, while 100 and 200 mg/kg ATE treatment increased the plasma high-density lipoprotein cholesterol level in the HFD-induced obese mice, as compared with the HFD group. Treatment with 200 and 400 mg/kg ATE also lowered the size of adipocytes in adipose tissue and reduced the lipid accumulation in liver. ATE treatment showed significantly lower expression level of adipogenesis-related proteins, such as peroxisome proliferator-activated receptor γ, fatty acid binding protein (aP2), fatty acid synthase in 3T3-L1 adipocytes; and furthermore, decreased peroxisome proliferator-activated receptor γ, aP2, fatty acid synthase, sterol regulatory element binding protein-1c, and lipoprotein lipase mRNA expression levels in WAT of the HFD-induced obese mice. Conclusions: These results suggested that the ATE has an anti-obesity effect, which may be elicited by regulating the expression of adipogenesis and lipogenesis-related genes and proteins in adipocytes and WAT of the HFD-induced obese mice.

Monascus pilosus-fermented black soybean inhibits lipid accumulation in adipocytes and in high-fat diet-induced obese mice

Objective: To explore the anti-obesity effects and the mechanism of action of Monascus pilosus(M. pilosus)-fermented black soybean (MFBS) extracts (MFBSE) and MFBS powders (MFBSP) in adipocytes and high-fat diet (HFD)-induced obese mice, respectively. Methods: Black soybean was fermented with M. pilosus, and the main constituents in MFBS were analyzed by HPLC analysis. In vitro, MFBSE were examined for anti-adipogenic effects using Oil-Red O staining. In vivo, mice were fed a normal-fat diet (NFD) control, HFD control or HFD containing 1 g/kg MFBSP for 12 weeks, and then body weight gain and tissues weight measured. Real-time PCR and western blot assay were used to determine the mechanism of anti-adipogenic effects. Results: MFBSE inhibited lipid accumulation in 3T3-L1 adipocytes without exerting cell cytotoxicity. MFBSP treatment in HFD-fed mice significantly decreased the body weight gain compared with the HFD control mice. MFBSE and MFBSP treatment resulted in significantly lower mRNA levels of adipogenesis-related genes, such as peroxisome proliferator-activated receptor γ(PPAR γ), fatty acid-binding protein 4 (FABP4), and fatty acid synthase (FAS), in adipocytes and in white adipose tissue (WAT) of HFD-induced obese mice. Conclusions: These results suggest that the anti-obesity effects of MFBS are elicited by regulating the expression of adipogenesis-related genes in adipocytes and WAT of HFD-induced obese mice.

Roots extracts of Adenophora triphylla var. japonica improve obesity in 3T3-L1 adipocytes and high-fat diet-induced obese mice

OBJECTIVE@#To investigate the anti-obesity activity and the action mechanism of the roots of Adenophora triphylla var. japonica extract (ATE) in high-fat diet (HFD)-induced obese mice and 3T3-L1 adipocytes.@*METHODS@#The roots of Adenophora triphylla were extracted with 70% ethanol. To demonstrate the compounds, linoleic acid was analyzed by using gas chromatography; and the anti-obesity effects and possible mechanisms of ATE were examined in 3T3-L1 adipocytes and HFD-induced obese mice.@*RESULTS@#Treatment with ATE inhibited the lipid accumulation without cytotoxicity in 3T3-L1 adipocytes. Furthermore, 200 and 400 mg/kg ATE treatment significantly decreased the body weight gain, white adipose tissues (WATs) weight and plasma triglyceride level, while 100 and 200 mg/kg ATE treatment increased the plasma high-density lipoprotein cholesterol level in the HFD-induced obese mice, as compared with the HFD group. Treatment with 200 and 400 mg/kg ATE also lowered the size of adipocytes in adipose tissue and reduced the lipid accumulation in liver. ATE treatment showed significantly lower expression level of adipogenesis-related proteins, such as peroxisome proliferator-activated receptor γ, fatty acid binding protein (aP2), fatty acid synthase in 3T3-L1 adipocytes; and furthermore, decreased peroxisome proliferator-activated receptor γ, aP2, fatty acid synthase, sterol regulatory element binding protein-1c, and lipoprotein lipase mRNA expression levels in WAT of the HFD-induced obese mice.@*CONCLUSIONS@#These results suggested that the ATE has an anti-obesity effect, which may be elicited by regulating the expression of adipogenesis and lipogenesis-related genes and proteins in adipocytes and WAT of the HFD-induced obese mice.

Monascus pilosus-fermented black soybean inhibits lipid accumulation in adipocytes and in high-fat diet-induced obese mice

OBJECTIVE@#To explore the anti-obesity effects and the mechanism of action of Monascus pilosus(M. pilosus)-fermented black soybean (MFBS) extracts (MFBSE) and MFBS powders (MFBSP) in adipocytes and high-fat diet (HFD)-induced obese mice, respectively.@*METHODS@#Black soybean was fermented with M. pilosus, and the main constituents in MFBS were analyzed by HPLC analysis. In vitro, MFBSE were examined for anti-adipogenic effects using Oil-Red O staining. In vivo, mice were fed a normal-fat diet (NFD) control, HFD control or HFD containing 1 g/kg MFBSP for 12 weeks, and then body weight gain and tissues weight measured. Real-time PCR and western blot assay were used to determine the mechanism of anti-adipogenic effects.@*RESULTS@#MFBSE inhibited lipid accumulation in 3T3-L1 adipocytes without exerting cell cytotoxicity. MFBSP treatment in HFD-fed mice significantly decreased the body weight gain compared with the HFD control mice. MFBSE and MFBSP treatment resulted in significantly lower mRNA levels of adipogenesis-related genes, such as peroxisome proliferator-activated receptor γ(PPAR γ), fatty acid-binding protein 4 (FABP4), and fatty acid synthase (FAS), in adipocytes and in white adipose tissue (WAT) of HFD-induced obese mice.@*CONCLUSIONS@#These results suggest that the anti-obesity effects of MFBS are elicited by regulating the expression of adipogenesis-related genes in adipocytes and WAT of HFD-induced obese mice.

Antioxidant activity and free radical scavenging activities of Streptomyces sp. strain MJM 10778

Objective: To investigate the antioxidant activity of soil-borne actinobacteria. Methods: The total phenolic contents, the level of antioxidant potential by DPPH radical scavenging activity, NO scavenging activity, and ABTS radical scavenging activity in ethyl acetate extract were determined. Results: The 16S rDNA sequencing analysis revealed that Streptomyces sp. strain MJM 10778, which was isolated from Hambak Mountain, Korea, has 99.9% similarity to Streptomyces misionensis (S. misionensis) NBRC 13063. The physiological and the morphological test revealed that the strain MJM 10778 has different characteristics from the strain NBRC 13063. The entire antioxidant assay with the ethyl acetate extract displayed good radical scavenging activity. The IC

Antioxidant activity and free radical scavenging activities of Streptomyces sp. strain MJM 10778

OBJECTIVE@#To investigate the antioxidant activity of soil-borne actinobacteria.@*METHODS@#The total phenolic contents, the level of antioxidant potential by DPPH radical scavenging activity, NO scavenging activity, and ABTS radical scavenging activity in ethyl acetate extract were determined.@*RESULTS@#The 16S rDNA sequencing analysis revealed that Streptomyces sp. strain MJM 10778, which was isolated from Hambak Mountain, Korea, has 99.9% similarity to Streptomyces misionensis (S. misionensis) NBRC 13063. The physiological and the morphological test revealed that the strain MJM 10778 has different characteristics from the strain NBRC 13063. The entire antioxidant assay with the ethyl acetate extract displayed good radical scavenging activity. The IC50 values of the strain MJM 10778 extract on DPPH, NO, and ABTS radicals were identified to be 92.8 μg/mL, 0.02 μg/mL, and 134.9 μg/mL, respectively. The ethyl acetate extract of the strain MJM 10778 showed an 81.50% of cell viability at 100 μg/mL in Raw264.7 cell viability assay.@*CONCLUSIONS@#The results obtained suggest that the ethyl acetate extract of Streptomyces sp. strain MJM 10778 could be considered as a potential source of drug for the diseases that is caused by free radicals with its anti-oxidant activities and low cytotoxicity.

Study on antioxidative, antidiabetic and antiobesity activity of solvent fractions of smilax china L. leaf extract / 한국영양학회지

Smilax china L., a native plant found in Asian countries, has several medicinal properties including antioxidant, anti-inflammatory, and anti-cancer effects. Although the root of the plant is commonly used as traditional herbal medicine in Korea and China, the medicinal properties of the leaves have not gained the same attention. In this study, we analyzed the antioxidant activity, alpha-glucosidase inhibitory effect and lipid accumulation inhibition effect of Smilax china L. leaf water extract (SCLE) and its solvent fractions. SCLE was fractionated by using a series of organic solvents, including ethylacetate (EA) and n-butanol (BuOH). The EA fraction had the highest total polyphenol content (440.20 +/- 12.67 mg GAE/g) and total flavonoid content (215.14 +/- 24.83 mg QE/g). The radical scavenging activity IC50 values of the EA fraction for 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2-azino-bis-(3-ethylbenzthiazoline)-6-sulfonic acid (ABTS) were 0.022 mg/mL and 0.13 mg/mL, respectively. Further, SOD-like activity and reducing power values of the EA fraction were higher than those of the other fractions. However, both the alpha-glucosidase and lipid accumulation inhibition assays showed that the BuOH fraction (83.35 +/- 4.18% at 1 mg/mL) and water extract (11.27 +/- 2.67%) were more effective than the EA fraction (64.13 +/- 6.35%, and 45.66 +/- 7.20%). These results provide new insights into the potential anti-diabetic and anti-obesity effects of Smilax china L. leaf.

A Case of Sheehan's Syndrome that Manifested as Bilateral Ptosis

Hypothyroidism can cause a variety of signs and symptoms of the neuromuscular system. However, ptosis in a patient with hypothyroidism is very rare. We report here on a case of central hypothyroidism that was due to Sheehan's syndrome and it manifested as bilateral ptosis in a 51-yr-old woman. She complained of exertional dyspnea and weakness. About 25-yr ago, she had a history of severe postpartum vaginal bleeding. The laboratory studies demonstrated hypopituitarism with secondary hypothyroidism. The ptosis was improved by replacement of thyroid hormone. Hypothyroidism should be considered in the differential diagnosis of patients who manifest with ptosis and that prompt replacement of hormone can lead to a complete recovery.

The Use of HbA1c for Diagnosis of Type 2 Diabetes in Korea / 대한내과학회지

BACKGROUND/AIMS: An HbA1c test result > or = 6.5% has recently been recommended as the defining criterion for diabetes by the American Diabetes Association. We compared the detection of diabetes using oral glucose tolerance test (OGTT)-based and HbA1c-based diagnostic criteria. Additionally, we identified the optimal HbA1c threshold for diabetes in Korea. METHODS: This study was a cross-sectional retrospective design using data from 405 subjects without known diabetes who underwent OGTT and HbA1c tests for the diagnosis of diabetes between January, 2005, and June, 2010, at Dongguk University Gyeongju Hospital, Korea. The OGTT is considered to be the gold standard for diagnosing diabetes. Based on a receiver operating characteristics (ROC) curve, optimal sensitivity and specificity were derived for identifying the HbA1c threshold. RESULTS: For diabetes, HbA1c at 6.5% gave a sensitivity of 52.9%, specificity of 95.1%, positive predictive value of 92.9%, and a negative predictive value of 62.7%. A total of 47.1% of subjects with newly diagnosed diabetes had HbA1c levels <6.5%. Results were similar in sex- and age-stratified analyses. To identify diabetes based on OGTT, the HbA1c threshold of 6.1% had an area under the curve (AUC) of 0.849 with 77.8% sensitivity and 71.7% specificity. CONCLUSIONS: In a Korean population, diabetes prevalence was lower using the HbA1c-based diagnostic criteria. An HbA1c threshold of 6.1% optimally identified diabetes by OGTT-based diagnostic criteria in Korea. Further large-scale, population-based studies are needed to evaluate the HbA1c threshold for diagnosing diabetes in Korea.

A Case of Thyroid Amyloidosis Misrecognized as Subacute Thyroiditis

Amyloid deposition in the thyroid is found in about 30-80% of the patients with primary or secondary amyloidosis. In a few patients with amyloidosis, the thyroid is enlarged and so called amyloid goiter occurs. The thyroid function usually remains normal, but occasionally hypothyroidism or thyrotoxicosis occurs in patients with thyroid amyloidosis. We have experienced one case of thyroid amyloidosis due to bronchiectasis and the patient developed painful goiter and transient thyrotoxicosis resembling subacute thyroiditis. Biopsies from the gastric antrum, duodenum, colon, kidney and thyroid were positive for deposition of amyloid. When patients have signs and symptoms of subacute thyroiditis, but they develop an unusual course, then the diagnosis of thyroid amyloidosis should be considered.

Paraganglioma of a Bladder with a Bladder Stone

Paragangliomas of the urinary bladder are very rare tumors of the paraganglion system that arise from chromaffin cells in or near the sympathetic ganglia. Only approximately 15% of them develop from extra-adrenal chromaffin tissue. Most of these tumors are hormonally active and secrete mainly noradrenaline (rarely adrenaline), calcitonin, and adrenocorticotropic hormone. Paragangliomas are generally benign tumors, with less than 10% being malignant. Here we report a case of a paraganglioma arising in a urinary bladder with a bladder stone.

The Current Status of Type 2 Diabetes Management at a University Hospital / 당뇨병

BACKGROUND: The prevalence of type 2 diabetes has increased worldwide, as have the incidence and mortality of associated cardiovascular complication. However current status of diabetes management is poor. This study was performed to evaluate the management of care for type 2 diabetes patients at a university hospital. METHODS: This study comprised 926 type 2 diabetes patients, over the age of 30, who were treated at the Dongguk University Gyeongju Hospital between January and December 2008. Medical records were reviewed to collect demographic information, biochemical test results and the pharmacologic agents prescribed. RESULTS: The mean age, duration of diabetes and body mass index were 62.5 +/- 11.8 years, 9.1 +/- 7.2 year and 24.7 +/- 6.3 kg/m2, respectively. There were 251/926 (27.1%) patients with cardiovascular disease. In addition, 49.2% and 27.5% of patients had HbA1c levels < 7% and < 6.5%, respectively. There were 66.3% of the patients with blood pressure < 130/80 mm Hg. Fifty one percent and 47.4% of the patients had an LDL-C < 100 mg/dL and a non-HDL-C < 130 mg/dL, respectively. In addition, 19.7% of the patients with cardiovascular disease had an LDL-C < 70 mg/dL. Antiplatelet agents were used in 81.2% of the patients. The mean number of HbA1c measurements was 1.07 +/- 0.7 /year. HbA1c and lipid profiles were not checked in 21.4% and 23.1% of the patients, respectively. Over the previous six months, 6.9% of the patients had not had their blood pressure monitored. CONCLUSION: Among the patients with type 2 diabetes evaluated, 30~70% received in inadequate level of care. These findings point to the need for more aggressive efforts for optimal metabolic control.

Responses: The Current Status of Type 2 Diabetes Management at a University Hospital (Korean Diabetes J 33(3):241-250, 2009) / 당뇨병

No abstract available.

Usefulness of Thallium-201 Scintigraphy for Differentiating Benign and Malignant Thyroid Nodules in Inconclusive Cases with Fine Needle Aspiration / 대한내분비학회지

BACKGROUND: Although fine needle aspiration(FNA) is recognized as the most accurate procedure in the differential diagnosis of thyroid nodules, about 20~30% of nodules remain inconclusive in FNA. Therefore, we assessed the usefulness of Thallium-201 scintigraphy in differentiating benign from malignant thyroid nodules in patients with inconclusive diagnosis by FNA. METHODS: We studied 43 patients with inconclusive diagnosis(29 of follicular neoplasm, 11 of cystic change and 3 of inadequate) by FNA, with the results being confirmed histopathologically by operation. Thallium-201 scintigraphy was performed at 15 minutes(early scan) and 2-3 hours(late scan) after the intravenous administration of 37 MBq of thallium-201. Malignant nodules were defined by the retention of Thallium-201 on delayed images. RESULTS: In the 43 patients with inconclusive FNA diagnosis, Thallium-201 scan had a sensitivity of 75.0%, specificity of 62.9% and accuracy of 65.1%. The positive and negative predictive values were 31.6% and 91.7%, respectively. In the 29 patients with follicular neoplasm by FNA, Thallium-201 scan had a sensitivity of 83.3%, specificity of 60.9% and accuracy of 65.5%. The positive and negative predictive values were 35.7% and 93.3%, respectively. CONCLUSION: In particular, Thallium-201 scintigraphy demonstrated a high negative predictive value, Therefore, for patients with inconclusive FNA findings, Thallium-201 scintigraphy might be useful in differentiating between benign and malignant thyroid nodules, and has the potential to reduce the rate of unnecessary operations in benign nodules.

A case of syndrome of inappropriate antidiuretic hormone secretion (SIADH) in small cell cancer of lung combined with squamous cell cancer of lung / 대한내과학회지

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the term applied to arginine vasopressin (AVP) excess associated with hyponatremia without edema in the absence of physiologic or pharmacologic stimuli to AVP secretion. SIADH is associated with various conditions such as malignant tumors, infection, central nervous system disorders, and different pharmacological agents. The patient was 73-year-old female. She was admitted to the hospital because of persistent cough, dizziness, general weakness and confusion. On admission, her serum osmolality was 253 mOsm/kg, urine osmolality was 416 mOm/kg, and urine Na concentration was 159 mEq/L. Her Chest X-ray and CT scan of lung showed about 4x3.5 cm sized mass at posterior basal segment of left lower lobe of the lung, and CT-guided percutaneous needle aspiration revealed small round cell with clusters of malignant squamous cells. She was treated by salt restriction, hypertonic saline infusion and demeclocycline. We planned chemotherapy for advanced combined lung cancer, but she was discharged because of poor general condition and associated pneumonia without cancer chemotherapy. We report a rare case of SIADH in small cell cancer of lung combined with squamous cell cancer of lung.

A case report of the Pulmonary Malignant Lymphomaof the mucosa-associated lymphoid tissue(MALT) / 결핵

The pulmonary lymphomas were thought to originate in specialized lymphoid tissue that is associated with bronchial mucosa(bronchus-associated lymphoid tissue(BALT)), and they were categorized as mucosa-associated lymphoid tissue(MALT) lymphoma. MALT lymphoma consists of a monoclonal population of cell, in contrast to reactive lymphoid proliferation, which consists of polyclonal cells. Lymphoma arising from MALT(=MALToma) represents a distinct clinicopathologic features. It is usually localized to their original site for a long time and shows much more favorable prognosis than lymphoma at other site. Some MALT lymphoma could arise simultaneously or successively in different organ or that cells from MALT lymphoma might circulate and give rise to another lymphoma by homing in the MALT of another organ, such as breast, salivary gland, stomach etc, and can be multifocally disseminated or recurred. We report a case of low-grade B-cell lymphoma of the mucosa-associated lymphoid tissue(MALT) of the lung, which was confirmed by open lung biopsy, immunohistochemistry and PCR assay.

Clinical Evaluation of Subpulmonic Effusion / 결핵

BACKGROUND: Diagnosis of subpulmonary effusion is thought to be somewhat difficut more than pulmonary effusion. Clinical course and pathophysiology are thought to be different from typical pulmonary effusion. This study was done for increasing high suspicious index and early diagnosis of subpulmonary effusion. METHOD: Among the patients at dept. of chest medicine, National Medical Center from January 1990 to Dec. 1993, 232 cases of typical pulmonary effusion and 42 cases of subpulmonary effusion were studied. RESULT: 1) The ratio of subpulmonary effusion and typical pulmonary effusion was about 1:5 2) Male to Female ratio was 1:1 in both effusion. 3) Rt. side pleural and subpleural effusion were slightly predominant. 4) Subjective symptoms are chest pain, cough and exertional dyspnea. There is no difference between subpulmonary and typical pulmonary effusion. 5) Duration of symptom was slightly longer in subpulmonary effusion. 6) The most common cases of pleural effusion is tuberculosis in both subpulmonary & typical pulmonary effusion. Non-specific pleuritis was more common in subpulmonary effusion. 7) Pleural effusion was recurred about one fifth in both subpulmonary & pulmonary effusion. CONCLUSION: We studied clinical course and laboratory findings between subpulmonary & pulmonary effusion. However there are no definite difference between subpulmonary & pulmonary effusion. Duration of symptom was slightly longer in subpulmonary effusion. Most common cause was tuberculosis. Non specific pleuritis was more prevalent in subpulmonary effusion.