PURPOSE: This study was conducted to examine the effects of simulation-based education regarding care in a cardio-pulmonary emergency care as related to knowledge, clinical performance ability, and problem solving process in new nurses. METHODS: An equivalent control group pre-post test experimental design was used. Fifty new nurses were recruited, 26 nurses for the experimental group and 24 nurses for the control group. The simulation-based cardio-pulmonary emergency care education included lecture, skill training, team-based practice, and debriefing, and it was implemented with the experimental group for a week in May, 2009. Data were analyzed using frequency, ratio, chi-square, Fisher's exact probability and t-test with the SPSS program. RESULTS: The experimental group who had the simulation-based education showed significantly higher know-ledge (t=5.76, p<.001) and clinical performance ability (t=5.86, p<.001) for cardio-pulmonary emergency care compared with the control group who had traditional education but problem solving process was not included (t=1.11, p=.138). CONCLUSION: The results indicate that a simulation-based education is an effective teaching method to improve knowledge and clinical performance ability in new nurses learning cardio-pulmonary emergency care. Further study is needed to identify the effect of a simulation-based team discussion on cognitive outcome of clinical nurses such as problem solving skills.
Adult ; Cardiopulmonary Resuscitation/*nursing ; *Clinical Competence ; *Competency-Based Education ; Educational Measurement ; Emergency Medical Services ; Female ; Humans ; Male ; *Problem Solving ; Program Evaluation ; Questionnaires ; Young Adult

Chronic granulomatous disease is a group of rare disorders characterized by a disease of oxidative metabolism of phagocytes with deficit of antimicrobial activity. Also, it has clinical features of chronic pyogenic infection, granuloma formation, hypergammaglobulinemia, anemia and leukocytosis.We experienced a case of chronic granulomatous disease with chronic recurrent infection, hypergammaglobulinemia and liver abscess. It was confirmed by modified NBT test. The result of patient's NBT test was less than 11%. The patient received subcutaneous injection of interferon-gamma, 200 million unit (0.1mg/m2 of body surface area per dose), on three consecutive days per week for 3 weeks and her symptom was improved. Then, we report a case of chronic granulomatous disease which is improved by interferon- therapy with brief review of literature.
Anemia ; Body Surface Area ; Granuloma ; Granulomatous Disease, Chronic* ; Humans ; Hypergammaglobulinemia ; Injections, Subcutaneous ; Interferon-gamma ; Liver Abscess ; Metabolism ; Phagocytes

PURPOSE: Overexpression of COX-2, an enzyme responsible fro the synthesis of prostaglandins, is well linked to human chronic lung diseases. The mechanism by which COX-2 expression is increased or enhanced in cancer cells remains largely unknown. Any compound which can reduce COX-2 expression may be considered as an anti-cancer agent. MATERIALS AND METHODS: Leptomycin B (LMB) is a metabolite of Streptomyces and a specific inhibitor of CRM1 nuclear export receptor. A549 is a human lung cancer cell line. To evaluate the effect of LMB on COX-2 expression induced by IL-1beta, a pro-inflammatory cytokine, in A549 cells, Western blot and RT-PCR assays were applied to measure COX-2 protein and mRNA expressions in response to IL-1beta, respectively. Luciferase experiments were done to measure promoter activity of COX-2, NF-kappaB or AP-1. CRM1 siRNA trasfection experiment was performed to knock-down endogenous CRM1. Biochemical protein fractionation method was also carried out to see intracellular localization of proteins. RESULTS: LMB at 9 nM strongly suppressed IL-1beta-induced expression of COX-2 protein that was attributable to decreased COX-2 transcript and promoter activity, but not mRNA stability. Distinctly, knock-down of CRM1 had no effect on COX-2 expression by IL-1beta. Moreover, LMB did not affect IL-1beta-induced phosphorylation of ERK-1/2, JNK- 1/2, and p38 MAPK or AP-1 promoter activity. In contrast, LMB blocked IL-1beta- mediated cytosolic IkappaB-alpha degradation, p65 NF-kappaB nuclear translocation, and NF-kappaB promoter activity. CONCLUSION: LMB potently down-regulates IL-1beta- induced COX-2 at transcriptional level in A549 cells, in part, through modulation of the IkappaB-alpha/NF-kappaB pathway but independent of CRM1, MAPKs and AP-1.
Active Transport, Cell Nucleus ; Blotting, Western ; Cell Line ; Cytosol ; Down-Regulation* ; Humans ; Luciferases ; Lung Diseases ; Lung Neoplasms* ; Lung* ; NF-kappa B ; p38 Mitogen-Activated Protein Kinases ; Phosphorylation ; Prostaglandins ; RNA Stability ; RNA, Messenger ; RNA, Small Interfering ; Streptomyces ; Transcription Factor AP-1

Behcet? disease is a recurring illness characterized by the triple symptom complex of aphthous stomatitis, genital ulceration, and uveitis. The disease is multisystemic disorder with involvement of skin, gastrointestinal tract, blood vessels, central nervous system, joints, and epididymis. Vascular involvement of Behcet? disease affects both arteries and veins and blood vessels of all sizes. Periosteal new bone formation is one feature of hypertrophic osteoarthropathy. Other features are clubbing and arthritis. Periosteal new bone formation on the bones of the lower extremities without other features of hypertrophic osteoarthropathy has been reported in patients with varicose veins, vitamin A intoxication, infantile cortical hyperostosis, tuberous sclerosis, congenital syphilis and chronic renal failure with hyperparathyroidism, and chronic venous insufficiency. However, periosteal new bone formation has not, to our knowledge, been described in patients with Behcet? disease yet although similar findings are occasionally noted in polyarteritis nodosa. We report a case of Behcet? disease complicated by leg swelling with periosteal new bone formation of right lower leg.
Arteries ; Arthritis ; Behcet Syndrome ; Blood Vessels ; Central Nervous System ; Epididymis ; Gastrointestinal Tract ; Humans ; Hyperostosis, Cortical, Congenital ; Hyperparathyroidism ; Joints ; Kidney Failure, Chronic ; Leg ; Lower Extremity ; Male ; Osteogenesis* ; Polyarteritis Nodosa ; Skin ; Stomatitis, Aphthous ; Syphilis, Congenital ; Tuberous Sclerosis ; Ulcer ; Uveitis ; Varicose Veins ; Veins ; Venous Insufficiency ; Vitamin A

BACKGROUND: Eosinophilia in hemodialysis (HD) patients has been associated with allergic reactions to dialyzers and exaggerated activation of complement during HD. Complement activation can lead to cytokine production. The cause of the eosinophilia is controversial and maybe multifactorial. Eosinophilia is stimulated by T lymphocytes and maybe related to the immune dysfunction of uremic patients. The aim of this study is to elucidate the relationship between the eosinophilia and serum cytokine concentrations in maintenance HD patients and to reveal whether the eosinophilia in HD patients reflects HD-associated cytokine production. METHODS: We examined 40 HD patients who were stable for a minimum of 3 months at our hemodialysis unit. We measured eosinophil count and eosinophil percent on peripheral blood smear. Eosinophilia was defined as >or=350 cells/mm3 or >or=5% on smear. The serum concentrations of Interleukin-1beta (IL-1beta), Interleukin-2 (IL-2), Interleukin-5 (IL-5), Interleukin-6 (IL-6) were measured by ELISA before (pre) and after (post) dialysis. RESULTS: Thirteen patients with eosinophilia were compared 27 patients without eosinophilia. In patients with eosinophilia, serum concentrations of IL-1beta and IL-2 were significantly elevated after dialysis than before dialysis (p<0.05). Post-HD IL-6 concentrations also were elevated, but statistically insignificant. IL-5 concentrations were not elevated after dialysis. In patients without eosinophilia, serum concentrations of IL-1beta, IL-2 and IL-6 were significantly elevated after dialysis (p<0.05). IL-5 concentrations were not elevated after dialysis. The eosinophil counts were not correlated to age, gender, underlying disease, serum levels of blood urea nitrogen, creatinine, albumin, CRP and the levels of post dialysis cytokines. CONCLUSION: Independently on eosinophilia in HD, the serum concentrations of cytokines (IL-1beta, IL-2 and IL-6) were elevated after HD. IL-5 concentrations were not elevated after dialysis. But we could not reveal whether the eosinophilia in maintenance HD patients may be a surrogate marker for the reflection of exaggerated cellular cytokine production during HD or not by this study.
Biomarkers ; Blood Urea Nitrogen ; Complement Activation ; Complement System Proteins ; Creatinine ; Cytokines ; Dialysis ; Enzyme-Linked Immunosorbent Assay ; Eosinophilia* ; Eosinophils ; Humans ; Hypersensitivity ; Interleukin-1beta ; Interleukin-2 ; Interleukin-5 ; Interleukin-6 ; Renal Dialysis* ; T-Lymphocytes

OBJECTIVE: This study examined the efficacy of the white matter (WM) to gray matter (GM) signal intensity ratio (SIR) in predicting the clinical prognosis of cardiac arrest patients. METHODS: Thirty-one patients who were resuscitated from cardiac arrest and underwent brain magnetic resonance imaging (MRI) were investigated retrospectively. Thirty one subjects with normal brain MRI findings served as the controls. The signal intensities (SI) were measured on T2-weighted image (T2WI). The circular regions of measurement (2–10 mm²) were placed over the regions of interest, and the average signals in GM and WM were recorded in the caudate nucleus (CN), putamen, anterior limb of the internal capsule, corpus callosum (CC), and in the cortex and WM of the frontal lobe. Cerebral performance category (CPC) 1–2 were classified as a good prognosis, and CPC 3–5 were classified as a poor prognosis. RESULTS: Most combinations of the SIR of WM to GM and most SIs of GM, except the frontal cortex, were significantly different between the two groups. On the other hand, the SI of WM was insignificant between both groups. In receiver operating characteristic (ROC) curve analysis, the SIR of the CC to CN had an area under the ROC curve (AUROC) of 1.00 for a cut-off value of 1.59 (sensitivity, 100%; specificity, 100%), the SIR of the CC to putamen had also an AUROC of 1.00 for a cut-off value of 1.43 (sensitivity, 100%; specificity, 100%). CONCLUSION: The SIR of WM to GM measured on a T2WI is related to the neurological outcome after a cardiac arrest.
Brain ; Caudate Nucleus ; Coma ; Corpus Callosum ; Extremities ; Frontal Lobe ; Gray Matter ; Hand ; Heart Arrest ; Humans ; Internal Capsule ; Magnetic Resonance Imaging ; Prognosis ; Putamen ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; White Matter

BACKGROUND: Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the human liver. However, the molecular changes and mechanisms that regulate the development and progression of HCC remain unclear. Beta-catenin is known as a multi-functional protein that acts as a regulator of the cadherin-mediated cell-cell adhesion system and also in the Wingless/Wnt signal transduction pathway. The aim of this study was to investigate the expression of beta-catenin and its possible role in HCC. METHODS: We investigated the expression of beta-catenin, Ki-67, TP53, alpha-smooth muscle actin and CD34 by performing immunohistochemical staining for 61 specimens of HCC and their adjacent non-tumorous tissue. We also examined the relationship between the nuclear expression of beta-catenin and the clinicopathologic parameters. RESULTS: The altered expression of beta-catenin was not detected in the nontumorous liver tissue. The nuclear expression of beta-catenin was observed in approximately 16% (10/61) of the HCC specimens. Double immunohistochemical staining for beta-catenin and E-cadherin showed a close relationship between nuclear translocation of beta-catenin and the loss of the membranous E-cadherin expression. Significant correlation was found between the nuclear translocation of beta-catenin and the tumor size, tumor necrosis and the presence of microvessel invasion and intrahepatic metastasis (p<0.05). CONCLUSIONS: This data indicates that nuclear translocation of beta-catenin could play a role in the growth and progression of HCC.
Humans ; Carcinoma, Hepatocellular ; Neoplasm Metastasis

BACKGROUND: Pseudoepitheliomatous hyperplasia (PEH) is a reactive proliferation of surface epithelium and can be confused with invasive squamous cell carcinoma (SCC) in head and neck biopsy specimens. To distinguish PEH from invasive SCC, immunohistochemical staining for claudin-1, E-cadherin and p53 was performed. METHODS: Eighteen cases of PEH and 29 invasive SCC from head and neck lesions were immunostained and examined. RESULTS: The invasive SCC showed increased staining of claudin-1 (p<0.001) and p53 (p<0.001) and decreased staining of E-cadherin (p=0.005) compared to the PEH specimens. The combined score calculated by adding the positive sum of claudin-1 and p53 and subtracting E-cadherin was useful for the differentiation of SCC from PEH (89.7% sensitivity and 88.9% specificity, p<0.001). CONCLUSION: The combined immunostaining for claudin-1, p53 and E-cadherin may help differentiate PEH from invasive SCC. The results of this study suggest that the increased expression of claudin-1 and p53 and the decreased expression of E-cadherin maybe markers for the aggressive growth of invasive SCC.
Biopsy

BACKGROUND/AIMS: Disruption of the cell-to-cell junction with changes in the expression of the junctional proteins is the hallmark of cancer invasion and metastasis. To investigate the roles of claudin-1, beta-catenin and E-cadherin in adenocarcinoma of the colon, the relationship of their expression with clinical and pathological factors were examined. METHODS: The expression of claudin-1, beta-catenin and E-cadherin were examined in 47 cases of adenocarcinoma of the colon by immunohistochemical staining. RESULTS: A reduced claudin-1 expression was associated with advanced lymph node metastasis (p=0.019) and histological dedifferentiation at the invasive front (p=0.030). A reduced expression of beta-catenin and E-cadherin were correlated with histological dedifferentiation (p=0.012, p=0.010, respectively). The reduced expression of two or more proteins was correlated with the histological findings of dedifferentiation (p=0.030). CONCLUSIONS: These results suggest that loss of claudin-1, beta-catenin and E-cadherin expression may be correlated with the progression of adenocarcinoma of the colon and associated with an advanced histological grade.
Adenocarcinoma ; beta Catenin ; Cadherins ; Claudin-1 ; Colon ; Lymph Nodes ; Neoplasm Metastasis ; Proteins

Capsule endoscopy (CE) enables evaluation of the entire mucosal surface of the small bowel (SB), which is one of the most important steps for evaluating obscure gastrointestinal bleeding. Although the diagnostic yield of SB CE depends on many clinical factors, there are no reports on quality indicators. Thus, the Korean Gut Image Study Group (KGISG) publishes an article titled, “Quality Indicators for Small Bowel Capsule Endoscopy” under approval from the Korean Society of Gastrointestinal Endoscopy (KSGE). Herein, we initially identified process quality indicators, while the structural and outcome indicators are reserved until sufficient clinical data are accumulated. We believe that outcomes of SB CE can be improved by trying to meet our proposed quality indicators.
Capsule Endoscopy* ; Endoscopy, Gastrointestinal ; Hemorrhage