PURPOSE: This study was done to identify the effects of nurse-physician collaboration on nursing performance and organizational commitment in intensive care unit (ICU) nurses. METHODS: A cross-sectional survey was used and data were collected from 203 ICU nurses working in two advanced general hospitals and two general hospitals. Data were analyzed using descriptive statistics, independent t-test, One-way ANOVA, Scheffé test, Pearson correlation coefficients and Hierarchical multiple regression with SPSSWIN 23.0 program. RESULTS: The sub-domains of nursephysician collaboration were as follows: 3.77±0.51 for sharing of patient information, 3.36±0.65 for decision-making process on the cure or care, and 3.20±0.72 for relationship between nurse and physician. Nurse-physician collaboration was significantly positively correlated with nursing performance and organizational commitment. Regression analysis showed that nurse-physician collaboration explained an additional 24.9%p of nursing performance and an additional 13.4%p of organizational commitment. 'Sharing of patient information' and 'Relationship between nurse and physician' were significant predictors of nursing performance. 'Relationship between nurse and physician' was a significant predictor of organizational commitment. CONCLUSION: These results provide evidence that the collaboration between nurses and physicians should be enhanced in terms of sharing patient information and mutual respect, to improve nursing performance and organizational commitment of ICU nurses.
Cooperative Behavior ; Critical Care ; Cross-Sectional Studies ; Hospitals, General ; Humans ; Intensive Care Units ; Nursing ; Work Performance

Background/Aims: Periampuilary diverticulum has been known to be associated with various bilio-pancreatic diseases such as choledocholithiasis and disturbs performing selective cannuiation of ERCP and EST. This present study aims to investigate anatomical morphology of periampullary diverticulum and to determine whether periampullary diverticulurn influences difficulty and complication performing of ERCP and to analyse the relationship between periampullary diverticulum and choledocholithiasis. Methods: We reviewed records of chart and diverticular pictures in 1389 cases of underwent ERCP and evaluated the incidence, size, direction, location of periampullary diverticulum and its influence against performing of ERCP and investigated its relationship with bilio-pancreatic diseases such as choledocholithiasis.(continue..)
Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Diverticulum* ; Incidence

BACKGROUND: The morphological characteristics of hepatocytes transplanted into the spleen have been studied. However few attempts has been made to determine the expression of genes in intrasplenically transplanted hepatocytes. The aim of this study was to explore whether the pattern of expression of albumin gene in intrasplenically transplanted hepatocytes is similar to that in adult liver, resulting in the long-term expression of this hepatocyte-specific gene. METHODS: Hepatocytes isolated from liver of syngeneic Fischer 344 rats and transplanted into the spleen of rats from the same strain survived for 12 months in the absence of immunosuppressive drugs. Microscopic examination of intrasplenic hepatocytes and Northern blotting for albumin gene expression of RNA extracted from liver and spleen was performed. RESULTS: Microscopy demonstrated that hepatocytes attached themselves only in the red pulp of the spleen and isolated hepatocytes preserved the fine structures characteristic of normal hepatic parenchymal cells. Throughout the 12 months period, intrasplenically transplanted hepatocytes expressed albumin mRNA. CONCLUSIONS: Intrasplenically transplanted hepatocytes represent a unique in vivo system of extrahepatic maintenance of hepatocytes. This novel transplantation system could be used to investigate hepatocyte engraft, proliferation and gene expression.
Adult ; Animals ; Blotting, Northern ; Gene Expression* ; Hepatocytes* ; Humans ; Liver ; Microscopy ; Rats ; RNA ; RNA, Messenger ; Spleen

BACKGROUND: Four platelet derived growth factor (PDGF) family members have been identified; the classical PDGFs, PDGF-A and PDGF-B, and the novel PDGFs, PDGF-C and PDGF-D, which were only recently discovered. METHODS: The present study was designed to determine the changes of the platelet derived growth factor (PDGF) subtypes (C & D) and their receptors (PDGFR)-alpha & beta expression in kidneys during pre- and postnatal development. RESULTS: All the protein levels of PDGFR-alpha and -beta and the mRNA levels of PDGF-C and D were high in kidneys during the prenatal period and decreased differently during the postnatal period. PDGFR-alpha was expressed in the interstitial space at embryo day 18. PDGFR-beta protein were expressed in metanephric blastema at embryo day 18. PDGF-C mRNA was expressed in metanephric blastema, developing glomerulus at embryo 18 day and in collecting duct at postnatal day 7. PDGF-D mRNA was expressed in the parietal and vesceral epithelial cells during pre and postnatal period. CONCLUSION: These results indicate that the PDGF subtypes (C & D) and their receptors (PDGFR-alpha & -beta) are differently expressed in the kidney during the prenatal and postnatal period.
Embryonic Structures ; Epithelial Cells ; Humans ; Kidney ; Platelet-Derived Growth Factor ; Rabeprazole ; Receptors, Platelet-Derived Growth Factor* ; RNA, Messenger

OBJECTIVES: Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication of cirrhosis. In the most recently published studies, the prevalence of SBP among hospitalized cirrhotics with ascites has been estimated to be around 10-15%, the mortality rate related to this complication being more than 50%. SBP is thought to appear as a consequence of the impaired defensive mechanisms against infection present in cirrhotic patients, such as depressed reticuloendothelial system phagocytic activity, impaired leukocyte function, reduced serum compliment levels, and low antibacterial activity of ascitic fluid. It has proposed that ascitic fluid opsonin capacity is directly correlated to ascitic protein concentration and that this explains an observed predisposition to infection in patients with low ascitic fluid protein concentration. This present study aims to investigate the frequency of the recurrence of SBP in a large series of cirrhotic patient who recovered from the first episode of SBP and to identify any possible predictors of recurrent SBP. METHOD: We reviewed records of chart in 312 consecutive cirrhotics with ascites patients treated in our hospital between January, 1988 and August, 1995. RESULTS: The incidence of SBP was 21.8%(68 cases) and showed 80.9% in male, 19.1% in female. Seventeen(25%) of the 68 patients included in the study after the resolution of their first episode of SBP developed one or more episodes of SBP during follow-up. SBP recurred once in 16 of these patients, twice in 1 patients. The cumulative probability of SBP recurrence was 47.1% at 6 months, 64.7% at 12 months, and 82% at 18 months of follow-up. This study reveals that neither ascitic fluid total protein nor the severity of liver disease(Child's class) predicts the occurence of recurrent SBP. CONCLUSON: We conclude that the occurrence of recurrent SBP is unrelated to the type of liver disease, and severity of liver disease did not predict the presence of recurrent SBP. Also, ascitic fluid total protein < or =1.0 g/dl, prothrombin time < or =45% may not be a sensitive predictor of recurrent SBP.
Ascites ; Ascitic Fluid ; Female ; Fibrosis* ; Follow-Up Studies ; Humans ; Incidence ; Leukocytes ; Liver ; Liver Diseases ; Male ; Mononuclear Phagocyte System ; Mortality ; Peritonitis* ; Prevalence ; Prothrombin Time ; Recurrence

BACKGROUND: Ampullary cancer is a malignant lesion in the pancreatobiliary system with a relatively good prognosis because of its slow growth, early appearance of symptoms and high resectability. Hndoscopic retrograde cholangiopancreaticography(ERCP) is an important and useful method in the diagnosis of ampullary cancer because it identifies the location of lesions endoseopically and by opacification of the bilio-pancreatic ducts and allows confirmation by biopsy, But the diagnostic accuracy of endoscopic forcep biopsy was variable according to the macroscopic appearance of ampullary cancer. In unexposed type ampullary cancer, biopsy after endoscopic sphincterotomy or intraluminal cannulatian biopsy has been recommended because the cancer tissue was either not visible at all or barely visible from the lumen of the duodenum. The purpose of this study was to evaluate the contribution of endoscopic sphincterotomy to the diagnosis of ampullary cancer and to compare the clinical eharasteristics of unexposed type ampullary cancer with those of exposed type ampullary cancer. METHOD: Thirty-one cases of the ampullary cancers over the past 5 years were reviewed. Macroscopically, thirty one ampullary cancers were classified into two types. The unexposed type ampullary cancer was defined normal ampullary mucosa with or without protruding. The exposed type ampullary cancer was defined abnormal ampullary mucosa including nodular, ulcerative, nodulo-ulcerative and polypoid appearance. Ampullary cancers were diagnosed preoperatively by forcep biopsy, biopsy after endoscopic sphincterotomy, or brushing cytology. RESULT: The proportion of unexposed type in ampullary cancer was 29%(9 cases). There were no differences of age, sex, diagnostic clue, distal common bile duct(CBD) shape and CBD dilatation by ERCP between unexposed and exposed type ampullary cancers. The serum bilirubin, alkaline phosphatase and GGT were lower in unexposed type comparting with exposed type. The unexposed ampullary cancers could be diagnosed with biopsy after endoscopic sphincterotomy except one case. Biopsy samples were successfully obtained immediately after sphincterotomy in 3 patients and a few days (3 days later-1 month later) after sphincterotomy in 5 patients. CONCLUSION: Weconsider the possibility of unexposed ampullary cancer in cases of jaundice or duct dilatation with normal ampullary cancer in cases of jaundice or duct dilatation with normal ampulla mucosa and should perform biopsy after endoscopic sphincterotomy.
Alkaline Phosphatase ; Bile ; Bilirubin ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Dilatation ; Duodenum ; Humans ; Jaundice ; Mucous Membrane ; Prognosis ; Sphincterotomy, Endoscopic ; Surgical Instruments ; Ulcer

PURPOSE: Although acute renal failure (ARF) commonly develops in patients with severe acute pancreatitis (SAP), the impact of ARF on disease severity is rarely reported in Korea. This study was performed to compare the clinical findings, morbidity and mortality between SAP patients with and without ARF. METHODS: We retrospectively evaluated the medical records of 102 patients with SAP between january 2001 and June 2008 in 3 hospitals. We investigated the incidence and clinical course of ARF in SAP patients. Then, we compared morbidity and mortality between the patients with ARF and normal renal function (NRF). RESULTS: Of the total 102 SAP patients, ARF was observed in 39 patients (38.2%). The peak serum creatinine level in ARF patients was 4.5+/-2.3 mg/dL. Eight of the 39 ARF patients (20.5%) received hemodialysis and ten patients (25.6%) died. When compared to NRF patiens, ARF patients (n=39) had higher incidence of dyspnea (17.9% vs 3.2%, p=0.011), loss of consciousness (17.9% vs 1.6%, p=0.003), and APACHE II scores more than 8 (92.3% vs 0%, p<0.001). The ARF group had also higher incidences of sepsis (35.9% vs 7.9%, p<0.001), multiorgan failure (15.4% vs 0%, p=0.001), respiratory failure (28.2% vs 4.7%, p=0.001) and mortality (25.6% vs 3.2%, p=0.001). Multivariate analysis demonstrated thrombocytopenia, hemoconcentration, and high LDH as independent risk factors of ARF in SAP patients. CONCLUSION: The incidence of ARF was high (38.2%) and ARF patients showed higher morbidity and mortality, compared to NRF patients. We suggest that early management of ARF should be performed for reducing the mortality in SAP patients.
Acute Kidney Injury ; APACHE ; Creatinine ; Dyspnea ; Humans ; Incidence ; Korea ; Medical Records ; Multivariate Analysis ; Pancreatitis ; Renal Dialysis ; Respiratory Insufficiency ; Retrospective Studies ; Risk Factors ; Sepsis ; Thrombocytopenia ; Unconsciousness

BACKGROUND: Bone growth factors, particularly bone morphogenic protein-2 (BMP-2), are required for effective treatment of significant bone loss. Despite the extensive development of bone substitutes, much remains to be desired for wider application in clinical settings. The currently available bone substitutes cannot sustain prolonged BMP-2 release and are inconvenient to use. In this study, we developed a ready-to-use bone substitute by sequential conjugation of BMP to a three-dimensional (3D) poly(L-lactide) (PLLA) scaffold using novel molecular adhesive materials that reduced the operation time and sustained prolonged BMP release. METHODS: A 3D PLLA scaffold was printed and BMP-2 was conjugated with alginate-catechol and collagen. PLLA scaffolds were conjugated with different concentrations of BMP-2 and evaluated for bone regeneration in vitro and in vivo using a mouse calvarial model. The BMP-2 release kinetics were analyzed using ELISA. Histological analysis and microCT image analysis were performed to evaluate new bone formation. RESULTS: The 3D structure of the PLLA scaffold had a pore size of 400 lm and grid thickness of 187–230 lm. BMP-2 was released in an initial burst, followed by a sustained release for 14 days. Released BMP-2 maintained osteoinductivity in vitro and in vivo. Micro-computed tomography and histological findings demonstrate that the PLLA scaffold conjugated with 2 lg/ml of BMP-2 induced optimal bone regeneration. CONCLUSION The 3D-printed PLLA scaffold conjugated with BMP-2 enhanced bone regeneration, demonstrating its potential as a novel bone substitute.

BACKGROUND/OBJECTIVES: Zanthoxylum schinifolium is traditionally used as a spice for cooking in East Asian countries. This study was undertaken to evaluate the anti-proliferative potential of ethanol extracts of Z. schinifolium leaves (EEZS) against human bladder cancer T24 cells.MATERIALS/METHODS: Subsequent to measuring the cytotoxicity of EEZS, the anti-cancer activity was measured by assessing apoptosis induction, reactive oxygen species (ROS) generation, and mitochondrial membrane potential (MMP). In addition, we determined the underlying mechanism of EEZS-induced apoptosis through various assays, including Western blot analysis. RESULTS: EEZS treatment concentration-dependently inhibited T24 cell survival, which is associated with apoptosis induction. Exposure to EEZS induced the expression of Fas and Fas-ligand, activated caspases, and subsequently resulted to cleavage of poly (ADPribose) polymerase. EEZS also enhanced the expression of cytochrome c in the cytoplasm by suppressing MMP, following increase in the ratio of Bax:Bcl-2 expression and truncation of Bid. However, EEZS-mediated growth inhibition and apoptosis were significantly diminished by a pan-caspase inhibitor. Moreover, EEZS inhibited activation of the phosphoinositide 3-kinase (PI3K)/Akt pathway, and the apoptosis-inducing potential of EEZS was promoted in the presence of PI3K/Akt inhibitor. In addition, EEZS enhanced the production of ROS, whereas N-acetyl cysteine (NAC), a ROS scavenger, markedly suppressed growth inhibition and inactivation of the PI3K/Akt signaling pathway induced by EEZS. Furthermore, NAC significantly attenuated the EEZS-induced apoptosis and reduction of cell viability. CONCLUSIONS Taken together, our results indicate that exposure to EEZS exhibits anticancer activity in T24 bladder cancer cells through ROS-dependent induction of apoptosis and inactivation of the PI3K/Akt signaling pathway.