BACKGROUND: Myocardial ischemia in human hypertension and in various animal models of hypertension may be due to abnormal maximal coronary vasodilator reserve and disturbaces of coronary vasomotion. The vascular reactivity defects in hypertension have been associated with the defective endothelium and sympathetic neural activation. However, such abnormalities in hypertension need to be elucidated. In the present study the effectsof cardiac ischemia reperfusion on coronary circulation, intramyocytic adenylates and purine nucleosides were examined in Langendorff-perfused Sprague Dawley rat (SD) and spontaneously hypertensive rat (SHR) hearts. Coronary venous and cardiac lactate and cardiac pyruvate were also measured. It should be noted that in the regulation of coronary flow the intrinsic flow autoregulation is highly variable due to coexisting metabolic flow control, and that natural coronary flow and cardiomyocytic energy state are normally reciprocally related in perfused heart. METHODS: For the Langendorff heart perfusion, bicarbonate perfusion buffer (pH 7.40+/-0.02,37degrees C) was equilibrated with 95% O2 : 5% CO2 and contained 5mM glucose (+5U/1 insulin) and 2mM pyruvate as energy-yielding substrates. Global hypoperfusion ischemia was induced by lowering coronary perfusion pressure of 100 to 40 cmH2O, followed by 20 min reperfusion. RESULTS: During the ischemia and reperfusion, metabolic acidosis and enhanced venous lactate output in SHR were observed with increases in coronary vascular resistance and myocardial oxygen consumption.In addition, coronary reactive hyperemia during reperfusion was depressed. Although ischemia-induced increase in combined adenosine plus inosine were abolished during prolonged reperfusion, SD still exhibited coronary vasodilation. The depressed reactive hyperemia in SHR was associated with decreases in cardiac adenosine triphosphate (ATP) pool and creatine phosphate/inorganic phosphate (CrP/Pi) ratio and an increase in cardiac lactate/pyruvate ratio. CONCLUSION: This abnormal vascular reactivity during ischemia and reperfusion in SHR may be in part due to an alteration in the cardiac energy state and hence to a mismatch between myocardial metabolic demand and supply.
Acidosis ; Adenosine ; Adenosine Triphosphate ; Animals ; Coronary Circulation ; Creatine ; Endothelium ; Glucose ; Heart* ; Homeostasis ; Humans ; Hyperemia ; Hypertension ; Inosine ; Ischemia ; Lactic Acid ; Models, Animal ; Myocardial Ischemia ; Oxygen ; Perfusion* ; Purine Nucleosides ; Pyruvic Acid ; Rats ; Rats, Inbred SHR* ; Reperfusion ; Vascular Resistance ; Vasodilation

BACKGROUND: The apnea test is an essential component in the clinical determination of brain death, however it may incur a significant risk of complications such as hypotension, hypoxia and even cardiac arrest. We analyzed the risk factors associated with a failed apnea test during brain death assessment in order to predict and avoid these adverse events. METHODS: Medical records on apnea tests performed for brain-dead donors at our institution between January 2009 and January 2016 were retrospectively reviewed. Age, gender, etiology of brain death, use of catecholamines and results of arterial blood gas analysis (ABGA), systolic/diastolic blood pressure (SBP/DBP), mean arterial pressure and central venous pressure prior to apnea test initiation were collected as variables. A-a gradient and P(aO2)/F(iO2) were calculated for more precise assessment of the respiratory system. In total, 267 cases were divided into two groups based on those who completed the apnea test and those who failed the test. RESULTS: 13 cases failed the apnea test. Among them, seven cases failed due to severe hypotension (SBP < 60 mmHg) and the others failed due to refractory hypoxia. In terms of hemodynamic state, SBP was significantly higher in the completed test group than the failed group (126.5 ± 23.9 vs. 103 ± 15.2, respectively; p = 0.001). In ABGA, the completed test group showed significantly higher P(aO2)/F(iO2) (313.6 ± 229.8 vs. 141.5 ± 131.0, respectively; p = 0.008) and a lower A-a gradient (278.2 ± 209.5 vs. 506.2 ± 173.1, respectively; p = 0.000). In multivariable analysis, low SBP (p = 0.003) and high A-a gradient (p = 0.044) were independent risk factors associated with a failed apnea test. CONCLUSIONS: Although the unexpected adverse events during the apnea test for brain death determination do not occur frequently, they can be fatal. If a brain-dead patient has low SBP and a high A-a gradient, clinicians should pay more attention and prepare for potential complications prior to the apnea test.
Anoxia ; Apnea* ; Arterial Pressure ; Blood Gas Analysis ; Blood Pressure ; Brain Death* ; Brain* ; Catecholamines ; Causality ; Central Venous Pressure ; Heart Arrest ; Hemodynamics* ; Humans ; Hypotension ; Medical Records ; Respiratory System ; Retrospective Studies ; Risk Factors ; Tissue Donors

No abstract available.
Coronary Circulation* ; Heart* ; Rats, Inbred SHR*

PURPOSE: The purpose of this study is to investigate clinical features and causative organisms in febrile infants younger than three months, to help identification of high risk patients for serious bacterial infection (SBI). METHODS: A total of 313 febrile infants younger than three months, who had visited Seoul National University Children's Hospital from January 2008 to December 2010 were included. Clinical features, laboratory findings, causative organisms, and risk factors of SBI were analyzed by retrospective chart review. Causative bacterial or viral pathogens were identified by gram stain and cultures, rapid antigen tests, or the polymerase chain reaction from clinically reliable sources. RESULTS: Among 313 infants, etiologic organisms were identified in 127 cases (40.6%). Among 39 cases of bacterial infections, Escherichia coli (66.7%) and Streptococcus agalactiae (12.8%) were common. Enterovirus (33.7%), respiratory syncytial virus (19.8%), and rhinovirus (18.8%) were frequently detected in 88 cases of viral infection. Patients with SBI (39 cases) showed significantly higher values of the white blood cell count (14,473+/-6,824/mm3 vs. 11,254+/-5,775/mm3, P=0.002) and the C-reactive protein (6.32+/-8.51 mg/L vs. 1.28+/-2.35 mg/L, P<0.001) than those without SBI (274 cases). The clinical risk factors for SBI were the male (OR 3.7, 95% CI 1.5-8.9), the presence of neurologic symptoms (OR 4.8, 95% CI 1.4-16.8), and the absence of family members with respiratory symptoms (OR 3.6, 95% CI 1.2-11.3). CONCLUSION: This study identified common pathogens and risk factors for SBI in febrile infants younger than three months. These findings may be useful to guide management of febrile young infants.
Bacterial Infections ; C-Reactive Protein ; Enterovirus ; Escherichia coli ; Fever ; Humans ; Infant ; Infant, Newborn ; Leukocyte Count ; Male ; Neurologic Manifestations ; Polymerase Chain Reaction ; Respiratory Syncytial Viruses ; Retrospective Studies ; Rhinovirus ; Risk Factors ; Sepsis ; Streptococcus agalactiae

PURPOSE: This study was done to identify and compare nursing performance including job stress, emotional labor and burnout between nurses who work in comprehensive nursing care service wards and general wards. METHODS: Participants were 187 nurses working in a general hospital in Busan which provides comprehensive nursing care service (comprehensive nursing care service ward: 95, general ward: 92). Data were collected using questionnaires and analyzed using descriptive statistics, χ² test, t-test, ANOVA, and multiple regression with the SPSS/WIN 23.0 program. RESULTS: There was no significant difference in the variables between comprehensive nursing care service ward nurses and general ward nurses. Factors influencing burnout were emotional labor in comprehensive nursing care service ward nurses while job stress and emotional labor were the factors influencing burnout in general ward nurses. CONCLUSION: The findings of this study indicate that comprehensive nursing care service can be a positive delivery system for nurses. Therefore, there is a need for strategies to integrate comprehensive nursing care service systematically.
Busan ; Hospitals, General ; Nursing Care* ; Nursing* ; Patients' Rooms* ; Stress, Psychological*

Fisting is an uncommon sexual activity, and death due to fisting is very rare. In the present report, we describe a case of a woman who died from fisting by her male partner. A 38-year-old woman went to a motel with a man after consuming alcohol, and there they kissed each other. As desired by woman, the man inserted his fingers into her vagina and anus, and later inserted his fist and forearm into her vagina and anus. After 20-30 minutes of fisting, the woman became unconscious and died. The autopsy confirmed the presence of perineal and vaginal lacerations with massive internal pelvic soft tissue injury with uterine artery rupture. A partial tear was noted at the rectosigmoid junction. The cause of death was hypovolemic shock due to uterine artery rupture. Following court trials, the assailant was sentenced to 4 years of imprisonment for the felony of inflicting bodily injury resulting in death.
Anal Canal ; Autopsy ; Cause of Death ; Female ; Fingers ; Forearm ; Humans ; Lacerations ; Male ; Rupture ; Sexual Behavior ; Shock ; Soft Tissue Injuries ; Unconscious (Psychology) ; Uterine Artery ; Vagina

PURPOSE: The purpose of this study was to analyze how a nursing student recognizes PBL with simulation education and its relationship to academic achievement. METHODS: The study objects were the students in C college who learn through PBL using simulator for 15 weeks(September 2007 to December 2007). Learning element recognition was developed by Cho(2002) and three key evaluations(performance, self-evaluation, and colleague evaluation) were designed by professors. RESULTS: Learning element recognition ranged from 2.37 to 4.83 with the average at 3.94. For Learning element recognition, students who preferred discussion score 4.15. This was statistically more significant than those who do not. Students who preferred presentations show significantly higher score in colleague evaluation. For Learning element recognition and academic achievement, self-evaluation and colleague evaluation showed relationship to PBL learning element. CONCLUSION: There was definitely a relationship with PBL learning element and academic achievement after learning the PBL with simulation education.
Achievement ; Diagnostic Self Evaluation ; Humans ; Learning ; Problem-Based Learning ; Students, Nursing

PURPOSE: The purpose of this study was to analyze nursing students' learning styles and relationship of learning style to participation and academic achievement. METHOD: The study participants were nursing students in C college learning through problem based learning (PBL). Data were collected using a questionnaire which included Kolb's learning styles. Performance evaluation and paper examination were used to evaluate academic achievement. RESULTS: Most of the students had converger type learning style. Student with a tendency to abstract conceptualization, such as converger type and assimilator type, preferred discussion and presentation. The students with converger type learning style participated and achieved better than students with diverger style. CONCLUSION: The results indicate that learning style was related to participation and academic achievement. Therefore in order to use PBL effectively, facilitators should consider students' learning styles.
Achievement ; Humans ; Learning ; Problem-Based Learning ; Surveys and Questionnaires ; Students, Nursing

Exercise induced asthma (EIA) is defined as acute, reversible, usually self-limiting airway obstruction which develop after strenous exercise in patients with asthma. EIA is a bigger problem in children than adults due to more active and smaller airways which obstruct more easily when bronchospasm develops. The exercise elicited many change in pulmonary function of asthmatic children. These change could be measured by measurements of PEFR, FEV1, FVC, or SRaw. The propose of this study is to determine the changes and sensitivity of different pulmonary function test in asthmatic children. 37 asthmatic children exercised on free running and pulmonary function tests were performed before and every 5 minutes during 15 minutes after exercise. The results were as follows. 1) In 37 asthmatic children, EIA developed in 23 children (62%) and did not developed in 14 children (38%). The difference in sex, height, weight, total eosinophil count, serum IgF and test between EIA and Non-EIA were not significant (P>0.05). 2) In EIA group, %PEFR was changed from 109.56% to 83.56%, But in Non-EIA group, %PEFR was not changed before and after exercise loading test. 3) In EIA group, %FEV1 was changed from 90.91% to 74.87%. But in Non-EIA group, %FEV1 was not changed before and after exercise loading test. 4) In EIA group, %FVC changed from 91.83% to 75.35%. But in Non-EIA group, %FVC was not change before and after exercise loading test. 5) There was significant difference in pre-exercise specific airway resistance between EIA (6.7+/-1.7) and normal children (5.8+/-2.2)(p<0.05). In EIA group, %SRaw was changed from 115.7% to 161.2%. But in Non-EIA group, %SRaw was not changed before and after exercise loading test. 6) During the post-exercise observation period, increasement of SRaw was greater than changes in any other pulmonary function test. SRaw is the most sensitive test for the ditection of exercise induced airway obstruction is asthmatic children.
Adult ; Airway Obstruction ; Airway Resistance* ; Asthma ; Asthma, Exercise-Induced ; Bronchial Spasm ; Child* ; Eosinophils ; Humans ; Peak Expiratory Flow Rate ; Respiratory Function Tests ; Running

Lung cancer is one of the most common types of malignancy in western nations with serious health problem, and it has become the leading cause of cancer death of males, second only to stomach cancer, in Korea. A review of the histopathology of 1363 cases (1231 patients) of lung carcinoma, diagnosed at the Keimyung University Medical center from 1987 to 1996, was performed to reclassify the type of carcinomas and to investigate the change in the distribution of histologic types of lung carcinoma according to age, sex and year. Among the 1363 cases, 132 patients underwent a surgical operation after biopsy. The diagnosis of each case was proven by histopathologic analysis of surgical specimens (13.2%) and biopsy materials (86.8%). The histologic types in our study were basically based on modified WHO classification (1982) and on new WHO classification (1999). The classification of small cell carcinoma was based on International Association for the Small Cell Lung Cancer (IASLC, 1988). Of the 1231 patients with lung carcinoma, 1012 were male and 219 were female (male to female ratio was 3.6:1). According to the analysis of age distribution, the most prevalent age group was 60~69 years in both sex as (n=516, 42.0%). Changing trends in sex distribution of lung carcinoma patients showed that the proportion of men had decreased throughout the years, whereas the proportion of women had significantly increased. Histologically, squamous cell carcinoma was the most common (n=624, 50.7%), followed by small cell carcinoma (21.1%), adenocarcinoma (18.1%), large cell undifferentiated carcinoma (2.1%), adenosquamous carcinoma (0.4%), and large cell neuroendocrine carcinoma (0.4%), in order of frequency. In men, squamous cell carcinoma was the most frequent type (55.1%). In women, adenocarcinoma was the most frequent type (39.7%). In both sexes, adenocarcinoma was the most common type in patients under the age of 40 (n=12, 41.4%), while squamous cell carcinoma proved the most frequent type in patients over the age of 40 (n=617, 51.3%). Changing trends of histologic types of lung cancer showed that the incidences of squamous cell carcinoma had significantly decreased throughout the years, whereas those of adenocarcinoma and small cell carcinoma had increased. In conclusion, the results showing increases in the percentage of female patients and in the number of cases of adenocarcinoma were noteworthy, and well correlated with other related reports.
Academic Medical Centers ; Adenocarcinoma ; Age Distribution ; Biopsy ; Carcinoma ; Carcinoma, Adenosquamous ; Carcinoma, Neuroendocrine ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Classification ; Diagnosis ; Female ; Humans ; Incidence ; Korea ; Lung Neoplasms ; Lung* ; Male ; Sex Distribution ; Small Cell Lung Carcinoma ; Stomach Neoplasms