BACKGROUND AND OBJECTIVES: Strain imaging has already been shown to quantify regional myocardial function in both acute ischemic myocardium and infarcted myocardium. We proposed that strain imaging could differentiate deformation of normal and ischemic myocardium that are without regional wall motion abnormality, as assessed by conventional echocardiography. The aim of this study is to determine the diagnostic value of strain imaging for the detection and localization of coronary lesions in patients with chest pain, but they are without apparent wall motion abnormalities. SUBJECTS AND METHODS: Strain imaging for advanced wall motion analysis was performed in 179 patients with suspicious stable angina (SA) and in 94 patients with suspicious acute coronary syndrome (ACS) prior to coronary angiography. All the patients had normal conventional wall motion scoring based on the standards of the American Society of Echocardiography. Longitudinal strain was measured in 3 apical views, and assessments of the strain value for individual segments with using an 18-segment division of the left ventricle were performed to determine the average strain value. Marked heterogeneity of strain was considered abnormal, and significant coronary artery disease was considered present if stenosis above 70% was noted on the quantitative angiography. RESULTS: Eighty (78%) of the 103 patients with SA and 18 (56%) of the 32 patients with ACS and who showed constant systolic strain throughout the left ventricular wall had normal or minimal coronary lesions. Fifty-one (67%) of the 76 patients with SA and 53 (85%) of the 62 patients with ACS and marked heterogeneity of strain had angiographically significant coronary stenosis. The receiver-operating characteristic (ROC) analysis of the peak systolic strain yielded that the ROC-area of peak systolic strain for the left anterior descending artery territory was 0.79 (95% CI 0.72-0.84), this was 0.87 (95% CI 0.79-0.91) for the left circumflex artery territory and 0.89 (95% CI 0.79-0.93) for the right coronary artery territory. CONCLUSION: Ultrasound-based strain imaging demonstrates a strong correlation with coronary angiography and it has potential as a noninvasive diagnostic tool for detecting coronary artery stenosis in patients with chest pain, but who are without apparent wall motion abnormalities on conventional echocardiography.
Acute Coronary Syndrome ; Angina, Stable ; Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Echocardiography ; Heart Ventricles ; Humans ; Myocardium ; Population Characteristics ; Sprains and Strains

PURPOSE: The purpose of this study is to evaluate the knowledge and attitudes of oncology ward nurses toward cancer pain management and to find ways to improve the educational program for nurses. METHOD: A total of 209 nurses working at the oncology ward of three hospitals in Seoul and a Gyenggi Province. The survey instrument used was the 32-item scale for evaluating nurses knowledge and attitudes originally developed by McCaffery and Ferrell'(1990), that was by Kim'(1997). RESULTS: In terms of the nurses knowledge of pain management, the result showed that the nurses scored an average of 67.8 out of 100 for phamacokinetics of opioids, 84.8 for classification of analgesics, 60.1 for pain assessment, and 70.7 for drug administration. 18.2% of the nurses hesitate to inject the narcotic agent because of concerns regarding the drug's potential side effects. there was significant difference in the knowledge of pain management according to the general characteristics of pain in terms of the nurses age(p=.001), position (p=.016), years of experiences(p=.002), experience of cancer pain education(p=.001). CONCLUSION: The also showed that nurses working at cancer ward lack knowledge. It is important to provide intensive education to nurses about cancer pain management.
Analgesics ; Analgesics, Opioid ; Classification ; Education ; Pain Management* ; Pain Measurement ; Seoul

PURPOSE: The purpose of this study is to evaluate the knowledge and attitudes of oncology ward nurses toward cancer pain management and to find ways to improve the educational program for nurses. METHOD: A total of 209 nurses working at the oncology ward of three hospitals in Seoul and a Gyenggi Province. The survey instrument used was the 32-item scale for evaluating nurses knowledge and attitudes originally developed by McCaffery and Ferrell'(1990), that was by Kim'(1997). RESULTS: In terms of the nurses knowledge of pain management, the result showed that the nurses scored an average of 67.8 out of 100 for phamacokinetics of opioids, 84.8 for classification of analgesics, 60.1 for pain assessment, and 70.7 for drug administration. 18.2% of the nurses hesitate to inject the narcotic agent because of concerns regarding the drug's potential side effects. there was significant difference in the knowledge of pain management according to the general characteristics of pain in terms of the nurses age(p=.001), position (p=.016), years of experiences(p=.002), experience of cancer pain education(p=.001). CONCLUSION: The also showed that nurses working at cancer ward lack knowledge. It is important to provide intensive education to nurses about cancer pain management.
Analgesics ; Analgesics, Opioid ; Classification ; Education ; Pain Management* ; Pain Measurement ; Seoul

OBJECTIVE: It has been suggested that overproduction of interleukin -18 (IL-18) may contribute to the pathogenesis of adult onset Still's disease (AOSD). Recently, positive association between a polymorphism in the IL-18 gene and different diseases like diabetes, sarcoidosis and asthma has been reported. The aim of the present study was to investigate the potential association of two single-nucleotide polymorphisms (SNPs) at position -137 (G/C) and -607 (C/A) in the promoter region of the IL-18 gene with susceptibility and clinical feature of AOSD in the Korean population. METHODS: We examined two SNPs of IL-18 in 70 patients with AOSD and 204 healthy control individuals. The genotyping were performed using sequence specific PCR. Haplotypes were analyzed by the estimated haplotype program. The patients with AOSD were subdivided into groups according to disease course: monocyclic systemic, polycyclic systemic, and chronic articular type. RESULTS: As for the -607 genotypes, 13 of the 69 patients had CC genotype (18.8%), 36 the CA type (52.2%) and 20 the AA type (29.0%). AOSD patients had higher frequency of A allele at -607 when compared to controls (OR 1.48, 95% CI 1.00~2.18, p=0.048). AOSD patients had significantly higher frequency of AA genotypes at -607 when compared to controls (AA vs CA& CC, OR 1.90, 95% CI 1.01~3.58, p=0.044). As for the -137 genotypes, of the 68 patients, 57 had GG genotype (83.8%), 9 the GC type (13.2%) and 2 (2.9%) had the CC type. No differences were found in allele and genotype frequencies between two groups. The haplotype frequencies of the IL-18 polymorphism were not significantly different between patients with AOSD and controls. The frequency of -137 GG genotype was significantly increased in chronic articular type compared to healthy control and systemic type of AOSD. CONCLUSION: In IL-18 gene polymorphisms, the A allele and AA genotye at position -607 might be genetic risk factors for the development of AOSD in Korean population. Further investigation in larger groups is required to provide more conclusive evidence regarding the role of the IL-18 gene polymorphism in AOSD.
Adult* ; Alleles ; Asthma ; Genotype ; Haplotypes ; Humans ; Interleukin-18* ; Interleukins ; Korea* ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide ; Promoter Regions, Genetic ; Risk Factors ; Sarcoidosis ; Still's Disease, Adult-Onset*

Two Korean black goat (approx. 2 and 3 years old) showing diarrhea and chronic weight loss were submitted to Animal and Plant Quarantine Agency. At necropsy, there were thickening of small intestine and enlargement of mesenteric lymph nodes. Microscopically, they had granulomatous enteritis in the small and large intestine and granulomatous lymphadenitis. By polymerase chain reaction (PCR) and acid fast stain, strong positive reaction and acid-fast rod bacteria were detected. According to the result of histopathology and PCR, we confirmed this case as Johne's disease. As far as we know, this is the first report of Johne's disease in Korean black goat.
Animals ; Bacteria ; Crohn Disease ; Diarrhea ; Goats* ; Intestine, Large ; Intestine, Small ; Lymph Nodes ; Lymphadenitis ; Paratuberculosis* ; Pathology ; Plants ; Polymerase Chain Reaction ; Quarantine ; Weight Loss

PURPOSE: The purpose of this study is to analyze the epidemiologic characteristics of sudden unexpected death in infancy and to evaluate the importance of postmortem autopsy. METHODS: We reviewed, retrospectively, medical records of 34 infants admitted to Kangnam General Hospital from January 1987 to December 2001 because of sudden unexpected death. We investigated the cause of death through medical history, death scene examination, autopsy findings, acylcarnitine and organic acid analysis. RESULTS: Among the total 34 infants, 18 were male(52.9%) and 16 were female(47.1%). Thirty infants(88%) were below the six months of age. Winter was the most affected season(38.2%). Eighteen infants(52.9%) died between 6 and 12AM. The prone sleeping position was observed more frequently than the supine position at death; nine cases in the prone position, six cases in the supine position. The cause of death of 23 cases could not be found by only history and death scene examination. Autopsy was done in 13 cases. Seven cases of them were thought to be SIDS. In six cases, we explained the cause of death with autosy findings. They were an endocardial fibroelastosis, a nesidioblastosis, a subdural hematoma, a bronchopneumonia and two fatty changes of liver. Metabolic screening tests performed in three cases to rule out metabolic disorder since 2000 were all normal. CONCLUSION: We concluded that autopsy and metabolic screening test should be performed to find out the cause of death in sudden unexpected death in infancy.
Autopsy* ; Bronchopneumonia ; Cause of Death ; Endocardial Fibroelastosis ; Hematoma, Subdural ; Hospitals, General ; Humans ; Infant ; Liver ; Mass Screening ; Medical Records ; Nesidioblastosis ; Prone Position ; Retrospective Studies ; Sudden Infant Death ; Supine Position

Background: There has been no comparison of the determinants of admission route between acute ischemic stroke (AIS) and acute myocardial infarction (AMI). We examined whether factors associated with direct versus transferred-in admission to regional cardiocerebrovascular centers (RCVCs) differed between AIS and AMI. Methods: Using a nationwide RCVC registry, we identified consecutive patients presenting with AMI and AIS between July 2016 and December 2018. We explored factors associated with direct admission to RCVCs in patients with AIS and AMI and examined whether those associations differed between AIS and AMI, including interaction terms between each factor and disease type in multivariable models. To explore the influence of emergency medical service (EMS) paramedics on hospital selection, stratified analyses according to use of EMS were also performed. Results: Among the 17,897 and 8,927 AIS and AMI patients, 66.6% and 48.2% were directly admitted to RCVCs, respectively. Multivariable analysis showed that previous coronary heart disease, prehospital awareness, higher education level, and EMS use increased the odds of direct admission to RCVCs, but the odds ratio (OR) was different between AIS and AMI (for the first 3 factors, AMI > AIS; for EMS use, AMI < AIS). EMS use was the single most important factor for both AIS and AMI (OR, 4.72 vs. 3.90). Hypertension and hyperlipidemia increased, while living alone decreased the odds of direct admission only in AMI;additionally, age (65–74 years), previous stroke, and presentation during non-working hours increased the odds only in AIS. EMS use weakened the associations between direct admission and most factors in both AIS and AMI. Conclusions Various patient factors were differentially associated with direct admission to RCVCs between AIS and AMI. Public education for symptom awareness and use of EMS is essential in optimizing the transportation and hospitalization of patients with AMI and AIS.