BACKGROUND:With the application of early reperfusion by thrombolysis after acute MI, the importance of nontransmural infarction is increasing. We evaluated 1) the changes of LV dimension, LV fibrosis and transforming growth factor-beta1 (TGF-beta1) mRNA expression in a rat model of nontransmural infarction and 2) effects of angiotensin converting enzyme inhibitor (ACEI) and angiotensin II receptor blocker (ATRB) treatment after nontransmural infarction. METHOD AND RESULTS: Female Sprague-Dawley rats were subjected to 45 minutes of coronary occlusion followed by reperfusion, and at 5 days after the operation, animals were randomized to untreated (MI-vehicle, n=19), captopril-treated (MI-captopril, n=15) and losartan-treated (MI-losartan, n=14) groups. LV dimension, measured by transthoracic echocardiography, was significantly increased at 26 days after MI, and both captopril and losartan treatment inhibited LV cavity dilatation (LV end-diastolic dimension (mm): MI-vehicle, MI-captopril, MI-losartan; 8.6 +/- 0.2, 7.8 +/- 0.2, 8.0 +/- 0.2, p<0.05 vs. MI-vehicle each). Interstitial fibrosis was reduced with both captopril and losartan treatment (p<0.05 vs. MI-vehicle). TGF-beta1 mRNA increased 2.6 fold at 10 days (p<0.05 vs. pre-MI), and normalized at 26 days after nontransmural MI. Captopril and losartan treatment blocked the induction of TGF-beta1 expression after nontransmural MI (p=S vs. pre-MI). CONCLUSION: After large nontransmural MI, ACEI and ATRB treatments attenuate LV remodeling and decrease interstitial fibrosis, at least partly by blocking the acute induction of TGF-beta1 mRNA expression.
Angiotensins* ; Animals ; Captopril ; Coronary Occlusion ; Dilatation ; Echocardiography ; Female ; Fibrosis ; Humans ; Infarction ; Losartan ; Models, Animal ; Peptidyl-Dipeptidase A* ; Rats, Sprague-Dawley ; Receptors, Angiotensin ; Reperfusion ; RNA, Messenger ; Transforming Growth Factor beta1 ; Transforming Growth Factors ; Ventricular Remodeling*

Cervical spine injury occurs in 3% of blunt trauma patients, and 10% of patients with cervical spine injuries have an associated head injury. The early recognition of cervical spine injury and treatment of the secondary injury are important in the management of trauma patients. At the time of diagnosis of cervical spine injury, 5~30% of patients have been reported to have experienced missed or delayed diagnosis. Of these, 10.5~29% were associated with permanent and critical neurologic injury, for example, death, quadriplesia, ect. The writers experienced two cases of missed traumatic cervical spine injury.
Craniocerebral Trauma ; Delayed Diagnosis ; Diagnosis ; Humans ; Spine*

PURPOSE: The purpose of this study was to investigate the welfare status of nurses and the status of fixed night shifts and flexible work arrangements in both general hospitals and advanced general hospitals in Korea. METHODS: A total of 167 hospitals participated in this study, done from April to October 2018. RESULTS: There were 103 hospitals utilizing the fixed night shift system, 22 in the two-shift system, 3 in the fixed holiday shift, 79 in the fixed shift system, and 39 in the short-time working system. The average welfare benefits for nurses increased to 33.02 million won on average. However, welfare services for the nurses were poor: 41.8% of the respondents had a nurses' lounge, 81.7% were given dormitory space at their place of employment, 41.8% had access to welfare facilities, and 56.4% were provided with welfare support countermeasures. CONCLUSION: The results show an increasing trend of hospitals to utilize fixed night shift and flexible work arrangements. An institutional strategy at the national policy level should be established to implement flexible work arrangements including the fixed night shift system, which has a poor level of welfare.
Employment ; Holidays ; Hospitals, General ; Korea ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to compare the working status and Standard Shiftwork Index (SSI) between night shift-fixed nurses and rotating shift nurses. METHODS: Participants were 367 nurses working as registered nurses at 7 different medical institutions. The data were collected from August 8, 2016 to September 30, 2016. RESULTS: Night shift fixed nurses were more satisfied with work schedule than rotating shift nurses. Rotating shift nurses reported higher SSI scores, such as chronic fatigue, musculoskeletal problems, than night shift fixed nurses. In SSI's sub-items, rotating shift nurses reported higher scores, such as the amount of sleep, feeling well after sleep, heartburn or stomach-ache and heartbeat irregularities, than night shift fixed nurses. CONCLUSION: The results indicated that night shift fixed system might be an effective method to improve nurses' work satisfaction. It is necessary to figure out any suitable night shift fixed system based on the characteristics of each nursing organization. The SSImight be an useful tool tomeasure the nurses' satisfaction in reference to their work shift.
Appointments and Schedules ; Fatigue ; Heartburn ; Humans ; Job Satisfaction ; Methods ; Nurses ; Nursing

Post-tonsillectomy hemorrhage (PTH) is the most frequent complication of tonsillectomy, and occasionally results in a lethal outcome. A 21-year-old man (height 180 cm, weight 95 kg) was scheduled for a bilateral tonsillectomy and uvulopalatopharyngoplasty for treatment of obstructive sleep apnea. He required 5 rounds of general anesthesia due to recurrent PTH. The anesthesiologist used sugammadex a total of 3 times to achieve the successful reversal of the deep neuromuscular blockade (NMB) induced by rocuronium. After sugammadex 2 mg/kg was administered, the NMB was reversed in 2 minutes each time. Re-administration of rocuronium within a short time interval after sugammadex may result in unpredictable effects of neuromuscular blocking agents. Sugammadex made it possible to perform a rapid, complete reverse when the residual block was maintained by an incomplete reversal of anticholinesterase.
Anesthesia, General ; Hemorrhage* ; Humans ; Neuromuscular Blockade* ; Neuromuscular Blocking Agents ; Postoperative Hemorrhage ; Sleep Apnea, Obstructive ; Tonsillectomy ; Young Adult

BACKGROUND: We performed this study to evaluate the potency and time course of rocuronium-induced neuromuscular block following moderate or severe acute normovolemic hemodilution (ANH) in rabbits. METHODS: Forty five rabbits were randomly assigned to the control (C) group, the moderate ANH (M) group, or the severe ANH (S) group. After stabilization of sevoflurane anesthesia, ANH was achieved by drainage of arterial blood and an intravenous infusion of 6% hydroxyethyl starch, during which hematocrit (Hct) decreased to 26.2 ± 2.5% in the M group and 17.6 ± 2.2% in the S group. We determined dose-response relationships of rocuronium in the three groups and created a time course of the action of 0.6 mg/kg rocuronium. RESULTS: The 50% effective dose (ED50) for rocuronium was 45% and 50% lower in the M and S groups, respectively, than in the C group (50.9 ± 6.3 µg/kg) (P < 0.001). The onset time after 0.6 mg/kg rocuronium was faster in the ANH groups compared with the C group (P < 0.001). The duration of neuromuscular block was prolonged by 38% and 43% in the M and S groups, respectively, compared with the C group (49.1 ± 6.9 min) (P < 0.001). CONCLUSIONS: ANH resulted in high potency, rapid onset, and prolonged duration of rocuronium. However, the severity of ANH did not alter the potency and duration of action of rocuronium.
Anesthesia ; Drainage ; Hematocrit ; Hemodilution* ; Infusions, Intravenous ; Neuromuscular Blockade ; Rabbits* ; Starch

PURPOSE: The aim of this study was to examine the associations between depression, anxiety, hostility and fighting spirit among patients with stomach, colorectal or breast cancer. MATERIALS AND METHODS: 223 patients, diagnosed as with stomach, colorectal or breast cancer, undergoing chemotherapy or follow up care, were the subjects of the study. The study design was cross-sectional at the time of the survey. The degrees of depression, anxiety and hostility of the patients were assessed by the SCL-90-R scores, and the fighting spirit was measured by the Mental Adjustment to Cancer (MAC) scale score. RESULTS: The scores of anxiety and hostility of the patients at younger age were higher than those at older age (p<0.01). The patients with metastasis were more depressed than those without it (p<0.01). There was a negative association between depression and fighting spirit (p<0.001). CONCLUSION: The study showed the more depressed cancer patients had lower fighting spirit score, which was known to be one of the most active psychosocial contributors in adjusting to cancer and survival.
Anxiety* ; Breast Neoplasms ; Depression* ; Drug Therapy ; Follow-Up Studies ; Hostility* ; Humans ; Korea* ; Neoplasm Metastasis ; Stomach

PURPOSE: This study was done to explore communication between nurses during preceptorship. METHODS: A qualitative study, using content analysis was conducted. Semistructured interviews were held with 10 nurses working in urban hospitals. RESULTS: A total of 226 significant statements were selected from the data and classified into 4 categories and 23 subcategories. Communication experiences of new nurses' own performance were responses to reproach - acceptance and apology, and unresponsiveness due to feeling small and uncomfortable; responses to questions - misanswer; responses to directions - unconditional acceptance. Communication experiences of new nurses' performance by nurse preceptors were kindness, stigmatization, talking behind one's back, criticism and reproach, impolite words, and emotional expression. Communication experiences of nurse preceptors's own performance were directives, sympathy, reproach, unkindness, authoritative strictness, and nonverbal expression: being cold, and lessening of tension. Communication experiences of nurse preceptors' performance by new nurses were response to criticism - recognition and apology for mistakes, evasion of responsibility, and excuses; responses to explanations-active acceptance, and difficulty with communication due to lack of comprehension. CONCLUSION: These results provide deep understanding of nurses' communication during preceptorship and should help in developing comprehensive education programs for preceptor nurses and new nurses.
Comprehension ; Education ; Hospitals, Urban ; Preceptorship* ; Qualitative Research ; Stereotyping

PURPOSE: Obesity has become a pandemic and especially the prevalence of childhood obesity has increased remarkably over the past years. Childhood obesity is often accompanied by the expected morbidities such as hyperlipidemia, fatty liver and glucose intolerance. We evaluated the pattern of alteration in the body mass index (BMI), serum adiponectin concentration, insulin resistance (HOMA-IR), and complication rates after one year follow-up. METHODS: Forty two obese children (age: 8-15 years, 95th percentile of BMI for age and sex) were examined twice annually on June, 2004 and July, 2005. The body mass index (BMI) and sexual maturity rating (SMR) were determined annually by the same examiner and serum fasting glucose, liver enzyme, lipid profiles, adiponectin, insulin and HOMA-IR were measured and annual results were compared. Upper abdominal sonography was performed to detect fatty liver. RESULTS: BMI (25.3+/-2.9 kg/m2 vs. 26.0+/-2.9 kg/m2) and HOMA-IR (3.6+/-1.8 vs. 4.7+/-1.9) have increased significantly after one-year follow-up. The serum adiponectin concentration (17.2+/-5.2 g/mL vs. 12.6+/-5.2 g/mL) has decreased after one year. The prevalence of hyperlipidemia and fatty liver were not changed significantly but that of hyperinsulinemia increased after one-year. HOMA-IR showed a positive correlation with BMI and SMR, but was negatively correlated with serum adiponectin concentration. CONCLUSION: Obese children in our study showed significant increment of insulin resistance during one year. These results suggest that well-organized and continuous obesity control is required especially for obese adolescent to prevent complication of obesity.
Adiponectin* ; Adolescent* ; Body Mass Index ; Child* ; Fasting ; Fatty Liver ; Follow-Up Studies* ; Glucose ; Glucose Intolerance ; Humans ; Hyperinsulinism ; Hyperlipidemias ; Insulin Resistance* ; Insulin* ; Liver ; Obesity ; Pandemics ; Pediatric Obesity ; Prevalence

Coronary artery fistula (CAF) is a rare form of congenital anomalies of the coronary arteries, and this is usually discovered by chance during coronary angiography. However, this type of fistula can cause important coronary morbidity and mortality leading to angina, syncope, congestive heart failure, myocardial infarction and sudden death. Bilateral CAFs are even rarer, and especially when combined with valvular heart disease. The coincidence of CAF with aortic regurgitation is relatively rare and this might sometimes cause myocardial ischemia. We present here a case of bilateral coronary-pulmonary artery fistulas that arose from the first diagonal branch of the left anterior descending artery and the conal branch of the right coronary artery combined with severe aortic regurgitation, and this all caused myocardial ischemia.
Aortic Valve Insufficiency ; Arteries ; Arteriovenous Fistula ; Coronary Angiography ; Coronary Vessels ; Death, Sudden ; Fistula ; Heart Failure ; Heart Valve Diseases ; Myocardial Infarction ; Myocardial Ischemia ; Pulmonary Artery ; Syncope