The purpose of this study is compare IVF cycle outcome in poor responders between clomiphene citrate (CC) stimulated and controlled ovarian hyperstimulation (COH) protocol. A total of 94 patients responding poorly in previous IVF cycles (estradiol<600 pg/ml or less than 3 oocytes retrieved) subsequently underwent either COH (COH group: 122 cycles, 68 patients) or CC-stimulated cycles (CC group: 43 cycles, 26 patients). CC was administered for five consecutive days starting on cycle day 3 at a dose of 100 mg daily. Serial transvaginal ultrasound examination was done from cycle day 8. Urine was collected 3~4 times before hCG injection for the detection of LH surge. The hCG was administered when serum estradiol reached greater than 150 Pg/ml and mean follicle diameter>16 mm. In COH group, ovarian stimulation was done using short protocol (GnRH-a/FSH/HMG/hCG). No difference in age or number of transferred embryos was found between CC group and COH group. COH group had significantly (p<0.05) higher mean peak level of E2 (810+/-112 vs 412+/-55 pg/ml) and greater number of retrieved oocytes (3.0+/-0.2 vs 2.0+/-0.2) than CC group. CC group had significantly embryos (1.8+/-0.2) compared with (2.1+/-0.2) in COH group. However, CC group had higher pregnancy rate than COH group per retrieval [26.9% (7/26) vs 6.2% (6/97)], or per transfer [31.8% (7/22) vs 7% (6/86)]. Although cycle cancellation rate in CC group (48.8%) was higher than that of COH group (21.3%), the pregnancy rate per cycle in CC group was still higher (16.3%) than COH group (4.9%). In addition, implantation rate in CC group was 17.5% (7/40), which was significantly p<0.01) higher than 3.9% (7/180) in COH group. These data suggest that oocyte and embryo quality are lower in COH cycles of poor responders than CC cycles. We suggest that clomiphene citrate stimulated IVF cycle may be more efficient than COH IVF cycle in poor responders in terms of lower costs and higher pregnancy performance.
Clomiphene* ; Embryonic Structures ; Estradiol ; Fertilization* ; Humans ; Oocytes ; Ovulation Induction ; Pregnancy ; Pregnancy Rate ; Ultrasonography

PURPOSE: This study aimed at not only suggest some ideas useful in planning and doing the safety education in the elementary schools in the near future putting into test the safety education proposal which has been developed by researchers in accordance with the national 7st education courses but also improve health of the children through taking right safety knowledge and sound safety attitude. METHOD: For this study 140 student are selected from 3-5th grade of the elementary school in Kyoungki-Do and Kwangwon-Do and have been taught the safety education during 10weeks, 10times. RESULT: 1) After the safety education, knowledge about the injury prevention of the children show to be significantly different from that they had before(t=-9.156, p=.000). 2) In order to look into any effect of the attitude about injury prevention after the safety education there were significant difference(t=-3.755, p=.000).CONCLUSION: As the findings of the study indicating that safety education expand the correct knowledge about injury prevention and have more affirmative and sound attitude about injury prevention. So it may be concluded that, safety education have the positive effect both knowledge and attitude about injury prevention among elementary school children.
Child* ; Education* ; Gangwon-do ; Humans ; Child Health

PURPOSE: This study was performed to investigate the perceived relationship among professional self-concept, head nurse's leadership, and nursing clinical competency by clinical nurses. METHODS: This study was a cross-sectional survey. Participants were 601 nurses working at the five general hospitals in four provincial cities, Gyeungbuk, Korea. Data were collected from July 14, 2010 to August 31 and analyzed by SPSS/PC ver 18.0 programs. RESULTS: Professional self-concept and head nurse's leadership were slightly above the middle average, but nursing clinical competency was good. According to participants' age, marital status, job satisfaction, and length of service, there were perceptional differences in professional self-concept, head nurse's leadership, and nursing clinical competency. Nursing clinical competency could be explained by head nurse's leadership, professional self-concept, job satisfaction and length of service. Head nurse's leadership was independent variable affecting nursing clinical competency, professional self-concept was partial mediating variable, and job satisfaction and length of service were extraneous variables. CONCLUSION: It is concluded that head nurse's leadership is more important than professional self-concept to improve nursing clinical competency. Nursing managers should plan various strategies to improve head nurse's leadership and professional self-concept, to increase clinical nurses' job satisfaction and length of service.
Cross-Sectional Studies ; Head ; Hospitals, General ; Job Satisfaction ; Korea ; Leadership ; Marital Status ; Negotiating

BACKGROUND: Allergic diseases are characterized by immediate - and late - phase reactions to various allergens by the selective activation of a subset of CD4 + T cells. In response to allergen, T cells isolated from atopic donors are biased to low levels of IFN - y and high levels of IL - 4, and vice versa by T cells from non - atopic donor. Objective : The aim of this study was to evaluate the patterns of IL - 4 and IFN - y production after Der p I stimulation and the effect on the cytokine production from T cells by budesonide, disodium cromoglycate and cyclosporin A in atopic and non - atopic individuals. MATERIAL AND METHOD: Seven Der p I specific atopic and 7 non - atopic individuals were selected. We decided the 50% inhibiting concentration of each immunomodulator by lymphocyte proliferation assay, and measured their effects on the cytokine production in vitro by intracellular IL - 4, IFN - y staining and flow cytometry. Results and CONCLUSION: There was significant difference on stimulation index ( SI ) of production of IFN - y as well as IL-4 after Der p I stimulation between atopic and non-atopic individuals ( IL - 4 ; 1.57 +/- 0.7 : 0.98 +/- 0.2, p = 0.026, IFN - r : 1.45 +/- 0.5 : 0.95 +/- 0.2, p = 0.048 ). The synthesis of IL - 4, and IFN - r were significantly inhibited after the stimulation of every immunomodulators in atopic individuals, DSCG couldnt inhibit IL - 4 and IFN - r in nonatopic individuals. There was no significant difference in the inhibiting effect of these immunomodulators in both of them.
Allergens ; Bias (Epidemiology) ; Budesonide ; Cromolyn Sodium ; Cyclosporine ; Dust* ; Flow Cytometry ; Humans ; Immunologic Factors ; Interferons* ; Interleukin-4 ; Lymphocytes ; Pyroglyphidae* ; T-Lymphocytes* ; Tissue Donors

The aim of this study is to determine whether or not hydrosalpinx affects pregnancy rate and implantation rate adversely in human IVF-ET program. 110 infertile couples with tubal factor undertaken IVF-ET treatment from May 1995 through April 1996 were included. Patients with tubal factor combined with other factors were excluded from this study. The hydrosalpinx group included 35 patients who had unilateral or bilateral hydrosapinx. Fifty four patients with proximal tubal occlusion without hydrosalpinx served as a control. The corrected hydrosalpinx group included 21 patients hydrosalpinx served as a control The corrected hydrosalpinx group included 21 patients who had undertaken either salpingectomy(n=5) or salpingoneostomy(n=16) before IVF-ET cycle. Controlled ovarian hyperstimulation was performed using GnRH agonist/human menopausal gonadotropin or follicular stimulation hormone(FSG). Thirty four hours after intramuscular injection of 10,000 IU human chorionic gonadotropin(hCG), trasvaginal sonography-guided oocyte retrieval was done, The cleaved embryos were transferred to the uterus on day two or three after fertilization. There was no significant difference in age(mean +/- SEM; 32.9 +/- 0.4, 32.7 +/- 0.6, 31.4 +/- 0.6), basal FSH level(7.1 +/- 0.3, 7.2 +/- 0 0.3, 7.0 +/- 0.4 mIU/ml) and estradiol on the day of hCG injection(2674 +/- 219, 3239 +/- 304, 3376 +/- 360 pg/ml) among the control, hydrosalpinix and corrected hydrosalpinx group, respectively(p > 0.05). The number of trasferred embryos(5.1 +/- 0.3, 5.6 +/- 0.3 and 5.4 +/- 0.6) were similar between the groups. The clinical pregnancy rate of 8.3% in hydrosalpingeal group was significantly lower than 25.4% of control group (p=0.057). However, in corrected hydrosalpinx group, pregnancy rate of 27.3% compared well with the control group. The implantation rate showed a similar pattern with pregnancy rate, i.e., hydrosalpingeal group had the lowest implantation rate of 2.0%, which was significantly lower than 11.6% of control group. In the corrected hydrosalpinx group, implantation rate(9.3%) recovered as that of the control group. The ectopic pregnancy rate(11.1%) of the hydrosalpingeal group was higher than that of the control group(1.7%) and was intermediate(4.5%) in corrected hydrosalpinx group(p > 0.05). In conclusion, these data show that hydrosalpinx affects the pregnancy rate adversely in IVF-ET cycyle. Thus, it is suggested that surgical correction of the hydrosalpinx before the initiation of IVF-ET cycle may be beneficial in increasing the pregnancy rate as well as decreasing the ectopic pregnancy.
Chorion ; Embryo Transfer* ; Embryonic Structures* ; Estradiol ; Family Characteristics ; Female ; Fertilization ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Humans ; Injections, Intramuscular ; Oocyte Retrieval ; Pregnancy Rate* ; Pregnancy* ; Pregnancy, Ectopic ; Sterilization, Tubal ; Uterus

BACKGROUND: Compared with conventional routes of delivering potent analgesics to postoperative patients, transdermal administration of fentanyl offers the advantages of simplicity and noninvasiveness. The analgesic efficacy and safty of transdermal fentanyl patch (TDFP) were evaluated postoperatively. METHOD: TDFP releasing 25 mcg/hr (Group 1) or placebo (Group 2) were applied to 40 women 6 hours before total abdominal hysterectomy under the general anesthesia. Postoperatively, self-administered intravenous fentanyl was maintained with a 20-mcg incremental dose and a 10-min. locking interval. Each group was assessed following 48 hours with respects to vital signs, VAS pain scores, hourly-used fentanyl doses, satisfaction scores and side effects. RESULT: VAS observed 24 hours, 36 hours after operation were significantly lower in group 1 than group 2. Hourly-used fentanyl doses were significantly lower in group 1 than group 2 at 2 hours, 6 hours, 12 hours and 24 hours after operation. The incidence of side effects were similar between group 1 and group 2. CONCLUSION: TDFP-25 mcg applied 6 hours before operation provides supplementary analges-ia after the postoperative period without significant side effects such as respiratory depression.
Administration, Cutaneous ; Analgesics ; Anesthesia, General ; Female ; Fentanyl* ; Humans ; Hysterectomy* ; Incidence ; Postoperative Period ; Respiratory Insufficiency ; Vital Signs

OBJECTIVE: To investigate the association between endometriosis and polymorphisms of N-acetyl transferase 2 (NAT2), glutathione S-transferase M1 (GSTM1), and cytochrome P450 (CYP) 1A1 genes in Korean infertile patients. MATERIALS AND METHODS: A total of 303 infertile patients who had undertaken diagnostic laparoscopy during January, 2001 through December, 2003 at Samsung Cheil Hospital enrolled in this study. The patients were grouped according to laparoscopic findings: minimal to mild endometriosis (group I: n=147), moderate to severe endometriosis (group II: n=57), normal pelvic cavity (n=99). Peripheral blood was obtained and genomic DNA was extracted. The genotypes of each genes were analyzed using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). For NAT2, RFLP was used to detect the wild type (wt) and mutant (mt) alleles, enabling classification into slow (mt/mt) or fast (wt/wt or wt/mt) acetylation genotypes. For GSTM1, PCR was used to distinguish active (+/- or +/+) from null (-/-) genotypes. For CYP1A1, MspI digestion was used to detect the wild type (A1A1), heterozygote (A1A2) or mutant (A2A2) genotypes. RESULTS: The genotype frequencies of NAT2 slow acetylator was 12.8%, 10.9%, 12.8% in group I, group II and control, respectively. The genotype frequencies of GSTM1 null mutation was 55.3%, 41.8%, 53.2% in group I, group II and control, respectively. The genotype frequencies of CYP1A1 MspI polymorphism was 16.3%, 9.1%, 18.1% in group I, group II and control, respectively. No significant difference was observed between endometriosis and normal controls in the genotype frequencies of the NAT2, GSTM1, CYP1A1 MspI polymorphism. CONCLUSION: The NAT2, GSTM1, CYP1A1 gene polymorphism may not be associated with the susceptibility of endometriosis in Korean women.
Acetylation ; Alleles ; Classification ; Cytochrome P-450 CYP1A1 ; Cytochrome P-450 Enzyme System* ; Cytochromes* ; Digestion ; DNA ; Endometriosis* ; Female ; Genotype ; Glutathione Transferase* ; Glutathione* ; Heterozygote ; Humans ; Laparoscopy ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Transferases*

PURPOSE: This study was conducted to suggest direction and strategy of safety education proper to elementary school children. METHOD: The subject of this survey consisted of 313 3rd-5th grade from 4 elementary schools in Kyungi-Do and Kwangwon-Do. Data were collected from March to May, 2002 using a questionnaire about "safety education needs", "knowledge about injury prevention", "attitude about injury prevention. RESULT: 1. The degree of safety education needs showed averaged 77.50 on the basis of 100 points. 2. The degree of knowledge and attitude about injury prevention showed averaged 72.81 and 81.74 seperately on the basis of 100 points. 3. With the respect to the demographic characteristics, there were stastically significant differences in safety education need according to children's grade(F=8.692, p=.003), sex(t=-2.059, p=.040), family type(t=-2.229, p=.027) and in knowledge & attitude about injury prevention, there statiscally significant difference according to experience of injury prevention education(t=3.058, p=.003; t=5.308, p=.000) each. 4. The level of safety education needs is correlated at signficant level with knowledge and attitude about injury prevention of childrens(r=.166, p=.048; r=.265, p=.001) and between knowledge and attitude about injury prevention, there was significant correlation (r=.427, p=.000). CONCLUSION: From this results, nurses can plan safety education program appropriate to children's needs, level of knowledge and attitude about injury prevention.
Child* ; Education* ; Gangwon-do ; Humans ; Child Health ; Surveys and Questionnaires

OBJECTIVES: The purpose of this study was to determine whether or not the shed endometrial tissues in menstrual fluid (MF) have adhesive potentials, using human amniotic membrane (AM). METHODS: The MF from 20 patients with regular menstruation was collected with Wallace catheter by aspiration from the uterine cavity on the second or third day of the menstrual period. The AM was obtained from the placenta of term delivery without any complication. The MF was washed and diluted fivefold with Hams F-10 medium supplemented with 10% fetal bovine serum. The cell suspension was placed on either epithelial layer (EP) or extracellular matrix layer (ECM) of the AM. After 5 days of culture, the adhesion sites were observed under a stereomicroscope. For histological observation, each cultured AM was prepared for the serial paraffin section. RESULTS: The adhesion sites of endometrial tissues in MF were found both ECM (20/20) and EP (11/20) of the AM. The size of adhesion sites in each AM were highly variable from microscopic to macroscopic size. CONCLUSION: We found that the shed endometrial tissues in MF have adhesive potential to epithelial layer in addition to extracellular matrix layer of amniotic membrane. This adhesive potential may be related to pathogenesis of endometriosis. We suggest that this culture system can be useful as an in-vitro model for endometriosis.
Adhesives* ; Amnion* ; Catheters ; Endometriosis* ; Extracellular Matrix ; Female ; Humans ; Menstruation ; Paraffin ; Placenta

OBJECTIVE: The aim of this study was to evaluate the efficacy of frozen-thawed ET in poor prognosis patients such as the old age (38~44 years; OA group) and the patients who did not achieve clinical pregnancy with the first fresh ET cycle (non-pregnant patients; NP group). METHODS: Laboratory and clinical data were collected from fresh and frozen-thawed ET cycles of OA and NP group. Controlled ovarian hyperstimulation (COH) and conventional insemination or ICSI, in vitro culture and ET were performed by routine procedures. Supernumerary embryos were frozen by the slow freezing method, and frozen embryos were thawed by the rapid thawing method. Embryo development, pregnancy and implantation rates were statistically analyzed by Student t-test and chi square test. RESULTS: Mean ages were similar between fresh ET (40.0+/-1.8 years, n=206) and frozen-thawed ET (39.9+/-1.9 years, n=69) cycles in OA group. However, the clinical pregnancy and implantation rate of subsequent frozen-thawed ET significantly higher than those of fresh ET cycles (29.0% and 11.2% vs. 16.5% and 7.0%, p<0.05). In NP group, there was no difference in the mean age between fresh ET (31.2+/-2.3 years, n=40) and frozen-thawed ET (31.9+/-3.1 years, n=119) in subsequent cycles. The clinical pregnancy and implantation rates were similar between the subsequent fresh ET (42.5% and 22.6%) and the frozen-thawed ET (40.3% and 18.8%). CONCLUSION: In old age patients, higher pregnancy rate of frozen-thawed ET compared to fresh ET cycles in this study. It may be related that better uterine environments for implantation in frozen-thawed ET cycles than that of non-physiological hormonal condition in uterus of fresh COH cycles.
Embryonic Development ; Embryonic Structures ; Female ; Freezing ; Humans ; Insemination ; Pregnancy ; Pregnancy Rate ; Prognosis ; Sperm Injections, Intracytoplasmic ; Uterus