BACKGROUND: This study was performed to evaluate the effects of intercostal nerve block added in intravenous patient-controlled analgesia (IV-PCA; PCA) on pain, pulmonary function and the movement of the ipsilateral arm after a thoracotomy. METHODS: Forty five patients undergoing elective thoracotomy were randomly allocated into one of three groups. The groups were divided as follows: PCA, ICB-PCA (PCA and intercostal nerve blocks by direct injection of 5 ml of 0.2% bupivacaine into the intercostal spaces of two upper and two lower segments around the surgical incision) and IM groups. For the PCA, the patients that received PCA, were administered IV bolus of 0.1 mg/kg of nalbuphine followed by PCA with 0.1% nalbuphine (basal rate 0.5 ml/hr, bolus dose 1 mg and lockout interval 8 minutes). In each group, VAS score, the inspiratory capacity and the movement of the ipsilateral arm were checked postoperatively at 6, 24, 48 and 72 hours. RESULTS: Inspiratory capacity was decreased less in ICB-PCA group (P<0.05) at 6 hour, but after 24 hour, there were no differences between the groups. The analgesic effect was significantly better in ICB-PCA group as compared to the PCA or IM groups (P<0.05). Furthermore, arm motion limitation after operation was the least in ICB-PCA group (P<0.01). CONCLUSION: Intraoperative intercostal nerve blocks added in PCA has a transient improvement of pulmonary function, and also provide better analgesia and improved ipsilateral arm motion after a thoracotomy than in PCA or IM analgesia. The authors recommend adding intercostal nerve block for patients undergoing thoracotomy who receive IV-PCA.
Analgesia ; Analgesia, Patient-Controlled ; Arm ; Bupivacaine ; Humans ; Inspiratory Capacity* ; Intercostal Nerves* ; Nalbuphine ; Passive Cutaneous Anaphylaxis ; Thoracotomy*

The purpose of this study was to photoelastically visualize the distribution of forces transmitted to the alveolus and surrounding structures using three different types of headgear for the distal movement of the upper molars. A photoelastic maxillary model was made and three different directional forces applied, which were high-pull, straight- pull, and cervical-pull. Stress distribution was recorded through circular polariscope, and two-dimensional photoelastic stress analysis was performed according to isochromatic fringe characteristics. The results were as follows: 1. In the case of high-pull headgear, bodily movement occurred in the medium-length outer bow, stress distribution in the apical region was 1st molar, 2nd premolar, 1st premolar in sequence and there was no apparent difference. 2. In the case of straight-pull headgear, bodily movement occurred in the long outer bow and stress distribution in the apical region was heavy in the 1st molar, 2nd premolar, 1st premolar in sequence. But, there were no apparent differences according to the length of the outer bow. 3. In the case of cervical-pull headgear, bodily movement also occurred in the long outer bow, and apical stress of the premolar region was heaviest among other cases and apical stress of the 2nd premolar was heaviest in the short outer bow. In clinical situations, to achieve bodily movement of the upper 1st molars without modifying outer bow height, applying an outer bow length as long as the inner bow length in high-pull headgear and applying an outer bow length longer than the inner bow length in straight-pull, cervical-pull headgear are recommended.
Bicuspid ; Molar*

Background: The Korean Blood Safety Commission established the Regional Networks for Blood Transfusion Management (RNBTM) Project which has operated in 14 regions across the country since 2017 to help blood transfusion management in small and medium-sized medical institutions. Since implementation of the RNBTM, participant’s satisfaction has not been evaluated, therefore in order to evaluate participant’s satisfaction and assist in future planning a survey was conducted. Methods: Fourteen facilitators participated in an anonymous on-line survey (5 questions). Laboratory Medicine (LM) doctors from small and medium-sized medical institutions from 14 regions also participated in a separate anonymous on-line survey (15 questions). Results: 14/14 (100%) facilitators responded to the survey. In addition to the RNBTM they were also in favor of establishing a Network of University Hospitals. 135 LM doctors responded to the survey. Of the RNBTM participants, 94.1% (111/118) replied that RNBTM was helpful in providing and exchanging blood transfusion information. Respondents indicated that they wished to remain part of RNBTM into the future because they felt that RNBTM not only helped improve quality of blood transfusions but also other aspects in the laboratory. In 70.4% (95/135) of participating medical institutions, LM doctors have been the Chairperson of the Hospital Transfusion Committee. Conclusion Extremely positive survey results were received from LM doctors. These survey results from LM doctors and facilitators will be helpful in developing and planning future projects related to RNBTM.

PURPOSE: This study aimed to investigate child abuse awareness and reporting intention among nursing and education students and correlations among the variables involved. METHODS: A cross-sectional study was conducted by administering an online questionnaire to 70 nursing college students and 70 education college students. Data were analyzed using descriptive statistics, t-test, chi-squared test, the Mann-Whitney U test, and Pearson's correlation in SPSS 21.0 (IBM, Armonk, NY). RESULTS: The mean score of child abuse awareness was 3.61±0.32 for nursing students and 3.60±0.36 for education students. The mean score of reporting intention was 5.65±0.90 for nursing students and 5.38±1.03 for education students. Females presented higher scores than males in the awareness of sexual abuse. The awareness of emotional abuse was higher in students who knew of reporting obligations or who had experienced abuse. Child abuse awareness and reporting intention were significantly positively correlated. Also, the number of times having received child abuse education was correlated with reporting intention in both mild and severe cases of abuse. CONCLUSION: Reporting intention is not only related to having received education, but also to the frequency of that education. Child abuse education is important to increase reporting intention and should be delivered repeatedly.
Child ; Child Abuse ; Child ; Cross-Sectional Studies ; Education ; Female ; Humans ; Intention ; Male ; Nursing ; Sex Offenses ; Students, Nursing

BACKGROUND: Although glyphosate, organophosphorus herbicide, has been used extensively in agricultural area, no clinical data of acute poisoning have been reported in Korea. The current study evaluated clinical characteristics of acute intoxication by glyphosate. METHODS: We retrospectively collect and analysed the clinical data of 16 acute glyphosate poisoned patients admitted to the department of internal medicine, Soonchunhyang University Chunan hospital from January 1999 through June 2000. RESULTS: 1) Thirteen of sixteen poisoning were male and mean age was 44.2 year-old. 2) The main cause of glyphosate ingestion was suicide intent (12 cases, 75%), and clinical severity was divided into 3 categories : mild (14 cases), moderate (1 case) and severe (1 case). 3) Nausea and vomiting were the most frequent clinical features (each 6 cases) and dyspnea (4 cases), cough (3 cases), sputum (3 cases) and sore throat (3 cases) were followed. Leucocytosis, hepatotoxicity, anemia, hypoxia and renal toxicity were observed in 9,8,5,6 and 3 cases, respectively. 4) No fatal case and severe complication, except 1 aspiration pneumonia and 1 acute respiratory failure, were observed in acute glyphosate poisonings. CONCLUSION: Our data supported that acute glyphosate poisoning dose not result in fatal in humans even after intentional ingestion of glyphosate.
Anemia ; Anoxia ; Chungcheongnam-do ; Cough ; Dyspnea ; Eating ; Herbicides ; Humans ; Internal Medicine ; Korea ; Male ; Nausea ; Organophosphorus Compounds ; Pharyngitis ; Pneumonia, Aspiration ; Poisoning ; Respiratory Insufficiency ; Retrospective Studies ; Sputum ; Suicide ; Vomiting

The cellular toxicities of surfactants, a solvent, and an antifreeze that are included in herbicide formulations were assessed by measuring their effects on membrane integrity, metabolic activity, mitochondrial activity, and total protein synthesis rate in a cell culture. Polyethylene glycol, propylene glycol, and monoethylene glycol exhibited no cellular toxicity even at a high concentration of 100 mM. Sodium lauryl ether sulfate and polyoxyethylene lauryl ether significantly damaged the membrane, disturbed cellular metabolic activity, and decreased mitochondrial activity and the protein synthesis rate; however, their toxicity was far below those of the severely toxic chemicals at comparable concentrations. The severely toxic category included polyoxypropylene glycol block copolymer, polyoxyethylene tallow amine, and polyoxyethylene lauryl amine ether. These surfactants were cytotoxic between 3.125 microM and 100 microM in a dose-dependent manner. However, the toxicity graph of concentration vs toxicity had a point of inflection at 25 microM. The slope of the toxicity graph was gentle when the concentration was below 25 microM and steep when the concentration was greater than 25 microM. In conclusion, our results suggest that the toxicity of surfactants be taken care of pertinent treatment of acute herbicide intoxication.
Animals ; Cell Line ; Cell Membrane/drug effects ; Herbicides/*chemistry ; Mice ; Mitochondria/drug effects ; Polyethylene Glycols/toxicity ; Sodium Dodecyl Sulfate/toxicity ; Surface-Active Agents/chemistry/*toxicity ; Toxicity Tests

BACKGROUND: Although chelation therapy with calcium disodium ethylenediamine tetraacetic acid (CaNa2EDTA) reduces body burden of lead and improves clinical side effects from lead, it is unclear whether long-term repeated chelation is safe for chronic lead poisoning with nephropathy. We described the consequential changes of renal function and clinicopathological findings during one to two years of monthly administration of CaNa2EDTA in patients with chronic lead nephropathy and excessive body lead burden. METHODS: Three patients diagnosed as chronic lead nephropathy received 1 g/day of intravenous CaNa2EDTA for a 3-5 day/cycle. A total of 48-86 g CaNa2EDTA was administered. Midtibial bone lead, chelatable lead, and blood lead levels were assessed. Renal function was determined in each chelation, and renal biopsies before and after chelation were conducted and compared for microscopic and immunofluorescence changes. RESULTS: Cortical bone lead levels showed a high burden of lead (>200 microgram Pb/g bone mineral). During CaNa2EDTA treatment, blood lead level and renal function were in steady state. No evidence of progression of renal pathology was observed in both renal biopsies, showing similar interstitial fibrosis and glomerular sclerosis. CONCLUSION: Our results suggest that long-term repeated chelation therapy with CaNa2EDTA is safe and effective for patients who have suffered from severe chronic lead poisoning, even though renal pathologic change has started.
Biopsy ; Body Burden ; Calcium ; Chelation Therapy* ; Edetic Acid ; Fibrosis ; Fluorescent Antibody Technique ; Humans ; Lead Poisoning ; Pathology ; Sclerosis

Chloracetanilide herbicides (alachlor, butachlor, metachlor) are used widely. Although there are much data about chronic low dose exposure to chloracetanilide in humans and animals, there are few data about acute chloracetanilide poisoning in humans. This study investigated the clinical feature of patients following acute oral exposure to chloracetanilide. We retrospectively reviewed the data on the patients who were admitted to two university hospitals from January 2006 to December 2010. Thirty-five patients were enrolled. Among them, 28, 5, and 2 cases of acute alachlor, metachlor, butachlor poisoning were included. The mean age was 49.8 +/- 15.4 yr. The poison severity score (PSS) was 17 (48.6%), 10 (28.6%), 5 (14.3%), 2 (5.7%), and 1 (2.9%) patients with a PSS of 0, 1, 2, 3, and 4, respectively. The age was higher for the symptomatic patients (1-4 PSS) than that for the asymptomatic patients (0 PSS) (43.6 +/- 15.2 vs 55.7 +/- 13.5). The arterial blood HCO3 was lower in the symptomatic patients (1-4 PSS) than that in the asymptomatic patients (0 PSS). Three patients were a comatous. One patient died 24 hr after the exposure. In conclusion, although chloracetanilide poisoning is usually of low toxicity, elder patients with central nervous system symptoms should be closely monitored and cared after oral exposure.
Acetamides/*poisoning ; Acetanilides/*poisoning ; Acute Disease ; Adult ; Aged ; Bicarbonates/blood ; Central Nervous System Diseases/diagnosis ; Female ; Herbicides/*poisoning ; Humans ; Male ; Middle Aged ; Poisoning/*diagnosis ; Retrospective Studies ; Severity of Illness Index ; Suicide, Attempted

BACKGROUND: To develop a novel treatment strategy for hepatitis B virus infection, a major cause of liver chirosis and cancer, we aimed to make human monoclonal antibodies inhibiting RNase H activity of P protein playing in important role in HBV replication. In this regard, phage display technology was employed and demonstrated as an efficient cloning method for human monoclonal antibody. So this study analysed the usability of human monoclonal antibody as protein based gene therapy. METHODS: RNase H of HBV was expressed as fusion protein with maltose binding protein and purified with amylose resin column. Single chain Fv (scFv) phage antibody library was constructed by PCR cloning using total RNAs of PBMC from 50 healthy volunteers. Binders to RNase H were selected with BIAcore 2000 from the constructed library, and purified as soluble antibody fragment. The affinity and sequences of selected antibody fragments were analyzed with BIAcore and ABI automatic sequencer, respectively. And finally RNase H activity inhibiting assay was carried out. RESULTS: Recombinant RNase H expressed in E. coli exhibited an proper enzyme activity. Naive library of 4.46 X 10(9) cfu was screened by BIAcore 2000. Two clones, RN41 and RN56, showed affinity of 4.5 X 10(-7) M and 1.9 X 10(-7) M, respectively. But RNase H inhibiting activity of RN41 was higher than that of RN56. CONCLUSION: We cloned human monoclonal antibodies inhibiting RNase H activity of P protein of HBV. These antibodies can be expected to be a good candidate for protein-based antiviral therapy by preventing a replication of HBV if they can be expressed intracellularly in HBV-infected hepatocytes.
Amylose ; Antibodies ; Antibodies, Monoclonal ; Bacteriophages* ; Cell Surface Display Techniques* ; Clone Cells ; Cloning, Organism ; Genetic Therapy ; Healthy Volunteers ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Hepatocytes ; Humans* ; Immunoglobulin Fragments ; Liver ; Maltose-Binding Proteins ; Polymerase Chain Reaction ; Ribonuclease H* ; Ribonucleases* ; RNA ; Single-Chain Antibodies

OBJECTIVE: The aim of this study was to evaluate the efficacy of metformin for ovualtion induction and pregnancy in clomiphene citrate (CC)-resistant women with polycystic ovary syndrome (PCOS). METHODS: From March 2001 to March 2002, 19 patients with PCOS who had at least two consecutive cycles of anovulation in response to CC treatment up to 250 mg/day at the Infertility Center of Moon Hwa Hospital were enrolled in this study. The participants were required to have tubal patency on hysterosalpingography and their husbands were required to have normal semen analysis. The mean age was 30.5 +/- 3.6 years, the body weight 62.7 +/- 10.1 kg, the duration of infertility 3.7 +/- 2.1 years and the BMI 24.7 +/- 3.6 kg/m2. For 19 patients, a total of 75 cycles were treated with 1) CC+gonadotropin (group 1; 24 cycles), 2) CC+metformin (group 2; 29 cycles), or 3) CC+gonadotropin+metformin (group 3; 22 cycles). As for gonadotropin, highly purified-follicle stimulating hormone (HP-FSH) or/and hMG were used from the 3rd day of CC treatment. In the first cycle, metformin (1,500 mg/day) was administered during 1-28 days of menstrual cycle. Metformin was discontinued when a pregnancy was confirmed. RESULTS: Among 19 patients, 17 patients were ovulated (89.5%) and 7 patients (36.8%) were pregnant. Of a total of 75 cycles, 51 cycles (68.0%) were ovulated successfully with one of three treatment methods. Metformin treatment had similar ovulation rate compared to gonadotropin treatment. There was no significant difference in ovulation rate among the three groups (70.8% vs 58.6% vs 63.7%). However, the pregnancy rate was significantly higher in group 3 (18.2%, 4 cycles) compared to group 1 (8.3%, 2 cycles) and group 2 (6.9%, 2 cycles). Of pregnant cycles, all 2 cycles from group 1 were spontaneously aborted. One cycle in group 2 and one cycle in group 3 were spontaneously aborted and all other pregnant cycles were normally delivered. CONCLUSION: With the combination therapy of metformin, the improvement in pregnancy rate among CC-resistant PCOS infertile women might be expected.
Anovulation ; Body Weight ; Clomiphene ; Female ; Gonadotropins ; Humans ; Hysterosalpingography ; Infertility ; Menstrual Cycle ; Metformin* ; Ovulation ; Polycystic Ovary Syndrome* ; Pregnancy ; Pregnancy Rate ; Semen Analysis ; Spouses