PURPOSE: This was a correlational study to identify effects of perception of clinical ladder system on job satisfaction and intention to leave in perioperative nurses. METHODS: Participants were 154 of perioperative nurses from larger general hospitals in Seoul. Data were collected from April, 16 to 22, 2013 using self-report questionnaires which included items on perception of clinical ladder system, job satisfaction, and intention to leave. Data were analyzed using frequency, t-test, ANOVA, Scheffe? test, Pearson correlation coefficients, and multiple stepwise regression. RESULTS: The average mean score for perception of clinical ladder system was midline at 2.69 point out of 4 point. Perception of clinical ladder system correlated positively with job satisfaction (r=.38, p<.01) and negatively with intention to leave (r=-.88, p<.01). Perception of clinical ladder system was the factor which most influenced job satisfaction explaining 17.1% of the variance, also perception of clinical ladder system was the factor which most influenced intention to leave, explaining 12.7% of the variance. CONCLUSION: Results of this study suggest that there is a need to enhance the perception of the clinical ladder system and to find ways to fulfill the expected effects for improving perioperative nurses' job satisfaction and reducing the intention to leave.
Career Mobility* ; Hospitals, General ; Intention* ; Job Satisfaction* ; Surveys and Questionnaires ; Seoul

This study investigated the effect of temporary cement and desensitizer on the bond strength of luting cements. Total 96 dentin specimens were divided into two groups with and without temporary cementation. For temporary cement-treated group, specimens were cemented with Temp-bond(R) and all specimens were stored in distilled water at 37 celsius degrees for 7 days. Each group was further divided into 3 subgroups with Gluma(R), One-step(R) application and without desensitizer. After desensitizer application, Ni-Cr specimens were luted to dentin surface with Panavia-F(R) and Vitremer(R). Specimens were placed in distilled water at 37 celsius degrees for 24 hours and shear bond strength between metal and dentin was measured by a universal testing machine. The results were as follows: 1. In Panavia-F(R) cemented groups, the combination of One-step(R) without temporary cement showed the greatest strength. Among the desensitizer types, One-step(R) showed the highest bond strength, followed by No-desensitizer, Gluma(R). 2. In Vitremer(R) cemented groups, the combination of no temporary cement and without desensitizer showed the greatest bond strength. Among the desensitizer types, No-desensitizer group showed the highest bond strength. 3. The use of Gluma(R) significantly reduced the shear bond strength in Panavia-F(R) and Vitremer(R) groups. 4. All temporary cement-treated groups showed a significant lower shear bond strength than without temporary cement groups. 5. Desensitizer application significantly influenced the bond strength of the resin cement and resin modified glass ionomer cement.
Cementation ; Dentin ; Glass Ionomer Cements ; Resin Cements ; Water

Psoriasis is a multi-factorial disease with various clinical manifestations. We present a case of unilateral psoriasis associated with ipsilateral lymphedema that developed after mastectomy for breast cancer. A 42-year-old Korean woman was referred to our clinic with a 1-month history of multiple erythematous scaly patches on the right arm, back, and breast and was diagnosed with psoriasis by a skin biopsy. Three years previously, she had been diagnosed with breast cancer (T1N2), underwent a right quadrantectomy and axillary lymph node dissection, and completed adjuvant chemotherapy followed by high-dose adjuvant radiotherapy. She had started rehabilitation therapy on the right arm for secondary lymphedema 30 months previously. Because of the long interval between radiation and psoriasis, we speculated that changes in the local milieu caused by the lymphedema might be a causative factor. We hereby report a rare case of unilateral psoriasis following post-mastectomy lymphedema.
Adult ; Arm ; Biopsy ; Breast ; Breast Neoplasms ; Chemotherapy, Adjuvant ; Female ; Humans ; Lymph Node Excision ; Lymphedema ; Mastectomy ; Psoriasis ; Radiotherapy, Adjuvant ; Skin

BACKGROUND: Granulocyte transfusion therapy has been used as supportive care for patients with prolonged neutropenia after intensive chemotherapy or peripheral blood stem cell transplantation (PBSCT). Here, we investigated clinical factors of granulocyte transfusion therapy for neutropenic patients with infection to evaluate its efficacy and safety. METHODS: A retrospective analysis of 25 neutropenic patients treated with 99 granulocyte collection and granulocyte transfusion therapy from October 2011 to April 2016 at the National Cancer Center was conducted. Two groups, a count recovery group with a cut off of >1,000/µL and a no recovery group were compared and symptoms related with granulocyte transfusion were analyzed. RESULTS: Granulocyte collection and transfusions were performed in 99 procedures. After granulocyte transfusion therapy, 21 patients (84%) showed count recovery, whereas 4 patients (16%) had no response. Significant differences in pre-absolute neutrophil count (29/µL vs. 0/µL, P=0.048), duration of neutropenia before granulocyte transfusion (11 days vs. 26 days, P=0.011), and total number of granulocyte transfusion (2 times vs. 11 times, P=0.049) were observed between groups. Temporary symptoms related granulocyte transfusion were observed in seven patients (28%); however, all patients showed clinical improvement. The median of the single transfusion volume was 220 mL (200 to 397 mL) and the mean total granulocyte content was 4.92×10¹⁰. CONCLUSION: Granulocyte transfusion therapy is safe and effective for patient with life threatening neutropenia and infection, also considerable for early onset trial for granulocyte transfusion.
Drug Therapy ; Granulocytes* ; Humans ; Leukocyte Transfusion ; Neutropenia* ; Neutrophils ; Peripheral Blood Stem Cell Transplantation ; Retrospective Studies

PURPOSE: We evaluated the concordance of laterality of the paretic eye and the torsional eye in unilateral superior oblique palsy showing an inferior oblique overaction. METHODS: Thirty-nine patients diagnosed as having a unilateral superior oblique palsy were evaluated for visual acuity, refractive manifestation, ocular movement, prism cover test, and fundus photograph. Of these patients, 32 derived from congenital causes and 7 acquired the condition from trauma. An ocular movement exam was performed to check an inferior oblique overaction, and a fundus photograph was used to measure the ocular torsional amount. Inferior oblique myectomy or recession was performed along with horizontal strabismus surgery. RESULTS: Objective extorsion was presented in paretic eyes of 29 patients (74.4%) and nonparetic eyes of 10 patients (25.6%). The congenital superior oblique palsy patients were divided into two groups by the concordance of laterality of paretic eyes and torsional eyes. In the concordance group of 22 patients, the torsional amount was decreased from +17.69 degrees to +7.98 degrees and inferior oblique overaction from +2.27 degrees to +0.25 degrees after an inferior oblique muscle weakening procedure. In the discordance group of 10 patients, torsional amount was decreased from +16.97 degrees to +8.73 degrees and inferior oblique overaction from +2.50 degrees to +0.21 degrees postoperatively. In acquired oblique palsy patients, all patients showed the concordance of laterality, and the torsional amount was decreased from +16.76 degrees to +8.80 degrees and inferior oblique overaction from +2.5 degrees to +0.21 degrees after inferior oblique weakening procedure. CONCLUSIONS: We found that the paretic eye and the torsional eye may not coincide in congenital superior oblique palsy but always coincide in acquired oblique palsy after trauma. After an inferior oblique muscle weakening procedure, ocular torsional amount of paretic or sound eye is decreased in every case.
Humans ; Paralysis* ; Strabismus ; Visual Acuity

PURPOSE: Leigh syndrome (LS) is a rare, progressive neurodegenerative disorder with characteristic abnormalities in the central nervous system. Such patients present with heterogeneous clinical symptoms and genetic abnormalities; thus, prognosis is difficult to anticipate. The present study investigates whether distinct patient characteristics are associated with mitochondrial DNA (mtDNA) mutation in LS patients. METHODS: We retrospectively analyzed data from patients diagnosed with LS at our hospital who were assessed using genomic sequencing of mtDNA. A subgroup analysis was performed to divide patients according to the mtDNA sequencing results. RESULTS: Among the 85 patients enrolled, 18 had mtDNA mutations. Most patients had lactic acidosis and a lactate/pyruvate ratio above 20, indicating respiratory chain abnormalities. In the subgroup analysis, the mutation group had a significantly higher female-to-male ratio, alanine level, ocular involvement, and midbrain and medulla abnormalities on magnetic resonance imaging (MRI). CONCLUSION: The subgroup analysis indicates that mtDNA sequencing is recommended for female patients, or those who exhibit ocular involvement, high alanine levels, or MRI findings with lesions in the midbrain and medulla.
Acidosis, Lactic ; Alanine ; Brain Stem ; Central Nervous System ; DNA, Mitochondrial* ; Electron Transport ; Female ; Humans ; Leigh Disease* ; Magnetic Resonance Imaging ; Mesencephalon ; Mitochondria ; Neurodegenerative Diseases ; Prognosis ; Retrospective Studies

OBJECTIVE: In vitro study systems for research of placental hypoxia are needed, among which human placental villous explant culture technique under experimentally variable condition is commonly used. So we performed this study to assess the viability of placental villous explant in normoxic and hypoxic culture that can provide validity for that system. METHOD: Placental villous explant tissues obtained from 9 cases of normal term pregnancies were incubated in normoxic (20% O2) and hypoxic (2~5% O2) condition for 72 hours. The viability of tissue was evaluated morphologically by microscopic examination and biochemically by LDH assay at variable time interval (0, 6, 12, 24, 48, 72 hours). The apoptosis of the tissue was assessed by TUNEL assay. RESULT: By light microscope, all of H&E stained placental explant tissue sections in normoxic and hypoxic culture showed intact villous integrities without definitive syncytial sloughing and fibrinoid necrosis as time elapsed. Tissue viability of LDH assay during 6, 24, 48, 72 hours of placental villous explants showed over all 52.3~67.6% and didn't show statistically significant difference between normoxic and hypoxic culture. Tissue viability in both groups maintained 61.2~67.6% for the first 24 hours and eventually decreased with time. TUNEL assay showed over all negative findings in normoxic and hypoxic culture at different time periods. CONCLUSION: In vitro human placental explant culture system can be a useful and feasible technique for research of placental hypoxia which is related to development of obstetrical complications such as preeclampsia, intrauterine fetal growth restriction and preterm labor and so on. But our in vitro placental explant system needs some modification in culture condition and technique for maximizing viability of the tissue.
Anoxia ; Apoptosis ; Culture Techniques ; Female ; Fetal Development ; Humans* ; In Situ Nick-End Labeling ; Necrosis ; Obstetric Labor, Premature ; Pre-Eclampsia ; Pregnancy ; Tissue Survival*

PURPOSE: This study aimed to evaluate the autonomic imbalance in syncope by comparing the baseline heart rate variability (HRV) between healthy children and those with vasovagal syncope. METHODS: To characterize the autonomic profile in children experiencing vasovagal syncope, we evaluated the HRV of 23 patients aged 7-18 years and 20 healthy children. These children were divided into preadolescent (<12 years) and adolescent groups. The following time-domain indices were calculated: root mean square of the successive differences (RMSSD); standard deviation of all average R-R intervals (SDNN); and frequency domain indices including high frequency (HF), low frequency (LF), normalized high frequency, normalized low frequency, and low frequency to high frequency ratio (LF/HF). RESULTS: HRV values were significantly different between healthy children and those with syncope. Student t test indicated significantly higher SNDD values (60.46 ms vs. 37.42 ms, P=0.003) and RMSSD (57.90 ms vs. 26.92 ms, P=0.000) in the patient group than in the control group. In the patient group, RMSSD (80.41 ms vs. 45.89 ms, P=0.015) and normalized HF (61.18 ms vs. 43.19 ms, P=0.022) were significantly higher in adolescents, whereas normalized LF (38.81 ms vs. 56.76 ms, P=0.022) and LF/HF ratio (0.76 vs. 1.89, P=0.041) were significantly lower in adolescents. In contrast, the control group did not have significant differences in HRV values between adolescents and preadolescents. CONCLUSION: The results of this study indicated that children with syncope had a decreased sympathetic tone and increased vagal tone compared to healthy children. Additionally, more severe autonomic imbalances possibly occur in adolescents than in preadolescents.
Adolescent* ; Child* ; Heart Rate* ; Humans ; Syncope ; Syncope, Vasovagal*

Obesity hypoventilation syndrome (OHS) is characterized by severe obesity, excessive daytime sleepiness, hypoxemia and hypercapnea. Because OHS mimics pulmonary hypertension or cor pulmonale, clinicians should recognize and treat this syndrome appropriately. A 58-year-old female visited the emergency room because of dyspnea. She was obese and had kyphoscoliosis. The patient also experienced snoring, recurrent choking during sleep and daytime hypersomnolence which worsened after gaining weight in the recent year. The arterial blood gas analysis showed she experienced hypoxemia and hypercapnea not only during nighttime but also daytime. We suspected OHS and the patient underwent polysomnography to confirm whether obstructive sleep apnea was present. During the polysomnography test, sleep obstructive apnea was observed and apnea-hypopnea index was 9.2/hr. The patient was treated with bilevel positive airway pressure therapy (BiPAP). After BiPAP for 4 days, hypoxemia and hypercapnia were resolved and she is currently well without BiPAP. We report a case successfully treated with clinical improvement by presuming OHS early in a patient who had typical OHS symptoms, even while having other conditions which could cause hypoventilation.
Airway Obstruction ; Anoxia ; Apnea ; Blood Gas Analysis ; Disorders of Excessive Somnolence ; Dyspnea ; Emergency Service, Hospital ; Female ; Humans ; Hypercapnia ; Hypertension, Pulmonary ; Hypoventilation ; Middle Aged ; Obesity Hypoventilation Syndrome* ; Obesity, Morbid ; Polysomnography ; Pulmonary Heart Disease ; Sleep Apnea, Obstructive ; Snoring

BACKGROUND: Therapeutic leukapheresis is the cytoreduction procedure performed before chemotherapy in patients with hyperleukocytosis for prevention of complication. However, there have been clinical concerns about bleeding tendency due to anticoagulant used during the procedure. The aim of our study was to compare the clinical characteristics and hematological parameters before and after therapeutic leukapheresis in order to evaluate its effect on bleeding tendency and to provide a guideline for treatment strategy. METHODS: The clinical data for 39 procedures of therapeutic leukapheresis performed on 17 patients with hyperleukocytosis from May 2005 to October 2013 at the National Cancer Center were reviewed retrospectively. RESULTS: The patients consisted of 11 males and six females. The mean age was 41 years old (range, 8~74). The mean number of therapeutic leukapheresis per patient was two (range, 1~4). Clinical symptoms improved in 14 patients (82%) after therapeutic leukapheresis and three patients (18%) were not yet to improve. The mean WBC count was significantly reduced by 32.6% (+/-17.4) after therapeutic leukapheresis, from 250,146/microL (+/-117,000) to 174,702/microL (+/-104,700) (P<0.001). The mean volume of single removal was 298 ml with 4.25x10(11)/L (+/-1.54) WBCs. After therapeutic leukapheresis, the mean platelet count showed a decline from 85x10(9)/L (+/-43) to 71x10(9)/L (+/-26). However, the prothrombin time (PT) and activated partial thromboplastin time (aPTT) did not show a significant increase (PT, P=0.637; aPTT, P=0.054). CONCLUSION: Therapeutic leukapheresis is demonstrated as an effective and safe treatment that can improve symptoms and reduce leukocytes in hyperleukocytosis.
Drug Therapy ; Female ; Hemorrhage ; Humans ; Leukapheresis* ; Leukocytes ; Leukostasis ; Male ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time ; Retrospective Studies