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BACKGROUND: Alterations in ventricular loading conditions lead to changes in action potential duration via mechanoelectrical feedback. A decrease in load immediately leads to prolongation of repolarization. QT interval and QT dispersion were measured to determine the long-term effect of changes in ventricular systolic load on the ventricular repolarization. METHOD: Corrected QT interval and QT dispersion were measured in 26 patients before and 3-6 months after valvuloplasty for pulmonary stenosis. To determine the effect of ventricular load on ventricular repolarization, patients were divided in 2 groups; Group 1 was those patients with a greater than 30 mmHg and Group 2 was those patients with a less than 30 mmHg decrease in right ventricular systolic pressure. RESULTS: Corrected QT interval (412.6+/-14.5 msec vs 426.4+/-16.8 msec, p < 0.05) and QT dispersion (35.0+/-7.3 msec vs 45.7+/-14..1 msec, p < 0.05)were increased significantly only in Group 1 after vlavuloplasty. CONCLUSION: It suggested that mechanoelectrical interactions are operative for long duration in humans that changes in ventricular load after successful pulmonary valvuloplasty showed long-term effect on the ventricular repolarization.
Action Potentials ; Balloon Valvuloplasty* ; Blood Pressure ; Humans ; Pulmonary Valve Stenosis*

Canavan disease(CD) is a rare autosomal recessive leukodystrophy caused by the deficiency of aspartoacylase and the accumulation in brain of N-acetylaspartate(NAA). CD has been reported mainly Ashkenazi Jews but also occurs in other ethnic groups. Usually it presents as early as the third month of life with megalencephaly, hypotonia later progressing to hypertonia, psychomotor and mental retardation, blindness, occasionally deafness and seizure. Diagnosis is based on the clinical feature, N-acetylaspartic aciduria, radiologic and pathologic findings. Histologically, the affected white matter shows extensive vacuolation and demyelination. There is no treatment for CD and the only prevention is through genetic counselling and prenatal diagnosis. We experienced a case of Canavan disease that was presented with hypotonia and developmental delay. Diagnosis was confirmed histologically. Radiologic findings are extensive high signal throughout the white matter on T2-weighted MRI and increased NAA peak and decreased choline peak of the white matter on MR spectroscopy.
Blindness ; Brain ; Canavan Disease* ; Choline ; Deafness ; Demyelinating Diseases ; Diagnosis ; Ethnic Groups ; Humans ; Intellectual Disability ; Jews ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Muscle Hypotonia ; Prenatal Diagnosis ; Seizures

PURPOSE: The purpose of this study was to assess the importance and contribution of 9 nursing outcomes and their indicators that could be applied to cerebrovascular patients. METHODS: Data were collected from 175 neurosurgical nurses working at two university affiliated hospitals and five secondary hospitals located in Gwang-ju. The Fehring method was used to estimate outcome content validity(OCV) and outcome sensitivity validity(OSV) of nursing outcomes and their indicators. Stepwise regression was used to evaluate relationship between outcome and its indicators. RESULTS: The core outcomes identified by the OCV were Tissue Perfusion: Cerebral, Nutritional Status, Neurological Status, and Wound Healing: Primary Intention, whereas highly supportive outcomes identified by the OSV were Oral Health, Self-Care: ADL, and Nutritional Status. All the critical indicators selected for Fehring method were not included in stepwise regression model. By stepwise regression analysis, the indicators explained outcomes from 19% to 52% in importance and from 21% to 45% in contribution. CONCLUSION: This study identified core and supportive outcomes and their indicators which could be useful to assess the physical status of cerebrovascular patients. Further research is needed for the revision and development of nursing outcomes and their indicators at neurological nursing area.
Activities of Daily Living ; Cerebrovascular Disorders ; Humans ; Intention ; Nutritional Status ; Oral Health

PURPOSE: This study was done to clarify attributes, antecedents, and consequences of spirituality. METHODS: Rodgers's evolutionary concept analysis was used to analyze fifty seven studies from the literature related to spirituality as it appears in systematic literature reviews of theology, medicine, counseling & psychology, social welfare, and nursing. RESULTS: Spirituality was found to consist of two dimensions and eight attributes: 1) vertical dimension: ‘intimacy and connectedness with God’ and ‘holy life and belief’, 2) horizontal dimension: ‘self-transcendence’, ‘meaning and purpose in life’, ‘self-integration’, and ‘self-creativity’ in relationship with self, ‘connectedness’ and ‘trust’ in relationship with others·neighbors·nature. Antecedents of spirituality were socio-demographic, religious, psychological, and health related characteristics. Consequences of spirituality were positive and negative. Being positive included ‘life centered on God’ in vertical dimension, and among horizontal dimension ‘joy’, ‘hope’, ‘wellness’, ‘inner peace’, and ‘self-actualization’ in relationship with self, ‘doing in love’ and ‘extended life toward neighbors and the world’ in relationship with others·neighbors·nature. Being negative was defined as having ‘guilt’, ‘inner conflict’, ‘loneliness’, and ‘spiritual distress’. Facilitators of spirituality were stressful life events and experiences. CONCLUSION: Spirituality is a multidimensional concept. Unchangeable attributes of spirituality are ‘connectedness with God’, ‘self-transcendence’, ‘meaning of life’ and ‘connectedness with others·nature’. Unchangeable consequences of spirituality are ‘joy’ and ‘hope’. The findings suggest that the dimensional framework of spirituality can be used to assess the current spiritual state of patients. Based on these results, the development of a Korean version of the scale measuring spirituality is recommended.
Counseling ; Humans ; Nursing ; Psychology, Social ; Spirituality* ; Theology ; Vertical Dimension

OBJECTIVES: The authors categorized and analyzed the documentation of cases referred to the Korean Neuropsychiatric Association between 2004 and 2008 to build a database for improving future medical investigations. METHODS: The cases in the documents were categorized according to key words and were statistically analyzed. The categories of keywords used were as follows : type of psychiatric disorder, inquiry about the disorder, death (including suicide), type of accident, referring institution, and inquiry about the relationship between the disorder and the case. RESULTS: Firstly, mood and psychotic disorders were the most common types of psychiatric disorder. Secondly, the most common cases were industrial accidents and medicine-related cases. Thirdly, etiology were most commonly asked inquiry about the psychiatric disorder, and in the core issues extracted from the documents, a causal relationship and a medical malpractice were most common. Finally, the most common referring institution was the Court. CONCLUSION: These results suggest that the psychiatrist, who is both a clinician and an investigator, should try to maintain reliability and objectivity in conducting medical investigations. In addition, to help medical investigations, there should be greater professional consensus on the evaluation of mental and behavioural disability.
Accidents, Occupational ; Consensus ; Humans ; Malpractice ; Psychiatry ; Psychotic Disorders ; Research Personnel

Malaria is a protozoan disease transmitted by the bite of female Anopheles mosquitoes. Only four species of Plasmodium can infect human, which are P. vivax, P. ovale, P. malariae, and P. falciparum. We experienced four cases of the imported falciparum malaria in children who were admitted due to fever, vomiting, diarrhea, abdominal pain, lethargic state, and/or altered mentality after traveling Kenya and Tanzania without chemoprophylaxis. Two of them were diagnosed as the cerebral malaria. Their peripheral blood smear films show multiple ring forms of P. falciparum, gametocytes in the erythrocytes, and malarial pigments in the cytoplasm of neutrophils. They are treated by quinine without complication. Recently, as the international travelers tended to be increasing, the incidence of the imported malaria was increasing in Korea. Therefore we should be established the strategies for the prevention and the treatment of the imported malaria.
Abdominal Pain ; Anopheles ; Chemoprevention ; Child* ; Culicidae ; Cytoplasm ; Diarrhea ; Erythrocytes ; Female ; Fever ; Humans ; Incidence ; Kenya ; Korea ; Malaria* ; Malaria, Cerebral ; Neutrophils ; Plasmodium ; Quinine ; Tanzania ; Vomiting

PURPOSE: Cytolethal distending toxin (CDT) considered as a key factor of localized aggressive periodontitis, endocarditis, meningitis, and osteomyelitis is composed of five open reading frames (ORFs). Among of them, the individual role of CdtA and CdtC is not clear; several reports presents that CDT is an AB2 toxin and they enters the host cell via clathrin-coated pits or through the interaction with GM3 ganglioside. So, CdtA, CdtC, or both seem to be required for the delivery of the CdtB protein into the host cell. Moreover, recombinant CDT was suggested as good vaccine material and antibody against CDT can be used for neutralization or for a detection kit. MATERIALS AND METHODS: We constructed the pET28a-cdtC plasmid from Aggregatibacter actinomycetemcomitans Y4 by genomic DNA PCR and expressed in BL21 (DE3) Escherichia coli system. We obtained the antibody against the recombinant CdtC in mice system. Using the anti-CdtC antibody, we test the native CdtC detection by ELISA and Western Blotting and confirm the expression time of native CdtC protein during the growth phase of A. actinomycetemcomitans. RESULTS: In this study we reconstructed CdtC subunit of A. actinomycetemcomitans Y4 and generated the anti CdtC antibody against recombinant CdtC subunit expressed in E. coli system. Our anti CdtC antibody can be interacting with recombinant CdtC and native CDT in ELISA and Western system. Also, CDT holotoxin existed at 24h but not at 48h meaning that CDT holotoxin was assembled at specific time during the bacterial growth. CONCLUSION: In conclusion, we thought that our anti CdtC antibody could be used mucosal adjuvant or detection kit development, because it could interact with native CDT holotoxin.
Aggressive Periodontitis ; Animals ; Bacterial Toxins ; Blotting, Western ; DNA ; Edetic Acid ; Endocarditis ; Enzyme-Linked Immunosorbent Assay ; Escherichia coli ; Meningitis ; Mice ; Open Reading Frames ; Osteomyelitis ; Plasmids ; Polymerase Chain Reaction

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BACKGROUND AND OBJECTIVES: Transcatheter device closure becomes the first option for treating secundum atrial septal defect (ASD), but the conventional method is sometimes unsuccessful even when the defect size indicates the closure to be feasible. To increase the success rate, modified methods have been introduced and used. This study aimed to find predictors for using the modified methods in the device closure of secundum ASDs. SUBJECTS AND METHODS: Between October 2010 and December 2012, 92 patients with ASDs underwent the transcatheter device closure. We analyzed the sizes of the defect, the surrounding rims, and the ratios of the left atrium (LA) dimensions to the device size in the patients who underwent the procedure either using the conventional or modified methods. RESULTS: Among the 88 successful cases (95.7%), 22 patients (25%) required modified methods (12 using pulmonary vein and 10 using balloon). The modified method group had the larger size of ASDs and smaller posterosuperior rim. The mean ratios of the LA anteroposterior diameter, width, and length to the device size were all significantly smaller in the modified methods group than in the conventional group (1.20 vs. 1.56, 1.32 vs. 1.71, and 1.61 vs. 2.07, respectively). We found that the risk factors for the modified methods were smaller retroaortic rim, larger ASD, and smaller LA dimension/device size. CONCLUSION: In addition to larger defects and smaller retroaortic rim, the smaller ratios of the LA dimensions to the device size influenced the need for the application of modified methods in the transcatheter device closure of ASDs.
Cardiac Catheterization ; Heart Atria ; Heart Defects, Congenital ; Heart Septal Defects, Atrial* ; Humans ; Pulmonary Veins ; Risk Factors ; Septal Occluder Device