Objective:To explore the function of the bridging epithelium between maxillary process and nasal process in the devel-opment of lip and palate.Methods:The fertilized white leghorn chick eggs incubated to the appropriate Hamburger and Hamilton(H-H)stages were examined by tissue histologic studies,scanning electron microscopy observation,BrdU assay and TUNEL assay re-spectively.Results:At H-H stage 24,the epithelia between maxillary,lateral nasal and globular process were juxtaposed.At H-H stage 26-27,string-like filopodia appeared and the bridging epithelium formed,then in the bridging epithelium cell proliferation was decreased and the apoptotic cells appeared.At H-H stage 28,the apoptosis of the bridging epithelium cells increased,the full fusion of the processes was completed.Conclusion:The occurrence of bridging epithelium between maxillary process and nasal process plays an important role in the development of lip and palate.

PURPOSE: To analyze the structure of Korean nurse labor market and examine its effect on hospital nurse staffing. METHODS: Secondary data were obtained from Statistics Korea, Education Statistics, and Health Insurance Review & Assessment Service and Patient Survey. Intensity of monopsony in the nurse labor market was measured by Herfindahl Hirshman Index (HHI). Hospital nurse staffing level was divided into high and low. While controlling for confounding factors such as inpatient days and severity mix of patients, effects of characteristics of nurse labor markets on nurse staffing levels were examined using multi-level logistic regressions. RESULTS: For characteristics of nurse labor markets, metropolitan areas had high intensity of monopsony, while the capital area had competitive labor market and the unemployed nurse rate was higher than other areas. Among hospital characteristics, bed occupancy rate was significantly associated with nurse staffing levels. Among characteristics of nurse labor markets, the effect of HHI was indeterminable. CONCLUSION: The Korean nurse labor market has different structure between the capital and other metropolitan areas. But the effect of the structure of nurse labor market on nurse staffing levels is indeterminable. Characteristics such as occupancy rate and number of beds are significantly associated with nurse staffing levels. Further study in support of the effect of nurse labor market is needed.
Hospitals ; Humans ; Logistic Models ; Nursing Staff, Hospital/economics/*supply & distribution ; Workplace

The real-time polymerase chain reaction (real-time RT-PCR) assay is currently used as a confirmatory test for the detection of coronavirus disease 2019 (COVID-19) since the disease is in community transmission stage in South Korea. However, the Ministry of Food and Drug Safety recently conditionally approved the COVID-19 self-test kit (which is a rapid severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] antigen detection assay), as an additional testing method. The rapid SARS-CoV-2 antigen detection test is difficult to use as a diagnostic tool or screening assay because of the high probability of false-negative results, as it has a lower sensitivity than the RT-PCR assay. However, it can be used as an adjunctive method because of high specificity and faster results. Considering the high specificity of the self-test kit, it is necessary to assume and treat COVID-19 self-test kit positive patients as confirmed COVID-19 patients. Therefore, emergency departments, pre-hospital caregivers and 119 rescuers should prepare a protocol with quarantined spaces and protective equipment for treating COVID-19 self-test kit positive patients, to prevent the spread of infection.

PURPOSE: Laparoscopic pyeloplasty was developed as a minimally invasive alternative to an open procedure for the treatment of ureteropelvic junction (UPJ) obstruction. We present our experience with the first 30 consecutive cases of laparoscopic pyeloplasty performed at our institution. MATERIALS AND METHODS: We studied 30 patients with ureteropelvic junction obstructions who underwent laparoscopic pyeloplasty between March 2004 and March 2009. Of the 30 patients, 5 patients underwent robot-assisted laparoscopic pyeloplasty (RALP) since April 2008. Patients were divided into 4 groups according to operative procedure: group 1, early laparoscopic pyeloplasty-dismembered (E/LP-D, n=9); group 2, late laparoscopic pyeloplasty-dismembered (L/LP-D, n=9); group 3, laparoscopic pyeloplasty-Fenger's method (LP-F, n=7); and group 4, RALP (n=5). RESULTS: The mean age of the patients was 34.0+/-12.8 years (range, 17-61 years). A crossing vessel was present in 37.9% of cases. Mean follow-up was 30+/-14 months (range, 11-62 months). Mean operative time was 267.3+/-78.7 minutes (range, 154-460 minutes), and the average length of the postoperative hospital stay was 4.6+/-1.6 days (range, 3-10 days). There were no intraoperative complications or transfusion. The success rate was 73.3%. The success rates of E/LP-D, L/LP-D, LP-F, and RALP were 6/9 (66.7%), 7/9 (77.8%), 5/7 (71.4%), and 4/5 (80%), respectively, without significant difference (p>0.05). Operation time and length of hospital stay were shorter in the L/LP-D group than in the E/LP-D group. CONCLUSIONS: Laparoscopic pyeloplasty may be an alternative treatment for an ureteropelvic junction obstruction, but the technical complexity of the procedure has made it difficult for many surgeons to adopt. RALP is a technically feasible management option for UPJ obstruction.
Follow-Up Studies ; Glycosaminoglycans ; Humans ; Intraoperative Complications ; Laparoscopy ; Length of Stay ; Operative Time ; Robotics ; Ureteral Obstruction

We conducted in-depth interviews with 11 Korean Disaster Relief Team (KDRT) members about stress related to disaster relief work and analyzed the interview data using the Consensual Qualitative Research (CQR) method in order to evaluate difficulties in disaster relief work and to develop solutions to these problems in cooperation with related organizations. Results showed that members typically experienced stress related to untrained team members, ineffective cooperation, and the shock and aftermath of aftershock experiences. Stress tended to stem from several factors: difficulties related to cooperation with new team members, the frightening disaster experience, and the aftermath of the disaster. Other stressors included conflict with the control tower, diverse problems at the disaster relief work site, and environmental factors. The most common reason that members participated in KDRT work despite all the stressors and difficulties was pride about the kind of work it involved. Many subjects in this study suffered from various stresses after the relief work, but they had no other choice than to attempt to forget about their experiences over time. It is recommended that the mental health of disaster relief workers will improve through the further development of effective treatment and surveillance programs in the future.
Disasters* ; Earthquakes* ; Mental Health ; Methods ; Nepal* ; Qualitative Research* ; Relief Work ; Rescue Work ; Shock

OBJECTIVE: Endotracheal intubation is extremely difficult to perform in patients wearing a cervical collar for a head and neck injury. Therefore, we analyzed actual measurements using the look externally, evaluate 3-3-2, Mallampati score, obstruction, and neck mobility (LEMON) criteria before and after cervical collar application to investigate the causes of a difficult airway. METHODS: This simulation study was performed in 76 healthy volunteers. We measured the mouth opening, modified Mallampati classification, and neck extension before and after cervical collar application. RESULTS: The mean inter-incisor distance significantly decreased from 4.3 to 2.6 cm (P < 0.001). Fifty-seven participants classified as I and II were newly classified as III and IV according to the modified Mallampati classification after cervical collar application (16% to 91%). The angles of neck extension significantly decreased from 44° to 22° after cervical collar application (P < 0.001). Before cervical collar application, our simulations predicted that 14 of 76 participants (18%) would have a difficult airway, whereas after cervical collar application, 76 of 76 (100%) were predicted to have a difficult airway. CONCLUSION: All values for the LEMON criteria (mouth opening, modified Mallampati classification, and neck extension) worsened significantly after cervical collar application. Additionally, a difficult airway was predicted in all participants after cervical collar application.
Airway Management ; Classification ; Head ; Healthy Volunteers ; Humans ; Intubation, Intratracheal ; Mouth ; Neck ; Neck Injuries

OBJECTIVE: This study examined patients who visited the emergency department of a national medical center equipped with rabies vaccine and rabies immunoglobulin to confirm whether the treatment for rabies vaccination was appropriate in the emergency department. METHODS: This was a retrospective study that included 397 patients from January 1, 2014, to October 31, 2017. The patients finally diagnosed with animal bites according to the International Classification of Diseases, 10th revision code, at emergency department were collected. RESULTS: Most of the patients were 20–30 years old. Most of them were bitten by a dog, especially in the upper limb. Only 84% of patients who met the domestic rabies post-exposure prophylaxis (PEP) criteria were vaccinated. Patients who did not meet the criteria, approximately 22.3%, were also vaccinated. Complications after vaccination included clinical symptoms, such as headache, numbness, mild itching, and heating sensation. CONCLUSION: Rabies is a disease that can be prevented through PEP. Rabies PEP is relatively expensive and difficult to vaccinate easily, so it is desirable to subdivide the existing domestic rabies PEP guidelines into reality. Emergency physicians should know the proper rabies vaccination criteria and vaccinate patients only if necessary. This will help reduce medical resources and the complications of rabies vaccinations.
Animals* ; Bites and Stings ; Dogs ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Headache ; Heating ; Hot Temperature ; Humans ; Hypesthesia ; Immunoglobulins ; International Classification of Diseases ; Post-Exposure Prophylaxis* ; Pruritus ; Rabies Vaccines ; Rabies* ; Retrospective Studies ; Sensation ; Upper Extremity ; Vaccination

Objective: This study examined the frequency of emergency department visits for syncope according to the day, week, and month. The frequency of syncope associated with holidays and the locations was also investigated. Methods: A retrospective study was performed on the frequency of patients discharged from the emergency department with a diagnosis of syncope from July 2016 to June 2017. Each 24-hour period was analyzed in four-hour intervals, and the frequency of occurrence was calculated for weekly and monthly time frames. In addition, the frequency of syncope associated with holidays and the locations where syncope occurred were analyzed for any possible trends. Results: For the 259 patients in this study, the frequency of the reflex syncope was significantly higher between 6 and 10 am (P=0.011), and showed a decreasing trend since that period (P=0.006). The number of reflex syncope visits on Mondays was significantly higher than on the other days (P<0.001) and a decreasing trend after Monday toward the weekend (P=0.023). A significant difference in the frequency of syncope associated with holidays was observed: 0.48 on weekdays, excluding the day after a holiday; 0.37 on a holiday; and 0.92 on the day after a holiday (P<0.001). Almost half of the reflex syncope events (44.3%) occurred in the subway. Conclusion The frequency of syncope was highest in the morning. In addition, reflex syncope showed a higher frequency on the day after a holiday, and the incidence was higher in the subway.

PURPOSE: This study was performed to assess frequency, timings of occurrence, and predictors of radiologic lung damage (RLD) after forward-planned intensity-modulated radiotherapy (FIMRT) for whole breast irradiation. METHODS: We retrospectively reviewed medical records of 157 breast cancer patients and each of their serial chest computed tomography (CT) taken 4, 10, 16, and 22 months after completion of breast radiotherapy (RT). FIMRT was administered to whole breast only (n=152), or whole breast and supraclavicular regions (n=5). Dosimetric parameters, such as mean lung dose and lung volume receiving more than 10 to 50 Gy (V10-V50), and clinical parameters were analyzed in relation to radiologic lung damage. RESULTS: In total, 104 patients (66.2%) developed RLD after whole breast FIMRT. Among the cases of RLD, 84.7% were detected at 4 months, and 15.3% at 10 months after completion of RT. More patients of 47 or younger were found to have RLD at 10 months after RT than patients older than the age (11.7% vs. 2.9%, p=0.01). In univariate and multivariate analyses, age >47 and V40 >7.2% were significant predictors for higher risk of RLD. CONCLUSION: RLD were not infrequently detected in follow-up CT after whole breast FIMRT. More detected cases of RLD among younger patients are believed to have developed at later points after RT than those of older patients. Age and V40 were significant predictors for RLD after whole breast intensity-modulated radiotherapy.
Breast Neoplasms ; Breast* ; Follow-Up Studies ; Humans ; Lung Injury* ; Lung* ; Medical Records ; Multivariate Analysis ; Radiotherapy ; Radiotherapy, Intensity-Modulated* ; Retrospective Studies ; Thorax

Unreduced small bowel intussusception requires operative treatment although the rate of spontaneous reduction is 60 to 70%. The aim of this study is to compare clinical characteristics and outcome between spontaneous reduction and operation group and to analyze factors related to decisions to treat small bowel intussusceptions. The records of 25 patients with small bowel intussusceptions treated in Seoul National University Children's Hospital from January 1999 to August 2009 were reviewed respectively. Spontaneous reduction group (n=12, 48%) had signs and symptoms of vomiting, abdominal pain, currant jelly stool, abdominal distension, fever, increased CRP but no rebound tenderness. One of them had been diagnosed with Henoch-Schonlein purpura and no one displayed pathologic leading point by image study. Operation group (n=13, 52%) consisted of patients who had primary surgery. Their signs and symptoms were similar to spontaneous reduction group. Seven of them had underlying diseases such as Crohn' disease, ALL, Lymphoma, Peutz-Jeghers syndrome (n=3), post-transplanted state of liver and 2 of them displayed Peutz-Jeghers polyp and Meckel's diverticulum as pathologic leading point by preoperative ultrasonography. Mean relieve interval (interval between onset of symptoms and reduction/operation) was 1.78 days in spontaneous reduction group and 2.25 days in operation group (p=0.341). Seven of operation group had manual reduction and 6 out of 7 received segmental resection of the small bowel. No one of them underwent manual reduction and all of them underwent segmental resection were found to have pathologic leading points [Peutz-Jeghers polyp (n=3), Meckel's diverticulum (n=2), lymphoma (n=1)] during operation. In conclusion, 48% of small bowel intussusceptions resolved spontaneously. Patients' symptoms and relieve intervals were not related to the operative decisions. We therefore recommend significant factors for determining treatment plan such as change of clinical symptoms, underlying disease or pathologic leading point by imaging.
Abdominal Pain ; Fever ; Humans ; Intussusception ; Liver ; Lymphoma ; Meckel Diverticulum ; Peutz-Jeghers Syndrome ; Polyps ; Purpura, Schoenlein-Henoch ; Vomiting