BACKGROUND AND OBJECTIVES: Adult studies have reported that patients with diabetes mellitus (DM) show ultrastructural and functional myocardial deterioration. The aim of this study was to assess whether cardiac functional deterioration can be detected in pediatric patients with type I DM and whether or not a relatively short duration of DM and hyperglycemia influences cardiac function. SUBJECTS AND METHODS: Forty-seven children and adolescents with DM and 38 healthy subjects (control group) were enrolled. Glycosylated hemoglobin (HbA1c), DM-induced complications, and left ventricular (LV) function as assessed using conventional and unconventional echocardiography {tissue Doppler imaging (TDI) and vector velocity imaging (VVI)} were evaluated. RESULTS: The conventional echocardiographic parameters, with the exception of early peak mitral inflow velocity, the findings of pulsed wave TDI at the annular level, and regional ventricular function by VVI, were not significantly different between the two groups. Using the conventional and unconventional indices of systolic and diastolic function, no significant relationship was found between the duration of DM and the echocardiographic parameters. The deceleration time (DT) and E'/A' had an inverse correlation with HbA1c (p=0.042 and p=0.016, respectively). CONCLUSION: Patients with DM in childhood and early adolescence rarely have insight on the significance of DM, and their diet is difficult to control. An alteration of myocardial function induced by DM may begin earlier than generally thought, and these changes are accelerated when glycemic control is poor. We recommend the early institution of close observation of patients with diabetes for alterations in cardiac function, in addition to other diabetic complications.
Adolescent ; Adult ; Child ; Deceleration ; Diabetes Complications ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Diet ; Echocardiography ; Hemoglobin A, Glycosylated ; Humans ; Hyperglycemia ; Ventricular Function ; Ventricular Function, Left

PURPOSE: The purpose of this study was to identify the factors associated with the health-related quality of life of family caregivers. METHODS: A cross-sectional study was conducted. This study included 191 primary family caregivers of elders who used home care services (home-visit nursing, home-visit care, daycare) covered by the public long-term care insurance. Data were collected using self-report questionnaires from December 2010 to June 2011. These data were analyzed by using hierarchical multiple regression. RESULTS: The majority of the family caregivers were female (79.6%) and daughters-in-law (28.8%). The mean depression score was 6.33+/-6.49 and the mean health-related quality of life score was 0.69+/-0.39. It was found that the factors affecting the health-related quality of life of family caregivers included depression (beta=-.406, p<.001), home-visit nursing use (beta=.296, p<.001), and daycare use (beta=.178, p=.015), which accounted for 36.6% of their health-related quality of life. CONCLUSION: Using home-visit nursing and daycare services has a positive effect on the health-related quality of life of family caregivers. To improve health-related quality of life of family caregivers, South Korea needs to fully activate the home-visit nursing and daycare services, and to strengthen family support programs.
Caregivers ; Community Health Nursing ; Cross-Sectional Studies ; Depression ; Female ; Home Care Services ; Humans ; Insurance, Long-Term Care ; Long-Term Care ; Quality of Life ; Republic of Korea ; Surveys and Questionnaires

Recently, the bcl-2 and p53 protein have been recognized as important factors that is contributed to programmed cell death. The objective of this study was to evaluate the prognostic significance of bcl-2 and p53 protein expression in uterine cervical carcinoma. The expression of bcl-2 and p53 in 59 cases of uterine cervical carcinoma (stage IB to IIB) were surgically treated from January 1993 to June 1994. The expression of bcl-2 and p53 was examined by immunohistochemical method using formalin fixed paraffin embedded tissue specimens. The 48 cases were squamous cell carcinoma and 11 cases were adenocarcinoma. The results were as follows: 1. The expression rate of bcl-2 protein was 28.8%(17/59) and there was no significant correlaltion between the expression of bcl-2 protein and the clinicopathologic parameters (histologic type, grade, FIGO stage, cervical invasion depth, lymph node metastasis, parametrial invasion, tumor size, neoadjuvant chemotherapy response, recurrence, survival). 2. The expression rate of p53 protein was 32.2%(19/59) and there was no significant correlation between expression of p53 protein and the clinicopathologic parameters. 3. There was significant correlation between and expression of bcl-2 and p53 protein (P 0.05). In conclusion, bcl-2 and p53 protein are thought to be possible factors in the carcinogenesis of uterine cervical carcinoma and correlate with progression of it. But further study will be required to clarify the role of bcl-2 and p53 in carcinogenesis of the uterine cervix.
Adenocarcinoma ; Carcinogenesis ; Carcinoma, Squamous Cell ; Cell Death ; Cervix Uteri ; Drug Therapy ; Female ; Formaldehyde ; Lymph Nodes ; Neoplasm Metastasis ; Paraffin ; Recurrence ; Uterine Cervical Neoplasms*

PURPOSE: The purpose of this study was to examine the effects on knowledge and performance in clinical nurses who participated in education on nursing recording focusing on the legal aspects. METHOD: The participants were working in medical departments in one hospital. There were 32 nurses in the experimental group and 25 in the control group. Pre-test was conducted on the two groups before education, and, in order to examine the effects of education, a post-test was conducted after three weeks. For the experimental group, the education on nursing recording focusing on legal aspects was provided as a lecture-led one-to-one training. RESULTS: Significant differences were found between the experimental and control groups in knowledge (F=15.728, p<.001), and performance (F=42.454, p<.001). CONCLUSIONS: The results of this study indicate that education on nurse recording enhances the knowledge and performance of the nurses. Thus education on nurse recording focusing on legal aspects should be required in the area of nursing science.
Jurisprudence ; Nursing Records

PURPOSE: The purpose of this study was to investigate actor and partner effects of sexual attitude and marital intimacy on sexual satisfaction in pregnant couples. METHODS: Data were collected from 176 pairs of the pregnant couples visiting for prenatal care at hospitals from June 18 to September 24, 2016. The collected data were analyzed by paired t-test and Pearson's correlation coefficients using SPSS 18.0 and interdependent effect (Actor-Partner Interdependence Model analysis) through AMOS 18.0. RESULTS: The sexual attitude and marital intimacy of the pregnant woman did not have a partner effect on the sexual satisfaction of her husband, respectively (β=.12, p=.141), (β=.01, p=.938). The sexual attitude of the husband had a partner effect on the sexual satisfaction of the pregnant woman (β=.13, p=.021), but the marital intimacy of the husband did not show a partner effect (β=.07, p=.202). CONCLUSION: Study suggests that the sexual attitude and marital intimacy of pregnant couples should be considered as factors when developing an intervention to improve sexual satisfaction in couples. Moreover, pregnant couples should participate in intervention together because the sexual satisfaction has conceptual view of interdependence in two-person relationships.
Family Characteristics* ; Female ; Humans ; Marriage ; Orgasm* ; Pregnancy ; Pregnant Women ; Prenatal Care ; Spouses

Tumor thrombus in the portal vein without any liver parenchymal abnormality is extremely rare. In the liver, the primary tumor most frequently presenting with intravascular tumor thrombi is hepatocellular carcinoma and lymphoma is rarely considered. Even though thrombosis occurs quite often in lymphoma, cases of tumor thrombus are rare and cases of tumor thrombus in the portal vein are even rarer. Only four cases of lymphoma with portal vein tumor thrombosis have been reported to date and all cases were the result of direct extensions of a dominant nodal or extra-nodal mass. To our knowledge, there has been no report on diffuse large B-cell lymphoma (DLBCL) presenting only within the lumen of the portal vein and not intravascular B-cell lymphoma. We present the first case of DLBCL presenting only within the lumen of the portal vein in an immunocompetent patient.

Laparoscopic cholecystectomy is a relatively new non-invasive surgical procedures, enjoying ever-increasing popularity and presenting new anesthetic challenges. The advantages of shorter hospital stay and more rapid return to normal activities are combined with less pain associated with the small limited incision and less postoperative ileus. During this procedure, the deliberate pneumoperitoneum with carbon dioxide(CO2) insufflation may cause some problems such as hypercarbia, hypertension, pneumomediastinum and other cardiovascular impairments. This study was performed to search a anesthetic method, which has least increase in blood pressure during CO2 insufflation, and to find out whether increased PaCO2 is a major causative factor in the changes of blood pressure during this period. Sixty patients of ASA class 1 or 2 were classified randomly into 3 groups. Group C(control group) was received enflurane-N2O-O2, and others were recieved enflurane-propofol(group P), or enflurane-propofol-fentanyl(group F), respectively. The blood pressure and heart rate were measured at 1 min before CO2 insufflation and 1 min, 5 min, 15 min after insufflation and 1 min before deflation, 5 min after deflation. Also PaCO2 were checked at 1 min before, and 15 min after insufflation. The results were follows ; 1) Changes of arterial pressure : The control group showed most prominent increasing in systolic and mean blood pressure during CO2 insufflation(P<0.05). Group F produced the least increase in blood pressure during CO2 insufflation, compared with group C and P(P<0.05). 2) Changes of heart rate : Although, in the preinsufflation period, heart rates in the group F were significantly lower than other groups, there were no significant changes in heart rates in each group. 3) Changes of PaCO2: There were no siginificant increases in PaCO2 in each group, and no differences between the groups. In conclusion, fentanyl and propofol added light enflurane anesthesia could be a method of the least increase in blood pressure during the laparoscopic cholecystectomy, and increased PaCO2 would not be a major causative factor in hypertension during CO2 insuftlation.
Anesthesia ; Anesthesia, General* ; Arterial Pressure ; Blood Pressure ; Carbon Dioxide* ; Carbon* ; Cholecystectomy, Laparoscopic ; Enflurane ; Fentanyl ; Heart Rate ; Humans ; Hypertension ; Ileus ; Insufflation ; Laparoscopy ; Length of Stay ; Mediastinal Emphysema ; Pneumoperitoneum ; Propofol

BACKGROUND: We performed competitive nested polymerase chain reaction (PCR) to evaluate the clinical utility of quantitative measurement of HBV DNA by PCR and it's correlation with other serologic hepatits B markers. Because hepatitis markers such as HBsAg, HBeAg, anti-HBe can not accurately reflect the replication of hepatitis B virus (HBV). METHODS: The internal standard was generated from the HBV core gene by point mutation, which would result in restriction site for the restriction enzyme Eco RI and performed competitive nested PCR followed by densitometric scanning of the amplified products of agarose gel. RESULTS: The sensitivity of nested PCR was 5 molecules in direct observation of agarose gel, but because of the background effect as taking polaroid photo graph it was 50 molecules by using densitometer. When DNA pellets for original 250 microL serum were diluted with 40 microL distilled water the low detection limit was 5.0 x10(3) molecules/microL, however it could be lowered when less diluted. Lower detection limit of densitometer was 6.25 pg by twofold serial dilution of 100 pg of purified HBV DNA PCR products, and regression showed y=0.93x-0.33 (y : density, x : concentration, 6.25 pg considered as 6.25 density). The reproducibility of the densitometer from high concentration was 4.3 +/-0.6 x10(6) molecules/microL(mean +/-SD, CV 14%), and low concentration was 3.7 +/-0.7 x10(4) molecules/microL(mean +/-SD, CV : 20%) Higher concentration of HBV DNA in HBeAg positive cases comparing with HBeAg negative cases was statistically significant (p<0.01). There was no correlation between HBV DNA concentration and serum value of alanine aminotransferase. CONCLUSION: Quantification of HBV DNA should be very useful in clinical follow-up of Post-therapy Patients and in anticipating Prognosis and infectivity of the disease, especially in cases of atypical hepatitis B and hepatitis B without seroconversion of routine hepatitis B markers. The shortcoming of the method seemed to be a rough estimate of HBV concentration as measuring the ratio of specimen/internal standard of two consecutive concentration among 10 folds serially diluted internal standard.
Alanine Transaminase ; Deoxyribonuclease EcoRI ; DNA ; Follow-Up Studies ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Humans ; Limit of Detection ; Point Mutation ; Polymerase Chain Reaction* ; Prognosis ; Sepharose ; Water

BACKGROUND: The risk of bleeding during extracorporeal membrane oxygenation (ECMO) is a potential deterrent in performing tracheostomy at many centers. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients supported by ECMO, we reviewed the clinical correlation between preoperative coagulation status and bleeding complication-related ST during ECMO. METHODS: From April 1, 2012 to March 31, 2016, ST was performed on 38 patients supported by ECMO. We retrospectively reviewed and analyzed the medical records including complications related to ST. RESULTS: Heparin was administered to 23 patients (60.5%) for anticoagulation during ECMO, but 15 patients (39.5%) underwent ECMO without anticoagulation. Of the 23 patients administered anticoagulation therapy, heparin infusion was briefly paused in 13 prior to ST. The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 ×109/L (range, 46 to 434 ×109/L), 1.2 (range, 1 to 2.3) and 62 seconds (27 to 114.2 seconds), respectively. No peri-procedural clotting complications related to ECMO were observed. Two patients (5.3%) suffering from ST-related major bleeding required surgical hemostasis. Minor bleeding after ST occurred in two cases (5.3%). No significant difference was found according to anticoagulation management (P = 0.723). No fatality was attributable to ST. CONCLUSIONS: The complication rates of ST in the patients supported by ECMO were low. Therefore, ST performed by an experienced operator, and with careful optimization of coagulation status, is a relatively safe procedure; the use of ST with ECMO should thus not be dismissed on account of the potential for bleeding caused by the administration of anticoagulants.
Anticoagulants ; Critical Illness ; Extracorporeal Membrane Oxygenation* ; Hemorrhage ; Hemostasis, Surgical ; Heparin ; Humans ; International Normalized Ratio ; Medical Records ; Partial Thromboplastin Time ; Platelet Count ; Retrospective Studies ; Tracheostomy*

Transoral endoscopic thyroid surgery vestibular approach (TOETVA) is now widely performed globally with good cosmetic outcomes. However, there are complications related to this approach which surgeons should be aware of. We report here a 41-year-old female patient who had an unusual ocular complication after total thyroidectomy via TOETVA. She was diagnosed with papillary thyroid carcinoma and received total thyroidectomy via TOETVA. She complained of floating particles in her right eye immediately after the operation. Fundus examination revealed intraocular hemorrhage in her right eye. At one-month follow-up, all of the intraocular hemorrhage was improved by fundus examination, resolving her chief complaint. Surgeons and anesthesiologists should be aware of increased intracranial pressure during the TOETVA and possible ocular complications after the surgery, although they are rare.