BACKGROUND: The reproducibility in grading a cervical intraepithelial neoplasia (CIN) are not perfect. The aim of this study was to assess the value of the immunohistochemical expression of p63 and the other biomarkers for grading a CIN (dysplasia and in situ carcinoma), and diagnosing invasive carcinomas. METHODS: Sixty six cervical specimens were immunostained with the monoclonal antibodies against p63, Ki-67, p27Kip1, and p53 to determine the localization. RESULTS: The p63 positive cells are well linked with squamous cell maturation and the degree of dysplasia. In mild dysplasia, the p63 positive cells were localized to the basal and parabasal cells, which gradually extended into the middle and upper layers in moderate and severe dysplasia. p63 expression was strong in immature squamous epithelium and invasive squamous cells, but was constantly absent in an adenocarcinoma. The Ki-67 positive cells were scattered from the parabasal cells to the superficial cells in accordance with the degree of dysplasia. p27Kip1 expression was noted in the intermediate cells in the normal cervix. In CIN, the p27Kip1 positive nuclei tended to extend to the basal cells, but it showed no diagnostic consistency in an invasive carcinoma. p53 expression was also variable. CONCLUSION: p63 is a useful diagnostic adjunct for grading CIN as well as for detecting microinvasion and squamous differentiation in invasive carcinoma. However, immunohistochemical expressions for the p27Kip1 and p53 have no correlation with the grade of CIN and squamous cell carcinoma.
Adenocarcinoma ; Antibodies, Monoclonal ; Biomarkers ; Carcinoma, Squamous Cell ; Cervical Intraepithelial Neoplasia ; Cervix Uteri ; Epithelium ; Female ; Uterine Cervical Neoplasms

The index on myocardial contractility of pure mitral regurgitation(MR) after mitral valve replacement is believed to be useful in determining proper operation time before irreversible myocardial damage by volume overload. Thus the authors examined pre and post-operative echocardiographic results of 20 cases of pure MR patients who had been admitted to Pusan National University hospital and compared the usefulness of each index. Pre and post-operative echocardiographic results were as follows respectively ; 1) Left ventricular internal dimension in diastole(LVIDd) were 6.49+/-0.19cm and 5.51+/-0.17cm. 2) Left ventricular internal dimension in systole(LVIDs) were 4.26+/-0.12 and 3.79+/-0.18cm. 3) Ejection fraction were 71.28+/-1.57% and 59.24+/-3.05%. 4) Fractional shortening(FS) were 34.09+/-1.18% and 27.21+/-1.84%. 5) Mean Vcf were 1.53+/-0.08cm/sec and 1.18+/-0.09cm/sec. 6) Left ventricular end-diastolic volume index(EDVI) were 196.35+/-18.33cc/m2 and 98.46+/-9.96cc/m2. 7) Left ventricular end-systolic volume index(ESVI) were 55.28+/-5.12cc/m2 and 41.88+/-6.07cc/m2. 8) Left ventricular end-systolic wall stress/ESVI(ESS/ESVI) were 2.3+/-0.21 and 3.91+/-0.83. ESS/ESVI showed significantly(p<0.05) elevated postoperative change, LVIDd, LVIDs, EF, FS, EDVI, ESVI revealed significantly(p<0.05) reduced postoperative change whereas Mean Vcf had no postoperative change. After examining correlation between preoperative and postoperative results of each index, it is believed that LVIDd, LVIDs, and ESS/ESVI were useful prognostic indices but were unrelated to postoperative ejection phase indices such as EF, FS, and MEan Vcf. Especially in case of LVIDd>6cm, LVIDs>4cm, and ESS/ESVI<2, the prognosis was poor due to myocardial damage by mitral regurgitation.
Busan ; Echocardiography ; Humans ; Mitral Valve Insufficiency* ; Mitral Valve* ; Prognosis ; Stroke Volume

Cytomegalovirus retinitis (CMV), an opportunistic infection of a immunocompromised patient, is a necrotizing retinitis occurred in AIDS or the patient using immunosuppressants. A 31-years-old male taken immunosuppressants after renal transplantation, had white granular foci and perivascular sheathings in the uper temporal retina of both eyes. Serologic test demonstrated positive response to bith IgG and IgM antibody against CMV. Argon laser photocoagulation was done and ganciclovir was intravenously treated 300 mg every 12 hours for three weeks without maintenance therapy. Nine months after treatment, there was no recurrence of retinitis. This result suggests CMV retinitis of renal transplanted patient may not need the maintenance therapy of ganciclovir.
Argon ; Cytomegalovirus Retinitis* ; Cytomegalovirus* ; Ganciclovir* ; Humans ; Immunocompromised Host ; Immunoglobulin G ; Immunoglobulin M ; Immunosuppressive Agents ; Kidney Transplantation ; Light Coagulation ; Male ; Opportunistic Infections ; Recurrence ; Retina ; Retinitis ; Serologic Tests

Type 2 diabetes is different between Asian and non-Asian populations. Compared with their Caucasian counterparts, Asian patients with type 2 diabetes have the characteristics of lower body mass index, lower insulin secretory response, and a lower degree of insulin resistance. Furthermore, a recent study revealed that the incretin effect is not decreased in Korean patients with type 2 diabetes compared with normal glucose tolerance. The HbA1c lowering efficacy of dipeptidylpeptidase-4 inhibitors, which enhances active incretin hormones, is greater in Asian people than in non-Asian people, which could be ascribed to their lower body mass indexes. Therefore, doctors should take these differing characteristics of type 2 diabetes in Asian patients into account for customized anti-diabetes therapy.
Asian Continental Ancestry Group ; Body Mass Index ; Diabetes Mellitus, Type 2 ; Glucose ; Humans ; Incretins ; Insulin ; Insulin Resistance

Purpose: This study used a mixed methods research design in an attempt to verify the effects of robot-assisted rehabilitation on the gait ability of stroke patients with hemiplegia, and thereby further understand the benefits and challenges of stroke patients’ experiences relying on robot-assisted rehabilitation. Methods: An exploratory sequential mixed methods study design was used in order to combine both quantitative and qualitative data. For the quantitative data collection, a total of 30 stroke patients with hemiplegia were recruited from one rehabilitation hospital. Qualitative data were collected through individual interviews using semi-structured questionnaires for a group of 15 patients who were currently undergoing robot-assisted rehabilitation. The data were analyzed through qualitative content analysis. Results: As a result of the quantitative analysis, there were significant differences between the two groups in terms of daily living activity patterns, total number of steps, and average walking speed. As a result of the qualitative analysis, the four main themes derived consisted of, ‘curiosity about the usage of robot-assisted rehabilitation,’ ‘pleasure experienced while using the robots,’ ‘insufficient information about robots,’ and ‘a lack of education about robot-assisted rehabilitation.’ Conclusions Robot-assisted rehabilitation had a significant effect on the walking ability of stroke patients with hemiplegia. Additionally, stroke patients with hemiplegia experienced difficulty during the course of their robot-assisted rehabilitation, due to a lack of sufficient information on correct usage techniques. These quantitative and qualitative findings could provide the basic foundation for the development of an educational program on robot-assisted rehabilitation.

Purpose: The purpose of this study was to describe the profile of graduates from accelerated second-degree Bachelor of Science in Nursing programs and to analyze the relative efficiency of nursing colleges using data envelopment analysis. Methods: An online survey link was emailed to the deans of nursing colleges, who were then asked to send the link to graduates of the respective colleges. The survey questionnaire included demographics, reasons for applying to the accelerated second-degree Bachelor of Science in Nursing program, employment after graduation, and nursing career satisfaction. Results: Sixty-two graduates of the accelerated second-degree Bachelor of Science in Nursing program responded to the survey. The mean age at admission was 24.28 (± 3.01) years. Reasons for applying to the accelerated second-degree Bachelor of Science in Nursing program were primarily increasing job security and using it as a stepping stone to another career. Nursing career job satisfaction was 4.81 (± 1.07) and more than 82% recommended this program. The data envelopment analysis found the average efficiency score to be 0.84 (± 0.20) and 4 nursing colleges to be relatively efficient. Conclusion The accelerated second-degree Bachelor of Science in Nursing program can be considered to be an effective means to produce quality nurses with non-nursing bachelor degrees in a short time; however, outcomes of this program need to be systematically monitored to maintain quality level. Through this, competent nurses with knowledge of adjacent studies will be added to the nursing workforce.

PURPOSE: Medical direction is an integral part of proper prehospital care, which is performed by EMS providers. In Gyunggi province, a number of measures have been implemented to improve the direct medical direction system. We aimed to report on the process and results of the newly implemented medical direction system. METHODS: This is a descriptive analysis of the newly implemented medical direction system for community EMS providers from June 2014 to October 2014. Direct medical direction was requested by emergency medical technicians (EMTs) during the study period, as follows: when a destination hospital was selected, EMTs requested medical direction from the physicians at the destination hospital. During the study period specially-trained advanced EMTs were permitted to perform intravenous (IV) access for fluid or glucose infusion without direct medical direction. EMTs were asked to complete records when they requested direct medical direction and performed IV access without medical direction. These records were collected and used in the analysis. RESULTS: Of 5949 direct medical direction requests, 5527 were analyzed; 2958 (53.5%) cases were requested to the destination hospitals, 2569 (46.5%) were requested to the centralized dispatch center. 'Patient evaluation' was the most common reason for EMTs to request medical direction to the destination hospitals (1680, 54.4%) and centralized dispatch center (980, 38.1%). EMTs' degree of satisfaction did not differ significantly between destination hospitals and the centralized dispatch center (4.12+/-0.82 and 4.09+/-0.84, p=0.053). IV access rate for hypotensive patients increased 6.1% during the study period compared to the same period of 2013 (17.6% and 11.5%, p<0.01). CONCLUSION: We found that it is feasible to request direct medical direction to the destination hospitals and perform IV access for fluid or glucose infusion without direct medical direction for specially-trained advanced EMTs. Continuing efforts to establish an optimized medical direction system would be required for proper pre-hospital care.
Emergency Medical Service Communication Systems ; Emergency Medical Services ; Emergency Medical Technicians ; Glucose ; Humans ; Korea

Granulomatosis with polyangiitis (GPA) is a disease characterized by a granulomatous necrotizing vasculitis of the small vessels, along with the presence of antineutrophil cytoplasmic antibody (ANCA), serologically. GPA is a multisystem disease, in which the diagnosis is frequently based on respiratory and renal manifestations, with rare breast invasion. To date, several cases of breast invasion by GPA have been published, and most cases have been positive for ANCA. However, ANCA-negative forms of breast invasion by GPA are extremely rare and have not been reported in Korea thus far. Therefore, we report a case of ANCA-negative GPA in a 70-year-old woman, who was initially presented with a localized palpable mass in the left breast.
Aged ; Antibodies ; Antibodies, Antineutrophil Cytoplasmic ; Breast* ; Cytoplasm* ; Diagnosis ; Female ; Humans ; Korea ; Vasculitis

PURPOSE: This report describes a case of granulomatosis with polyangiitis (GPA) in which the gingival manifestation was crucial in both making an early diagnosis and possibly in deciding the approach to treatment. METHODS: A 57-year-old sailor presented to the Department of Dentistry at Ulsan University Hospital complaining of gingival swelling since approximately 2 months. He had orofacial granulomatous lesions and the specific gingival manifestation of strawberry gingivitis. RESULTS: The diagnosis of GPA was made on the basis of clinical symptoms and signs, and confirmed by the presence of the anti-neutrophil cytoplasmic antibody and a positive biopsy. The patient was admitted to the hospital and subsequently placed on a disease-modifying therapy regimen that included methotrexate and prednisone. CONCLUSIONS: Identification of the gingival manifestation of the disease permitted an early diagnosis and prompt therapy in a disease in which time is a crucial factor. Because of its rapid progression and potentially fatal outcome, an early diagnosis of GPA is important. Therefore, dentists should be aware of the oral signs and symptoms of such systemic diseases.
Antibodies, Antineutrophil Cytoplasmic ; Biopsy ; Dentistry ; Dentists ; Diagnosis* ; Early Diagnosis ; Fatal Outcome ; Fragaria ; Gingiva ; Gingivitis ; Humans ; Methotrexate ; Middle Aged ; Military Personnel ; Prednisone ; Ulsan

PURPOSE: Roux-en-Y reconstruction (RY) in laparoscopic distal gastrectomy for gastric cancer is a more complicated procedure than Billroth-I (BI) or Billroth-II. Here, we offer a totally laparoscopic simple RY using linear staplers. MATERIALS AND METHODS: Each 50 consecutive patients with totally laparoscopic distal gastrectomy with RY and BI were enrolled in this study. Technical safety and surgical outcomes of RY were evaluated in comparison with BI. RESULTS: In all patients, RY gastrectomy using linear staplers was safely performed without any events during surgery. The mean operation time and anastomosis time were 177.0+/-37.6 min and 14.4+/-5.6 min for RY, respectively, which were significantly longer than those for BI (150.4+/-34.0 min and 5.9+/-2.2 min, respectively). There were no differences in amount of blood loss, time to flatus passage, diet start, length of hospital stay, and postoperative inflammatory response between the two groups. Although there was no significant difference in surgical complications between RY and BI (6.0% and 14.0%), the RY group showed no anastomosis site-related complications. CONCLUSION: The double stapling method using linear staplers in totally laparoscopic RY reconstruction is a simple and safe procedure.
Aged ; Female ; Gastrectomy/*methods ; Gastric Bypass/*methods ; Humans ; Laparoscopy/*methods ; Male ; Middle Aged ; Stomach Neoplasms/surgery