Purpose: This was a descriptive study aimed at providing basic data on readaptation of hospital nurses after parental leave by exploring levels of parenting stress, co-worker support, and work-life balance and identifying factors affecting work-life balance. Methods: A survey using a convenience sampling was conducted with 86 nurses who were within their first year reinstatement after parental leave. Structured questionnaires were used, including the above named main variables and other general characteristics. Data were collected from February to May, 2019 from three tertiary hospitals in Seoul. Data were statistically analyzed using independent t-test, one-way ANOVA, Pearson correlation coefficient, and multiple regression analysis. Results: Work-life balance showed a statistical difference depending on the level of education; it showed negative correlations with commuting time and fatigue and positive correlations with the attitude to job rotation, health status, and quality of sleep. There was a negative correlation between parenting stress and work-life balance and a positive correlation between co-worker support and work-life balance. Work-life balance was influenced by fatigue, parenting stress, health status, and co-worker support in the regression model. Conclusion Parenting stress, co-worker support, health status and fatigue of nurses reinstated from parental leave should be improved to enhance their work-life balance.

PURPOSE: This study was done to analyze the trend of theory application in articles published in the Journal of Korean Academy of Nursing Administration (JKANA) over the last 10 years. METHODS: Four hundred and eighty-five articles were reviewed to determine the scope of theory-applied research. General characteristics, study design and keywords classification by nursing meta-paradigm were analyzed using established analysis framework. RESULTS: Twenty-four articles (4.9%) were identified as theory-applied research publications. More than half of the articles (54.2%) stated that a theoretical framework was used; the number of theories used in the 24 articles was 27 including nine nursing theories. The majority of the studies were conducted in hospital settings. In the keyword classification by nursing meta-paradigm, 28 environment-related keywords were identified but only 7 keywords were related to health. CONCLUSION: The results show that theory application in Korean nursing administration research is very limited. It is necessary to create a positive educational environment for graduate students to learn about nursing theories as well as theories from other disciplines. In addition, different levels of nursing theories should be continuously developed in the field of nursing administration.
Classification ; Humans ; Nursing Administration Research ; Nursing Research ; Nursing Theory ; Nursing

BACKGROUNDS/AIMS: In hepatocellular carcinoma (HCC), bile duct invasion occurs far more rarely than vascular invasion and is not well characterized. In addition, the pathologic finding of bile duct invasion is not considered an independent prognostic factor for HCC following surgery. In this study, we determined the characteristics of HCC with bile duct invasion, and assessed the clinical significance of bile duct invasion. METHODS: We retrospectively reviewed the medical records of 363 patients who underwent hepatic resection for HCC at Seoul National University Hospital (SNUH) from January 2009 to December 2011. Preoperative, operative, and pathological data were collected. The risk factors for recurrence and survival were analyzed. Subsequently, the patients were divided into 2 groups according to disease stage (American Joint Committee on Cancer/International Union Against Cancer 7th edition): early stage (T1 and 2) and advanced stage (T3 and 4) group; and risk factors in the sub-groups were analyzed. RESULTS: Among 363 patients, 13 showed bile duct invasion on pathology. Patients with bile duct invasion had higher preoperative total bilirubin levels, greater microvascular invasion, and a higher death rate than those without bile duct invasion. In multivariate analysis, bile duct invasion was not an independent prognostic factor for survival for the entire cohort, but, was an independent prognostic factor for early stage. CONCLUSIONS: Bile duct invasion accompanied microvascular invasion in most cases, and could be used as an independent prognostic factor for survival especially in early stage HCC (T1 and T2).
Bile Ducts* ; Bile* ; Bilirubin ; Carcinoma, Hepatocellular* ; Cohort Studies ; Humans ; Joints ; Medical Records ; Mortality ; Multivariate Analysis ; Pathology ; Recurrence ; Retrospective Studies ; Risk Factors ; Seoul

SINE-VNTR-Alu (SVA) elements are present in hominoid primates and are divided into 6 subfamilies (SVA-A to SVA-F) and active in the human population. Using a bioinformatic tool, 22 SVA element-associated genes are identified in the human genome. In an analysis of genomic structure, SVA elements are detected in the 5' untranslated region (UTR) of HGSNAT (SVA-B), MRGPRX3 (SVA-D), HYAL1 (SVA-F), TCHH (SVA-F), and ATXN2L (SVA-F) genes, while some elements are observed in the 3'UTR of SPICE1 (SVA-B), TDRKH (SVA-C), GOSR1 (SVA-D), BBS5 (SVA-D), NEK5 (SVA-D), ABHD2 (SVA-F), C1QTNF7 (SVA-F), ORC6L (SVA-F), TMEM69 (SVA-F), and CCDC137 (SVA-F) genes. They could contribute to exon extension or supplying poly A signals. LEPR (SVA-C), ALOX5 (SVA-D), PDS5B (SVA-D), and ABCA10 (SVA-F) genes also showed alternative transcripts by SVA exonization events. Dominant expression of HYAL1_SVA appeared in lung tissues, while HYAL1_noSVA showed ubiquitous expression in various human tissues. Expression of both transcripts (TDRKH_SVA and TDRKH_noSVA) of the TDRKH gene appeared to be ubiquitous. Taken together, these data suggest that SVA elements cause transcript isoforms that contribute to modulation of gene regulation in various human tissues.
3' Untranslated Regions ; 5' Untranslated Regions ; Exons ; Gene Expression Profiling ; Genome, Human ; Genomics ; Humans ; Lung ; Organ Specificity ; Poly A ; Primates ; Protein Isoforms

Fasiglifam (TAK-875) a G-protein coupled receptor 40 (GPR40) agonist, significantly improves hyperglycemia without hypoglycemia and weight gain, the major side effects of conventional anti-diabetics. Unfortunately, during multi-center Phase 3 clinical trials, unexpected liver toxicity resulted in premature termination of its development. Here, we investigated whether TAK-875 directly inflicts toxicity on hepatocytes and explored its underlying mechanism of toxicity. TAK-875 decreased viability of 2D and 3D cultures of HepG2, a human hepatocarcinoma cell line, in concentration- (>50 μM) and time-dependent manners, both of which corresponded with ROS generation. An antioxidant, N-acetylcysteine, attenuated TAK-875-mediated hepatotoxicity, which confirmed the role of ROS generation. Of note, knockdown of GPR40 using siRNA abolished the hepatotoxicity of TAK-875 and attenuated ROS generation. In contrast, TAK-875 induced no cytotoxicity in fibroblasts up to 500 μM. Supporting the hepatotoxic potential of TAK-875, exposure to TAK-875 resulted in increased mortality of zebrafish larvae at 25 μM. Histopathological examination of zebrafish exposed to TAK-875 revealed severe hepatotoxicity as manifested by degenerated hypertrophic hepatocytes with cytoplasmic vacuolation and acentric nuclei, confirming that TAK-875 may induce direct hepatotoxicity and that ROS generation may be involved in a GPR40-dependent manner.
Acetylcysteine ; Cell Line ; Cytoplasm ; Fibroblasts ; GTP-Binding Proteins ; Hepatocytes ; Humans ; Hyperglycemia ; Hypoglycemia ; Larva ; Liver ; Mortality ; Reactive Oxygen Species* ; RNA, Small Interfering ; Weight Gain ; Zebrafish

BACKGROUND: Adipose-derived stem cells (ADSCs) exert immunomodulatory effects in the treatment of transplant rejection. This study aimed to evaluate the effects of ADSCs on the skin graft survival in a human-to-rat xenograft transplantation model and to compare single and multiple injections of ADSCs. METHODS: Full-thickness human skin xenografts were transplanted into the backs of Sprague–Dawley rats. The rats were injected subcutaneously on postoperative days 0, 3, and 5. The injections were as follows: triple injections of phosphate-buffered saline (PBS group), a single injection of ADSCs and double injections of PBS (ADSC 9 1 group), and triple injections of ADSCs (ADSC 9 3 group). The immunomodulatory effects of ADSCs on human skin xenografts were assessed. RESULTS: Triple injections of ADSCs considerably delayed cell-mediated xenograft rejection compared with the PBS and ADSC 9 1 groups. The vascularization and collagen type 1–3 ratios in the ADSC 9 3 group were significantly higher than those in the other groups. In addition, intragraft infiltration of CD3-, CD4-, CD8-, and CD68-positive cells was reduced in the ADSC 9 3 group. Furthermore, in the ADSC 9 3 group, the expression levels of proinflammatory cytokine interferon-gamma (IFN-c) were decreased and immunosuppressive prostaglandin E synthase (PGES) was increased in the xenograft and lymph node samples. CONCLUSION This study presented that triple injections of ADSCs appeared to be superior to a single injection in suppressing cell-mediated xenograft rejection. The immunomodulatory effects of ADSCs are associated with the downregulation of IFN-c and upregulation of PGES in skin xenografts and lymph nodes.

OBJECTIVE: The purpose of this study is to evaluate the clinical and hematological effects of tocilizumab in active rheumatoid arthritis (RA) patients. METHODS: Fourteen patients with active RA were enrolled in this study. The patients received tocilizumab 8 mg/kg intravenously every four weeks for 6 months. Disease activity, anemia-related factors including serum hepcidin-25, and hematological parameters were monitored at baseline and at 1, 3, and 6 months after the initiation of treatment. RESULTS: Significant reductions in tender joint count, swollen joint count, visual analogue scale, erythrocyte sedimentation rate (ESR), and C-reactive (CRP) protein plus reductions in a 28-joint disease activity score were observed within one month after the first tocilizumab treatment. These effects lasted throughout the six-month study period. In addition, significant improvements in anemia-related factors such as hepcidin-25, ferritin, iron, hemoglobin, red blood cell counts and mean corpuscular volume were observed during the treatment period. Hematological parameters were improved with reductions in counts for leukocytes, monocytes, neutrophils, and platelets. The lymphocyte counts and their subset numbers were unchanged. Changes in hepcidin levels showed significant correlation with changes in CRP, ESR, ferritin, hemoglobin and counts for red blood cells, leukocytes, and neutrophils during the treatment period. CONCLUSION: This study demonstrates that tocilizumab significantly and meaningfully reduces disease burden in patients with active RA. In addition, tocilizumab diminishes the levels of inflammatory anemia by inhibiting hepcidin production. These clinical data provide evidence of a favorable outcome from tocilizumab in RA.
Anemia* ; Arthritis, Rheumatoid* ; Blood Sedimentation ; Erythrocyte Count ; Erythrocyte Indices ; Erythrocytes ; Ferritins ; Hepcidins* ; Humans ; Iron ; Joints ; Leukocytes ; Lymphocyte Count ; Monocytes ; Neutrophils

BACKGROUND/AIMS: We sought to identify predictors of significant tricuspid regurgitation (TR) after successful permanent pacemaker (PPM) implantation in Korean patients. METHODS: Of 404 patients who underwent PPM implantation, 187 patients who had both baseline and follow-up echocardiographic examinations were assigned to one of two groups: no development or change in TR (Group I, n = 172, 65.5 +/- 13.7 years) versus the development of significant TR (Group II, n = 15, 72.1 +/- 8.3 years). Clinical, laboratory, and echocardiographic variables were compared between the two groups. RESULTS: Overall, the grade of TR was significantly aggravated from 0.46 +/- 0.73 to 0.81 +/- 0.84 (p < 0.001) during 3.1 +/- 1.8 years of follow-up (0.49 +/- 0.75 to 0.69 +/- 0.74 in Group I, p < 0.001; 0.13 +/- 0.35 to 2.27 +/- 0.46 in Group II, p < 0.001). The de novo development or aggravation of TR was observed in 66 patients (35.3%), and significant TR developed in 15 patients (8.0%). The presence of atrial fibrillation (AF) was significantly higher (53.3 vs. 18.6%, p = 0.002), and the implantation of a ventricle pacing, ventricle sensing, inhibited by ventricular event (VVI) type pacemaker was more frequent in Group II than in Group I (46.7 vs. 15.1%, p = 0.002). Other variables were not different between the groups. CONCLUSIONS: The development or aggravation of TR was not rare after successful PPM implantation, even though the development of significant TR was uncommon. The presence of AF and the implantation of a VVI type pacemaker were predictors of the development of significant TR. Together, the results of this study suggest that the development or aggravation of TR should be monitored carefully after PPM implantation.
Atrial Fibrillation ; Echocardiography ; Follow-Up Studies ; Humans ; Tricuspid Valve Insufficiency*

An aneurysm of the subclavian artery is rare. Recently, we experienced a case of a ruptured subclavian artery aneurysm presenting as hemoptysis. The patient had experienced atypical chest discomfort, and computed tomography (CT) revealed a small aneurysm of the left subclavian artery (SCA). Hemoptysis occurred 2 weeks later. Follow-up CT showed a ruptured aneurysm at the proximal left SCA. Endovascular treatment with a graft stent was performed by bilateral arterial access with a 12-Fr introducer sheath placed via cutdown of the left axillary artery and an 8-Fr sheath in the right femoral artery. A self-expandable Viabahn covered stent measuring 13x5 mm was introduced retrogradely via the left axillary sheath and was positioned under contrast guidance with an 8-Fr JR4 guide through the femoral sheath. After the procedure, hemoptysis was not found, and the 3-month follow-up CT showed luminal patency of the left proximal SCA and considerable reduction of the hematoma.
Aneurysm ; Aneurysm, Ruptured ; Axillary Artery ; Femoral Artery ; Follow-Up Studies ; Hematoma ; Hemoptysis ; Humans ; Phenobarbital ; Stents ; Subclavian Artery ; Thorax ; Transplants

BACKGROUND: Aortic stiffness and intima-media thickness (IMT) are known to be associated with ischemic stroke. The aim of the present study was to investigate the differences of aortic stiffness and IMT between cerebral infarction (CI) and transient ischemic attack (TIA). METHODS: A total of 500 patients with acute stroke were divided into 2 groups: the TIA group (n = 230, 62.4 +/- 12 years, 144 males) versus CI group (n = 270, 63.4 +/- 11 years, 181 males). Aortic stiffness index and IMT, as well as conventional cardiovascular risk factors, were compared. RESULTS: The prevalence of hypertension, diabetes, and dyslipidemia were significantly higher, and left atrial volume and E/E' were significantly elevated in the CI group than in the TIA group. Carotid IMT was significantly thicker in the CI group than in the TIA group. Aortic stiffness index beta was significantly higher (7.99 +/- 2.70 vs. 7.02 +/- 4.30, p = 0.043) and aortic IMT was significantly thicker (1.53 +/- 0.41 vs. 1.45 +/- 0.39 mm, p = 0.040) in the CI group than in the TIA group. Aortic stiffness index beta was significantly correlated with the IMT of the aorta (r = 0.279, p = 0.014), right (r = 412, p < 0.001) and left carotid artery (r = 441, p < 0.001). CONCLUSION: Aortic stiffness index beta and IMT were significantly higher in patients with CI than TIA. The result of the present study suggested that CI is associated with more advanced degree of atherosclerotic and arteriosclerotic process than TIA.
Aorta ; Carotid Arteries ; Cerebral Infarction ; Dyslipidemias ; Humans ; Hypertension ; Ischemic Attack, Transient ; Prevalence ; Risk Factors ; Stroke ; Vascular Stiffness