Purpose: To compare changes in the swept-source (SS) anterior-segment optical coherence tomography (AS-OCT) parameters and intraocular pressure (IOP) control after lens extraction in various spectra of primary angle-closure disease (PACD). Methods: A total 92 eyes from 92 patients with PACD who underwent lens extraction were included in the study. All patients underwent IOP measurement preoperatively and at 1 day, 1 week, and 1, 3, and 6 months postoperatively. SS AS-OCT was performed in all subjects preoperatively and 1 month postoperatively. All participants were divided into two groups depending on the presence of glaucomatous optic disc or visual field damage (group A, PAC suspect or PAC; group B, PAC glaucoma). The changes in IOP and anterior chamber angle parameters of SS AS-OCT of each group were compared. Regression analysis was performed to find factors associated with the degree of IOP reduction after lens extraction. Results: Preoperatively, there was no significant difference in IOP between the two groups (16.3 ± 2.5 mmHg vs. 16.9 ± 3.2 mmHg, p = 0.297), but the number of glaucoma medications used was greater in group B (0.6 ± 1.0 vs. 2.0 ± 0.9, p < 0.001). Postoperatively, IOP was not significantly different, but the number of medications used was greater in group B (0.2 ± 0.7 vs. 0.9 ± 0.8, p < 0.001). Anterior chamber angle parameters including angle opening distance and trabecular-iris angle had a greater increase in group B after lens extraction. However, the residual iridotrabecular contact (ITC) index was significantly greater in group B (5.6 ± 7.0 vs 10.7 ± 12.1, p = 0.014). A greater change in the ITC index was related to a greater degree of IOP reduction (β coefficient, 0.429; p < 0.001). Conclusions Eyes with PAC glaucoma had a greater residual ITC index after lens extraction compared with eyes of other PACD spectrum and required a greater number of glaucoma medications to maintain a similar level of IOP.

Background: In Korea, the safety culture is led by national policy. How the policy ensures a patient safety culture needs to be investigated. This study aimed to examine the way in which physicians and nurses regard, understand, or interpret the patient safety-related policy in the hospital setting. Methods: In this qualitative study, we conducted four focus group interviews (FGIs) with 25 physicians and nurses from tertiary and general hospitals in South Korea. FGIs data were analyzed using thematic analysis, which was conducted in an inductive and interpretative way. Results: Three themes were identified. The healthcare providers recognized its benefits in the forms of knowledge, information and training at least although the policy implemented by the law forcibly and temporarily. The second theme was about the interaction of the policy and the Korean context of healthcare, which makes a “turning point” in the safety culture.The final theme was about some strains and conflicts resulting from patient safety policy. Conclusion To provide a patient safety culture, it is necessary to develop a plan to improve the voluntary participation of healthcare professionals and their commitment to safety.Hospitals should provide more resources and support for healthcare professionals.

PURPOSE: We aimed to evaluate the clinical significance of a disintegrin and metalloproteinase 8 (ADAM 8) as a potential blood biomarker for gastric cancer (GC). MATERIALS AND METHODS: Blood ADAM 8 was measured by ELISA. Cytokines/chemokines [interleukin-23 (IL-23), stromal cell-derived factor 1α/CXC chemokine ligand 12 (SDF-1α/CXCL12), interleukin-8 (IL-8), and soluble CD40 ligand (sCD40L)] were measured by chemiluminescent immunoassay. They were compared among five groups; normal/gastritis, high-risk, early GC (EGC), advanced GC (AGC) without distant metastasis, and AGC with distant metastasis by one-way analysis of variance in both training (n=80) and validation dataset (n=241). Clinicopathological features of GC and GC-associated cytokines were evaluated for their correlations with blood ADAM 8. To evaluate the diagnostic accuracy to predict GC, receiver operating characteristic (ROC) curve and logistic regression were used. RESULTS: Blood ADAM 8 significantly increased along GC carcinogenesis in both training (ANOVA, p<0.001) and validation dataset (p<0.001). It was significantly higher in EGC compared to high-risk (post-hoc Bonferroni, p=0.041) and normal (p<0.001). It was also higher in AGC compared with high-risk (p<0.001) and normal (p<0.001) groups. However, no significant difference was found between cancer groups. Blood ADAM 8 was correlated with N-stage (Spearman's correlation, γs=0.320, p=0.011), but not with T-stage or M-stage. Pearson's correlations showed blood ADAM 8 was closely correlated with pre-inflammatory cytokines, IL-23 (p=0.036) and SDF-1α/CXCL12 (p=0.037); however, it was not correlated with pro-angiogenic cytokine IL-8 (p=0.313), and sCD40L (p=0.702). ROC curve and logistic regression demonstrated that blood ADAM 8 showed higher diagnostic accuracy (sensitivity, 73.7%; specificity, 86.2%) than CEA (sensitivity, 23.1%; specificity, 91.4%). Combination of ADAM 8 and CEA further increased the diagnostic accuracy to predict GC (sensitivity, 81.8%; specificity, 84.0%). CONCLUSION: Blood ADAM 8 is a promising biomarker for early detection of GC.
Carcinogenesis ; CD40 Ligand ; Cytokines ; Dataset ; Early Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Immunoassay ; Interleukin-23 ; Interleukin-8 ; Logistic Models ; Neoplasm Metastasis ; ROC Curve ; Sensitivity and Specificity ; Stomach Neoplasms

BACKGROUND: Because conventional echocardiographic parameters have several limitations, strain echocardiography has often been introduced in clinical practice. However, there are also obstacles in using it in clinical practice. Therefore, we wanted to find the current status of awareness on using strain echocardiography in Korea. METHODS: We conducted a nationwide survey to evaluate current use and awareness of strain echocardiography from the members of the Korean Society of Echocardiography. RESULTS: We gathered total 321 questionnaires from 25 cardiology centers in Korea. All participants were able to perform or interpret echocardiographic examinations. All participating institutions performed strain echocardiography. Most of our study participants (97%) were aware of speckle tracking echocardiography and 185 (58%) performed it for clinical and research purposes. Two-dimensional strain echocardiography was the most commonly used modality and left ventricle (LV) was the most commonly used cardiac chamber (99%) for clinical purposes. Most of the participants (89%) did not think LV strain can replace LV ejection fraction (LVEF) in their clinical practice. The common reasons for not performing routine use of strain echocardiography was diversity of strain measurements and lack of normal reference value. Many participants had a favorable view of the future of strain echocardiography. CONCLUSION: Most of our study participants were aware of strain echocardiography, and all institutions performed strain echocardiography for clinical and research purposes. However, they did not think the LV strain values could replace LVEF. The diversity of strain measurements and lack of normal reference values were common reasons for not using strain echocardiography in clinical practice.
Cardiology ; Echocardiography* ; Heart Ventricles ; Korea* ; Reference Values

Congenital lymphatic dysplasia is a rare congenital maldevelopment of the lymphatic system, in which dysfunction of the lymphatic system may cause leakage of lymph fluid into the limbs and the pleural, pericardial, or peritoneal cavity. We experienced a case of hydrops fetalis with subcutaneous lymphedema, chylothorax, chylous ascites and pericardial effusion. Lymphangiography revealed a critical defect of lymphatic system. Here, we report the first case of premature infant with congenital lymphatic dysplasia confirmed by lymphangiography, which is the first reported in Korea.
Chylothorax ; Chylous Ascites ; Edema* ; Extremities ; Humans ; Hydrops Fetalis* ; Infant, Newborn ; Infant, Premature ; Korea ; Lymphatic System ; Lymphedema ; Lymphography ; Pericardial Effusion ; Peritoneal Cavity

Necrotizing enterocolitis (NEC) characterized by inflammatory intestinal necrosis is a major cause of mortality and morbidity in newborns. Deep RNA sequencing (RNA-Seq) has recently emerged as a powerful technology enabling better quantification of gene expression than microarrays with a lower background signal. A total of 10 transcriptomes from 5 pairs of NEC lesions and adjacent normal tissues obtained from preterm infants with NEC were analyzed. As a result, a total of 65 genes (57 down-regulated and 8 up-regulated) revealed significantly different expression levels in the NEC lesion compared to the adjacent normal region, based on a significance at fold change ≥ 1.5 and P ≤ 0.05. The most significant gene, DPF3 (P < 0.001), has recently been reported to have differential expressions in colon segments. Our gene ontology analysis between NEC lesion and adjacent normal tissues showed that down-regulated genes were included in nervous system development with the most significance (P = 9.3 × 10⁻⁷; P(corr) = 0.0003). In further pathway analysis using Pathway Express based on the Kyoto Encyclopedia of Genes and Genomes (KEGG) database, genes involved in thyroid cancer and axon guidance were predicted to be associated with different expression (P(corr) = 0.008 and 0.020, respectively). Although further replications using a larger sample size and functional evaluations are needed, our results suggest that altered gene expression and the genes' involved functional pathways and categories may provide insight into NEC development and aid in future research.
Axons ; Colon ; Enterocolitis, Necrotizing* ; Gene Expression Profiling* ; Gene Expression* ; Gene Ontology ; Genome ; Humans* ; Infant, Newborn ; Infant, Premature ; Mortality ; Necrosis ; Nervous System ; Pilot Projects* ; Sample Size ; Sequence Analysis, RNA ; Thyroid Neoplasms ; Transcriptome

BACKGROUND: Fundamental echocardiography has some drawbacks in patients with difficult-to-image echocardiograms. The aim of this study is to evaluate impact of contrast echocardiography (CE) on ventricular function assessment and clinical diagnosis in routine clinical echocardiography. METHODS: Two hundred sixty patients were prospectively enrolled over 3 years in 12 medical centers in Korea. General image quality, the number of distinguishable segments, ability to assess regional wall motion, left ventricular (LV) apex and right ventricle (RV) visualization, LV ejection fraction, changes in diagnostic or treatment plan were documented after echocardiography with and without ultrasound contrast agent. RESULTS: Poor or uninterpretable general image was 31% before contrast use, and decreased to 2% (p<0.05) after contrast use. The average number of visualized LV segments was 9.53 before contrast use, and increased to 14.46 (p<0.001) after contrast use. The percentage of poor or not seen LV regional wall motion was decreased from 28.4% to 3.5% (p<0.001). The percentage of poor or not seen LV apex and RV was decreased from 49.4% to 2.4% (p<0.001), from 30.5% to 10.5% (p<0.001), respectively. Changes in diagnostic procedure and treatment plan after CE were 30% and 29.6%, respectively. CONCLUSION: Compared to fundamental echocardiography, CE impacted LV function assessment and clinical decision making in Korean patients who undergo routine echocardiography.
Asian Continental Ancestry Group ; Clinical Decision-Making ; Diagnosis* ; Echocardiography* ; Heart Ventricles ; Humans ; Korea ; Prospective Studies ; Ultrasonography ; Ventricular Function*

PURPOSE: This study aims to compare the effectiveness and safety of ultrasound-guided contrast enema comparing with exploratory laparotomy for meconium plug syndrome in preterm infants. METHODS: Fifty-three preterm infants who were diagnosed with meconium plug syndrome among the neonates admitted to the Neonatal Intensive Care Unit of the Seoul National University Bundang Hospital from March 2008 to August 2015 were analyzed retrospectively. Four-teen infants among the 53 infants were excluded and Thirty-nine infants were analyzed. That time were divided into Period I and Period II. There was no pediatric radiologist and we couldn't try contrast enema in Period I. Pediatric radiologist was appointed and ultrasound guided contrast enema has been available in Period II. RESULTS: There were no specific differences of demographic characters between both Periods. Invasive procedure including contrast enema was increased in Period II than Period I (81% vs. 42%; P<0.05) and there were more exploratory laparotomy in Period I than in Period II (42% vs. 7%; P<0.05). Complications after treatment of meconium plug syndrome were more frequent in exploratory laparotomy groups than in ultrasound-guided contrast enema (57% vs. 0%; P<0.05) and total parenteral nutrition days were longer in laparotomy groups than in contrast enema groups (61±30 days vs. 31±13 days; P<0.05). CONCLUSION: We suggest that ultrasound-guided contrast enema with hyperosmolar water-soluble contrast is more therapeutic and safe therapy than exploratory laparotomy for meconium plug syndrome.
Enema* ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Laparotomy ; Meconium* ; Parenteral Nutrition, Total ; Retrospective Studies ; Seoul ; Ultrasonography

PURPOSE: This study aims to compare the effectiveness and safety of ultrasound-guided contrast enema comparing with exploratory laparotomy for meconium plug syndrome in preterm infants. METHODS: Fifty-three preterm infants who were diagnosed with meconium plug syndrome among the neonates admitted to the Neonatal Intensive Care Unit of the Seoul National University Bundang Hospital from March 2008 to August 2015 were analyzed retrospectively. Four-teen infants among the 53 infants were excluded and Thirty-nine infants were analyzed. That time were divided into Period I and Period II. There was no pediatric radiologist and we couldn't try contrast enema in Period I. Pediatric radiologist was appointed and ultrasound guided contrast enema has been available in Period II. RESULTS: There were no specific differences of demographic characters between both Periods. Invasive procedure including contrast enema was increased in Period II than Period I (81% vs. 42%; P<0.05) and there were more exploratory laparotomy in Period I than in Period II (42% vs. 7%; P<0.05). Complications after treatment of meconium plug syndrome were more frequent in exploratory laparotomy groups than in ultrasound-guided contrast enema (57% vs. 0%; P<0.05) and total parenteral nutrition days were longer in laparotomy groups than in contrast enema groups (61±30 days vs. 31±13 days; P<0.05). CONCLUSION: We suggest that ultrasound-guided contrast enema with hyperosmolar water-soluble contrast is more therapeutic and safe therapy than exploratory laparotomy for meconium plug syndrome.
Enema* ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Laparotomy ; Meconium* ; Parenteral Nutrition, Total ; Retrospective Studies ; Seoul ; Ultrasonography

PURPOSE: This study was done to investigate the level of nursing students' awareness, attitude, safety climate, and performance of infection control, and to identify factors influencing performance. METHODS: The sample consisted of 239 nursing students from 5 nursing schools. Data were collected from November 15 to December 11, 2013 and analyzed by frequency, t-test, ANOVA, Pearson correlation coefficients, and multiple stepwise regression with SPSS/WIN 21.0. RESULTS: Of the participants, 216 (90.4%) had experienced contact with infectious diseases. The performance of personal hygiene was scored the highest followed by standard precautions, transmission precautions, and vaccination. There were significant correlations between awareness, attitude, safety-climate and performance. Awareness, safety-climate, attitude, contents of infection control education, and direct exposure to infectious disease collectively explained 30% of the variance in performance, and awareness was the most influential factor. CONCLUSION: The results indicate that performance of infection control by nursing students can be increased if awareness, safety climate, attitude, and contents of infection control education are improved, and exposure to infectious disease is decreased. These findings can be utilized to improve performance by developing education programs for infection control.
Climate ; Communicable Diseases ; Education ; Humans ; Hygiene ; Infection Control* ; Nursing* ; Schools, Nursing ; Students, Nursing ; Vaccination