Background/Aims: Low-level viremia (LLV) after nucleos(t)ide analog treatment was presented as a possible cause of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). However, detailed information on patients’ adherence in the real world was lacking. This study aimed to evaluate the effects of LLV on HCC development, mortality, and cirrhotic complications among patients according to their adherence to entecavir (ETV) treatment. Methods: We performed a retrospective observational analysis of data from 894 consecutive adult patients with treatment-naïve CHB undergoing ETV treatment. LLV was defined according to either persistent or intermittent episodes of <2,000 IU/mL detectable hepatitis B virus DNA during the follow-up period. Good adherence to medication was defined as a cumulative adherence ≥90% per study period. Results: Without considering adherence in the entire cohort (n=894), multivariate analysis of the HCC incidence showed that LLV was an independent prognostic factor in addition to other traditional risk factors in the entire cohort (P=0.031). Good adherence group comprised 617 patients (69.0%). No significant difference was found between maintained virologic response and LLV groups in terms of the incidence of liver-related death or transplantation, HCC, and hepatic decompensation in good adherence group, according to multivariate analyses. Conclusions In patients with treatment-naïve CHB and good adherence to ETV treatment in the real world, LLV during treatment is not a predictive factor for HCC and cirrhotic complications. It may be unnecessary to adjust their antiviral agent for patients with good adherence who experience LLV during ETV treatment.

Intense pulsed light (IPL) is a high-intensity polychromatic incoherent light of a determined wavelength spectrum, fluence, and pulse duration. Clinicians can combine these variable factors of IPL for the purpose of selective destruction of target chromophores. Due to these properties, IPL has been widely used for numerous indications including hair removal and treatment of vascular or pigmented lesions. For skilled and experienced clinicians, IPL is a great treatment modality; however it can be a source of serious adverse effects when performed by untrained clinicians. Thus, to promote the proper and safe use of IPL, we summarized the origin, history, basic principles, and clinical application of IPL and discussed qualification factors needed for clinicians who use IPL.
Hair Removal

BACKGROUND/AIMS: The prevalence of occult HBV infection (OBI) in patients with chronic hepatitis C (CHC) in Korea has not been reported. Additionally, it is unclear whether OBI influences treatment outcome in CHC patients. We investigated the prevalence of OBI and its impact on treatment outcome in patients with CHC. METHODS: Seventy-six patients with CHC were enrolled and treated with pegylated or conventional interferon and ribavirin. Hepatitis B virus (HBV) DNA was detected by nested polymerase chain reaction. RESULTS: Among the 68 patients who completed treatment and follow-up, HBV DNA was detected in serum from nine (13.2%) patients, liver tissue from 10 (14.7%), and serum or liver tissue from 15 (22.1%). OBI was diagnosed in nine (12.7%) control subjects. No difference in the prevalence of OBI between patients with CHC and controls was observed (13.2 vs. 12.0%; p = 0.92). No significant differences in age, sex, genotype 1 frequency, amount of hepatitis C virus RNA, anti-hepatitis B surface antigen/anti-hepatitis B core-IgG seropositivity, staging, or histology grading were observed in patients with or without HBV DNA. Sustained virological response was achieved in 73.3% of patients with OBI and 83.0% without OBI (p = 0.46). CONCLUSIONS: These results demonstrate that a significant proportion of patients with CHC have occult HBV infection and that OBI does not affect treatment outcome in patients with CHC.
DNA ; Follow-Up Studies ; Genotype ; Hepacivirus ; Hepatitis B virus ; Hepatitis C, Chronic ; Hepatitis, Chronic ; Humans ; Interferons ; Korea ; Liver ; Prevalence ; Ribavirin ; RNA ; Treatment Outcome

We report a case of Langerhans cell sarcoma presented as a solitary mass in the left supraclavicular area in a 31-year-old woman. Computed tomography revealed a relatively well-defined and lightly enhancing mass in the left supraclavicular area, measuring 5.5x4.5x3.2 cm. Excision was subsequently performed. Microscopically, the specimen consisted of an enlarged and partially effaced lymph node. Nests of different size composed of atypical tumor cells were located in the paracortex and the medulla of the lymph node. The tumor cells exhibited abundant eosinophilic or clear cytoplasm and displayed marked nuclear atypia and increased mitotic figures. Infiltration of many eosinophils was identified in the periphery and between the tumor cells. The tumor cells were reactive for CD1a and S100 protein. Ultrastructually, they were found to have Birbeck granules in the cytoplasm.
Adult ; Antigens, CD1 ; Cytoplasm ; Eosinophils ; Female ; Humans ; Langerhans Cell Sarcoma ; Lymph Nodes

PURPOSE: The purpose of this study was to explore the direction for development of the Korean Journal of Adult Nursing toward becoming an international journal through analysing the accepted and rejected papers during the last three years (2007-2009). METHODS: Two hundred and ten accepted papers were analyzed focusing on research methodology and key words using descriptive statistics. In addition, rejected papers were reviewed to analyze their study designs and key words. RESULTS: The proportion of quantitative research was 86.4% while the proportion of qualitative research was 9.5%. The majority of the qualitative research design was survey (71.8%). Sixty percent of the research had verbal consent and 32.7% had written consent from the participants. The prevailing data collection settings were hospitals (52.1%), and community (22.7%). The most frequently used research domain was health. It was noted that theoretical framework was rarely presented. The paper rejection rate was 31.5% and among the rejected paper, 75.3% was survey. CONCLUSION: The results of this analysis suggest that published studies have been improved and diversified compared with the papers published before the year 2007. However, translation research, clinical trials by nurses, and more detailed evaluation process for ethics in research need to be facilitated.
Adult ; Data Collection ; Humans ; Nursing Research ; Qualitative Research ; Rejection (Psychology) ; Research Design

BACKGROUND AND OBJECTIVES: Reactive oxygen species are known to be produced when atrial fibrillation develops. This study was performed to investigate the effects of hydrogen peroxide (H2O2) on the action potential parameters of the mouse atrium. SUBJECTS AND METHODS: Mouse (ICR) atrial fibers were excised and immersed in cold bicarbonate-containing Tyrode's solution. The preparations were then perfused with oxygenated (95% O2, 5% CO2) Tyrode's solution and driven by an electrical stimuli 1 ms in duration at a frequency of 1 Hz. The transmembrane potentials were recorded at 0, 2.5, 5, 10, 20 and 30 minute, and compared between groups I (control), II (H2O2 0.1 mM), III (H2O2 0.5 mM) and IV (H2O2 1 mM). RESULTS: In group I, the maximal diastolic potential (MDP), action potential amplitude (APA), maximal slope at phase 0 depolarization (Vmax), action potential duration until 50% and 90% of repolarization (APD50, APD90) were unchanged with increasing time. In group II, the MDP and APA were unchanged, but the Vmax was decreased, and the APD50 and APD90 prolonged. In group III, the MDP was increased and the Vmax decreased; the APD50 and APD90 were prolonged, but the APA unchanged. In group IV, the MDP was increased, the Vmax and APA decreased And the APD50 and APD90 prolonged. After-depolarization was observed in 40% (8/20) and 54.5% (12/22) of groups III and IV, respectively, and asystole occurred in 18.2% (4/22) of group IV. CONCLUSION: Hydrogen peroxide changed the action potential parameters in both time and dose dependent manner, and also elicited after-depolarization at higher concentrations. These results suggest reactive oxygen species are involved in the electrical remodeling and arrhythmogenesis in atrial myocardium.
Action Potentials* ; Animals ; Atrial Fibrillation ; Atrial Remodeling ; Free Radicals ; Heart Arrest ; Hydrogen Peroxide ; Membrane Potentials ; Mice* ; Myocardium* ; Oxygen* ; Reactive Oxygen Species

OBJECTIVE: The purpose of this study was to examine the long-term effects of Hospital Information System(HIS) on nurses' job pattern and satisfaction, and attitudes toward electronic medical record system. METHODS: Prospective survey using repeated measures design was performed to compare the changes between 2 years and 4 years after introduction of HIS in a tertiary hospital. Participants were 374 nurses working in the target hospital. Questionnaire was developed by researchers based on Walker, Eyman, Krall, Prophet, and Flanagan(1996)'s study and consisted of 21 questions about job pattern, job satisfaction, and attitudes toward computerization and paper record system. RESULTS: Overall time for documentation, shift reporting, communication with other departments were reduced. Otherwise, direct nursing time was not increased after HIS. Nurses showed positive responses on changes of job pattern after HIS while job satisfaction has been decreased. In addition, nurses' attitudes toward hospital information system and paper medical record system showed they were accepting computerized information system. CONCLUSION: This study identified the long-term positive effects of HIS and the need for nursing sensitive hospital information system.
Electronic Health Records ; Hospital Information Systems* ; Information Systems ; Job Satisfaction ; Medical Records ; Nursing ; Prospective Studies ; Surveys and Questionnaires ; Tertiary Care Centers

BACKGROUND: It is recommended that ABO, Rh typing and unexpected antibody screening should be tested during pregnancy in order to prevent hemolytic disease of the newborn (HDN). However, it is unclear that a routine prenatal antibody screening test predicts the occurrence of HDN. We performed a retrospective study to determine the frequency of unexpected antibody during pregnancy, antibody specificity, and the usefulness of prenatal antibody screening as a predictor of HDN. METHODS: All 6,293 prenatal antibody screening were tested at Eulji hospital from April 1997 to December 2002. The results of antibody screening and identification test were reviewed in laboratory sheet. The past transfusion and pregnant history and postnatal HDN evidence were reviewed in pregnant women with positive antibody screening. A commercial two cell panel, Selectogen I, II, and panel cell (Ortho Diagnostic Systems Inc., Raritan, USA) were used with tube method until March 1999. In April 1999, reagent cells were changed to a gel agglutination test with ID-Diacell I, II and ID-Dia Panel of DiaMed-ID Micro Typing System (DiaMed AG, Cressier, Switzerland). RESULTS: Positive results of antibody screening test were found in 52 cases (0.83%, 52/6,293). Only 28 cases of them were tested antibody identification. Antibody specificity was identified at 22 cases and 17 (77.3%, 17/22) women had unexpected antibodies which are not associated with HDN. They were 11 with anti-Lea , 3 with anti-Leb, and 3 with anti-P1. The others were 3 cases of anti-E, 1 of anti-M, and 1 of anti-S. However, no one had evidence of HDN. CONCLUSION: These results suggest that routine prenatal antibody screening may not be necessary for all pregnant women except Rh (D) negative women or those who have a history of HDN.
Agglutination Tests ; Antibodies ; Antibody Specificity ; Female ; Humans ; Infant, Newborn ; Mass Screening* ; Pregnancy ; Pregnant Women ; Retrospective Studies

BACKGROUND: We evaluated the performance and analysis time of HLC-723 G7 (Tosoh corp. Tokyo, Japan) hemoglobin (Hb) A1c autoanalyzer. It utilizes cation exchange high performance liquid chromatography (HPLC) method and has a reduced analysis time compared with that of an earlier model HLC-723GHb V A1c 2.2(TM) (HLC-723GHb V, Tosoh corp. Tokyo, Japan). METHODS: We evaluated linearity, precision and comparison with HLC-723GHb V following NCCLS guidelines and counted the number of tests per hour to estimate analysis time. RESULTS: Linearity through the range from 5.8% to 13.9% was good (r2=0.9930, relative nonlinearity <2.5%). The within-run coefficients of variation (CVs) for groups of low, middle, and high level were 1.09%, 0.76%, and 0.68% and total CVs for each group were 1.60%, 0.91%, and 1.00%, respectively. Correlation equation between HLC-723 G7 and HLC-723GHb V was HLC-723 G7=1.0308 (HLC-723GHb V)-0.2896 %Hb A1c (r=0.9992, P<0.0001). Analysis time of HLC-723 G7 was 1.2 minutes per test compared with 2.1 minutes of HLC-723GHb V. CONCLUSIONS: HLC-723 G7 showed the acceptable performance and shortening analysis time therefore, it was suitable for reducing turn around time of Hb A1c assay.
Chromatography, Liquid ; Hemoglobin A, Glycosylated

OBJECTIVES: The microdose of gonadotrophin-releasing hormone agonist (GnRHa) has been suggested as a beneficial method of ovulation induction for poor responders. However, the effect of microdose of GnRHa itself has not been evaluated yet. We performed a prospective sutdy to assess the effect of microdose of GnRHa (5 microgram of triptorelin acetate) on the luteinizing hormone (LH) and follicle stimulating hormone (FSH). Secondary objective of this study is to assess how long the down-regulation of gonadotrophin secretion by microdose GnRHa persists. METHODS: Five microgram of triptorelin was injected daily into five normally menstruating women for 7 days starting from cycle day 3. The blood sample was drawn for 12h with 4h interval, then for 6days with 4 h interval and once a day for 14days, In next cycle, same amount of triptorelin was injected into the same subjects daily for 3 days. The blood sample was drawn twice a day for 20days. Serum FSH, LH and extradiol level was measured. RESULTS: The serum LH and FSH level increased rapidly after injection of first GnRHa. The FSH level reached peak (27.53+/-6.34 IU/l) in 5h while LH level reached peak (34.35+/-7.18 IU/l) in 4h. The flare of gonadotrophins persisted even after second and third day injection of GnRHa, although the peak levels were not as high as first injection. The down regulation of gonadotrophin was established in 4-5 days. The estradiol level increased for 4-5 days then decreased. When GnRHa was given for 7days, the estradiol level began to rise 7-8 days after last injection; when given for 3days, the estradiol level began to rise 3-6 days after last injection. CONCLUSION: Even with ultra-low dose of GnRHa, the down-regulation of gonadotrophin could be achieved. The flare-up of gonadotrophin would persist for 3days with this dose. The duration of down regulation was influenced by the duration of GnRHa administration.
Down-Regulation ; Estradiol* ; Female ; Follicle Stimulating Hormone ; Gonadotropin-Releasing Hormone* ; Gonadotropins* ; Humans ; Luteinizing Hormone ; Ovulation Induction ; Prospective Studies ; Triptorelin Pamoate