• Journal of Korean Medicine Rehabilitation
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• v.27 no.4
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• pp.111-119
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• 2017

Objectives Clinical pathway (CP), is management plans that display goals for patients and have led to improve outcomes for many diseases. In Korea, Interest in Korean medicine's stabilization (Clinical pathway, Clinical Practice Guideline) is increasing, But the number of studies is scare. Method and Analysis This trials composes nonequivalent control group pretest-posttest design to conduct clincal pathway trial for the acute pain after back surgery. The subjects were 10 control patients with back surgery, and 10 experimental patients with application of integrative CP. Each group patient will observed 6 weeks. We check validation of CP. Also we compared the patient's status using the pain, function, Quality of life index between the two groups. Discussion This trial is the first CP for the acute pain after back surgery using integrative medicine concepts. Aim of this trial is to find the effectiveness and validity of clincal pathway for acute pain after back surgery.

• Journal of Korean Neurosurgical Society
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• v.51 no.6
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• pp.338-342
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• 2012

Objective : The aim of this study is to implement a critical pathway (CP) for patients undergoing lumbar laminectomy or microdiscectomy and describe the results before and after the CP in terms of length of hospital stay and cost. Methods : From March 2008 to February 2009, 61 patients underwent lumbar laminectomy or microdiscectomy due to stenosis or one- or two-level disc herniation in our department and were included in the prepathway group. After development and implementation of the CP in March 2009, 58 patients were applicable for the CP, and these were classified as the postpathway group. Results : The CP, which established a 6-day hospital stay (5 bed-days), was fulfilled by 42 patients (72.4%) in the postpathway group. The mean length of stay was 5.4 days in the postpathway group compared to 6.9 days in the prepathway group, demonstrating a 20% reduction, which was a statistically significant difference ($p{\leq}0.000$). There was a statistically significant reduction in charges for bed and nursing care (p=0.002). Conclusion : Implementation of a CP for lumbar laminectomy or microdiscectomy produced significant decreases in length of hospitalization and charges for bed and nursing care. We believe that this CP reduces the unnecessary use of hospital resources without increasing risk of adverse events.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.13
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• pp.5389-5393
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• 2014

Background: A clinical pathway (CP) can standardize and improve perioperative care for a number of interventions. In hepatic surgery, however, pertinent evidence is very limited. This study was conducted to implement a CP for hepatocellular carcinoma (HCC) patients undergoing hepatectomy, and to evaluate its effects on hospital costs, length of hospital stay (LOHS) and early clinical outcomes. Materials and Methods: Medical records for HCC patients undergoing hepatectomy were retrospectively reviewed before implementation of a CP (the non-CP group) from March 2012 to August 2012. This information was compared with the data collected prospectively from patients after implementation of the CP (the CP group) between September 2012 and April 2013. Hospital costs, LOHS and early clinical outcomes were evaluated and compared between groups. Results: There were no significant differences in terms of patient clinical characteristics between the two groups. For clinical outcome measures, no significant differences were found in postoperative complications, mortality and readmission rate. The hospital costs were significantly reduced from 24,844 RMB in the non-CP group to 19,761 RMB in the CP group (p<0.01). In addition, patients of the CP group also had shorter LOHS compared with the non-CP group (8.3 versus 12.3 days, p<0.001). Conclusions: The CP proved to be an effective approach to minimize hospital costs and LOHS with hepatectomy for HCC without compromising patient care.

• Molecules and Cells
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• v.41 no.12
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• pp.1008-1015
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• 2018

$I{\kappa}B$, a cytoplasmic inhibitor of nuclear factor-${\kappa}B$ ($NF-{\kappa}B$), is reportedly degraded via the proteasome. However, we recently found that long-term incubation with proteasome inhibitors (PIs) such as PS-341 or MG132 induces $I{\kappa}B{\alpha}$ degradation via an alternative pathway, lysosome, which results in $NF-{\kappa}B$ activation and confers resistance to PI-induced lung cancer cell death. To enhance the anti-cancer efficacy of PIs, elucidation of the regulatory mechanism of PI-induced $I{\kappa}B{\alpha}$ degradation is necessary. Here, we demonstrated that PI up-regulates nuclear factor (erythroid-derived 2)-like 2 (Nrf2) via both de novo protein synthesis and Kelch-like ECH-associated protein 1 (KEAP1) degradation, which is responsible for $I{\kappa}B{\alpha}$ degradation via macroautophagy activation. PIs increased the protein level of light chain 3B (LC3B, macroautophagy marker), but not lysosome-associated membrane protein 2a (Lamp2a, the receptor for chaperone-mediated autophagy) in NCI-H157 and A549 lung cancer cells. Pretreatment with macroautophagy inhibitor or knock-down of LC3B blocked PI-induced $I{\kappa}B{\alpha}$ degradation. PIs up-regulated Nrf2 by increasing its transcription and mediating degradation of KEAP1 (cytoplasmic inhibitor of Nrf2). Overexpression of dominant-negative Nrf2, which lacks an N-terminal transactivating domain, or knock-down of Nrf2 suppressed PI-induced LC3B protein expression and subsequent $I{\kappa}B{\alpha}$ degradation. Thus, blocking of the Nrf2 pathway enhanced PI-induced cell death. These findings suggest that Nrf2-driven induction of LC3B plays an essential role in PI-induced activation of the $I{\kappa}B$/$NF-{\kappa}B$ pathway, which attenuates the anti-tumor efficacy of PIs.

• Journal of the korean academy of Pediatric Dentistry
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• v.42 no.3
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• pp.226-232
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• 2015

Critical pathway (CP) defines the optimal care process, sequencing and timing of intervention by multidisciplinary health care teams for a particular diagnosis and procedure. The aim of the study was to evaluate the clinical usefulness and the satisfaction of patients and dental staff after implementation of a critical pathway for the dental treatment of disabled children and adolescents under conscious sedation. Thirty patients are divided in two groups (Pre-CP and CP) at the department of Pediatric Dentistry of Pusan National University Dental Hospital. The satisfaction levels of patients/guardians and the staff members were collected by survey questionnaire. The parents' satisfaction was significantly improved after the implementation of CP. Also, medical/dental staff members were highly satisfied with its usefulness. The application of a critical pathway for disabled children and adolescents might be useful and improve the satisfaction of the parents and medical/dental staff members.

• Applied Chemistry for Engineering
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• v.32 no.6
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• pp.647-652
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• 2021

In this study, Saussurea Lappa roots were extracted using ethanol and n-hexane, and also the effects on proliferation of human hair dermal papilla cells and fibroblast and related signaling pathway were evaluated. 3-[4, 5-dimethylthiazol-2-yl]-2, 5 diphenyl tetrazolium bromide (MTT) assay was conducted for cell proliferation effect of Saussurea Lappa root extract, and extracellular signal-related kinase (ERK), serine/threonine protein kinase (Akt), wingless-related integration site (Wnt)/𝛽-catenin signaling pathway, and 5𝛼-reductase expression through western blot analysis were measured. Saussurea Lappa root extract significantly increased human hair dermal papilla cells and propagation of fibroblast, promoted phosphorylation of ERK and Akt that get involved in cell proliferation. Additionally, Saussurea Lappa root extract significantly decreased promotion of Akt phosphorylation and cell proliferation by MEK/ERK inhibitor PD98059 and PI3K/Akt inhibitor LY294002. Also, Saussurea Lappa root extract induced intranuclear 𝛽-catenin accumulation by promoting phosphorylation of 𝛽-catenin (Ser552, 675) through phosphorylation of GSK-3𝛽 (Ser9), and suppressed activation of 5𝛼-reductase type I and II. Overall, Saussurea Lappa root induces cell proliferation through vitalization of ERK and Akt route of human hair dermal papilla cells and fibroblast and apoptosis defense mechanism, and can be helpful in hair loss prevention and hair growth by vitalizing the 𝛽-catenin signaling pathway and inhibiting activation of 5𝛼-reductase, which can be used as a potential hair care products.

• Journal of agricultural medicine and community health
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• v.47 no.1
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• pp.1-13
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• 2022

Objectives: This study aimed to establish a linkage model involving regional responsible medical institutions after analyzing the existing conditions and deriving problems through qualitative analysis within the community care system. Methods: A total of 14 participants of this study were selected through the snowball sampling method, including 7 community care service providers and 7 service users. As for the research data, primary data were collected through interviews, and as a result of analyzing according to Aday&Anderson' model, a total of 5 catergories, 8 topics, and 22 sub theme were derived. Results: The problem derived from the interview is that division services are provided for each institution due to the absence of a key central institution of community care system, and users' commercial institutions is unclear. The second is the inconsistency between the needs and supply for community care, resulting in a possibility of delay in returning to the community after discharge. Based on these problems, it is necessary to unify it as an community care window of the Dong-community center. In addition, there is a need for public health centers to play an active role, and to establish a public-private joint system with the Health and Living Support Center to establish a model that can play a certain role. Conclusions: Therefore, based on the results of this study, it can be used as basic data when constructing community care model and applying it as an expanded model in the future.

• Tuberculosis and Respiratory Diseases
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• v.54 no.4
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• pp.449-458
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• 2003

Background : Cyclosporin A(CsA) and tacrolimus(FK506) have been widely used as immunosuppressants. The effects of CsA, or FK506, on the $I{\kappa}B/NF-{\kappa}B$ pathway have been shown to vary according to the cell type. However, their effects on the $I{\kappa}B/NF-{\kappa}B$ pathway have not been reported in bronchial epithelial cells. In this study, the effects of CsA and FK506 on the $I{\kappa}B/NF-{\kappa}B$ pathway in bronchial epithelial cells, monocytes, lymphocytes and alveolar macrophages were evaluated. The relationship between their effects on the $I{\kappa}B/NF-{\kappa}B$ pathway and $I{\kappa}B$ kinase(IKK) activity was also investigated. Methods : BEAS-2B and A549 cells, pulmonary alveolar macrophages, peripheral blood monocytes and lymphocytes were used. The cells were pre-treated with CsA, or FK506, for various time periods, followed by stimulation with TNF-${\alpha}$, LPS or IL-$1{\beta}$. The $I{\kappa}B{\alpha}$ expressions were assayed by Western blot analyses. The IKK activity was evaluated by an in vitro immune complex kinase assay, using GST-$I{\kappa}B{\alpha}$ as the substrate. Results : Neither CsA nor FK506 affected the level of $I{\kappa}B{\alpha}$ expression in any of the cell types used in this study. CsA pre-treatment inhibited the TNF ${\alpha}$-induced $I{\kappa}B{\alpha}$ degradation in bronchial epithelial cells. In contrast, the TNF ${\alpha}$-induced $I{\kappa}B{\alpha}$ degradation was not affected by FK506 pre-treatment. However, FK506 suppressed the cytokine-induced $I{\kappa}B{\alpha}$ degradation in the pulmonary alveolar macrophages, peripheral blood monocytes and lymphocytes. The inhibitory effect of CsA, or FK506, on $I{\kappa}B{\alpha}$ degradation was not related to IKK. Conclusions : CsA and FK506 suppressed the $I{\kappa}B{\alpha}$ degradation in bronchial epithelial cells, monocytes, lymphocytes and alveolar macrophages, so this may not be mediated through IKK.

• Journal of Microbiology and Biotechnology
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• v.33 no.9
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• pp.1213-1227
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• 2023

Fetal growth restriction (FGR) is a prevalent obstetric condition. This study aimed to investigate the role of Toll-like receptor 9 (TLR9) in regulating the inflammatory response and gut microbiota structure in FGR. An FGR animal model was established in rats, and ODN1668 and hydroxychloroquine (HCQ) were administered. Changes in gut microbiota structure were assessed using 16S rRNA sequencing, and fecal microbiota transplantation (FMT) was conducted. HTR-8/Svneo cells were treated with ODN1668 and HCQ to evaluate cell growth. Histopathological analysis was performed, and relative factor levels were measured. The results showed that FGR rats exhibited elevated levels of TLR9 and myeloid differentiating primary response gene 88 (MyD88). In vitro experiments demonstrated that TLR9 inhibited trophoblast cell proliferation and invasion. TLR9 upregulated lipopolysaccharide (LPS), LPS-binding protein (LBP), interleukin (IL)-1β and tumor necrosis factor (TNF)-α while downregulating IL-10. TLR9 activated the TARF3-TBK1-IRF3 signaling pathway. In vivo experiments showed HCQ reduced inflammation in FGR rats, and the relative cytokine expression followed a similar trend to that observed in vitro. TLR9 stimulated neutrophil activation. HCQ in FGR rats resulted in changes in the abundance of Eubacterium_coprostanoligenes_group at the family level and the abundance of Eubacterium_coprostanoligenes_group and Bacteroides at the genus level. TLR9 and associated inflammatory factors were correlated with Bacteroides, Prevotella, Streptococcus, and Prevotellaceae_Ga6A1_group. FMT from FGR rats interfered with the therapeutic effects of HCQ. In conclusion, our findings suggest that TLR9 regulates the inflammatory response and gut microbiota structure in FGR, providing new insights into the pathogenesis of FGR and suggesting potential therapeutic interventions.

• Journal of Korean Academy of Nursing
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• v.53 no.2
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• pp.236-248
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• 2023

Purpose: Nursing informatics competency is used to manage and improve the delivery of safe, high-quality, and efficient healthcare services in accordance with best practices and professional and regulatory standards. This study examined the relationship between nursing informatics competency (NIC), nursing care left undone, and nurse reported quality of care (NQoC) and nursing productivity. A path model for their effects on nursing productivity among clinical nurses was also established. Methods: Data were collected using structured questionnaires answered by 192 nurses working in a tertiary hospital located in J city, Korea, and analyzed using SPSS/WIN 23.0 and AMOS 21.0 program. Results: The fit indices of the alternative path model satisfied recommended levels χ² = .11 (p = .741), normed χ² (χ² /df) = .11, SRMR = .01, RMSEA = .00, GFI = 1.00, NFI = 1.00, AIC = 18.11. Among the variables, NIC (β = .44, p < .001), NQoC (β = .35, p < .001) had a direct effect on nursing productivity. Due to the mediating effect of NQoC on the relationship between NIC and nursing productivity, the effect size was .14 (95% CI .08~.24). Meanwhile, nursing care left undone through NQoC in the relationship between NIC and nursing productivity, has a significant mediation effect (estimate .01, 95% CI .00~.03). The explanatory power of variables was 44.0%. Conclusion: Education and training for enhancing NIC should be provided to improve nursing productivity, quality of care and to reduce missed nursing care. Furthermore, monitoring the quality of nursing care and using it as a productivity index is essential.