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In this study, a Delphi survey was conducted to generate the framework of a mathematics competency, called Attitude and Practice. Sixteen participants in the two consecutive rounds of the Delphi survey included mathematics education expert in student affect or educational psychology, and in-service mathematics teachers with a master’s degree or higher. We first established the definition of Attitude and Practice and identified their components while securing validity evidence from the Delphi survey results. Attitude and Practice are the competency to engage in mathematical activities with the joy and passion of doing mathematics as an individual or a group. Next, we characterized the components of Attitude and Practice as follows: (1) pleasure of learning mathematics, including interest, self-efficacy, and meta-affect (2) passion for mathematics including perseverance and seeking challenges, (3) doing mathematics together, including resolving conflicts and motivation for collaboration, and (4) global citizenship and enjoying mathematics culture. We defined and validated the specific components with the literature review and the Delphi survey responses. The results of this study will serve as a foundation of research to develop scenario-based assessments for students’ attitudes and practices. Furthermore, the framework established in this study can provide insights into the evaluation of mathematics competency of Attitude and Practice regarding Korean mathematics educators who have experienced difficulties in defining and assessing Attitude and Practice.

Background Papillary breast lesions (PBLs) comprise diverse entities from benign and atypical lesions to malignant tumors. Although PBLs are characterized by a papillary growth pattern, it is challenging to achieve high diagnostic accuracy and reproducibility. Thus, we investigated the diagnostic reproducibility of PBLs in core needle biopsy (CNB) specimens with World Health Organization (WHO) classification. Methods Diagnostic reproducibility was assessed using interobserver variability (kappa value, κ) and agreement rate in the pathologic diagnosis of 60 PBL cases on CNB among 20 breast pathologists affiliated with 20 medical institutions in Korea. This analysis was performed using hematoxylin and eosin (H&E) staining and immunohistochemical (IHC) staining for cytokeratin 5 (CK5) and p63. The pathologic diagnosis of PBLs was based on WHO classification, which was used to establish simple classifications (4-tier, 3-tier, and 2-tier). Results On WHO classification, H&E staining exhibited ‘fair agreement’ (κ = 0.21) with a 47.0% agreement rate. Simple classifications presented improvement in interobserver variability and agreement rate. IHC staining increased the kappa value and agreement rate in all the classifications. Despite IHC staining, the encapsulated/solid papillary carcinoma (EPC/SPC) subgroup (κ = 0.16) exhibited lower agreement compared to the non-EPC/SPC subgroup (κ = 0.35) with WHO classification, which was similar to the results of any other classification systems. Conclusions Although the use of IHC staining for CK5 and p63 increased the diagnostic agreement of PBLs in CNB specimens, WHO classification exhibited a higher discordance rate compared to any other classifications. Therefore, this result warrants further intensive consensus studies to improve the diagnostic reproducibility of PBLs with WHO classification.

Background Urothelial carcinoma (UC) accounts for roughly 90% of bladder cancer, and has a high propensity for diverse differentiation. Recently, certain histologic variants of UC have been recognized to be associated with unfavorable clinical outcomes. Several UC studies have also suggested that tumor budding is a poor prognostic marker. Distant metastasis of UC after radical cystectomy is not uncommon. However, these metastatic lesions are not routinely confirmed with histology. Methods We investigated the histopathologic features of 13 cases of UC with biopsy-proven distant metastases, with a special emphasis on histologic variants and tumor budding. Results Lymph nodes (6/13, 46%) were the most common metastatic sites, followed by the lung (4/13, 31%), liver (4/13, 31%), and the adrenal gland (2/13, 15%). The histologic variants including squamous (n = 1), micropapillary (n = 4), and plasmacytoid (n = 1) variants in five cases of UC. Most histologic variants (4/5, 80%) of primary UCs appeared in the metastatic lesions. In contrast, high-grade tumor budding was detected in six cases (46%), including one case of non-muscle invasive UC. Our study demonstrates that histologic variants are not uncommonly detected in distant metastatic UCs. Most histologic variants seen in primary UCs persist in the distant metastatic lesions. In addition, high-grade tumor budding, which occurs frequently in primary tumors, may contribute to the development of distant metastasis. Conclusions Therefore, assessing the presence or absence of histologic variants and tumor budding in UCs of the urinary bladder, even in non-muscle invasive UCs, may be useful to predict distant metastasis.

This study aimed to show the effects of Korean medicine treatment (particularly bee-venom pharmacopunture) on a patient with brachial plexus palsy. A 64-year-old woman was diagnosed with brachial plexus palsy on the right upper extremity and was treated with Korean and Western medicine from September 30th to November 6th, 2019. Improvement of the patient’s symptoms was evaluated using the Manual Muscle Test, Range of Motion and visual analogue scale. After treatment, the patient’s Manual Muscle Test grade and Range of Motion were improved, and the Visual Analogue Scale score indicated the intensity of her right hand numbness had decreased. These results suggested that improper use of crutches can result in brachial plexus palsy and a Korean-Western medicine treatment regimen primarily focused on bee-venom pharmacopunture, may be effective in reducing the symptoms of brachial plexus palsy.

This study analyzed the features of the IB"s mathematics assessment and proposed methods to settle the mathematics process-focused assessment in schools. According to the difficulties of teachers investigated in the previous studies, solutions were derived by the documents related to assessment in the IB MYP and DP curriculum and interviews with teachers in IB schools. As a result, research and policy were proposed to support teachers. First, design an assessment frame that has the curriculum competency as an assessment element, and suggest the approaches toward reflecting competencies. Second, provide examples of typical assessment tasks and scoring rubrics, and the achievement level of each assessment criterion to detail the task, and engage students in the TSC process. Third, present an objective assessment method to produce the result and a feedback method. Fourth, to improve the fairness of teachers' autonomous assessment, provide external organization inspections, teacher training, and feedback on teacher assessment. Additionally, it is suggested that criterion-referenced assessment, assessment framework development study, change of student"s view on the assessment, and reduction of teacher's workload would be necessary as conditions for mitigating teachers' difficulties.

In this study, the structural relationships between students" affect, meta-affect, and meta-cognition in mathematics learning were analyzed using structural equations. Affect in mathematics is defined by cognizing value, interest, and confidence, whereas meta-affect involves affective awareness, evaluation, regulation and using. Meta-cognition is characterized by critical thinking, rehearsal, self-regulation, elaboration and organization. The model was secured by verifying the model fit, the convergent and discriminant validity, and the final model was established. The study revealed that affect in mathematics learning had a direct effect on meta-affect and meta-cognition. In other words, the more positive the students" interest, confidence, and recognition of value in mathematics learning, the higher was the meta-affect associated with affect. Affect had a tremendous indirect effect on meta-cognition via meta-affect, and thus the total effect of the affect on meta-cognition in mathematics learning was very large. Finally, the meta-affect had a direct effect on meta-cognition. In this study, affect, meta-affect, and meta-cognition were investigated as student characteristics; however, we have not investigated the formation of these variables. Therefore, further experimental studies are proposed to improve the meta-affect via teaching and learning strategies, investigation into the educational role of meta-affect as a learning goal and the impact of research into the role of affect in meta-cognitive strategy, and a closer analysis of similarity between meta-affect and meta-cognition.

International Baccalaureate (IB) is a well-known international curriculum developed by the International Baccalaureate Organization (IBO) in 1968. IB's purpose is to nurture global talent with creativity and international minds and so many countries globally such as France, Spain, and Japan have adopted the IB curriculum. This study analyzed mathematics contents and teaching and learning approaches of the IB DP which is a high school level curriculum and interviewed a mathematics teacher working for an IB DP school. As a result, the IB DP comprises a higher level of mathematics contents compared with the Korean mathematics curriculum, but guides teachers to provide conceptually-focused lessons by controlling the difficulty level of assessment items Additionally, the IB DP emphasizes inquiry-based teaching and learning approaches, use of technology, connections of mathematics and other subjects, and the consistency of teaching and learning and assessment. Based on the results, we suggest the direction of high school mathematics education in regard to mathematics contents, teaching and learning methods, and the consistency of teaching and learning methods and assessments.

Background Distinguishing prostatic stromal invasion (PSI) by urothelial carcinoma (UC) from in situ UC involving prostatic ducts or acini with no stromal invasion (in situ involvement) may be challenging on hematoxylin and eosin stained sections. However, the distinction between them is important because cases with PSI show worse prognosis. This study was performed to assess the utility of double cocktail immunostains with high molecular weight cytokeratin (HMWCK) and GATA-3 to discriminate PSI by UC from in situ UC involvement of prostatic ducts or acini in the prostate. Methods Among 117 radical cystoprostatectomy specimens for bladder UCs, 25 cases showed secondary involvement of bladder UC in prostatic ducts/acini only or associated stromal invasion and of these 25 cases, seven cases revealed equivocal PSI. In these seven cases with equivocal PSI, HMWCK, and GATA-3 double immunohistochemical stains were performed to identify whether this cocktail stain is useful to identify the stromal invasion. Results In all cases, basal cells of prostate glands showed strong cytoplasmic staining for HMWCK and UC cells showed strong nuclear staining for GATA-3. In cases with stromal invasion of UC, GATA-3-positive tumor cells in the prostatic stroma without surrounding HMWCK-positive basal cells were highlighted and easily recognized. Among seven equivocal cases, two cases showed PSI and five in situ UC in the prostate. In two cases, the original diagnoses were revised. Conclusions Our study suggested that HMWCK and GATA-3 double stains could be utilized as an adjunct method in the distinction between PSI by UC from in situ UC involving prostatic ducts or acini.

The purpose of this study was to analyze the characteristics of communicational thinking in successful collaborative problem solving. In collaborative problem solving communication, the sender and receiver infer meaning to all mathematical objects and interpret them. From the semiotic perspective, this study reached the following results by analyzing the interpretants formed from the objects. First, in the early stages of problem solving, immediate interpretant were formed from the communicational thinking of students' guesses, hypotheses, and perceptions, revealing the purpose-oriented characteristics of communicational thinking. Second, many dynamic interpretants were made in the communicational thinking, allowing the sign to perform practically. Third, the final interpretant obtained as a result of the students' communicational thinking confirmed that the problem solving result has a universal character that can be recognized by anyone. Based on these findings, it is suggested that teachers must design tasks that allow them to use a variety of mathematical approaches on their own. And it is suggested that affective as well as cognitive domain should be achieved and that studies to examine students' thinking process by applying semiotics should be activated.

The purpose of this study was to analyze the abduction in mathematical problem-posing and problem-solving activities. Abduction is more concerned with creating new things than deduction and inductive reasoning. According to the student"s rules, abduction are classified as selective and creative. Selective abduction is again classified into 'manipulative selective abduction' and 'theoretical selective abduction'. Creative abduction is again classified into 'little creative abduction' at the level of mathematics in school and 'big creative abduction' at the level of academic mathematics. Four middle school sophomore students performed problem-posing activities on four tasks. As for the results of analysis on abduction types by problem-posing stages, all four abduction types were observed. But at the problem-solving stages, manipulative selective abduction and theoretical selective abduction were frequently used, while creative abduction was never used. Thus, for the education of mathematical creativity, deepening and expanding problem-posing is necessary that all the type of abduction has been expressed in the problem-posing activity.

Diffuse involvement of colorectal lymphoma masquerading as colitis is a very rare presentation of primary colorectal lymphoma. Detecting occult lymphoma is difficult in the setting of diffuse colonic involvement with no definite mass and inflammatory mucosal changes. We encountered a case of diffuse-type primary colorectal lymphoma simulating ulcerative colitis in a previously healthy 31-year-old woman. Despite multiple mucosal biopsies, the biopsy diagnosis was not made due to unawareness of atypical lymphocytes admixed with dense lymphoplasmacytic infiltration. The present case emphasizes the importance of being aware of this rare presentation of primary colorectal lymphoma in order to avoid misdiagnosis.

Background: Campylobacter jejuni is an important food-borne pathogen that causes human gastroenteritis. This study was conducted to investigate the incidence of isolation, antimicrobial susceptibility pattern, and C. jejuni genotype from diarrhea patients in Busan, Korea.Methods: A total of 97 C. jejuni were isolated from diarrhea patients during five food-borne outbreaks from 2014 to September 2017. Antimicrobial susceptibility tests were carried out by the broth microdilution method for ciprofloxacin (CIP), nalidixic acid (NAL), tetracycline (TET), chloramphenicol, azithromycin (AZI), erythromycin (ERY), streptomycin (STR), gentamicin, and telithromycin. To investigate C. jejuni genotypes, pulsed-field gel electrophoresis (PFGE) profile analysis was performed.Results: The isolation rate of C. jejuni was 2.0% for the last 4 years and increased annually. Antimicrobial resistance rates of C. jejuni were shown to be in the order of NAL (90.9%), CIP (89.4%), TET (13.6%), AZI (3.0%), ERY (3.0%), and STR (1.5%). The proportion of multidrug-resistance was 18.2%, and they commonly contained quinolones (CIP-NAL). Analysis of PFGE patterns of SmaI-restricted DNA of C. jejuni isolates showed 17 clusters; cluster 11 was the major genotype pattern.Conclusion: This study will provide useful data for the proper use of antimicrobials and the management of resistant C. jejuni. Also it will help to provide data for the epidemiological investigation of foodborne diseases caused by C. jejuni, which is expected to increase in the future. (Ann Clin Microbiol 2019;22:42-49)

Liquid biopsy for detection of mutation from circulating tumor DNA is a new technology which is attractive in that it is non-invasive. Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) is an effective first line drug for advanced non-small cell lung cancer patients who harbor activating EGFR mutation. During the course of treatment, resistance against TKI arises which can be contributed to EGFR T790M mutation in about 50–60% of patients. Third generation TKI may overcome the resistance. In patients who cannot undergo tissue biopsy due to variable reasons, liquid biopsy is an excellent alternative for the detection of EGFR T790M mutation. However, this relatively novel method requires standardization and vigorous quality insurance. Thus, a standard set of guideline recommendations for liquid biopsy for EGFR mutation testing suitable for the Korean medical community is necessary. In this article, we propose a set of provisional guideline recommendations that was discussed and approved by the Cardiopulmonary Pathology Study Group of the Korean Society of Pathologists.

PURPOSE: To identify the effects of delivery-nursing simulation education using team-based learning on the delivery nursing knowledge, self-efficacy, and clinical competence of nursing students. METHODS: The study used a nonequivalent, control group, quasi-experimental design. The team-based learning was applied to the experimental group, while the individual learning was applied to the control group. Data were collected from October 12 to December 7, 2016, and analyzed using the SPSS/WIN 22.0 program. RESULTS: Comparison between the experimental and control group showed no significant difference in delivery-nursing knowledge (t=−0.33, p=.741) or self-efficacy (t=−0.65, p=.515). However, a significant difference (t=−2.09, p=.048) in the nursing-skills aspect of clinical competence was found between the experimental and control groups after the practical simulation education. CONCLUSION: Delivery-nursing simulation education using team-based learning was more effective in improving the nursing-skills aspect of nursing competence than was delivery-nursing simulation education based on individual learning.

PURPOSE: The purpose of this study was to develop a scale to evaluate parenting stress of international marriage immigrant women from Vietnam and the Philippines. METHODS: The concept of parenting stress of international marriage immigrant women was analysed with a hybrid model. Data were collected from 273 international marriage immigrant women from Vietnam and the Philippines who were raising their children aged 1 to 6 years. These collected data were subjected to exploratory factor analysis, multitrait/multi-item matrix assessment, Pearson correlation coefficient analysis, and Cronbach's alpha internal consistency measurement. RESULTS: The final instrument consisted of 28 items. The following six factors were extracted by exploratory factor analysis: ‘insufficiency of parenting support system’, ‘role burden of mothers’, ‘maladjustment of children’, ‘confusion of parenting methods due to cultural differences’, ‘unskilled Korean communication’, and ‘ordinary difficulties’. Construct validity (factor analysis, convergent validity, and discriminant validity) and criterion-related validity were confirmed. Cronbach's α value of total items was .92(95% CI .91-.94). Cronbach's α of values for these factors ranged from .76 to .85. CONCLUSION: The parenting stress scale for international marriage immigrant women is a valid and reliable tool.

Background Cervical cytology for uterine cervical cancer screening has transitioned from conventional smear (CS) to liquid-based cytology (LBC), which has many advantages. The aim of this study was to compare the proportion of unsatisfactory specimens from CS versus LBC at multiple institutions including general hospitals and commercial laboratories. Methods Each participating institution provided a minimum of 500 Papanicolaou (Pap) test results for analysis. Pap tests were classified according to the participating institution (commercial laboratory or general hospital) and the processing method (CS, ThinPrep, SurePath, or CellPrep). The causes of unsatisfactory results were classified as technical problems, scant cellularity, or complete obscuring factors. Results A total of 38,956 Pap test results from eight general hospitals and three commercial laboratories were analyzed. The mean unsatisfactory rate of LBC was significantly lower than that of CS (1.26% and 3.31%, p = .018). In the LBC method, samples from general hospitals had lower unsatisfactory rates than those from commercial laboratories (0.65% vs 2.89%, p = .006). The reasons for unsatisfactory results were heterogeneous in CS. On the other hand, 66.2% of unsatisfactory results in LBC were due to the scant cellularity. Conclusions Unsatisfactory rate of cervical cancer screening test results varies according to the institution and the processing method. LBC has a significantly lower unsatisfactory rate than CS.

BackgroundRenal tubulointerstitial fibrosis is a common feature of the final stage of nearly all cause types of chronic kidney disease. Although classic peroxisome proliferator-activated receptor γ (PPARγ) agonists have a protective effect on diabetic nephropathy, much less is known about their direct effects in renal fibrosis. This study aimed to investigate possible beneficial effects of lobeglitazone, a novel PPARγ agonist, on renal fibrosis in mice.MethodsWe examined the effects of lobeglitazone on renal tubulointerstitial fibrosis in unilateral ureteral obstruction (UUO) induced renal fibrosis mice. We further defined the role of lobeglitazone on transforming growth factor (TGF)-signaling pathways in renal tubulointerstitial fibrosis through in vivo and in vitro study.ResultsThrough hematoxylin/eosin and sirius red staining, we observed that lobeglitazone effectively attenuates UUO-induced renal atrophy and fibrosis. Immunohistochemical analysis in conjunction with quantitative reverse transcription polymerase chain reaction and Western blot analysis revealed that lobeglitazone treatment inhibited UUO-induced upregulation of renal Smad-3 phosphorylation, α-smooth muscle actin, plasminogen activator inhibitor 1, and type 1 collagen. In vitro experiments with rat mesangial cells and NRK-49F renal fibroblast cells suggested that the effects of lobeglitazone on UUO-induced renal fibrosis are mediated by inhibition of the TGF-β/Smad signaling pathway.ConclusionThe present study demonstrates that lobeglitazone has a protective effect on UUO-induced renal fibrosis, suggesting that its clinical applications could extend to the treatment of non-diabetic origin renal disease.

PURPOSE: This paper examined the relationship between knowledge differences of maternal oral health and of relevant demographic variables. METHODS: Participants included 239 pregnant women who were recruited from Women's Hospital located in B city who agreed to participate in this study. The data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation analysis using the SPSS 21.0 program. RESULTS: Maternal knowledge of oral health was moderate level (10.22±2.36). Scores of maternal knowledge of oral health were different according to age, education, occupation, parity, and dental care experience in pregnancy. Level of oral healthcare knowledge was weakly related to age and education. CONCLUSION: Consequently, it is necessary to encourage pregnant women to take part in oral health education program during antenatal care.

PURPOSE: The aim of this study was to conduct a concept analysis of cultural nursing competence. METHODS: Cultural nursing competence was analyzed using Rodgers' evolutionary concept development method. A literature search using the keywords "cultural nursing competence", "intercultural nursing competence", "cultural nursing", "cultural health nursing", and "cultural competence" was conducted in PubMed, CINAHL, ERIC, and RISS on material published before 2015. Database and bibliographic searches yielded 35 records. RESULTS: Cultural nursing competence comprised cognitive, affective, and behavioral domains. The critical attributes of the concept were sensitivity, equality, and activity. The analysis identified the following dimensions: awareness, openness, and coherence. The consequences of cultural nursing competence were personal satisfaction and social justice. The definition contained competence on both an individual and social level. CONCLUSION: Cultural competency enhances quality of care by narrowing health disparities and increasing client satisfaction. The concept analysis of cultural nursing competence may offer an acceptable framework which can be used to develop psychometric tools of this concept and provide guidelines in nursing practice.

Background : /Aims: Pyogenic liver abscess (PLA) is a life-threatening condition, despite advances in diagnostic technology and strategies for treatment. A strong predictor of mortality in this condition is septic shock. This study describes clinical, biochemical, and radiologic features in patients with PLA with or without septic shock, with the intent of describing risk factors for septic shock. Methods : : Of 358 patients with PLA enrolled, 30 suffered septic shock and the remaining 328 did not. We reviewed the medical records including etiologies, underlying diseases, laboratory, radiologic and microbiologic findings, methods of treatment and treatment outcomes. Results : : The case fatality rate was 6.1%. In univariate analysis, the presence of general weakness, mental change, low platelet level, prolonged PT, high BUN level, high creatinine level, low albumin level, high AST level, high CRP level, abscess size ＞6 cm, the presence of gas-forming abscess, APACHE II score ≥20, and the presence of Klebsiella pneumoniae infection were significantly associated with septic shock. Multivariate analysis showed the presence of mental change (p=0.004), gas-forming abscess (p=0.012), and K. pneumoniae infection (p=0.027) were independent predictors for septic shock. Conclusion : s: The presence of mental change, gas-forming abscess, and K. pneumoniae infection were independent predictors for septic shock in patients with PLA. (Korean J Gastroenterol 2016;67:245-252)

PURPOSE: This study is an explorative survey to examine emotional labor, stress, and premenstrual syndrome among hospital nurses and to examine relationships among them. METHODS: Data were collected from 228 nurses working at hospitals using structured questionnaires from September to October, 2014. Data were analyzed using SPSS 21.0 by frequency, descriptive statistics, t-test, one-way ANOVA, and Pearson's correlation coefficient. RESULTS: Score of emotional labor was different by work time per week (F=4.03, p=.019), and menstrual amount (F=5.18, p=.006). Level of stress was different by marital status (t=2.29, p=.023), pattern of work (t=-3.63, p

Background: Analysis of mutations in the epidermal growth factor receptor gene (EGFR) is important for predicting response to EGFR tyrosine kinase inhibitors. The overall rate of EGFR mutations in Korean patients is variable. To obtain comprehensive data on the status of EGFR mutations in Korean patients with lung cancer, the Cardiopulmonary Pathology Study Group of the Korean Society of Pathologists initiated a nationwide survey. Methods: We obtained 1,753 reports on EGFR mutations in patients with lung cancer from 15 hospitals between January and December 2009. We compared EGFR mutations with patient age, sex, history of smoking, histologic diagnosis, specimen type, procurement site, tumor cell dissection, and laboratory status. Results: The overall EGFR mutation rate was 34.3% in patients with non-small cell lung cancer (NSCLC) and 43.3% in patients with adenocarcinoma. EGFR mutation rate was significantly higher in women, never smokers, patients with adenocarcinoma, and patients who had undergone excisional biopsy. EGFR mutation rates did not differ with respect to patient age or procurement site among patients with NSCLC. Conclusions EGFR mutation rates and statuses were similar to those in published data from other East Asian countries.

The leading cause of morbidity and mortality in patients with acromegaly is cardiovascular complications. Myocardial exposure to excessive growth hormone can cause ventricular hypertrophy, hypertension, arrhythmia, and diastolic dysfunction. However, congestive heart failure as a result of systolic dysfunction is observed only rarely in patients with acromegaly. Most cases of acromegaly exhibit high levels of serum insulin-like growth factor-1 (IGF-1). Acromegaly with normal IGF-1 levels is rare and difficult to diagnose. Here, we report a rare case of an acromegalic patient whose first clinical manifestation was severe congestive heart failure, despite normal IGF-1 levels. We diagnosed acromegaly using a glucose-loading growth hormone suppression test. Cardiac function and myocardial hypertrophy improved 6 months after transsphenoidal resection of a pituitary adenoma.

PURPOSE: This study was to understand the meaning of women's experience of spontaneous delivery with midwives at midwifery clinics or home. METHODS: van Kaam's Psychophenomenological method composed of a four-stage, 12-step format was used. In-depth interviews were carried out from January to July, 2011, with twelve women. RESULTS: Through the data analysis, 403 significant statements, 172 elements, 48 subcategories, and 19 categories were extracted, and from the 19 categories, 8 themes were drawn. The eight themes were: "Conflict on whether a hospital or a midwifery clinic", "Choosing natural delivery with the assurance of her ability to delivery spontaneously and having trust in the midwives." "Being encouraged by a midwife and family members with one accord", "Experience of the spontaneous delivery process on body", "Comfortable delivery in spite of painful process", "Deeply impressed by the overwhelming joy of birth", "Satisfaction with spontaneous delivery", and "Deeper love among family members". CONCLUSION: Through this study, women's delivery experiences with midwives was of spontaneous delivery. Women's birth of self-confidence and trust between the midwives and the women to predict a spontaneous delivery is a powerful factor. Also, family support and midwives delicate care was identified as factors in spontaneous delivery.

PURPOSE: The purpose of this study was to identify the relationships between life style, menstrual attitude and premenstrual syndrome in nursing students. METHODS: The study participants were 246 nursing students of a university in Gyeunggi province. Data were collected by a self-administered questionnaire from May to June, 2012. Collected data were analyzed using the SPSS/WIN 20.0 program with descriptive statistics, Pearson correlation coefficient, t-test, one-way ANOVA and Scheffe test. RESULTS: Students who had undesirable alcohol habits (r=.15, p=.020) and negative menstrual attitude (r=.17, p=.009) experienced more a severe premenstrual syndrome (PMS). Students with dysmenorrhea had more severe PMS (F=12.41, p

Background: Interstitial tonicity increases vascular endothelial growth factor-C (VEGF-C), a lymphangiogenic factor in salt-induced hypertension. Therefore, it can be assumed that changes of serum VEGF-C level may be associated with increasing blood pressure. However, there is no report about the changes of serum VEGF-C levels in patients with chronic kidney disease (CKD). The aims of this study were to investigate the changes of serum and urine VEGF-C levels in patients with CKD stage 3–4 and to evaluate the relationship between blood pressure and serum VEGF-C levels in the patients with CKD stage 5 and hemodialysis. Methods: Glomerular filtration rate (GFR) was assessed by the Modification of Diet in Renal Disease equation. Blood pressure and VEGF-C levels (serum and urine) were measured by enzyme-linked immunosorbent assay (ELISA) in nine patients with stage 3–4 CKD, 41 hemodialysis patients, and eight healthy individuals. Results: The median serum level of VEGF-C in patients with stage 3–4 CKD and stage 5 hemodialysis significantly decreased in comparison with healthy individuals. Urinary VEGF-C excretion increased in patients with stage 3–4 CKD compared with healthy control patients. For 41 hemodialysis patients, the serum level of VEGF-C in patients with stage 1 or stage 2 hypertension with hemodialysis did not significantly increase when compared with prehypertension hemodialysis patients. Conclusion: We demonstrated that circulating levels of VEGF-C were decreased in patients with CKD, and the decrease of VEGF-C in patients with stage 3–4 CKD coincided with an increase in the urinary excretion of VEGF-C.