Probing the issue of informed consent in health care in Korea-concept analysis and guideline development

PURPOSE

The purpose of the study was to identify how informed consent is conceptualized by patients, family members, physicians, and nurses in Korea, and to develop guidelines for clinical practice in Korea.

METHODS

This study employed the hybrid model to define the concept of informed consent through theoretical and fieldwork phases. For the theoretical phase, attributes of informed consent were identified through a review of the literature, and in-depth interviews were conducted for the fieldwork phase to develop attributes from the data and to verify the attributes identified from the literature review. Purposive sampling was done for 48 participants (12 patients, 12 family members, 12 physicians, 12 nurses), who were interviewed from selected units (orthopedics, cardiothoracic surgery, obstetrics/gynecology) from two university hospitals in Seoul and Kwangju, Korea. Attributes and processing issues of informed consent were extracted from both phases.

RESULTS

Core attributes of informed consent include the patient's self-directed decision-making, fulfillment of legal responsibility, focusing on forging a trusting relationship, assuming active responsibility for explanations (physicians) and granting consent (patient), factors related to sufficient explanation, and the role of family. Findings were integrated into a set of guidelines for patients and family and health care professionals.

CONCLUSION

The guidelines developed in the present study offer empirical parameters for an effective process of obtaining informed consent in Korea by seeking to decrease the gap in perceptions of informed consent among patients, family members, physicians, and nurses. The importance of advocating patients and developing a trusting relationship between health care providers and patients is especially noteworthy.

Auranofin promotes retinoic acid- or dihydroxyvitamin D3-mediated cell differentiation of promyelocytic leukaemia cells by increasing histone acetylation

BACKGROUND AND PURPOSE

To investigate the molecular mechanism for the effect of auranofin on the induction of cell differentiation, the cellular events associated with differentiation were analysed in acute promyelocytic leukaemia (APL) cells.

EXPERIMENTAL APPROACH

The APL blasts from leukaemia patients and NB4 cells were cotreated with auroanofin and all-trans-retinoic acid (ATRA) at suboptimal concentration. The HL-60 cells were treated with auroanofin and a subeffective dose of 1alpha,25-dihydroxyvitamin D3 (1,25(OH)2 vit D3) in combination. The effect of auroanofin was investigated on histone acetylation at the promoter of differentiation-associated genes and expression of cell cycle regulators.

KEY RESULTS

Treatment with auroanofin and ATRA cooperatively induced granulocytic differentiation of fresh APL blasts isolated from patients and NB4 cells. The combined treatment also increased reorganization of nuclear PML bodies and histone acetylation at the promoter of the RARbeta2 gene. Auroanofin also promoted monocytic differentiation of the HL-60 cells triggered by subeffective concentration of 1,25(OH)2 vit D3. The combined treatment of auroanofin and 1,25(OH)2 vit D3 stimulated histone acetylation at p21 promoters and increased the accumulation of cells in the G0/G1 phase. Consistent with this, the expressions of p21, p27 and PTEN were increased and the levels of cyclin A, Cdk2 and Cdk4 were decreased. Furthermore, the hypophosphorylated form of pRb was markedly increased in cotreated cells.

CONCLUSIONS AND IMPLICATIONS

These findings indicate that auroanofin in combination with low doses of either ATRA or 1,25(OH)2 vit D3 promotes APL cell differentiation by enhancing histone acetylation and the expression of differentiation-associated genes.

Polymorphisms in the type IV collagen alpha3 gene and the risk of COPD

A number of genome-wide linkage analyses have identified the 2q33.3-2q37.2 region as the most likely to contain the genes that contribute to the susceptibility to chronic obstructive pulmonary disease (COPD). It was hypothesised that the type IV collagen alpha3 (COL4A3) gene, which is one of the genes located in the 2q33.3-2q37.2 region, may act as a low-penetrance susceptibility gene for COPD. To test this hypothesis, the association of COL4A3 -1162T>C, IVS2+12C>A, P141L, G162E, H451R, P574L and *315C>A polymorphisms with the risk of COPD was investigated in a case-control study of 311 COPD patients and 386 controls. The presence of at least one 451R allele was associated with a significantly higher risk of COPD compared with the 451 H/H genotype (adjusted odds ratio 1.48, 95% confidence interval (1.03-2.14)). When the subjects were stratified according to age and COPD severity, the 451R allele was associated with a significantly higher risk of COPD only in younger individuals with severe COPD (3.02 (1.37-6.67)). In conclusion, these findings suggest that the type IV collagen alpha3 gene contributes to the genetic susceptibility to chronic obstructive pulmonary disease.

Sensory and instrumental analysis for slipperiness and compliance of food during swallowing

In spite of its importance, there have been few attempts to evaluate the sensory attributes of the food bolus during swallowing. In the current study, the slipperiness, the degree of slide for the food bolus through the mucosal surface of the oro-pharynx, and the compliance, how easily the shape of a food bolus can be transformed for automatic and comfortable swallowing, were derived among several sensory attributes related to the swallowing. Therefore, the study aims were twofold: (1) to develop the methods of sensory and instrumental analyses for determining the slipperiness and compliance of the food bolus during swallowing and (2) to examine the appropriateness of the newly designed devices by correlating the data between the sensory and instrumental analyses. Six commercial food products were evaluated by 10 trained panelists for each attribute. The devices for assessing each attribute were developed in consideration of the oro-pharyngeal movements. The sensory and instrumental analyses showed high correlation and regression coefficients as well as intensity differences of the 6 samples for each attribute. In conclusion, the slipperiness and the compliance were suitable for acquiring a better understanding of the sensory attributes of the food bolus during swallowing, and the newly developed devices showed a high potential for determining those attributes.

Pre-operative transarterial chemoembolization for resectable hepatocellular carcinoma adversely affects post-operative patient outcome

BACKGROUND

Long-term outcomes after hepatic resection for hepatocellular carcinoma are not satisfactory because of high recurrence rates. Aim To assess whether a single session of pre-operative transarterial chemoembolization affects post-operative outcome.

METHODS

We analysed outcomes retrospectively in 334 consecutive patients who underwent hepatic resection for hepatocellular carcinoma, initially judged resectable. Ninety-seven of these patients had each undergone a single session of pre-operative transarterial chemoembolization (transarterial chemoembolization + hepatic resection group), whereas 237 had not (hepatic resection group).

RESULTS

Most clinicopathological characteristics were similar in the two groups. The overall survival rate was significantly higher in the hepatic resection than in the transarterial chemoembolization + hepatic resection group (P = 0.011), whereas their disease-free survival rates were comparable (P = 0.67). The overall and disease-free survival rates of the transarterial chemoembolization + hepatic resection group with incomplete tumour necrosis were significantly lower than those of the hepatic resection group (P < 0.001 and P = 0.006, respectively). Multivariate analysis showed that pre-operative transarterial chemoembolization, serum alpha-fetoprotein elevation (>1000 ng/mL), tumour size (>5 cm) and vascular invasion were independent risk factors for poor overall survival after hepatic resection.

CONCLUSIONS

A single session of pre-operative transarterial chemoembolization for initially resectable hepatocellular carcinoma worsens overall survival rate. It may also increase the risk of tumour recurrence in patients who achieve incomplete tumour necrosis.

The development of sausage including meat from spent laying hen surimi

The sausage samples were made from pork with spent laying hen breast surimi. The samples were divided into 4 groups [sausage made from pork (control) and sausage made from pork with 20% (T1), 40% (T2), and 60% (T3) of spent laying hen breast surimi]. In proximate compositions, the moisture and ash contents of the control were higher than sausage containing spent laying hen surimi samples in all storage periods. The pH and cooking loss were higher in T3 compared with other sausage samples. However, there was no significant difference in water-holding capacity among the sausage samples, whereas shear force was significantly higher in T2. In meat color, sausage containing spent laying hen surimi samples (T1, T2, and T3) have shown to have higher lightness (L) compared with control, and redness (a) was significantly higher in control and T1. Total amino acid content and essential amino acids were increased in sausage containing spent laying hen surimi samples at 0 d of storage. In fatty acid composition, saturated fatty acid was higher in control than sausage containing spent laying hen surimi samples. Thiobarbituric acid reactive substances value was lower in sausage containing spent laying hen surimi samples than control at 2 and 4 wk of storage. Cholesterol content was lower in control compared with sausage containing spent laying hen surimi samples. In sensory evaluation, most test items were not significantly different among the sausage samples although tenderness was higher in T2 and T3 at 0 d of storage.

DYRK1A-mediated hyperphosphorylation of Tau. A functional link between Down syndrome and Alzheimer disease

Most individuals with Down syndrome show early onset of Alzheimer disease (AD), resulting from the extra copy of chromosome 21. Located on this chromosome is a gene that encodes the dual specificity tyrosine phosphorylation-regulated kinase 1A (DYRK1A). One of the pathological hallmarks in AD is the presence of neurofibrillary tangles (NFTs), which are insoluble deposits that consist of abnormally hyperphosphorylated Tau. Previously it was reported that Tau at the Thr-212 residue was phosphorylated by Dyrk1A in vitro. To determine the physiological significance of this phosphorylation, an analysis was made of the amount of phospho-Thr-212-Tau (pT212) in the brains of transgenic mice that overexpress the human DYRK1A protein (DYRK1A TG mice) that we recently generated. A significant increase in the amount of pT212 was found in the brains of DYRK1A transgenic mice when compared with age-matched littermate controls. We further examined whether Dyrk1A phosphorylates other Tau residues that are implicated in NFTs. We found that Dyrk1A also phosphorylates Tau at Ser-202 and Ser-404 in vitro. Phosphorylation by Dyrk1A strongly inhibited the ability of Tau to promote microtubule assembly. Following this, using mammalian cells and DYRK1A TG mouse brains, it was demonstrated that the amounts of phospho-Ser-202-Tau and phospho-Ser-404-Tau are enhanced when DYRK1A amounts are high. These results provide the first in vivo evidence for a physiological role of DYRK1A in the hyperphosphorylation of Tau and suggest that the extra copy of the DYRK1A gene contributes to the early onset of AD.

Perception of legal liability by registered nurses in Korea

Liability to the nursing profession is imperative if nurses are to act as an autonomous body. Assessing and communicating effectively is a vital part of nursing for patient safety. This study was designed to identify the attitudes of Korean nurses toward liability in assessment and communication and to investigate the relationship among the variables (i.e., legal awareness, attitudes toward doctor's duty to supervise nurses). The attitudes toward doctor's duty reflect the status of nurses' dependency on doctor's supervision. The study participants were 288 registered nurses in RN-BSN courses at two colleges in Korea. The level of legal awareness was measured using a 25-item Legal Awareness Questionnaire developed by the authors. The measuring instrument for attitudes toward doctor's duty to supervise nurses and nurses' liability was the Attitude toward Duty and Liability Questionnaire, which was modified by the authors. There were significant correlation between attitude toward doctor's duty and nurses' liability, but not between legal awareness and liability attitude. The results of this study suggest that the present educational content aimed at improving liability attitudes of nurses should be refocused with attitude-oriented education and should include an understanding of the increased accountability that comes with greater autonomy in nursing practice.

Auranofin blocks interleukin-6 signalling by inhibiting phosphorylation of JAK1 and STAT3

Auranofin (AF) is a sulphur-containing gold compound. Because of its anti-inflammatory and immunosuppressive activities, AF has been widely used for the therapeutic treatment of rheumatoid arthritis. However, little is known about its mechanism of action. To elucidate the molecular mechanism underlying the anti-inflammatory effect of AF, we studied the effects of AF on cellular responses to interleukin-6 (IL-6). In HepG2 human hepatoma cells, AF markedly inhibited IL-6-induced phosphorylation of janus kinase 1 (JAK1) and signal transducer and activator of transcription 3 (STAT3) and STAT3 translocation into the nucleus. Consistent with this, AF diminished IL-6-induced production of the acute-phase proteins, haptoglobin, fibrinogen, C3 complement and alpha(1)-acid glycoprotein, and gene expression of vascular endothelial growth factor, all of whose transcriptional activities are regulated by STAT3. The inhibitory activity of AF on STAT3 phosphorylation was also demonstrated in primary cells, i.e. fibroblast-like synoviocytes from rheumatoid arthritis patients, human umbilical vein endothelial cells and rat astrocytes. Auranofin-mediated inhibition of STAT3 phosphorylation was recovered by pretreatment with antioxidants containing thiol groups. These findings suggest that the anti-inflammatory action of AF is associated with a blockade of JAK1/STAT3 signalling. Thiol-group-reactive proteins may be involved in AF-induced suppression of JAK1/STAT3 phosphorylation.

Integrin-linked kinase controls Notch1 signaling by down-regulation of protein stability through Fbw7 ubiquitin ligase

Integrin-linked kinase (ILK) is a scaffold and protein kinase that acts as a pivotal effector in integrin signaling for various cellular functions. In this study, we found that ILK remarkably reduced the protein stability of Notch1 through Fbw7. The kinase activity of ILK was essential for the inhibition of Notch1 signaling. Notably, the protein level and transcriptional activity of the endogenous Notch1 intracellular domain (Notch1-IC) were higher in ILK-null cells than in ILK wild-type cells, and the level of endogenous Notch1-IC was increased by the blocking of the proteasome, suggesting that ILK enhances the proteasomal degradation of Notch1-IC. ILK directly bound and phosphorylated Notch1-IC, thereby facilitating proteasomal protein degradation through Fbw7. Furthermore, we found down-regulation of Notch1-IC and up-regulation of ILK in basal cell carcinoma and melanoma patients but not in squamous cell carcinoma patients. These results suggest that ILK down-regulated the protein stability of Notch1-IC through the ubiquitin-proteasome pathway by means of Fbw7.

Risk of occupational tuberculosis in National Tuberculosis Programme laboratories in Korea

SETTING

Mycobacteriology laboratories in the National Tuberculosis Control Programme in Korea.

OBJECTIVES

To determine tuberculosis (TB) risk by type of work among laboratory workers compared to non-laboratory workers.

DESIGN

Retrospective study of TB incidence among technicians involved in acid-fast bacilli smear microscopy or culture and/or drug susceptibility testing (DST) compared with that among managerial/clerical workers.

RESULTS

Two cases developed among 77 non-laboratory workers, two among 88 smear microscopy technicians, and 11 among 76 culture/DST technicians during the observation period. Compared to non-laboratory workers, the relative risk of TB was 1.4 (95% CI 0.2-10.0) among microscopy technicians and 7.8 (95% CI 1.7-34.9) among culture/DST technicians. TB developed among 7/15 DST technicians compared to only 2/59 culture/non-DST technicians. Compared to non-laboratory workers, the relative risk for DST technicians was 21.5 (95% CI 4.5-102.5).

CONCLUSION

DST led to the highest relative risk among all types of mycobacteriology work, while performing smear microscopy alone did not pose an elevated risk compared to clerical work.

Protein Kinase C-delta Stimulates Haptoglobin Secretion

Haptoglobin (Hp) is a glycoprotein that is produced by hepatic cells and secreted into the circulation. While studying the physiologic functions of Hp, we found that Hp synthesized in THP-1 monocytic cells was largely retained within cells, although Hp is considered a secretory protein. To investigate the molecular mechanism on Hp secretion in THP-1 cells, in the present study, we examined the effect of protein kinase C (PKC) on Hp secretion. When several inhibitors of PKC isoforms were tested, only Rottlerin, a specific inhibitor of PKC-delta, completely blocked Hp secretion from cells to culture medium. To confirm the role of PKC-delta in Hp secretion, Hp-overexpressing COS7 cells were transiently transfected with a wild-type or a dominantnegative mutant of the PKC-delta gene. Mutant PKC-delta significantly inhibited Hp secretion, whereas the wild-type gene slightly increased Hp secretion. These results demonstrate that the PKC-delta signal is involved in Hp secretion.

Frequency and distribution of patellar luxation in dogs. 134 cases (2000 to 2005)

This study investigated the frequency and distribution of patellar luxation in the dogs presented to the Chonbuk National University Animal Medical Centre during January 2000 to September 2005. Patellar luxations were classified as medial or lateral, and unilateral or bilateral, were graded I to IV, and were subdivided according to age, sex and size of the dogs. The incidence of medial patellar luxation (MPL) was greater than the incidence of lateral patellar luxation (LPL) in both small and large dogs. Small-breed dogs were admitted almost exclusively with MPL. LPL was found uncommon; however it was observed more often in larger-breed dogs. Surgical correction was performed primarily in the dogs (165 stifles in 111 dogs) with grade II, III and IV patellar luxations following different surgical techniques. The combination of the surgical techniques was found to be more effective for the management of the disease. The prognosis was found to be favourable, because when the grade was low, the dog was younger, without cruciate ligament rupture, and as the surgical correction was performed with combination of more techniques.

Identification of the effect of extracellular polymeric substances on bacterial adhesion to the membrane surface in a membrane bioreactor using Pseudomonas fluorescens

In a membrane bioreactor (MBR) process containing a variety of bacteria, the bacterial adhesion to the membrane surface, prior to cake formation, causes an increased filtration resistance. In this study, Pseudomonas fluorescens, commonly found in the municipal wastewater treatment process with activated sludge, was used to show the effects of extracellular polymeric substances (EPS) on bacterial adhesion to the membrane surface in the MBR. Of the various roles of EPS in promoting membrane fouling, the adhesion of bacteria to the membrane surface was calculated using the specific cake resistance (alpha, m/kg). Although the amount of EPS binding with bacteria was increased by the addition of Ca2+, there was no significant effect on the bacterial growth. The results of the particle size distribution showed that the addition of Ca2+ increased flocculation, allowing the formation of a complex with the bacteria and EPS. In order to identify the effects of the addition of Ca2+ on the hydrophobicity, the contact angle was also measured. The result showed that the addition of Ca2+ showed no significant differences in the hydrophobicity, even though there was an increase in flocculation. With the bacteria containing a higher EPS concentration, a higher specific cake resistance was observed. From the results of the adhesion experiment, which was conducted with various EPS levels, displayed as the COD and TOC concentration, an increased EPS concentration was shown to promote bacterial adhesion to the membrane surface.

Application of mulch for treating metals in urban runoff: batch and column test

Among the many methods available for the removal of heavy metals in urban nonpoint source pollution (NSP), adsorption has been shown to be an economically feasible alternative. To adsorb the amount of heavy metals in runoff, filtration of runoff through a specially constructed filter system is one possible treatment method. The mulch layer in a specially constructed filter system functions through adsorptive-filtration, where some pollutants are immobilised through sorption and some pollutants associated with suspended solids are immobilised through filtration. Therefore, the major interest of this study was to investigate the possibility of utilising mulch for the adsorption of heavy metals such as cadmium, copper, lead and zinc for a solution typical of those found in urban runoff using the flask-type adsorption batch tests and laboratory column tests. From the equilibrium sorption batch tests, it was observed that the adsorption of heavy metals on mulch with the same initial concentrations of metals in the solution decreased in the order Pb(II) > Cu(II) > Zn(II) > Cd(II) regardless of changes in pH. In column tests, the breakthrough curves for various heavy metals' adsorption by mulch showed that the binding strength of the following metal ions onto mulch was as follows: Pb(II) > Cu(II) > Zn(II) > Cd(II).

The role of p38 MAPK activation in auranofin-induced apoptosis of human promyelocytic leukaemia HL-60 cells

In a previous study, we reported an antileukaemic activity of auranofin (AF), demonstrating its dual effects: on the induction of apoptotic cell death and its synergistic action with retinoic acid on cell differentiation. In this study, we investigated the downstream signalling events of AF-induced apoptosis to determine the molecular mechanisms of AF activity. Treatment of HL-60 cells with AF induced apoptosis in a concentration- and time-dependent manner. Western blot analysis showed that AF-induced apoptosis was accompanied by the activation of caspase-8, caspase-9, and caspase-3, and the release of cytochrome c from the mitochondria. The phosphorylation and kinase activities of p38 mitogen-activated protein kinase (p38 MAPK) increased gradually until 12 h after AF (2 microM) treatment, and p38 MAPK was also activated concentration-dependently. Pretreatment with SB203580, a specific inhibitor of p38 MAPK, significantly blocked DNA fragmentation and the cleavage of procaspase-8, procaspase-3, and poly-ADP-ribose polymerase (PARP), whereas SB203580 alone had no effect. Reactive oxygen species (ROS) were also detected within 1 h after AF treatment, and the antioxidant N-acetyl-L-cysteine (NAC) effectively protected the cells from apoptosis by inhibiting the phosphorylation of p38 MAPK and the activation of caspases. These results suggest that ROS generation and the subsequent activation of p38 MAPK are essential for the proapoptotic effects of AF in human promyelocytic leukaemia HL-60 cells.

Effects of cross-linking molecular weights in a hyaluronic acid-poly(ethylene oxide) hydrogel network on its properties

We examined the effects of cross-linking molecular weights on the properties of a hyaluronic acid (HA)-poly(ethylene oxide) (PEO) hydrogel. Swelling behaviors, mechanical strength and rheological behaviors of the HA-PEO hydrogel were evaluated by employing different cross-linking molecular weights (100 kDa and 1.63 mDa) of the HAs in the hydrogel networks. The low molecular weight of HA was obtained in advance by treating high molecular weight HA with a hydrogen chloride solution. Methacrylation of HA was obtained by grafting aminopropylmethacrylate to its caroboxylic acid functional groups. While reduction of the HA molecular weights was confirmed by gel permeation chromatography, the degree of methacrylate grafting to the HA was measured by (1)H-nuclear magnetic resonance. Synthesis of the HA-PEO hydrogel was successfully achieved via the Michael-type addition reaction between the methacrylate arm groups in the HA and the six thiol groups in PEO. The hydrogel formation was not dependent upon the HA molecular weights and its gelation behaviors were markedly different. Compared to the properties of the high molecular weight HA-based PEO one, the low molecular weight HA-based hydrogel induced quicker hydrogelation, as observed from the behaviors of the elastic and viscous modulus. Furthermore, the low molecular weight HA-based hydrogel demonstrated stronger mechanical properties as measured with a texture analyzer, lower water absorption as measured with a microbalance and smaller pore sizes on its surface and cross section as observed with scanning electron microscopy. The information about the effects of the cross-linking molecular weights of the gel network on the properties of the HA-based PEO hydrogel may lead to better design of hydrogels, especially in tissue engineering applications.

Determination of volatile flavor components in danggui cultivars by solvent free injection and hydrodistillation followed by gas chromatographic–mass spectrometric analysis

The rhizome of Angelica gigas Nakai, Angelica sinensis Diels and Angelica acutiloba Kitagawa (Umbelliferae) were chopped and extracted by hydrodistillation (HD) and solvent free solid injector (SFSI) methods to obtain the volatile compounds that were then characterized and identified by gas chromatography-mass spectrometry (GC/MS). SFSI extraction yielded a generally higher amount of volatile compounds than that produced by HD. A total of 48 components [including terpenes (8), aldehydes (4), alcohol (2), coumarins (9), Phthalide (3), acids (2) and sterols (2)] were identified by SFSI and gas chromatography-mass spectrometry from the three species of danggui cultivars, whereas, 24-essential oil was obtained by HD for Korean danggui only. According to these analyses, several coumarin derivatives such as decursinol angelate (16.83%) and decursin (29.34%) were found to be the dominant ones, followed by lomatin (10.25%) and marmesin (9.33%) in Korean danggui. Furfural and butylidene phthalide were the main components in Japanese in addition to butylidene dihydro-phthalide in Chinese danggui. Some parameters affecting the extraction efficiency such as injector temperature, injection time and pre-heating time were optimized. The results showed that the SFSI-method gave a higher yield of components with higher molecular mass than hydrodistillation. SFSI required little time to prepare the sample, little sample mass and a small quantity of organic solvent was needed. It can be concluded that analysis of volatile flavor compounds by SFSI in combination with gas chromatography/mass spectrometry is a suitable monitoring technique to differentiate danggui cultivars.

A DNA Vaccine Encoding a Fatty Acid-Binding Protein of Clonorchis sinensis Induces Protective Immune Response in Sprague-Dawley Rats

Clonorchis sinensis, the Chinese liver fluke, resides chronically in the biliary tract, and fatty acid-binding protein (FABP) is known to play an important role in the intracellular transport of long-chain fatty acids obtained from the host. Although FABP has stimulated considerable interest as a vaccine candidate, the nature of C. sinensis FABP (CsFABP) remains unclear. We investigated the immunogenicity and protective efficacy of a DNA vaccine encoding CsFABP. The intradermal injection of plasmid DNA carrying the CsFABP gene (pcDNA3.1-FABP) into Sprague-Dawley (SD) rats induced both humoural and cellular immune responses. Animals injected with pcDNA3.1-FABP developed FABP-specific antibody, which is dominance of IgG2a in sera. In addition, the DNA vaccine elicited the production of IFN-gamma, but not the production of IL-4 in spleen cells stimulated with recombinant FABP. Moreover, pcDNA3.1-FABP induced a significant level of protection, decreased worm burden (40.9%, P<0.05) in SD rats against C. sinensis metacerariae challenge. These results suggest that pcDNA3.1-FABP induces a typical T helper-1-dominated immune response and it is a good candidate for use in future clonorchiasis vaccination studies.

Standardization of Korean nursing terminology

Korean nursing terminology was standardized to improve sharing and exchange of nursing data and information. English nursing terms were collected from existing nursing terminology, journal articles, nursing records, text books, and nursing/medical dictionaries, translated into Korean and were tested for their validity. More than 9000 terms were standardized and published on a website for further feedback from the users. This study will contribute to communication within the nursing community and with other health care professionals.

Comparison of membrane biofouling in nitrification and denitrification for the membrane bioreactor (MBR)

Batch filtration tests were conducted to compare the characteristics of membrane biofouling with regard to nitrification and denitrification. A Modified Fouling Index (MFI) was obtained using a stirred cell tester. The denitrification assays showed higher membrane fouling rates than the nitrification assays. The fouling became worse, not only due to pore blocking resistance, but also from cake layer resistance after denitrification. The Extracellular Polymeric Substances (EPS) concentration and relative hydrophobicity were decreased after denitrification, resulting in floc deterioration. The floc deterioration was assumed to have increased the cake layer resistance in the filtration test. The protein Soluble Microbial Products (SMP) concentration, portion of high molecular weight in carbohydrate SMP and relative hydrophobicity were increased after denitrification, which was assumed to cause membrane pore blocking. The changes in the EPS and SMP characteristics were the main fouling parameters in denitrification.