Prognostic influences of B-cell lymphoma 2–positive expression on late recurrence in breast cancer

Purpose@#B-cell lymphoma 2 (BCL2) has an antiapoptotic role, however, has resulted in it being a powerful favorable prognostic factor in breast cancer. Several studies revealed BCL2 is strongly associated with a lower rate of early recurrence after initial treatment in breast cancer patients, but study of a prolonged effect after 5 years is lacking. We investigated BCL2 as a prognostic factor in breast cancer in comparison to early and late recurrence. @*Methods@#We retrieved data from 2,198 patients with primary breast cancer who underwent surgical treatment and adjuvant treatment at the breast cancer center between 2005 and 2015. Each molecular subtype was classified, and Ki-67 and BCL2 were also assessed by immunohistochemistry. BCL2 and the association between molecular subtypes were assessed in early and late recurrences, respectively. Five-year postrecurrence survival and BCL2 were also assessed. @*Results@#The BCL2-positive group was associated with favorable clinicopathologic characteristics. The time to recurrence was significantly longer in the BCL2-positive group (P = 0.035). Late recurrence after 5 years was higher in the BCL2-positive group (P = 0.029). In multivariate survival analysis, tumor size and BCL2-positive expression were the only independent prognostic factors for late recurrence (P = 0.004). In the patients with recurrence, 5-year postrecurrence survival was significantly higher in the BCL2-positive group (P < 0.001). @*Conclusion@#Our result showed that prognosis was better in BCL2-positive patients compared to BCL2-negative patients at late recurrence. We suggested that BCL2 expression could be used as a marker to help determine additional adjuvant therapy or extended hormone therapy in hormone-dependent breast cancer.

Reduction in malodor, gingival index and plaque index after 4-week use of new concept oral irrigator / 대한구강보건학회지

Objectives@#This study aimed to evaluate the changes in clinical indexes related to periodontitis, such as malodor, gingival and plaque indexes, during the adjuvant use of a high pressure oral irrigator (COMORAL ® , SMDsolutions, Seoul, Korea) in volunteers. @*Methods@#We recruited 17 volunteers from an advertisement posted on Dankook University’s bulletin board. The oral malodor, gingival index, and plaque index of each volunteer were during the adjuvant use of a high pressure oral irrigator within a 4-week period. @*Results@#Routine tooth brushing was done together with the adjuvant use of a new high pressure oral irrigator in the 4-week period. The oral malodor, gingival index, and plaque index measured after 2 and 4 weeks of use significantly decreased (P＜0.05) compared with the baseline values obtained before the start of the study. @*Conclusions@#The adjuvant use of a new high pressure oral irrigator with routine tooth brushing in volunteers may more effectively manage daily oral hygiene.

Comparing the Postoperative Outcomes of Single-Incision Laparoscopic Appendectomy and Three Port Appendectomy With Enhanced Recovery After Surgery Protocol for Acute Appendicitis: A Propensity Score Matching Analysis

Purpose@#The objective of this study was to compare the perioperative outcomes between single-incision laparoscopic appendectomy (SILA) and 3-port conventional laparoscopic appendectomy (CLA) in enhanced recovery after surgery (ERAS) protocol. @*Methods@#Of 101 laparoscopic appendectomy with ERAS protocol cases for appendicitis from March 2019 to April 2020, 54 patients underwent SILA with multimodal analgesic approach (group 1) while 47 patients received CLA with multimodal analgesic approach (group 2). SILA and CLA were compared with the single institution’s ERAS protocol. To adjust for baseline differences and selection bias, operative outcomes and complications were compared after propensity score matching (PSM). @*Results@#After 1:1 PSM, well-matched 35 patients in each group were evaluated. Postoperative hospital stays for patients in group 1 (1.2 ± 0.8 vs. 1.6 ± 0.8 days, P = 0.037) were significantly lesser than those for patients in group 2. However, opioid consumption (2.0 mg vs. 1.4 mg, P=0.1) and the postoperative scores of visual analogue scale for pain at 6 hours (2.4±1.9 vs. 2.8 ± 1.4, P = 0.260) and 12 hours (2.4 ± 2.0 vs. 2.9 ± 1.5, P = 0.257) did not show significant difference between the 2 groups. @*Conclusion@#SILA resulted in shortening the length of hospitalization without increase in complications or readmission rates compared to CLA with ERAS protocol.

Comparing the Postoperative Outcomes of Single-Incision Laparoscopic Appendectomy and Three Port Appendectomy With Enhanced Recovery After Surgery Protocol for Acute Appendicitis: A Propensity Score Matching Analysis

Purpose@#The objective of this study was to compare the perioperative outcomes between single-incision laparoscopic appendectomy (SILA) and 3-port conventional laparoscopic appendectomy (CLA) in enhanced recovery after surgery (ERAS) protocol. @*Methods@#Of 101 laparoscopic appendectomy with ERAS protocol cases for appendicitis from March 2019 to April 2020, 54 patients underwent SILA with multimodal analgesic approach (group 1) while 47 patients received CLA with multimodal analgesic approach (group 2). SILA and CLA were compared with the single institution’s ERAS protocol. To adjust for baseline differences and selection bias, operative outcomes and complications were compared after propensity score matching (PSM). @*Results@#After 1:1 PSM, well-matched 35 patients in each group were evaluated. Postoperative hospital stays for patients in group 1 (1.2 ± 0.8 vs. 1.6 ± 0.8 days, P = 0.037) were significantly lesser than those for patients in group 2. However, opioid consumption (2.0 mg vs. 1.4 mg, P=0.1) and the postoperative scores of visual analogue scale for pain at 6 hours (2.4±1.9 vs. 2.8 ± 1.4, P = 0.260) and 12 hours (2.4 ± 2.0 vs. 2.9 ± 1.5, P = 0.257) did not show significant difference between the 2 groups. @*Conclusion@#SILA resulted in shortening the length of hospitalization without increase in complications or readmission rates compared to CLA with ERAS protocol.

Influence of Hip Fracture on Knee Pain During Postoperative Rehabilitation

OBJECTIVE: To investigate whether fracture type, surgical procedure, or fracture grade affect knee pain during postoperative rehabilitation after a hip fracture. METHODS: We conducted a retrospective case-controlled study of 139 patients during postoperative rehabilitation after surgery for hip fractures. Patients were divided into two groups: patients experiencing knee pain during the first week of postoperative rehabilitation, and patients without knee pain. We compared the types of fracture, surgical procedure, and fracture grade between the two groups. RESULTS: We enrolled 52 patients (37.4%) with knee pain during the first weeks of postoperative rehabilitation. For type of fracture, knee pain was more common with intertrochanteric fracture than with femur neck fracture (48.8% vs. 21.1%, respectively; p=0.001). For the surgical procedure, there was no significant difference between the groups. For the fracture grade, the grades classified as unstable fractures were more common in the group of intertrochanteric fracture patients with knee pain than in those without knee pain (74.1% vs. 36.4%, respectively; p=0.002). CONCLUSION: Intertrochanteric fracture affected knee pain after hip fracture surgery more than did femur neck fracture, particularly in unstable fractures. Furthermore, there was no difference in each fracture type according to the surgical procedure. Careful examination and management for knee pain is needed in patients with hip fracture surgery.

The Development and Application of a New Problem Based Learning Module for Students in an Advanced Practice Nurse Program for Oncology

PURPOSE: The purposes of this study were to develop a problem based learning (PBL) module for cancer symptom management and oncology emergencies, and to evaluate the module after applying it for students in an advanced practice nurse program for oncology. METHODS: This study was a methodological research project. We invited a total of 13 graduates from an advanced practice nurse program to evaluate topics for the PBL module development. Five experts developed a PBL module for a selected topic. Eight students from an advanced practice nurse program participated in the PBL learning experience and evaluated their learning experiences. RESULTS: Tumor lysis syndrome, pain, disseminated intravascular coagulation and hypercalcemia were evaluated to be the most relevant and needed topics for the module. Oncology emergency PBL module-tumor lysis syndrome was developed through expert validation. Evaluation of PBL learning was 3.76 (out of 4 points) in a pilot test. CONCLUSION: The new PBL module provided a positive learning experience to students. The new PBL module can be used as the standardized clinical practice education in the oncology advanced practice nurse program and developing further PBL modules for different topics is recommended.

Effects of salmon DNA fraction in vitro and in a monosodium iodoacetate-induced osteoarthritis rat model

PRF001 is a fragmented DNA polymer extracted from the testes of salmon. The purpose of this study was to assess the anti-inflammatory effect of PRF001 in vitro as well as the protective effect of PRF001 intake against arthritis in a rat model. In vitro, cell survival and inflammatory markers after H₂O₂ treatment to induce cell damage were investigated in CHON-001 cells treated with different concentrations of PRF001. In vivo, osteoarthritis was induced by intra-articular injection of monosodium iodoacetate (MIA) into the knee joints of rats. After consumption of PRF001 (10, 50, or 100 mg/kg) for 4 weeks, inflammatory mediators and cytokines in articular cartilage were investigated. In vitro, the levels of inflammatory markers, IL-1β, TNF-α, COX-2, iNOS, and PGE2, were significantly suppressed by PRF001 treatment. In vivo, the inflammatory mediators and cytokines, IL-1β, p-Erk1/2, NF-κB, TNF-α, COX-2, and PGE2, as well as MMP3 and MMP7, which have catabolic activity in chondrocytes, were decreased in the MIA-induced osteoarthritic rats following intake of PRF001. Histological analysis revealed that PRF001 had a protective effect on the articular cartilage. Altogether, these results demonstrated that the anti-inflammatory property of PRF001 contributes to its protective effects in osteoarthritis through deregulating IL-1β, TNF-α, and subsequent signals, such as p-Erk1/2, NF-κB, COX-2, PGE2, and MMPs.

Corrigendum to: Effects of salmon DNA fraction in vitro and in a monosodium iodoacetate-induced osteoarthritis rat model

The authors note that on pages 167 (Fig. 2A), 168 (Fig. 3A), and 169 (Fig. 4A), the figure label “RPF-001” should instead appear as “PRF-001.”

Botulinum Toxin Injection in the Treatment of Postextubation Dysphagia: A Case Report

Prolonged intubation is known to bring on postextubation dysphagia (PED) in some patients. We have noted that there were some studies to investigate specific type and pattern of PED, which showed large variety of different swallowing abnormalities as mechanisms of PED that are multifactorial. There are several options of treatment in accordance with the management of these abnormalities. A botulinum toxin (BoT) injection into the upper esophageal sphincter (UES) can improve swallowing functions for patients with this disorder, by working to help the muscle relax. In this case, the conventional treatment was not effective in patients with PED, whereas the BoT injection made a great improvement for these patients. This study suggests that the UES pathology could be the main cause of PED.

Validation of the Korean Version of the Mini-Sleep QuestionnaireeInsomnia in Korean College Students

PURPOSE: This study aimed to evaluate the reliability and validity of the Korean version of the Mini-Sleep QuestionnaireeInsomnia in Korean college students. METHODS: A total of 470 students from six nursing colleges in South Korea participated in the study. The translation and linguistic validation of the Mini-Sleep Questionnaire-Insomnia was performed based on guidelines. The Pittsburgh Sleep Quality Index and the Perceived Stress Scale were used to validate the measure. Cronbach α, item-total correlation for internal consistency reliability and intraclass correlation coefficient for testeretest reliability were evaluated. Exploratory factor analysis for construct validity, Pearson's correlation with the Pittsburgh Sleep Quality Index and the Perceived Stress Scale for concurrent validity, and the receiver operating character curve for predictive validity were assessed. RESULTS: The 4-item Mini-Sleep QuestionnaireeInsomnia had a Cronbach α of .69 and the item-total correlations were higher than .30. Cronbach α increased to .73 if the item assessing the use of sleeping pills and tranquilizers was deleted. This item had marked skewness and kurtosis issues. Factor analysis indicated unidimensionality, explaining 53.0% of the total variance. The measure showed high testeretest reliability (i.e., intraclass correlation coefficient = .84), acceptable concurrent validity (r with the Pittsburg Sleep Quality Index = .69; r with the Perceived Stress Scale = .31) and predictive validity [area under curve = .85; 95% confidence interval (0.81, 0.90)]. CONCLUSION: The Mini-Sleep QuestionnaireeInsomnia showed acceptable reliability and validity. Yet, the limited distribution in sleep medications warrants further evaluations in the clinical population.

Effects of a Standardized Patient Simulation Program for Nursing Students on Nursing Competence, Communication Skill, Self-efficacy and Critical Thinking Ability for Blood Transfusion / 기본간호학회지

PURPOSE: This study was conducted to identify the effects of a standardized patients (SP) simulation program for nursing students on nursing competence, communication skill, self-efficacy and critical thinking ability for blood transfusion. METHODS: A nonequivalent control group non-synchronized design study was used and included as participants 96 junior nursing students at C University. The SP group (n=48) participated in the teaching class using a SP, while the control group (n=48) received conventional practice education. The outcome measurements were nursing competence, communication skill, self-efficacy, and critical thinking ability for transfusion. RESULTS: Nursing competence, communication skill, self-efficacy, and critical thinking ability improved for students in both groups after training (2.01< or =t< or =13.03, p<.05). Self-efficacy showed greater improvement in students in the SP group compared to the control group (t=3.36, p<.001). CONCLUSION: SP simulation practice may be more effective in enhancing self-efficacy than that of conventional practice education. Whether self-efficacy will contribute to enhancing learning motivation for nursing students needs further examination.

Neuroprotective Effect of Chebulagic Acid via Autophagy Induction in SH-SY5Y Cells

Autophagy is a series of catabolic process mediating the bulk degradation of intracellular proteins and organelles through formation of a double-membrane vesicle, known as an autophagosome, and fusing with lysosome. Autophagy plays an important role of death-survival decisions in neuronal cells, which may influence to several neurodegenerative disorders including Parkinson's disease. Chebulagic acid, the major constituent of Terminalia chebula and Phyllanthus emblica, is a benzopyran tannin compound with various kinds of beneficial effects. This study was performed to investigate the autophagy enhancing effect of chebulagic acid on human neuroblastoma SH-SY5Y cell lines. We determined the effect of chebulagic acid on expression levels of autophagosome marker proteins such as, DOR/TP53INP2, Golgi-associated ATPase Enhancer of 16 kDa (GATE 16) and Light chain 3 II (LC3 II), as well as those of its upstream pathway proteins, AMP-activated protein kinase (AMPK), mammalian target of rapamycin (mTOR) and Beclin-1. All of those proteins were modulated by chebulagic acid treatment in a way of enhancing the autophagy. Additionally in our study, chebulagic acid also showed a protective effect against 1-methyl-4-phenylpyridinium (MPP+) - induced cytotoxicity which mimics the pathological symptom of Parkinson's disease. This effect seems partially mediated by enhanced autophagy which increased the degradation of aggregated or misfolded proteins from cells. This study suggests that chebulagic acid is an attractive candidate as an autophagy-enhancing agent and therefore, it may provide a promising strategy to prevent or cure the diseases caused by accumulation of abnormal proteins including Parkinson's disease.

The Development and Evaluation of a New Educational Program, Introduction to Clinical Nursing, for Third Year Nursing Students / 기본간호학회지

PURPOSE: The purpose of this study was to evaluate the effects of a newly developed Introduction to Clinical Nursing (ICN) program on critical thinking skills, communication competence, self-efficacy, and clinical performance self-confidence in nursing students in their third year. METHODS: One group pre-test and post-test design was used with three data collection time points (pre-test, post-test1 and post-test2). Participants were 74 third year nursing students approaching their first clinical practicum. The new program included (a) simulated clinical encounters regarding situations of assessing hospitalized patents and caring for patients with oxygenation needs, (b) objective structured clinical examination of skills, (c) lectures, and (e) field trips. Data were analyzed using paired t-tests. RESULTS: After the ICN course, critical thinking skills(significant only between pretest and post-test2), communication competence, and clinical performance self-confidence improved significantly (p<.05). There was no improvement in the self-efficacy total score but there was significant improvement in the subscale, self-regulatory efficacy. CONCLUSIONS: The study results indicate that the ICN course may be effective in increasing critical thinking skills, communication competence, and clinical performance self-confidence in nursing students. However, the effect size was very small and modifications of this program should be considered to develop more cost-effective educational programs.

Uncertainty and Nursing Need According to Illness Phases in Cancer Patients / 성인간호학회지

PURPOSES: This study examined uncertainty and nursing need according to illness phases(phase I, II, III) in cancer patients, and investigated relationships between uncertainty and nursing need. METHODS: A cross-sectional descriptive study was conducted with a sample of 121 adult cancer patients treated in two hospitals. RESULTS: As for the total score, the uncertainty was not significantly different across the subgroups by illness phase. As for the subscale score, however, two sub-scales of the uncertainty were different across the subgroups. 'The unpredictability' was highest in illness phase I and II groups, while 'the lack of information' was highest in the illness phase III group. Nursing need as the total score was not significantly different across the subgroups by illness phase. However, all subscale scores of the nursing need were significantly different across the subgroups. Educational need was highest in the illness phase I group; physical and emotional needs were highest in the illness phase III group. Uncertainty and nursing need were not related to each other at any illness phase. CONCLUSION: The results suggest that nursing need and uncertainty may change across illness phases. Clinicians need to consider this pattern in caring for cancer patients.

Henoch-Scholein Purpura Presenting with Acute Abdominal Pain Preceding Skin Rash: Review of 23 Cases

PURPOSE: For the early diagnosis of Henoch-Schonlein purpura(HSP) presenting with acute abdominal pain preceding skin rash. METHODS: The clinical, endoscopic and radiological records of 23 cases of HSP, presenting with gastrointestinal symptoms preceding skin rash were reviewed. RESULTS: The intervals from the onset of abdominal pain to the development of the skin rash were one day to 30 days(median five days), most of them were within two weeks. The presenting abdominal symptoms were abdominal pain(23 cases), vomiting(16 cases), hematochezia or melena(eight cases) and hematemesis(three cases). The abnormal endoscopic findings include coalescing erythematous lesions, areas of submucosal hemorrhage and superficial erosions and ulcers. The upper gastro intestinal endoscopy showed the abnormalities in 21 of 23 cases, which were observed in the duodenum(21 cases), the stomach(12 cases) and the esophagus(one case). Duodenitis with hemorrhage and/or erosions in the descending duodenum was the sole endoscopic abnormality in two cases and was the most marked finding in three cases. Sigmoidoscopy showed the abnormalities in six of eight cases. The abdominal ultrasonogram showed abnormalities in 12 of 17 cases, which included small bowel wall thickening(eight cases) and intramural hemorrhage(three cases). Recurrences after three months of symptom free intervals developed in four cases; three of them had persistent nephritis beyond one year. CONCLUSION: The erosive hemorrhagic duodenitis in the descending duodenum in the upper endoscopy and the small bowel wall thickening in the abdominal ultrasonogram can be useful findings in the diagnosis of HSP presenting with acute abdomen.

Developmental Test in Children

No abstract available.

Ocular Findings in Children with Down's Syndrome

In order to identify the characteristic ocular findings in Down's syndrome(DS), 123 Korean children with DS prospectively underwent ocular examination, including visual acuity assessment, slit-lamp biomicroscopy, ocular motility, cycloplegic refraction, and ophthalmoscopy. The ocular findings in decreasing prevalence were the following:upward slanting of the palpebral fissure(78 patients, 63%), epicanthus(75 patients, 61%), epiblepharon(66 patients, 54%), astigmatism(38 patients, 31%), hyperopia(35 patients, 28%), myopia(31 patients, 25%), strabismus(31 patients, 25%, 18 esotropia and 13 exotropia), nystagmus(27 patients, 22%), nasolacrimal duct obstruction(21 patients, 17%), blepharoconjunctivitis(20 patients, 16%), retinal abnormalities(18 patients, 15%), cataract(4 patients, 13%), and glaucoma(1 patient, 0.8%). Brushfield spots and keratoconus were not found. The ocular findings in Korean children with DS are characterized as an unreported, high incidence of epiblepharon, the highest rate of exotropia as reported, and no cases of Brushfield spots. The difference in the incidence of these ocular abnormalities according to race and age should be considered in every patient with DS.

The Resourcefulness and the Health-Promoting Behaviors of Cancer Patients / 성인간호학회지

The purpose of this study was to define the degree of the resourcefulness and the health-promoting behavior of cancer patients, to identify the relationship between the resourcefulness and the health promoting behaviors and to provide the basis for strategic nursing intervention. This study was conducted by an exploratory survey. Data were collected by self-reported questionnaires from 97 cancer patients in a university hospital in Tae-Gu from September to December of 1998. The sample data were collected by using a convenient sampling method. The following instruments were used in the study after some adaptation: Park Chai Soon's Health Promoting Lifestyle Profile, Oh Pok Ja's instrument for health promotion behavior and the Rosenbaum self-control schedule(SCS). The reliability of instruments was tested with Chronbach'alph(.79-.89). Data was analyzed by using the SAS program. T-test, ANOVA, and Pearson's coefficients of correlation. The results of this study were as follows: First, the average score of the resourcefulness variable was 22.20; the range of the score was from -30 to +81 The average score of the performance in the health promoting behavior variable was 96.13; the range of the score was from 39 to 137 Second, the resourcefulness variable was significantly different from such demographic factors as gender and perceived health status, but there was no statistically significant difference between the demographic factors and the health promoting behavior variable, except that of perceived health status. Third, the performance in health promoting behavior of cancer patients was significantly correlated with the resourcefulness of cancer patients(r= .50) In conclusion, resourcefulness was identified to be an important variable that could contribute to promote health-promoting behavior.

Relating Factors and Health Promoting Behaviors of a Family Caregiver / 성인간호학회지

The purpose of this study was to define health promoting behaviors of a family caregiver, to identify the factors affecting the performance in health-promoting behaviors, and to provide basis for nursing intervention strategies to promote health promoting behaviors. Study variables were induced from the Pender's Health Promotion Model and also from the literature that was related to the family caregiver's experiences. This study was conducted on the exploratory survey. Data were collected by self-reported questionnaires from 218 family caregivers in a university hospital in Tae-Gu, between March 13 and April 11, 1997. The subjects of this study were 218 adult caregivers. The samples data were collected by using a convenience sampling method. The following instruments were used in the study after some adaptation : Park Chai soon' Health Promoting Life-style Profile, Park Chai soon's Self-efficacy Instrument and Rogenberg's Self-esteem Scale. In addition, items measuring family caregiver-professional interaction were made by the present author based on related studies. The reliabilities of instruments were tested with Chronbach's alpha (.75-.89). Data were analyzed by using the SAS program, t-test, ANOVA, Pearson's coefficients of correlation and stepwise multiple regression technique was applied to analyses data. The results of this study were as follows. First, the average score of the performance in the health-promoting behavior variable was 130.88 ; the range of the score was from 83 to 189. The variables with the highest degree of the performance were self-actualization and interpersonal relationship. Second, the relationships between the degree of the performance in health-promoting behaviors and its exploratory factors were as follows ; the performance in the health-promoting behaviors was significantly correlated with self-efficacy, self-esteem, perceived health status, caregiver-professional interaction, perceived severity of illness, caregiving stress and change of health-concern. The performance in the health-promoting behaviors was significantly different from such demographic variables such as age and sex. Third, stepwise multiple regression analyses showed that : 1. Self-efficacy was the main predictor and accounted for 36% of the total variance. 2. Self-efficacy, age, caregiver-professional interaction and self-esteem, altogether accounted for 47.5% of the total variance. In conclusion, self-efficacy, age caregiver-professional interaction and self-esteem were identified to be important variables that contributed to promote health-promoting behaviors.

A Case of Insulin: dependent Diabetes Mellitus Carrying the 3243 bp tRNALUR(UUR)-- Point Mutation of Mitochondrial DNA / 대한내과학회지

We describe a case of insulin-dependent diabetes mellitus(lDDM) with a mutation at nucleotide 3243 of mitochondrial DNA. A 24-years-old female presented with recurrent episodes of generalised tonic clonic seizures, cognitive decline, short stature, bilateral sensory neural hearing loss, bilateral optic neuropathy, lactic acidosis, and basal ganglia calcifications in addition to IDDM. Maternal transmission of the disease was suggested, by the fact that her mother have died of diabetic complications of the age of 50. Heteroplasmy of wild type and mutant mitochondrial DNA derived from peripheral leucocytes was detected by Apa I digestion of the polymerase chain reaction products amplified with a set of primer for tBNALUR(UUR) Adenosin-to guanidine substitution, occurring at nucleotide position 3243 in tRNALUR(UUR) gene in comparison with reference sequences was confirmed.