Treated chronic hepatitis B is a good prognostic factor of diffuse large B-cell lymphoma

Background/Aims@#Chronic hepatitis B (CHB) is a risk factor for non-Hodgkin lymphoma (NHL). Our recent study suggested that antiviral treatment may reduce the incidence of NHL in CHB patients. This study compared the prognoses of hepatitis B virus (HBV)-associated diffuse large B-cell lymphoma (DLBCL) patients receiving antiviral treatment and HBV-unassociated DLBCL patients. @*Methods@#This study comprised 928 DLBCL patients who were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) at two referral centers in Korea. All patients with CHB received antiviral treatment. Time-to-progression (TTP) and overall survival (OS) were the primary and secondary endpoints, respectively. @*Results@#Among the 928 patients in this study, 82 were hepatitis B surface antigen (HBsAg)-positive (the CHB group) and 846 were HBsAg-negative (the non-CHB group). The median follow-up time was 50.5 months (interquartile range [IQR]=25.6–69.7 months). Multivariable analyses showed longer TTP in the CHB group than the non-CHB group both before inverse probability of treatment weighting (IPTW; adjusted hazard ratio [aHR]=0.49, 95% confidence interval [CI]=0.29–0.82, p=0.007) and after IPTW (aHR=0.42, 95% CI=0.26–0.70, p<0.001). The CHB group also had a longer OS than the non-CHB group both before IPTW (HR=0.55, 95% CI=0.33–0.92, log-rank p=0.02) and after IPTW (HR=0.53, 95% CI=0.32–0.99, log-rank p=0.02). Although liver-related deaths did not occur in the non-CHB group, two deaths occurred in the CHB group due to hepatocellular carcinoma and acute liver failure, respectively. @*Conclusions@#Our findings indicate that HBV-associated DLBCL patients receiving antiviral treatment have significantly longer TTP and OS after R-CHOP treatment than HBV-unassociated DLBCL patients.

Benzyl Isothiocyanate-Induced Cytotoxicity via the Inhibition of Autophagy and Lysosomal Function in AGS Cells

Gastric adenocarcinoma is among the top causes of cancer-related death and is one of the most commonly diagnosed carcinomas worldwide. Benzyl isothiocyanate (BITC) has been reported to inhibit the gastric cancer metastasis. In our previous study, BITC induced apoptosis in AGS cells. The purpose of the present study was to investigate the effect of BITC on autophagy mechanism in AGS cells. First, the AGS cells were treated with 5, 10, or 15 μM BITC for 24 h, followed by an analysis of the autophagy mechanism. The expression level of autophagy proteins involved in different steps of autophagy, such as LC3B, p62/SQSTM1, Atg5-Atg12, Beclin1, p-mTOR/mTOR ratio, and class III PI3K was measured in the BITC-treated cells. Lysosomal function was investigated using cathepsin activity and Bafilomycin A1, an autophagy degradation stage inhibitor. Methods including qPCR, western blotting, and immunocytochemistry were employed to detect the protein expression levels. Acridine orange staining and omnicathepsin assay were conducted to analyze the lysosomal function. siRNA transfection was performed to knock down the LC3B gene. BITC reduced the level of autophagy protein such as Beclin 1, class III PI3K, and Atg5-Atg12. BITC also induced lysosomal dysfunction which was shown as reducing cathepsin activity, protein level of cathepsin, and enlargement of acidic vesicle. Overall, the results showed that the BITC-induced AGS cell death mechanism also comprises the inhibition of the cytoprotective autophagy at both initiation and degradation steps.

R-MPV followed by high-dose chemotherapy with thiotepa-based and autologous stem cell transplantation for newly diagnosed primary central nervous system lymphoma: a single-center experience

Background@#High-dose chemotherapy followed by autologous stem cell transplantation (HDC-ASCT) as a consolidation treatment is a promising approach for eligible patients with newly diagnosed primary central nervous system lymphoma (PCNSL). @*Methods@#In this retrospective analysis, 22 patients with newly diagnosed PCNSL received chemotherapy with rituximab, methotrexate, procarbazine, and vincristine. Those who showed complete or partial response subsequently received consolidation HDC-ASCT with a thiotepa-based conditioning regimen but did not undergo radiotherapy. @*Results@#The PCNSL patients had a median age of 57 years (range, 49‒67 yr); of the total patients, 9.1% had a performance status of 2 or higher, and 72.1% had multiple lesions.Approximately 82% of patients received six cycles of induction chemotherapy, which was well tolerated with excellent disease control. The rate of confirmed or unconfirmed complete response increased from 45.5% at the period of interim analysis to 81.8% prior to the initiation of HDC-ASCT. With a median follow-up of 19.6 months (range, 7.5‒56.5 mo), the 2-year progression-free survival and overall survival estimates were 84% and 88%, respectively. No treatment-related deaths occurred. Grade 3 toxicity was recorded in 90.9% of the patients after undergoing the HDC-ASCT, and the most common grade 3 adverse event was febrile neutropenia without sepsis. @*Conclusion@#The discussed treatment approach is feasible in patients with newly diagnosed PCNSL, yielding encouraging results.

A Case of Paraneoplastic Pemphigus as a Preceding Manifestation of Underlying Follicular Lymphoma Treated with R-CHOP

Paraneoplastic pemphigus is a rare, life-threatening disorder associated with an underlying neoplasm, which presents with painful stomatitis and polymorphous skin lesions. Successful diagnosis of paraneoplastic pemphigus can lead to the diagnosis and treatment of the underlying malignancy.However, involvement of the respiratory system is typically unresponsive to treatment. Herein, we report the case of a 44-year-old female diagnosed with paraneoplastic pemphigus with underlying follicular lymphoma treated with a chemotherapy regimen including rituximab. Her skin lesions and underlying lymphoma responded to treatment, but bronchiolitis obliterans continued to progress and resulted in fatal respiratory failure.

Infant Mother’s Experiences with the Sustained Nurse Home-Visiting Program

Purpose@#The purpose of this study was to understand the experiences of mothers of infants who received sustained nurse home visiting services. The program of sustained home visit by nurses (Seoul Maternal Early Childhood Sustained Home-Visiting Program) is an intervention program. Its effectiveness has been verified in Australia, where services are provided to families in a vulnerable families during the period from prenatal period until the newborn is 2 years old. @*Methods@#The study protocol used qualitative approaches. Eleven mothers of infants who received nursing services in December 2015 were invited for an in-depth interview. The data collected were subjected to directed content analysis. @*Results@#The following 4 themes were identified from the analysis: (1) reduction in suspicion and increased feeling of benefit from the visiting service, (2) emotional support to the parents and use of community resources, (3) reliance on friendly nurses, and (4) gaining confidence about parenting and motherhood. @*Conclusion@#Sustained nursing home visiting services can be applied effectively in South Korea. The concrete narrations and descriptions of the experiences of mothers in this study can be used as a base for education, practice, and research.

A Case of Paraneoplastic Pemphigus as a Preceding Manifestation of Underlying Follicular Lymphoma Treated with R-CHOP

Paraneoplastic pemphigus is a rare, life-threatening disorder associated with an underlying neoplasm, which presents with painful stomatitis and polymorphous skin lesions. Successful diagnosis of paraneoplastic pemphigus can lead to the diagnosis and treatment of the underlying malignancy.However, involvement of the respiratory system is typically unresponsive to treatment. Herein, we report the case of a 44-year-old female diagnosed with paraneoplastic pemphigus with underlying follicular lymphoma treated with a chemotherapy regimen including rituximab. Her skin lesions and underlying lymphoma responded to treatment, but bronchiolitis obliterans continued to progress and resulted in fatal respiratory failure.

Impact of Perceived Importance to Rehabilitation Nursing, Role Conflict, and Working Environment on Performance of Rehabilitation Nursing of Nurses in Rehabilitation Hospitals / 재활간호학회지

Purpose@#The purpose of this study was to investigate the relationship among perceived importance to rehabilitation nursing, role conflict, working environments, and the performance of rehabilitation nursing in rehabilitation hospitals nurses. @*Methods@#The participants in this study were 254 nurses from 8 rehabilitation hospitals. Data was collected using a self administered questionnaire. Collected data was analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients and multiple regression analysis with the SPSS 24.0 program. @*Results@#Each average score of performance of rehabilitation nursing, perceived importance to rehabilitation nursing, role conflict, working environment were 3.27±0.46, 4.16±0.46, 3.62±0.63, 2.54±0.46. The factors influencing the performance of rehabilitation nursing were the perceived importance to rehabilitation nursing (β=.39, p<.001) and the working environment (β=.19, p=.002). @*Conclusion@#Findings of this study indicate the necessity of strengthening perceived importance of rehabilitation nursing and improving working environment to improve the performance of rehabilitation nursing in rehabilitation hospitals.

Prominent seasonal variation in pulmonary embolism than deep vein thrombosis incidence: a Korean venous thrombosis epidemiology study

Background/Aims@#Seasonal variation is an environmental factor proposed to affect the incidence of venous thromboembolism (VTE). However, VTE seasonal variation is not well studied in Asian populations, which have different genetic determinants of VTE compared to Westerners. The present study aimed at investigating seasonal variation of VTE occurrence and the effect of various demographic factors (i.e., age, sex, and co-morbidities) on variation. @*Methods@#VTE seasonal variation was evaluated in 59,626 index cases (from January 2009 to December 2013) in the Korean Health Insurance Review and Assessment Service database. We quantified and compared VTE occurrence across four seasons, and additionally assessed monthly through a chronobiological analysis. @*Results@#VTE incidence varied both seasonally and monthly, with new cases peaking in the winter (January and February) and the lowest incidence in the summer (August and September). After adjusting for sex, age, type of VTE, and combined cancer diagnosis, winter remained a significant independent factor driving VTE incidence. Additionally, seasonal variation was prominent in patients aged 60 years or older and in patients with pulmonary embolism, but not so prominent in patients of aged less than 60 years and patients with deep vein thrombosis. @*Conclusions@#Seasonal variation was a weak but independent contributor to VTE incidence in a Korean population diagnosed from 2009 to 2013, especially in those individuals with old age or suffering from a pulmonary embolism.

Determining Nurse Staffing By Classifying Patients Based on their Nursing Care Needs / 간호행정학회지

The Relationship between Average Length of Stay and Nurse Staffing in General Hospitals from 1996 to 2016 / 간호행정학회지

Purpose@#To analyze the effects of average length of stay (ALOS) on RN staffing. @*Methods@#Public data of patient surveys collected 8 times between 1996 and 2016 were analyzed. The sample included 2,408,669 discharged patients from 2,266 general hospitals. The ALOS for each hospital was computed by dividing the sum of inpatient days by the number of discharges. RN staffing was defined as the number of RNs per 100 inpatients. ALOS was transformed into base-2 logarithmic values for regression analysis. @*Results@#ALOS decreased from 13.3 to 9.6 days.Large hospitals in the capital region had the greatest reduction, from 15.7 to 7.4 days. RN staffing increased from 32.7 to 54.8 RNs per 100 patients. ALOS had an inverse relationship with RN staffing. Controlling for other factors, a 50% reduction in ALOS was associated with increases in RN staffing by 12.18 and 13.72 RNs per 100 inpatients in large hospitals in the capital region and elsewhere, respectively. @*Conclusion@#Hospitals may have to increase staffing to respond to the increased workload resulting from the shortened ALOS. It remains uncertain whether such increases in staffing were sufficient for the increased workload. Changes in ALOS should be taken into account when determining appropriate staffing.

The Relationship between Average Length of Stay and Nurse Staffing in General Hospitals from 1996 to 2016 / 간호행정학회지

Purpose@#To analyze the effects of average length of stay (ALOS) on RN staffing. @*Methods@#Public data of patient surveys collected 8 times between 1996 and 2016 were analyzed. The sample included 2,408,669 discharged patients from 2,266 general hospitals. The ALOS for each hospital was computed by dividing the sum of inpatient days by the number of discharges. RN staffing was defined as the number of RNs per 100 inpatients. ALOS was transformed into base-2 logarithmic values for regression analysis. @*Results@#ALOS decreased from 13.3 to 9.6 days.Large hospitals in the capital region had the greatest reduction, from 15.7 to 7.4 days. RN staffing increased from 32.7 to 54.8 RNs per 100 patients. ALOS had an inverse relationship with RN staffing. Controlling for other factors, a 50% reduction in ALOS was associated with increases in RN staffing by 12.18 and 13.72 RNs per 100 inpatients in large hospitals in the capital region and elsewhere, respectively. @*Conclusion@#Hospitals may have to increase staffing to respond to the increased workload resulting from the shortened ALOS. It remains uncertain whether such increases in staffing were sufficient for the increased workload. Changes in ALOS should be taken into account when determining appropriate staffing.

Similar transplant outcomes between haploidentical and unrelated donors after reduced-intensity conditioning with busulfan, fludarabine, and anti-thymocyte globulin in patients with acute leukemia or myelodysplastic syndrome

BACKGROUND: Although T-cell-replete hematopoietic cell transplantation (HCT) from haploidentical donors (HIDs) using anti-thymocyte globulin (ATG) has shown promising outcomes, previous studies often adopted heterogenous graft sources and conditioning.METHODS: We retrospectively compared HCT outcomes from 62 HIDs, 36 partially-matched unrelated donors (PUDs), and 55 matched unrelated donors (MUDs) in patients with acute leukemia or myelodysplastic syndrome using the same graft source of peripheral blood and a reduced intensity conditioning of busulfan, fludarabine, and ATG.RESULTS: The estimates of 3-yr disease-free survival (DFS) and overall survival (OS) rates were not significantly different among the MUD, HID, and PUD groups, at 46%, “41%, and 36%” for the DFS rate (P=0.844), and 55%, 45%, and 45% for the OS rate (P=0.802), respectively. Cumulative incidence of relapse and non-relapse mortality at 3 yr was similar among different donor types. Subsequent multivariable analyses showed that the sex of the patient (male) and a high/very high disease risk index were independently associated with poorer DFS and OS, while the donor type was not.CONCLUSION: T-cell replete HCT from HIDs using an ATG-containing reduced intensity conditioning regimen may be a reasonable option in the absence of matched related donors in patients with acute leukemia or myelodysplastic syndrome.

Comparison of Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery Pulmonary Segmentectomy / 대한흉부외과학회지

BACKGROUND: Uniportal video-assisted thoracoscopic surgery (VATS) has proven safe and effective for pulmonary wedge resection and lobectomy. The objective of this study was to evaluate the safety and feasibility of uniportal VATS segmentectomy by comparing its outcomes with those of the multiportal approach at a single center. METHODS: The records of 84 patients who underwent VATS segmentectomy from August 2010 to August 2018, including 33 in the uniportal group and 51 in the multiportal group, were retrospectively reviewed and analyzed. RESULTS: Anesthesia and operative times were similar in the uniportal and multiportal groups (215 minutes vs. 220 minutes, respectively; p=0.276 and 180 minutes vs. 198 minutes, respectively; p=0.396). Blood loss was significantly lower in the uniportal group (50 mL vs. 100 mL, p=0.013) and chest tube duration and hospital stay were significantly shorter in the uniportal group (2 days vs. 3 days, p=0.003 and 4 days [range, 1–14 days] vs. 4 days [range, 1–62 days], p=0.011). The number of dissected lymph nodes tended to be lower in the uniportal group (5 vs. 8, p=0.056). CONCLUSION: Our preliminary experience indicates that uniportal VATS segmentectomy is safe and feasible in well-selected patients. A randomized, prospective study with a large group of patients and long-term follow-up is necessary to confirm these results.

Comparison of Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery Pulmonary Segmentectomy

BACKGROUND@#Uniportal video-assisted thoracoscopic surgery (VATS) has proven safe and effective for pulmonary wedge resection and lobectomy. The objective of this study was to evaluate the safety and feasibility of uniportal VATS segmentectomy by comparing its outcomes with those of the multiportal approach at a single center.@*METHODS@#The records of 84 patients who underwent VATS segmentectomy from August 2010 to August 2018, including 33 in the uniportal group and 51 in the multiportal group, were retrospectively reviewed and analyzed.@*RESULTS@#Anesthesia and operative times were similar in the uniportal and multiportal groups (215 minutes vs. 220 minutes, respectively; p=0.276 and 180 minutes vs. 198 minutes, respectively; p=0.396). Blood loss was significantly lower in the uniportal group (50 mL vs. 100 mL, p=0.013) and chest tube duration and hospital stay were significantly shorter in the uniportal group (2 days vs. 3 days, p=0.003 and 4 days [range, 1–14 days] vs. 4 days [range, 1–62 days], p=0.011). The number of dissected lymph nodes tended to be lower in the uniportal group (5 vs. 8, p=0.056).@*CONCLUSION@#Our preliminary experience indicates that uniportal VATS segmentectomy is safe and feasible in well-selected patients. A randomized, prospective study with a large group of patients and long-term follow-up is necessary to confirm these results.

Differential impact of anti-thymocyte globulin dosing by disease risk index in alternative donor peripheral blood stem cell transplantation in patients with acute leukemia or myelodysplastic syndrome after reduced intensity conditioning

No abstract available.

Effect of Platinum-Based Chemotherapy on PD-L1 Expression on Tumor Cells in Non-small Cell Lung Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Programmed death-1 (PD-1)/PD-1 ligand (PD-L1) axis blockades have revolutionized the treatment of advanced non-small cell lung cancer (NSCLC). We assessed the effect of platinum-based chemotherapy on tumor PD-L1 expression and its clinical implications. MATERIALS AND METHODS: We used immunohistochemistry to retrospectively evaluate the percentage of tumor cells with membranous PD-L1 staining (tumor proportion score) in paired tumor specimens obtained before and after platinum-based neoadjuvant chemotherapy (NACT) in 86 patients with NSCLC. We analyzed the correlation between the change in PD-L1 tumor proportion score and clinicopathologic characteristics, response to NACT, and survival. RESULTS: The PD-L1 tumor proportion score increased in a significant proportion of patients with NSCLC after platinum-based NACT (Wilcoxon signed-rank test, p=0.002). That pattern was consistent across clinically defined subgroups except for patients with partial response to NACT. Tumors from 26 patients (30.2%) were PD-L1‒negative before NACT but PD-L1-positive after NACT, whereas the reverse pattern occurred in six patients (7%) (McNemar’s test, p < 0.001). Increase in PD-L1 tumor proportion score was significantly associated with lack of response to NACT (Fisher exact test, p=0.015). There was a tendency, albeit not statistically significant, for patients with an increase in PD-L1 tumor proportion score to have shorter survival. CONCLUSION: Tumor PD-L1 expression increased after platinum-based NACT in a significant proportion of patients with NSCLC. Increase in tumor PD-L1 expression may predict poor clinical outcome.

Cytokine Production in Cholangiocarcinoma Cells in Response to Clonorchis sinensis Excretory-Secretory Products and Their Putative Protein Components

Clonorchis sinensis is a carcinogenic human liver fluke that promotes hepatic inflammatory environments via direct contact or through their excretory-secretory products (ESPs), subsequently leading to cholangitis, periductal fibrosis, liver cirrhosis, and even cholangiocarcinoma (CCA). This study was conducted to examine the host inflammatory responses to C. sinensis ESPs and their putative protein components selected from C. sinensis expressed sequenced tag (EST) pool databases, including TGF-β receptor interacting protein 1(CsTRIP1), legumain (CsLeg), and growth factor binding protein 2 (CsGrb2). Treatment of CCA cells (HuCCT1) with the ESPs or bacterial recombinant C. sinensis proteins differentially promoted the secretion of proinflammatory cytokines (IL-1β, IL-6, and TNF-α) as well as anti-inflammatory cytokines (IL-10, TGF-β1, and TGF-β2) in a time-dependent manner. In particular, recombinant C. sinensis protein treatment resulted in increase (at maximum) of ~7-fold in TGF-β1, ~30-fold in TGF-β2, and ~3-fold in TNF-α compared with the increase produced by ESPs, indicating that CsTrip1, CsLeg, and CsGrb2 function as strong inducers for secretion of these cytokines in host cells. These results suggest that C. sinensis ESPs contribute to the immunopathological response in host cells, leading to clonorchiasis-associated hepatobiliary abnormalities of greater severity.

Development of Emotional Labor Measurement Tool for Hospital Nurses / 간호행정학회지

PURPOSE: The study was done to analyze attributes of emotional labor experienced by clinical nurses working in domestic hospitals and to develop tools for measurement. METHODS: The concept of nurse emotional labor was verified through concept analysis based on Hybrid model. The preliminary Nurse Emotional Labor Scale were examined for content validity, reliability and validity. The scale was verified with 500 nurses working in general hospitals located in Kangwon-do. RESULTS: Attributes of the nurse emotional labor concept were derived from three types: surface type, internalize type and control behaviors and identified as having six constitutive factors: conscious surface behaviors, casual behaviors, empathy effort, repress, solve and endure. The results of the construct validity test of the tool showed 8 factors. The Nurse Emotional Labor Measurement Tool had a significant correlation (r=.35, p < .001) with the Scale of Morris & Felman in result of criterion-related validity. And the internal consistency reliability Cronbach's α coefficient was .93. CONCLUSION: The development process showed that to accurately describe emotional labor of nurses, it is necessary to consider not only quantitative aspects but also qualitative aspects and content aspects.

The Effects of Donepezil, an Acetylcholinesterase Inhibitor, on Impaired Learning and Memory in Rodents

A previous study in humans demonstrated the sustained inhibitory effects of donepezil on acetylcholinesterase (AChE) activity; however, the effective concentration of donepezil in humans and animals is unclear. This study aimed to characterize the effective concentration of donepezil on AChE inhibition and impaired learning and memory in rodents. A pharmacokinetic study of donepezil showed a mean peak plasma concentration of donepezil after oral treatment (3 and 10 mg/kg) of approximately 1.2 ± 0.4 h and 1.4 ± 0.5 h, respectively; absolute bioavailability was calculated as 3.6%. Further, AChE activity was inhibited by increasing plasma concentrations of donepezil, and a maximum inhibition of 31.5 ± 5.7% was observed after donepezil treatment in hairless rats. Plasma AChE activity was negatively correlated with plasma donepezil concentration. The pharmacological effects of donepezil are dependent upon its concentration and AChE activity; therefore, we assessed the effects of donepezil on learning and memory using a Y-maze in mice. Donepezil treatment (3 mg/kg) significantly prevented the progression of scopolamine-induced memory impairment in mice. As the concentration of donepezil in the brain increased, the recovery of spontaneous alternations also improved; maximal improvement was observed at 46.5 ± 3.5 ng/g in the brain. In conclusion, our findings suggest that the AChE inhibitory activity and pharmacological effects of donepezil can be predicted by the concentration of donepezil. Further, 46.5 ± 3.5 ng/g donepezil is an efficacious target concentration in the brain for treating learning and memory impairment in rodents.

Combination of clinical and laboratory characteristics may serve as a potential diagnostic marker for torsion on mature cystic teratomas

OBJECTIVE: The objective of this study was to evaluate clinical and laboratory characteristics of torsion on mature cystic teratomas (MCTs). In addition, we examined whether these factors could be helpful in diagnosing MCT torsion. METHODS: A retrospective medical record review was conducted for 384 patients who had undergone surgery and histologically verified ovarian MCTs at single university hospital between July 2006 and May 2017. Patients with or without torsion groups were compared with respect to clinical presentation, laboratory findings and surgical course. In addition, statistically significant indicators of the factors were additionally evaluated for diagnostic value. RESULTS: White blood cell (WBC) count, neutrophil count, neutrophil to lymphocyte (N/L) ratio, and tumor size were higher in the torsion group (n=24) than in the control group (n=360; P≤0.005 for all). The age was younger in the torsion group than in the control (P=0.009). In the area under the curve (AUC) of the 5 factors obtained by univariate and multivariate logistic regression, the age was 0.657, the WBC count was 0.838, the neutrophil count was 0.806, the N/L ratio was 0.725, and the cyst size was 0.705. Receiver operating characteristic analysis indicated that the AUC for the combined use of age, WBC count, neutrophil count, N/L ratio, and tumor size was 0.898 (95% confidence interval, 0.833–0.962; P < 0.001). CONCLUSION: The combined measurement of age, WBC count, neutrophil count, N/L ratio, and tumor size may be used as a potential diagnostic marker for the torsion on MCTs.