Development and Validation of the Resilience Scale for Kidney Transplantation (RS-KTPL)

Purpose@#This study developed a resilience scale for kidney transplantation (RS-KTPL) and assessed its reliability and validity. @*Methods@#During the tool development phase, the concept of resilience in 10 patients who had undergone a kidney transplant was analyzed by integrating results from the theoretical and field research stages. Initial tool items were then derived. These items underwent content validity verification, item review, and a preliminary survey. The validation phase involved two main surveys, conducted using the preliminary 59 items derived from the development phase for data gathering. The first survey had 266 participants, and the second had 205 participants. Using the collected data, the structural validity, convergent validity, discriminant validity, criterion validity, and reliability of the tool items were verified, ultimately establishing the final items. @*Results@#The RS-KTPL comprises six factors with 27 items confirmed through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) on a 4-point Likert scale: positive thought transition through recovery belief, supportive relationships with others, self-awareness of negative psychological reactions, physical health control, homeostasis control, and supportive relationships with medical staff. The cumulative explanation of the tool was 50.71%. The model fit of the RS-KTPL was represented as follows: GFI 0.88, CFI 0.93, TLI 0.91, RMSEA 0.04, and SRMRI 0.06. Convergent, discriminant, and criterion validity were also secured. The reliability of the tool, measured by Cronbach a was 0.87. @*Conclusions@#The RS-KTPL can be used to identify the level of resilience in patients who have undergone a kidney transplant, enabling them to recognize their strengths and areas of improvement for enhanced resilience. This tool can be applied in clinical nursing practices to comprehensively assess the resilience of patients with a kidney transplant, providing direction for nursing intervention plans to enhance patient resilience.

The Influence of Leader-Member Exchange Relationship, Perceived Organizational Support, and Work-Life Balance on Tertiary Hospital Nurses’ Retention Intention / 기본간호학회지

Purpose@#This descriptive survey-based study was conducted to understand the influence of leader-member exchange, perceived organizational support, and work-life balance on retention intention, with the ultimate aim of increasing retention intention among nurses. @*Methods@#Data were collected from 150 nurses with more than 6 months of experience at a tertiary general hospital with 700 beds in Seoul, Korea. The collected data were analyzed using SPSS version 28.0. Hierarchical multiple regression analysis was performed to identify factors influencing retention intention. @*Results@#Job satisfaction (β=.28, p<.001) and the work and growth factor (β=.39, p<.001) had significant influences on the intention to stay. These factors accounted for approximately 49% of the variance in retention intention. @*Conclusion@#In this study, variables that can affect the retention intention of hospital nurses were identified, and the work and growth factor, which is a component of work-life balance, was found to affect retention intention. It is necessary to develop a competency development program that can foster the development of professional nurses and a system that can apply the program in practice.

Development of Nursing Clinical Judgment Scale

Purpose@#This study aimed to develop a nursing clinical judgment scale (NCJS) and verify its validity and reliability in assessing the clinical judgment of nurses. @*Methods@#A preliminary instrument of the NCJS comprising 38 items was first developed from attributes and indicators derived from a literature review and an in-depth/focus interview with 12 clinical nurses. The preliminary tool was finalized after 7 experts conducted a content validity test based on a data from a preliminary survey of 30 hospital nurses in Korea. Data were collected from 443 ward, intensive care unit, emergency room nurses who voluntarily participated in the survey through offline and online for the verification of the construct validity and reliability of the scale. @*Results@#The final scale comprised 23 items scored on a 5-point Likert scale. Six factors – integrated data analysis, evaluation and reflection on interventions, evidence on interventions, collaboration among health professionals, patient-centered nursing, and collaboration among nurse colleagues – accounted for 64.9% of the total variance. Confirmatory factor analysis supported the fit of the measurement model, comprising six factors (root mean square error of approximation = .07, standardized root mean square residual = .04, comparative fit index = .90). Cronbach’s α for all the items was .92. @*Conclusion@#The NCJS is a valid and reliable tool that fully reflects the characteristics of clinical practice, and it can be used effectively to evaluate the clinical judgment of Korean nurses. Future research should reflect the variables influencing clinical judgment and develop an action plan to improve it.

Influence of Reward and Nursing Professional Pride on Nursing Intention in Patient with Emerging Infectious Disease / 임상간호연구

Purpose@#The purpose of this study was to investigate the influence of nurses on the nursing intentions in patients with emerging infectious diseases. @*Methods@#Data were collected from 201 nurses with over one year of clinical experience in a general hospital located in Seoul, South Korea. A structured self-report questionnaire was utilized to measure belief factors, core factors, rewards, and nursing professional pride, as well as nursing intentions in patients with emerging infectious diseases. @*Results@#The results revealed that nurses' intentions to provide care for patients with emerging infectious diseases were significantly influenced by perceived behavioral control (β=.26, p<.001), clinical experience (β=-.14, p=.008), behavioral beliefs (β=.31, p= .010), feeling of vocation (β=.29, p=.012) and attitudes toward behaviors (β=.08, p=.034). @*Conclusion@#Enhancing nurses' intentions to provide care for patients with emerging infectious diseases requires the implementation of systemic and educational strategies aimed at strengthening their confidence and beliefs.

Effects of Auricular Acupressure on the Knee Pain, Joint Angle and Sleep among Elderly Workers with Knee Osteoarthritis: A Quasi-experimental Study / 재활간호학회지

Purpose@#The purpose of this study was to examine the effects of auricular acupressure on the knee pain, joint angle and sleep among elderly workers with knee osteoarthritis. @*Methods@#This study conducted with a randomized, single-blind, and quasi-experimental design. Participants were 41 elderly workers with knee osteoarthritis and they were allocated to the experimental group (n=21) and sham control group (n=20). The intervention lasted six weeks. In order to examine intervention effects of auricular acupressure, Visual Analogue Scale (VAS), and extension, flexion, Pittsburg Sleep Quality Index (PSQI), Fitbit tracker were measured in order to examine the effects of auricular acupressure. @*Results@#Auricular acupressure was effective for knee pain relief after 6 weeks (F=2.83, p=.024). There was no difference in joint angle. Sleep quality was significantly affected by sleep duration (t=3.02, p=.004), habitual sleep efficiency (t=2.36, p=.029), and daytime dysfunction (t=2.16, p=.038), and the sleep stage was effective on slight sleep (t=2.19, p=.034). @*Conclusion@#The findings of this study suggest that auricular acupressure can be a complementary nursing intervention for the elderly workers with knee osteoarthritis to decrease knee pain and to improve sleeping disorder, and has advantages such as reduction of medical expenses, convenience, and high safety.

The impact of peripheral neuropathy symptoms, self-care ability, and disturbances to daily life on quality of life among gynecological cancer patients undergoing chemotherapy: a cross-sectional survey

This study investigated the effects of peripheral neuropathy symptoms, self-care ability,and disturbances to daily life on quality of life (QoL) among gynecological cancer patients undergoing chemotherapy.Methods: The participants included 144 patients with gynecological cancer undergoing anticancerchemotherapy at a tertiary hospital in Seoul, South Korea, from December 1, 2021 to January 28,2022. Convenience sampling was used to recruit patients who had received 4 or more cycles of chemotherapy using a paclitaxel-platinum regimen, and a self-reported questionnaire was used to collect data. Descriptive statistics, the t-test, analysis of variance, Scheffé test, Pearson correlation coefficients, and multiple regression analysis were performed.Results: Most of the participants had ovarian cancer (70.1%) or endometrial cancer (14.6%), andthe most common number of treatment cycles was 6 to 10 (29.2%). The mean QoL (60.83±19.89)was greater than the midpoint. The regression model analyzing the patients’ QoL was statisticallysignificant (F=15.38, p<.001) with an explanatory power of 56.7%. Self-care ability (β=.39, p<.001),disturbances to daily life (β=–.38, p<.001), the duration of peripheral neuropathy symptoms(β=2.14, p=.034), and regular exercise (β=–2.12, p=.036) were found to significantly affect QoL.Conclusion: Efforts to improve the self-care ability of gynecological cancer patients who have experienced peripheral neuropathy after receiving chemotherapy and mitigate disturbances to their dailylife can improve their QoL. Healthcare professionals should identify peripheral neuropathy symptoms and examine the effects of the symptoms on patients’ daily lives. Improving the self-care abilityof patients and alleviating their limitations in daily life may improve QoL.

Hypertriglyceridemia with acute pancreatitis in a 14-year-old girl with diabetic ketoacidosis

Diabetic ketoacidosis (DKA) is a medically fatal condition in poorly controlled hyperglycemia or newly diagnosed diabetes mellitus. Severe hypertriglyceridemia (HTG) is an uncommon complication of DKA and can be associated with acute pancreatitis (AP). We present the clinical manifestations, laboratory findings, and management of AP associated with HTG in a 14-year-old girl with DKA. The patient, with a 7-year history of type 2 diabetes presented with epigastric pain, 1 month after stopping insulin injection. DKA, severe HTG, and AP were diagnosed based on the laboratory and imaging tests. She recovered from DKA after conventional treatment for DKA, and her triglyceride (TG) level was reduced from 10,867 mg/dL to the normal range after 7 days of admission without antilipid medication. Given that her C-peptide level was not too low and considering her negative diabetes-related antibodies and high TG level, targeted gene panel sequencing was performed on the genes associated with diabetes and HTG. We identified a heterozygous mutation, c.4607C>T (p. Ala1537Val), in ABCC8 related to maturityonset diabetes of the young (MODY) 12. To our knowledge, this is the first reported case of HTG-induced AP with DKA in a patient with MODY. In addition, we reviewed the literature for pediatric cases of HTG with DKA. In patients with DKA, timely awareness of severe HTG related to insulin deficiency is crucial for improving the consequences of AP. We recommend considering AP in all DKA patients presenting with severe HTG to ensure early and proper management.

Association of Disaster Perception, Disaster Attitudes, and Communication Skills with Disaster Nursing Competence among Nurse Officers at Armed Forces Hospitals / 기본간호학회지

Purpose@#This study aimed to examine the effects of disaster perception, disaster attitude, and communication skills on disaster nursing competence among nurse officers at armed forces hospitals. @*Methods@#In this descriptive study, data were collected from 191 nurse officers at armed forces hospitals in Korea, using convenience sampling. Data were analyzed by conducting descriptive statistics, the independent sample t-test, one-way analysis of variance, the Scheffé test, Pearson correlation coefficients, and multiple regression analysis. @*Results@#The mean scores for disaster perception, disaster attitude, communication skills, and disaster nursing competency were 73.02±7.66, 36.86±3.96, 57.97±6.39, and 52.88±7.66, respectively. Disaster perception was correlated with disaster attitude (r=.32, p=.002), communication skills (r=.46, p<.001) and disaster nursing competence (r=.40, p<.001). Disaster attitude was correlated with communication skills(r=.28, p<.001) and disaster nursing competence (r=.19, p=.008). Communication skills were correlated with disaster nursing competence (r=.50, p<.001). The factors influencing nurse officers’ disaster nursing competence were communication skills (β=.34, p<.001), disaster perception (β=.20, p=.003), experience in disaster education (β=-.20, p=.001), experience in disaster nursing work (β=-.14, p=.022) and working experience (β=.14, p=.033). @*Conclusion@#Disaster nursing competence had a positive correlation with recognition of communication skills, disaster perception, experience of disaster education, and experience of disaster nursing work.

Innate Type 2 Response to Aspergillus fumigatus in a Murine Model of Atopic Dermatitis–like Skin Inflammation

Background@#Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease mediated by T helper type 2 (Th2) cells in acute phase. Group 2 innate lymphoid cells (ILCs) play a role in the initiation of the Th2 response. Although mold exposure is associated with the development of AD, studies on the underlying mechanisms are lacking. This study investigated whether group 2 ILCs are involved in inflammation in AD-like skin induced by Aspergillus fumigatus (Af). @*Methods@#We investigated changes of group 2 ILCs population in Af-induced AD-like skin lesions. To induce AD-like skin lesions, Af extracts were applied to the dorsal skin of BALB/c and Rag1−/− mice five times per week, with repeat exposures at 2-week intervals. @*Results@#The clinical parameters were higher in the Af-treated group than in the control group. Histologic findings revealed epiderrmal and dermal thickening as well as eosinophil and mast cell infiltration into the skin of Af-treated mice. Populations of group 2 ILCs in the skin were also significantly higher in the Af-treated group. In addition, interleukin-33 mRNA expression was significantly higher in the skin lesions of the Af-treated mice. In the Rag1−/− mice lacking mature lymphocytes, AD-like skin lesions were still induced by Af and ILCs depletion using an anti-CD90.2 mAb lowered the Af-induced inflammatory response. @*Conclusions@#Group 2 ILCs may play a role in a murine model of Af-induced AD-like skin lesions.

Innate Type 2 Response to Aspergillus fumigatus in a Murine Model of Atopic Dermatitis–like Skin Inflammation

Background@#Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease mediated by T helper type 2 (Th2) cells in acute phase. Group 2 innate lymphoid cells (ILCs) play a role in the initiation of the Th2 response. Although mold exposure is associated with the development of AD, studies on the underlying mechanisms are lacking. This study investigated whether group 2 ILCs are involved in inflammation in AD-like skin induced by Aspergillus fumigatus (Af). @*Methods@#We investigated changes of group 2 ILCs population in Af-induced AD-like skin lesions. To induce AD-like skin lesions, Af extracts were applied to the dorsal skin of BALB/c and Rag1−/− mice five times per week, with repeat exposures at 2-week intervals. @*Results@#The clinical parameters were higher in the Af-treated group than in the control group. Histologic findings revealed epiderrmal and dermal thickening as well as eosinophil and mast cell infiltration into the skin of Af-treated mice. Populations of group 2 ILCs in the skin were also significantly higher in the Af-treated group. In addition, interleukin-33 mRNA expression was significantly higher in the skin lesions of the Af-treated mice. In the Rag1−/− mice lacking mature lymphocytes, AD-like skin lesions were still induced by Af and ILCs depletion using an anti-CD90.2 mAb lowered the Af-induced inflammatory response. @*Conclusions@#Group 2 ILCs may play a role in a murine model of Af-induced AD-like skin lesions.

The Effect of Laughter Therapy on Sleep in Community-dwelling Elders with Sleep Disorders / 기본간호학회지

Purpose@#The purpose of this study was to examine the effect of laughter therapy on the quality and quantity of sleep in elders with sleep disorders. @*Methods@#This was a quasi-experimental study using a non-equivalent control group pretest-posttest design with 59 participants and included elders with sleep disorders, The Pittsburgh Sleep Quality Index (PSQI) scores of five or more points were: 29 in the experiment group and 30 in the control group. The experimental group participated in laughter therapy sixteen times, twice a week for 50 min per session for 8 weeks. @*Results@#The results showed that laughter therapy was effective according to the PSQI (F=86.13, p<.001), total sleep time (F=9.34, p<.001), sleep efficiency (F=45.34, p<.001), sleep onset latency in the experimental group x2=13.77, p=.001, and in the control group x2=11.95, p=.003), number of awakenings (F=31.21, p<.001), light sleep (F=5.09, p=.008), deep sleep (F=15.13, p<.001), and serum melatonin levels (Z=-3.90, p<.001). but rapid eye movement sleep time did not differ significantly between the groups. @*Conclusion@#The results of the study indicate that laughter therapy may be an effective nursing intervention to improve quantity and quality of sleep in community-dwelling elderly.

Effects of Auricular Acupressure on Blood Pressure and Stress Responses in Adults with Prehypertension / 기본간호학회지

Purpose@#This study was done to examine the effects of auricular acupressure (AA) on blood pressure (BP) and stress responses in adults with prehypertension. @*Methods@#This single-blind, randomized, placebo-controlled study was conducted from September 2019 to February 2020. Participants were recruited through bulletin board notices in D city. The experimental group (n=27) received 8 weeks of AA intervention on specific acupoints (shenmen, kidney, heart, occiput, adrenal gland) to reduce blood pressure and stress, whereas the control group (n=25) received AA unspecific acupoints (helix 1-5). The outcomes were measured using BP, perceived stress scale (PSS), cortisol, and heart rate variability (HRV). Collected data were analyzed using Fisher’s exact test, chi-square, Shapiro-Wilk normality test, paired t-test, independent t-test, Mann-Whitney U test, repeated measures ANOVA and Friedman test with the SPSS/WIN 24.0. @*Results@#Statistical differences were found between the groups for systolic BP (x2=85.64, p<.001), diastolic BP (x2=27.76, p=.001), PSS (F=9.439, p=.003), low frequency (F=5.22, p=.027), heart rate (F=3.208, p=.045), and HRV index (F=3.579, p=.035). Cortisol did not differ significantly between the experimental group and control group. @*Conclusion@#The findings show that AA leads to improvements in BP and stress responses in adults with prehypertension. Therefore, AA can be used as an alternative nursing intervention for hypertension prevention and stress management.

Effect of Auricular Acupressure on Sleep and Pruritus in Patients Undergoing Hemodialysis / 기본간호학회지

Purpose@#The aim of this study was to evaluate the effects of auricular acupressure on sleep quality and pruritus in patients undergoing hemodialysis and to propose an effective and evidence-based nursing intervention. @*Methods@#This was a single-blind, nonequivalent, group comparison study with 42 participants. The experimental period was a total of 8 weeks, and five different acupressure sites were applied in each group. Dependent variables were measured before the intervention, at the 4th week of the intervention, and at the 8th week of the intervention. @*Results@#There were significant differences in the Pittsburgh sleep quality index, total sleep time, sleep efficiency, sleep onset latency, light sleep, deep sleep, number of awakenings, serum melatonin levels, subjective pruritus and skin hydration. No significant difference was found in skin pH between the two groups. @*Conclusion@#Auricular acupressure was found to be an effective nursing intervention to improve sleep quality and to reduce pruritus in patients undergoing hemodialysis.

The Effect of Hand Press Pellet Therapy on Arthralgia, Ankylosis, and Depression in Elderly Women with Knee Osteoarthritis / 재활간호학회지

Purpose@#The purpose of this study was to examine the effects of hand press pellet on hand acupuncture point in elderly women with knee osteoarthritis. @*Methods@#This study used a nonequivalent control group pretest-posttest design. The hand press pellet therapy was conducted 3 times a week for 6 weeks. Sixty-five participants were randomly allocated to an experimental group (n=33) and a control group (n=32). The Western Ontario and McMaster Universities Arthritis (WOMAC) Index and Geriatric Depression Scale (GDS) were used as measurement instruments. Data were analyzed with x2 test (Fisher's exact test), Shapiro-Wilk test, Mann-Whitney test, and Wilcoxon signed ranks test using the SPSS/WIN 25.0 program. @*Results@#The hand press pellet therapy group had significant improvements in the knee joint pain (z=-4.32, p<.001), knee joint stiffness (z=-4.02, p<.001), difficulty of activity daily life (z=-4.74, p<.001), and depression score (z=-2.12, p=.034) compared with the control group. @*Conclusion@#The hand press pellet therapy has been shown to be effective in knee joint pain, knee joint stiffness, difficulty of activity daily life and depression.

Nonclassic congenital lipoid adrenal hyperplasia diagnosed at 17 months in a Korean boy with normal male genitalia: emphasis on pigmentation as a diagnostic clue

Congenital lipoid adrenal hyperplasia (CLAH) is one of the most fatal conditions caused by an abnormality of adrenal and gonadal steroidogenesis. CLAH results from loss-of-function mutations of the steroidogenic acute regulatory (STAR) gene; the disease manifests with electrolyte imbalances and hyperpigmentation in neonates or young infants due to adrenocortical hormone deficiencies, and 46, XY genetic male CLAH patients can be phenotypically female. Meanwhile, some patients with STAR mutations develop hyperpigmentation and mild signs of adrenal insufficiency, such as hypoglycemia, after infancy. These patients are classified as having nonclassic CLAH (NCCLAH) caused by STAR mutations that retain partial activity of STAR. We present the case of a Korean boy with normal genitalia who was diagnosed with NCCLAH. He presented with whole-body hyperpigmentation and electrolyte abnormalities, which were noted at the age of 17 months after an episode of sepsis with peritonitis. The compound heterozygous mutations p.Gly221Ser and c.653C>T in STAR were identified by targeted gene-panel sequencing. Skin hyperpigmentation should be considered an important clue for diagnosing NCCLAH.

Effects of Auricular Acupressure on Joint Pain, Range of Motion, and Sleep in the Elderly with Knee Osteoarthritis

PURPOSE: The purpose of this paper is to determine effects of auricular acupressure on knee pain, range of motion, and sleep in the elderly with knee osteoarthritis. METHODS: This is an experimental study designed with randomization and single-blind in a placebo-control approach. The subjects included the elderly with knee osteoarthritis who were using an elderly welfare facility. In each of the groups, 28 subjects were assigned. For the experimental group, auricular acupressure was applied to five pressure points related to the pain caused by osteoarthritis and sleep. In the case of the placebo-control group, auricular acupressure was applied to other five points than the former. The intervention lasted eight weeks. In order to examine intervention effects of auricular acupressure, joint pain, Pressure Pain Thresholds (PPTs), and extension and flexion range of motion (ROM) were measured weekly. As for the pre- and post-examinations, pain, sleep quality, and the time-by-sleep stage of the patients with knee osteoarthritis were measured. RESULTS: The VAS scores in the experimental group with auricular acupressure significantly decreased through time (p<.001) and WOMAC also significantly decreased (p<.01) compared with the placebo-control group. However, there were no significant differences in PPTs. The flexion (p<.01) and extension (p<.001) ROMs measured for eight weeks improved over time. Meanwhile, sleep quality improved significantly after the intervention termination (p<.01), but there was no significant difference found in the time-by-sleep stage. CONCLUSION: Auricular acupressure applied for eight weeks was found to be effective in reducing joint pain, improving knee ROM, and improving sleep quality in patients with degenerative knee arthritis.

Development of Aspergillus fumigatus-induced chronic atopic dermatitis mouse model

PURPOSE: Atopic dermatitis (AD) is the most common chronic and relapsing inflammatory skin disease with skin barrier defects and altered immune responses. Chronic inflammation leads to irreversible fibrosis in the skin and there is no treatment to completely abolish the inflammation and fibrosis. To prevent or treat the chronic process of AD, it is necessary to develop a murine model of AD that reflects the chronic process to identify the mechanism. The aims of this study were to develop a chronic AD model with a crude extract Aspergillus fumigatus (Af) antigen. METHODS: We applied Af extract (40 µg) epicutaneously to the dorsal skin of BALB/c mice for 5 consecutive days per week during a period of 5 weeks for a chronic AD model, and 5 consecutive days repeatedly with 2 weeks interval for an acute AD model. RESULTS: The clinical score and transepidermal water loss were more increased in the chronic AD model than in the acute AD model. Histologic findings showed that more increased epidermal thickness, neutrophil infiltration and hyperkeratosis in the chronic model than in the acute model. Skin fibrosis was more prominent in the chronic model than in the acute model. The mRNA expression levels of transforming growth factor (TGF)-β, thymic stromal lymphopoietin, and interleukin-33 were increased in the skin of the chronic model compared to the acute model. The levels of total IgE, Af-specific IgE, IgG1, and IgG2a were significantly increased in the chronic model compared to controls. CONCLUSION: The Af-induced chronic AD model showed prominent fibrosis and increased TGF-β expression in the skin, which suggests that these models may be useful in the research for the mechanism of the chronic process in AD.

ERRATUM: Correction of Funding Resource: Development of Aspergillus fumigatus-induced chronic atopic dermatitis mouse model

In this article, the funding resource was misprinted unintentionally.

Clinical Significance of Random Urinary Vanillylmandelic Acid in Patients with Neuroblastoma / 임상소아혈액종양

BACKGROUND: To evaluate the value of random urinary vanillylmandelic acid (VMA) as a surrogate marker for monitoring tumor response and predicting outcome in patients with neuroblastoma (NB). METHODS: Medical records of 91 patients newly diagnosed with NB at the Samsung Medical Center between June 2014 and August 2017 were reviewed. Clinical associations and other prognostic factors, including age at diagnosis, stage, pathologic subtype, MYCN amplification, and other cytogenetic aberrations, were analyzed. Furthermore, the significance of random urinary VMA level in predicting outcome and tumor response was also evaluated. RESULTS: The median random urinary VMA level at diagnosis was 27.9 (range: 1.7–600) mg/g creatinine. Abdominal primary site, male sex, advanced stage, less differentiated pathology (poorly differentiated, undifferentiated), 11q deletion, and high-risk tumor were associated with a higher VMA level at diagnosis. The VMA level decreased during chemotherapy (28.4%, 16.9%, and 9.6% of the VMA level at diagnosis after 3, 6, and 9 cycles of chemotherapy, respectively). A higher VMA level at diagnosis tends to be associated with a better overall survival in high-risk patients with borderline significance (58.3±18.6% vs. 76.5±13.4%, P=0.050). However, in the multivariate analysis, the VMA level was not a significant predictor of survival. A slower reduction in VMA level during chemotherapy was not associated with a worse overall survival. However, event free survival was significantly better in the rapid responder group. CONCLUSION: A higher VMA level was associated with high-risk features at diagnosis of NB. Random urinary VMA is a valuable marker for monitoring NB response during chemotherapy.

Anomalous Origin of the Right Subclavian Artery in a Patient with D-transposition of the Great Arteries

This case report concerns a young patient with an extremely rare combination of d-transposition of the great arteries (d-TGA) and anomalous origin of the right subclavian artery. In our patient, the right subclavian artery originated from the pulmonary artery, which is why he did not show reversed differential cyanosis. We conclude that the presence of an aortic arch anomaly should be considered in patients with d-TGA who do not present with reversed differential cyanosis. A further imaging work-up, including computed tomography or magnetic resonance imaging, might be helpful.