Spiritual nursing education programme for nursing students in Korea: a systematic review and meta-analysis.

PURPOSE: This study conducts a systematic review and meta-analysis to understand the characteristics and contents of studies on spiritual nursing education programmes and their effects. METHODS: The literature search included five databases (RISS, KISS, DBpia, Science ON, and KmBase) published in South Korea until September 30, 2021. Nine studies were included in the final review, with six for the meta-analysis using the RevMan 5.4. 1 programme. The programmes targeted nursing students and nurses in the RN-BSN course and employed methods such as lecturing, discussions, and case presentations. The contents focused on self-spirituality awareness, spirituality-related concepts, understanding others' spirituality, and the process and application of spiritual nursing. RESULTS: The meta-analysis revealed statistically significant effects on spiritual nursing competencies, spirituality, spiritual well-being, existential well-being, and spiritual needs, except self-esteem. Spiritual nursing education was effective in enhancing spiritual nursing competencies. CONCLUSION: The study confirmed that spiritual nursing education effectively improves spiritual nursing competency, indicating a need for increased focus and administrative and financial support for such education in schools and hospitals. Furthermore, future studies should employ randomised experimental designs to examine the effects of online education programmes with short training time on clinical nurses in hospitals.

Music from noise-canceling headphones is beneficial against anxiety in male bladder cancer patients undergoing follow-up cystoscopy: A prospective randomized trial.

INTRODUCTION: Bladder cancer, with a greater incidence in males than in females, requires frequent cystoscopies. We aim to evaluate the effect of music played through noise-canceling headphones on male bladder cancer patients during follow-up cystoscopy. METHODS: A total of 160 male bladder cancer patients undergoing follow-up flexible cystoscopy were randomly divided into the noise-canceling headphones without music group and the noise-canceling headphones with music group (groups 1 and 2, respectively; n = 80 per group). The patients' clinical characteristics were examined and objective and subjective measurements were compared before and after cystoscopy. The primary outcomes that were evaluated included the visual analog scale (VAS, 0-10) and the state-trait anxiety inventory (STAI, 20-80). Other outcomes, including vital signs and scores for assessing satisfaction and the willingness to repeat the procedure, were also examined. RESULTS: The characteristics of the patients in groups 1 and 2, and their pre-cystoscopy status, did not differ significantly. Although post-cystoscopy vital signs for the objective parameters and VAS pain scores were similar between the groups, subjective parameters were not. When compared with group 1, post-cystoscopy STAI-state scores were significantly lower in group 2, whereas patients' satisfaction scores and the willingness to repeat the procedure were significantly higher in group 2 (p = 0.002, 0.001, and 0.001, respectively). Additionally, in group 2, STAI-state scores changed significantly after the procedure when compared with before the procedure (p = 0.002). CONCLUSION: In male bladder cancer patients, music from noise-canceling headphones might have reduced anxiety and improved satisfaction and the willingness to repeat cystoscopy.

Health and medical experience of migrant workers: qualitative meta-synthesis.

BACKGROUND: Migrant workers in Korea are contributing to economic development by resolving labour shortages due to the increase in the ageing population, and they have become necessary and important in the Korean economy. However, long working hours, poor working conditions, and cultural differences can cause migrant workers to experience disadvantages in using health and medical services. Therefore, this study aimed to understand and analyse the health and medical service experience of migrant workers in Korea by reviewing previous studies in order to improve their health and access to medical services. METHOD: The qualitative meta-synthesis method suggested by Thomas and Harden was used. The key question for searching the literature is 'What is the status of the use of health and medical service by migrant workers in Korea and the attributes that affect them?' Five electronic databases (RISS, KCI, KISS, Science ON, and KMbase) were searched for Korean literature published in academic journals until 6 November 2022 using a combination of "migrant worker or foreign worker or foreign labourer or migrant" and "medical or health" in Korean. RESULTS: A total of nine studies out of 1,006 were included in the review after methodological quality assessment using the Critical Appraisal Skills Program (CASP). The results of studies were synthesised into three themes and ten sub-themes: 'Personal factors' of personal health beliefs and the financial burden of healthcare costs; 'Cultural factors' of cultural differences in the lifestyle, cultural differences in the healthcare environment, and traditional medicine in the country; and 'Socio-institutional factors' of poor and difficult working environment, insufficient information about medical institutions, policies with a lack of practical applicability, systems of healthcare institutions, and healthcare services usage. CONCLUSIONS: This study identified the experiences of migrant workers in using health and medical care services. The results of this study can be used as a basis for improving the health of migrant workers and access to healthcare services. Based on the results of this study, it is necessary to improve the health management ability of migrant workers by developing a health management platform that can support Korean medical information and provide professional and accurate self-health management information.

Deep learning algorithm for the automated detection and classification of nasal cavity mass in nasal endoscopic images.

Nasal endoscopy is routinely performed to distinguish the pathological types of masses. There is a lack of studies on deep learning algorithms for discriminating a wide range of endoscopic nasal cavity mass lesions. Therefore, we aimed to develop an endoscopic-examination-based deep learning model to detect and classify nasal cavity mass lesions, including nasal polyps (NPs), benign tumors, and malignant tumors. The clinical feasibility of the model was evaluated by comparing the results to those of manual assessment. Biopsy-confirmed nasal endoscopic images were obtained from 17 hospitals in South Korea. Here, 400 images were used for the test set. The training and validation datasets consisted of 149,043 normal nasal cavity, 311,043 NP, 9,271 benign tumor, and 5,323 malignant tumor lesion images. The proposed Xception architecture achieved an overall accuracy of 0.792 with the following class accuracies on the test set: normal = 0.978 ± 0.016, NP = 0.790 ± 0.016, benign = 0.708 ± 0.100, and malignant = 0.698 ± 0.116. With an average area under the receiver operating characteristic curve (AUC) of 0.947, the AUC values and F1 score were highest in the order of normal, NP, malignant tumor, and benign tumor classes. The classification performances of the proposed model were comparable with those of manual assessment in the normal and NP classes. The proposed model outperformed manual assessment in the benign and malignant tumor classes (sensitivities of 0.708 ± 0.100 vs. 0.549 ± 0.172, 0.698 ± 0.116 vs. 0.518 ± 0.153, respectively). In urgent (malignant) versus nonurgent binary predictions, the deep learning model achieved superior diagnostic accuracy. The developed model based on endoscopic images achieved satisfactory performance in classifying four classes of nasal cavity mass lesions, namely normal, NP, benign tumor, and malignant tumor. The developed model can therefore be used to screen nasal cavity lesions accurately and rapidly.

Immediate-start peritoneal dialysis without break-in-period: an 18-year retrospective cohort study on patient survival.

Background: Immediate-start peritoneal dialysis (ISPD) is an effective renal replacement therapy that can prevent central venous catheterization due to its immediate initiation of peritoneal dialysis (PD) after catheter insertion without a break-in period. This study aimed to investigate the effect of ISPD on long-term patient survival. Methods: In this retrospective single-center cohort study, 178 consecutive patients who started PD from August 2005 to March 2023 were enrolled, from whom 144 patients with ISPD were analyzed. PD was initiated without a break-in period within 24 hours of catheter insertion using percutaneous needle-guidewire technique. The primary outcome was patient survival, estimated using the Kaplan-Meier method. A Cox proportional hazard regression model was used to identify factors independently associated with patient survival. Results: The median follow-up period was 4.00 years (interquartile range, 1.23‒5.75 years). The mean age of patients was 61.6 ± 13.6 years; 58 patients (40.3%) were male and 93 patients (64.6%) were diabetic. Overall patient survival rates at 1, 3, 5, and 10 years were 98.5%, 93.5%, 92.1%, and 65.6%, respectively. The technique survival rates at 1, 3, 5, and 10 years were 88.1%, 74.9%, 63.2%, and 40.2%, respectively. The peritonitis-free survival rates at 1, 3, 5, and 10 years were 92.3%, 76.0%, 59.4%, and 28.0%, respectively. In the multivariate analysis, diabetes was the only factor associated with patient survival and technique survival. Conclusion: Our study demonstrated that patient survival and technique survival rates were relatively high in ISPD patients who were catheterized using percutaneous needle-guidewire technique.

Treatment Outcomes of Olfactory Neuroblastoma: A Multicenter Study by the Korean Sinonasal Tumor and Skull Base Surgery Study Group.

OBJECTIVES: Due to the rarity of olfactory neuroblastoma (ONB), there is ongoing debate about optimal treatment strategies, especially for early-stage or locally advanced cases. Therefore, our study aimed to explore experiences from multiple centers to identify factors that influence the oncological outcomes of ONB. METHODS: We retrospectively analyzed 195 ONB patients treated at nine tertiary hospitals in South Korea between December 1992 and December 2019. Kaplan-Meier survival analysis was used to evaluate oncological outcomes, and a Cox proportional hazards regression model was employed to analyze prognostic factors for survival outcomes. Furthermore, we conducted 1:1 nearest-neighbor matching to investigate differences in clinical outcomes according to the use of neoadjuvant chemotherapy. RESULTS: In our cohort, the 5-year overall survival (OS) rate was 78.6%, and the 5-year disease-free survival (DFS) rate was 62.4%. The Cox proportional hazards model revealed that the modified Kadish (mKadish) stage and Dulguerov T status were significantly associated with DFS, while the mKadish stage and Hyams grade were identified as prognostic factors for OS. The subgroup analyses indicated a trend toward improved 5-year DFS with dural resection in mKadish A and B cases, even though the result was statistically insignificant. Induction chemotherapy did not provide a survival benefit in this study after matching for the mKadish stage and nodal status. CONCLUSION: Clinical staging and pathologic grading are important prognostic factors in ONB. Dural resection in mKadish A and B did not show a significant survival benefit. Similarly, induction chemotherapy also did not show a survival benefit, even after stage matching.

Etiology and clinical characteristics of acute viral hepatitis in South Korea during 2020-2021: a prospective multicenter study.

This prospective, 12-center study investigated the etiology and clinical characteristics of acute viral hepatitis (AVH) during 2020-2021 in South Korea, and the performance of different diagnostic methods for hepatitis E virus (HEV). We enrolled 428 patients with acute hepatitis, of whom 160 (37.4%) were diagnosed with AVH according to predefined serologic criteria. The clinical data and risk factors for AVH were analyzed. For hepatitis E patients, anti-HEV IgM and IgG were tested with two commercial ELISA kits (Abia and Wantai) with HEV-RNA real-time RT-PCR. HAV, HEV, HBV, HCV, Epstein-Barr virus (EBV), cytomegalovirus, and herpes simplex virus accounted for AVH in 78.8% (n = 126), 7.5% (n = 12), 3.1% (n = 5), 1.9% (n = 3), 6.9% (n = 11), 1.2% (n = 2), and 0.6% (n = 1) of 160 patients (median age, 43 years; men, 52.5%; median ALT, 2144 IU/L), respectively. Hospitalization, hemodialysis, and intensive care unit admission were required in 137 (86.7%), 5 (3.2%), and 1 (0.6%) patient, respectively. Two patients developed acute liver failure (1.3%), albeit without mortality or liver transplantation. Ingestion of uncooked clams/oysters and wild boars' blood/bile was reported in 40.5% and 16.7% of patients with HAV and HEV, respectively. The concordance rate between the anti-HEV-IgM results of both ELISA kits was 50%. HEV RNA was detected in only 17% of patients with HEV. The diagnosis of HEV needs clinical consideration due to incomplete HEV diagnostics.

Contralateral Cavernous Sinus Thrombosis Caused by Sphenoid Sinusitis: Case Report and Literature Review.

Cavernous sinus thrombosis (CST) is a rare but life-threatening infectious disease whose diagnosis and treatment are challenging. CST can result in ocular and neurologic morbidities, as well as fatal systemic complications due to systemic thrombus. Occasionally, these clinical symptoms can be a result of contralateral sinusitis. A 75-year-old female presented with severe headache and fever. Magnetic resonance imaging revealed a multifocal filling defect in both cavernous sinuses, with heterogeneous enhancement and thrombosis of the right superior ophthalmic vein. Intravenous antibiotic was administered, and endoscopic sinus surgery was performed. The patient was discharged 40 days after admission and there were no neurologic symptoms and no evidence of sequelae during the 10-month follow-up. Symptoms of CST on the contralateral side are often missed, which delays initiation of appropriate treatment. When CST secondary to paranasal sinusitis is diagnosed, clinicians should consider contralateral as well as ipsilateral infection of the paranasal sinus. Preventing disease progression and complications through early and aggressive antibiotic administration along with sinus surgery is crucial.

CT-based three-dimensional invasiveness analysis of adenocarcinoma presenting as pure ground-glass nodules.

Background: We invest computed tomography (CT) image differences between non-invasive adenocarcinomas (NIAs) and invasive adenocarcinomas (IAs) presenting as pure ground glass nodules (GGNs). Methods: From 2013 to 2019, 48 pure GGNs were surgically resected in 45 patients. Of these, 40 were pathologically diagnosed as non-small cell lung cancers (NSCLCs). We assessed them using the Synapse Vincent (Fujifilm Co., Ltd., Tokyo, Japan) three-dimensional (3D) analysis system; we drew histograms of the CT densities. We calculated the maximum, minimum, means, and standard deviations of the densities. The proportions of GGNs of high CT density were compared between the two groups. The diagnostic performance was investigated via receiver operating curve (ROC) analysis. Results: Of the 40 pure GGNs, 20 were NIAs (4 adenocarcinomas in situ and 16 minimally IAs) and 20 IAs. Significant correlations were evident between histological invasiveness and the maximum and mean CT densities and the standard deviation. Neither the nodule volume nor the minimum CT density significantly predicted invasiveness. A CT volume density proportion >-300 Hounsfield units optimally predicted the invasiveness of pure GGNs; the cutoff was 5.41% with a sensitivity of 85% and a specificity of 95%. Conclusions: CT density reflected the invasiveness of pure GGNs. A CT volume proportion density >-300 Hounsfield units may significantly predict histological invasiveness.

Health-related quality of life of migrant workers: a systematic literature review.

BACKGROUND: Currently, the number of migrant workers residing in Korea is continuously increasing, which is exacerbating the workforce shortage in its society. Migrant workers experience health problems or stress due to rapid environmental changes, consequently impairing their quality of life (QoL). Accordingly, this literature review aimed to prepare basic data by identifying factors related to the health-related quality of life (HRQoL) of migrant workers in Korea. METHOD: In total, the literature search used seven databases to find all documents corresponding to related subject words until June 7, 2022, including PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, Regional Information Sharing Systems, Korean Medical database, Science ON, and DataBase Periodical Information Academic. Furthermore, this study used the Cochrane Library and Google Scholar to manually search, to include comprehensive literature. Moreover, both English and Korean were used to search for the main terms. RESULTS: In total, nine articles were selected. The World Health Organization Quality of Life Brief Version tool was used in six studies to measure HRQoL. Factors affecting the HRQoL of domestic migrant workers included general characteristics such as monthly income and residence period, physical and psychological health-related characteristics such as health promotion behaviour, medical service satisfaction, and depression, and social factors such as social support and cultural adaptation stress. Social support was an important variable affecting the QoL. Particularly, increased social support improved health-related QoL. In addition, higher medical service satisfaction and lower cultural adaptation stress increased HRQoL. CONCLUSIONS: Social factors such as social support and cultural adaptation stress affect the HRQoL of migrant workers. Therefore, the social integration program should be expanded to ensure that migrant workers can adapt to the domestic culture at an early stage. In addition, people require active support to improve the QoL in Korea through activities such as self-help groups to help them cope with stressful situations and experience positive emotions. Moreover, it is necessary to provide information on domestic medical services as well as support for medical information for self-health management to improve the quality of medical services for migrant workers.

A novel microcoring technology: A completely new concept of enlarged pore treatment.

BACKGROUND: Enlarged facial pores are a common dermatological and cosmetic concern, which are difficult to treat because their pathogenesis is multifactorial. Many technological treatments have been developed to treat enlarged pores. Despite these efforts, enlarged pores remain problematic for many patients. OBJECTIVES: Microcoring technology has recently been developed to treat pores and serve as a leading primary treatment option to address these concerns. METHODS: Three patients underwent a single treatment of rotational fractional resection. The 0.5 mm diameter rotating scalpels were used to resect the skin pores in the cheek region. The resected site was evaluated 30 days after treatment, and the patients underwent scanning in bilateral 45° views at 60 cm from the face with the same brightness setting. RESULTS: The three patients improved in terms of enlarged pores and had no severe skin-related adverse effects. Furthermore, the three patients showed satisfactory treatment outcomes after 30 days of follow-up. CONCLUSION: Rotational fractional resection is a new concept that produces measurable permanent results for enlarged pore removal. These cosmetic procedures produced promising outcomes in a single treatment. However, the current clinical procedures trend demands minimally invasive treatment for enlarged pores.

Decreased Expression of Urethral Caveolin-1, -2, and -3 in the Rat Model of Overactive Bladder: Potential Mediator of Functional Interaction of Urethra and Urinary Bladder.

PURPOSE: To investigate the effect of detrusor overactivity (DO) on the urethral expression of caveolin (CAV)-1, -2, and -3 of urethra in an animal model of cyclophosphamide (CYP)-induced cystitis rat. METHODS: Female Sprague-Dawley rats were divided into the control group (n=20) and the cystitis group (n=20). Cystitis was induced by intraperitoneal injection of CYP (200 mg/kg). An urodynamic study was done 3 days after the CYP injection to measure functional change of the urinary bladder and urethra. Cellular localization and expression of CAV-1, -2, and -3 in the rat urethra were determined by immunohistochemistry (IHC) and Western blot. RESULTS: Urodynamic experiments demonstrated a decreased contraction interval in the cystitis group compared to the control (3.9±1.0 minutes vs. 6.6±1.2 minutes, P<0.05). Conversely, contraction pressure increased significantly in the cystitis group compared to the control (22.4±0.7 mmHg vs. 11.5±0.4 mmHg, P<0.05). The urethral pressure was decreased in the cystitis group compared to the control (4.05 ±2.5 mmHg vs. 5.8 ±2.8 mmHg, P <0.05). The IHC and Western blot data showed that CAV-1, -2, and -3 expression decreased significantly in the cystitis group compared control group (P<0.05). CONCLUSION: The decreased urethral CAV-1, -2, and -3 in the DO rats suggests that CAVs might be related with the functional change of urethra in association with DO of urinay bladder.

Inflammatory Endotypes of Chronic Rhinosinusitis in the Korean Population: Distinct Expression of Type 3 Inflammation.

PURPOSE: Cluster analyses on inflammatory markers of chronic rhinosinusitis (CRS) in Asians from multicenter data are lacking. This multicenter study aimed to identify the endotypes of CRS in Koreans and to evaluate the relationship between the endotypes and clinical parameters. METHODS: Nasal tissues were obtained from patients with CRS and controls who underwent surgery. The endotypes of CRS were investigated by measuring interleukin (IL)-5, interferon (IFN)-γ, IL-17A, IL-22, IL-1ß, IL-6, IL-8, matrix metalloproteinase-9, eotaxin-3, eosinophil cationic protein, myeloperoxidase (MPO), human neutrophil elastase (HNE), periostin, transforming growth factor-ß1, total immunoglobulin E (IgE), and staphylococcal enterotoxin (SE)-specific IgE. We performed hierarchical cluster analysis and evaluated the phenotype, comorbidities, and Lund-Mackay computed tomography (LM CT) score in each cluster. RESULTS: Five clusters and 3 endotypes were extracted from 244 CRS patients: cluster 1 had no upregulated mediators compared to the other clusters (mild mixed inflammatory CRS); clusters 2, 3, and 4 had higher concentrations of neutrophil-associated mediators including HNE, IL-8, IL-17A, and MPO (T3 CRS); and cluster 5 had higher levels of eosinophil-associated mediators (T2 CRS). SE-specific IgE was undetectable in T3 CRS and had low detectable levels (6.2%) even in T2 CRS. The CRS with nasal polyps (CRSwNP) phenotype and LM CT scores showed no significant differences between T2 and T3 CRS, while the incidence of comorbid asthma was higher in T2 CRS than T3 CRS. In T3 clusters, higher levels of neutrophilic markers were associated with disease severity and CRSwNP phenotype. CONCLUSIONS: In Koreans, there is a distinct T3 CRS endotype showing a high proportion of CRSwNP and severe disease extent, along with T2 CRS.

Course Transformation to Enhance Student Learning in Undergraduate Nursing Course: From a Self-Determination Theory Perspective.

AIM: The purpose of the study was to investigate whether course transformation teaching strategies using repetitive quizzing and peer-tutor supplemental instruction help enhance students' learning experiences and learning outcomes based on self-determination theory. BACKGROUND: Undergraduate baccalaureate pharmacology and pathophysiology courses were redesigned as part of a campus-wide course transformation program to promote students' perceptions of learning and academic achievement. METHOD: Students in the nursing pathopharmacology course participated in the two-time online perception survey (pretest and posttest) and knowledge-based exams. RESULTS: Results revealed that the course transformation implemented to support students' basic psychological needs was significantly associated with both learning outcomes and students' feelings of competence while also decreasing attrition rates. CONCLUSION: Considering the depth and breadth of pathopharmacology content, the teaching intervention using repetitive quizzing and peer-tutor supplemental instruction may contribute to improving students' understanding of the course content while promoting their competence.

Associations Between Chronic Rhinosinusitis and Cancers: A Nationwide Population-Based Cohort Study.

OBJECTIVE: Chronic rhinosinusitis (CRS) is one of the most common chronic inflammatory diseases. The effect of chronic inflammation caused by CRS on the occurrence of various cancers has not been thoroughly evaluated. This study aimed to investigate the increased incidences of 10 types of cancers among CRS patients with/without nasal polyps (NP) using a national population-based database from the Korean Health Insurance Review and Assessment Service. STUDY DESIGN: A case-control cohort study. METHODS: We compared the prevalence of various comorbidities between CRS and control participants from a national cohort dataset of the Korean Health Insurance Review and Assessment Service. METHODS: CRS participants (n = 6,919) and non-CRS (n = 27,676) participants were selected from among the 514,866 participants from 2002 to 2015. A stratified Cox proportional hazards model was utilized to assess the hazard ratio (HR) of CRS for 10 types of cancers. RESULTS: A stratified Cox proportional hazard model demonstrated that the adjusted HR for hematologic malignancy was significantly higher in the CRS patients than in the controls regardless of the presence of NP (2.90 for total CRS; 2.15 for CRS with NP; 4.48 for CRS without NP). The HR for thyroid cancer was significantly higher in the CRS patients without NP but not in those with NP (1.50 for total CRS; 1.78 for CRS without NP). CONCLUSION: This study showed that CRS participants had a significantly higher prevalence of hematologic malignancy and thyroid cancer. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:1044-1051, 2023.

Incidence of Asthma, Atopic Dermatitis, and Allergic Rhinitis in Korean Adults before and during the COVID-19 Pandemic Using Data from the Korea National Health and Nutrition Examination Survey.

The prevalence of allergic diseases has been increasing globally prior to COVID-19. The pandemic resulted in changes in lifestyle and personal habits such as universal mask-wearing and social distancing. However, there is insufficient information on the impact of the COVID-19 pandemic on the prevalence of allergic conditions such as asthma, atopic dermatitis, and allergic rhinitis. We analyzed the incidence rate for self-reported and doctor-diagnosed cases of allergic diseases of asthma, atopic dermatitis, and allergic rhinitis. A total of 15,469 subjects were registered from a national cohort dataset of the National Health and Nutrition Examination Survey. Using multiple logistic regression analysis, we calculated the adjusted odds ratio (OR) for each disease in 2020 compared to 2019. Subgroup analyses were performed according to age and sex. There were no statistically significant differences between the incidence of doctor-diagnosed and current allergic diseases in 2019 and 2020 (asthma, p = 0.667 and p = 0.268; atopic dermatitis, p = 0.268 and p = 0.973; allergic rhinitis, p = 0.691 and p = 0.942, respectively), and subgroup analysis showed consistent results. Among the Korean population from 2019 to 2020, the incidence of the allergic diseases asthma, atopic dermatitis, and allergic rhinitis did not decrease as expected.

Korean nurses' perception and performance on communication with physicians in clinical deterioration.

Effective communication between nurses and physicians is necessary for prompt and accurate responses in clinical deterioration. This study aimed to examine nurses' perception and performance of communication with physicians in clinical deterioration situations in the ward. A descriptive research design with a survey of 250 ward nurses working in 2 tertiary hospitals was used. Regarding communication with the physician, nurses' perception was highest for timeliness, followed by accuracy, understanding, satisfaction, and openness, and their performance was highest for preparation, followed by situation, background, assessment, and recommendation. It is suggested that proactive activities for improving openness, accuracy, satisfaction, and mutual understanding between physicians and nurses are required for patient safety. Additionally, the performance for assessment and recommendations should be improved. Education programs for nurses and physicians should be developed and applied to clinical practice to promote understanding and trust in interprofessional communication.

Therapeutic effect of intra-articular injected 3'-sialyllactose on a minipig model of rheumatoid arthritis induced by collagen.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic inflammatory disease of joint, but there is no known cure. 3'-sialyllactose (3'-SL) is an oligosaccharide that is abundant in breast milk of mammals, and has anti-inflammatory properties. However, the efficacy of 3'-SL on RA remains unclear. The objective of the present study was to evaluate the therapeutic effect of 3'-SL after it was directly injected into the knee joint cavity of a RA minipig model. RESULTS: Minipig RA model was induced by intra-articular injection of bovine type II collagen emulsified with complete or incomplete Freund's adjuvant into left knee joint. In clinical assessment, lameness and swelling of the hindlimb and increased knee joint width were observed in all animals. After the onset of arthritis, 3'-SL (0, 2, 10, and 50 mg/kg) was directly administered to the left knee joint cavity once a week for 4 weeks. Compared to the vehicle control group, no significant difference in macroscopic observation of the synovial pathology or the expression of inflammation-related genes (IL-1ß, TNF-α, and COX2) in the synovial membrane of the knee joint was found. In microscopic observation, cell cloning of the articular cartilage was significantly reduced in proportion to the concentration of 3'-SL administered. CONCLUSIONS: Our results suggest that intra-articular injected 3'-SL had a therapeutic effect on collagen-induced arthritis at the cellular level with potential as a medication for RA.

Clinical characteristics and outcome of iatrogenic colonic perforation related to diagnostic vs. therapeutic colonoscopy.

AIM: Iatrogenic colonic perforation (ICP) is a rare serious complication of colonoscopy, where standard treatment is controversial. This study aimed to characterize diagnostic ICP (DICP) compared to therapeutic ICP (TICP) and determine the possible indication of endoscopic repair. METHODS: We studied patients with ICP over 7 years starting in 2011. Their demographics and data regarding perforation, treatment, and outcome were investigated by retrospective review of medical records, and the diagnostic and therapeutic groups were compared. RESULTS: Among 29,882 patients who underwent colonoscopy, ICP was identified in 28 (0.09%: diagnostic, 15/24,758, 0.06%; therapeutic, 13/5124, 0.25%). A total of 56 patients (33 DICP and 23 TICP) including 28 referred cases were analyzed. Mean age was 62.3 ± 11.4 years, and 24 were men. Perforations occurred mostly in the rectosigmoid region and half were detected during or immediately after colonoscopy. Endoscopic treatment was successful in 22 cases and 34 required surgery. Mortality occurred in 4 (7.1%). Compared to TICP, DICP was more prevalent in females and rectosigmoid region and more frequently detected immediately (all p < 0.05); DICP tended to occur in older patients, be larger and have better chance of endoscopic repair. Regardless of type of ICP, female predominance, smaller perforation, more frequent immediate detection, and shorter hospital stay (all p = 0.01) were found in the endoscopic repair group. CONCLUSION: DICP was more frequent in the rectosigmoid area in older women and could be detected immediately. Immediate detection and small perforation size could be important factors for endoscopic repair. Careful attention and gentle manipulation should be required.