Subcutaneous emphysema and pneumomediastinum following orbital blowout pathological fracture in a cat with nasal lymphoma: a case report.

BACKGROUND: Subcutaneous emphysema and pneumomediastinum are rare complications associated with orbital blowout pathological fracture. CASE PRESENTATION: A 7-year old, castrated male Abbysinian cat presented with anorexia, lethargy, nausea, eyelid swelling, nasal discharge, and sneezing. Based on the clinical and diagnostic work-up, the cat was diagnosed with T cell high-grade nasal lymphoma associated with orbital pathological fracture due to the tumour invasion. After chemotherapy, the cat showed massive subcutaneous emphysema from frontal region to abdomen and pneumomediastinum due to orbital blowout pathological fracture. As the nasal mass decreased in volume; the air had moved from the maxillary sinus to the subcutaneous region and the mediastinum through fascial planes in the head and neck region. CONCLUSIONS: This is a first case report of a massive subcutaneous emphysema and pneumomediastinum due to an orbital blowout pathological fracture following chemotherapy in feline nasal lymphoma in veterinary medicine.

VERTEBRAL HEART SCALE SYSTEM IN CLINICALLY HEALTHY SIBERIAN WEASEL (MUSTELA SIBIRICA).

In several species, the vertebral heart scale (VHS) measurement is frequently used to provide a more objective evaluation of cardiomegaly. However, normal-sized parameters for radiographic measures of the cardiac silhouette in Siberian weasels (Mustela sibirica) have not been determined. Right lateral (n = 24) and ventrodorsal (n = 20) thoracic radiographs from free-ranging Siberian weasels with clinically normal cardiac and pulmonary function were acquired and evaluated to determine the specific VHS for the Siberian weasel. The mean (SD) VHS of the right lateral (RL) and the ventrodorsal (VD) views were 6.70 (0.60) and 6.95 (0.69), respectively. VD view radiographs had a considerably higher VHS than RL view radiographs, and RL view measures were less variable than VD view values. The VHS of Siberian weasels was unaffected by age, body weight, or sex. The results determined in this study can be used in clinical diagnostic and radiographic evaluations of Siberian weasels.

Who is more likely to adopt and comply with the electronic patient-reported outcome measure (ePROM) mobile application? A real-world study with cancer patients undergoing active treatment.

PURPOSE: This study aims to identify factors associated with the adoption and compliance of electronic patient-reported outcome measure (ePROM) use among cancer patients in a real-world setting. METHODS: This prospective cohort study was conducted at the Samsung Medical Center in Seoul, Korea, from September 2018 to January 2019. Cancer patients aged 18 years or older who owned smartphones and who were receiving chemotherapy or radiation therapy were eligible for this study. Patients were asked to use the app to report their symptoms every 7 days for a total of 21 days (3 weeks). Logistic regression was performed to identify the factors associated with the adoption and compliance. RESULTS: Among 580 patients, 417 (71.9%) adopted the ePROM app and 159 (27.4%) out of 417 had good compliance. Patients who had greater expectations regarding the ease of use (adjusted odds ratio [aOR] 2.67, 95% CI: 1.28-5.57) and usefulness (aOR 1.69, 95% CI: 1.05-2.72) of the ePROM app were more likely to adopt the app than those who did not. Patients who had greater satisfaction with usefulness (aOR 1.89, 95% CI 1.10-3.25) were more likely to comply with using the app, but satisfaction with ease of use was not related to the compliance. CONCLUSION: While expectation regarding the ease of use and usefulness of the ePROM app was associated with the adoption of the app, satisfaction with ease of use was not related to compliance with the ePROM app. Satisfaction with usefulness was associated with the compliance of ePROM app use.

Comparison of cross-sectional area and fat infiltration of suboccipital muscles between normal dogs and dogs with atlantoaxial instability.

BACKGROUND: Atlantoaxial instability (AAI) is primarily a congenital neurological disorder affecting young toy-breed dogs. So far, most studies have focused on bones and ligaments related to AAI, and there are no studies on the suboccipital muscles (SOMs) that occupy a large area from the occipital bone to C2 in dogs. This study evaluated the cross-sectional area (CSA) and fat infiltration of the SOMs using magnetic resonance imaging (MRI), specifically, T1-weighted images, in normal dogs (≤ 5 kg) and AAI dogs. The relationship between the severity of the neurological symptoms of AAI (group A and group B) and the values from MRI was also assessed. RESULTS: AAI dogs had significantly smaller CSA (P = 0.029) and greater fat infiltration (P = 0.044) of the SOMs compared to normal dogs. AAI dogs with mild neurological symptoms for a long period (group A) had greater fat infiltration than AAI dogs with severe neurological symptoms (group B) (P = 0.035). CONCLUSIONS: The muscle changes are most likely due to spinal cord compression resulting from instability; however, the possibility that chronic changes of the muscle may play an additional role in maintaining stability in this region cannot be excluded. This study provides fundamental quantitative information of the SOMs in normal and AAI dogs.

Quad-dimensional acculturation, cultural integration, and life satisfaction of South Sudanese refugee young adults in the United States: A quasilongitudinal qualitative study.

OBJECTIVE: This study aims to describe acculturation among South Sudanese refugees (SSRes) as young adults in the U.S. based on a tridimensional (3D) acculturation framework. METHOD: Aligning with a community-based participatory research (CBPR) approach, the present study was designed to investigate in-depth individual experiences of SSRes in two phases, conducting 19 interviews in 2007 and 11 interviews in 2014-2015. The data analysis employed a modified grounded theory approach. RESULTS: A grounded theory emerged indicating that, over time, SSRes experienced quad-dimensional acculturation that included South Sudanese, mainstream American, African American, and African cultures and orientations. Although bidimensional acculturation was prominent in Phase 1, quad-dimensional acculturation emerged and was salient in Phase 2. Furthermore, participants who demonstrated an integrated perspective toward their acculturation tended to report higher life satisfaction scores than those who expressed conflicted perspectives. CONCLUSIONS: The findings have theoretical and practical implications for African refugees' adjustment and psychological well-being. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Measurement of tracheal diameters using ultrasonography versus computed tomography in Beagle dogs.

OBJECTIVE: To compare ultrasonography with computed tomography (CT) for assessment of tracheal diameter as a feasibility study for endotracheal tube selection. STUDY DESIGN: Prospective study. ANIMALS: A total of nine Beagle dogs with a median (interquartile range) weight of 7.4 (7.2-7.7) kg. METHODS: Tracheal diameter measurements were obtained at two locations: 1 cm proximal to caudal border of the cricoid cartilage (sublaryngeal; SL) and dorsal to above cranial border of the manubrium (thoracic inlet; TI). For CT, dogs were anesthetized with propofol and sevoflurane, in sternal recumbency, and measurements obtained after controlled ventilation-induced apnea and the endotracheal tube cuff was deflated. Transverse diameter, right and left 45° oblique diameters were measured. For ultrasonography, unsedated dogs were standing with slight neck extension, and images obtained in ventrodorsal, 45° right and left oblique ways after expiration. Diameters between the tracheal lumen mucosal borders were measured. The degree of agreement between the tracheal diameters measured at SL and TI locations with CT (TDCT-SL and TDCT-TI) and ultrasonography (TDUS-SL and TDUS-TI) was verified using the Bland-Altman method. RESULTS: The agreement between the measurements obtained with CT and ultrasonography was revealed by Bland-Altman analyses, although ultrasonography tended to slightly underestimate the tracheal diameter. CONCLUSIONS AND CLINICAL RELEVANCE: Ultrasonography can be applied for tracheal diameter measurement. Although further studies are required, an endotracheal tube selection method, using ultrasonography, could be proposed.

Development and Validation of Digital Health Technology Literacy Assessment Questionnaire.

In clinical practice, assessing digital health literacy is important to identify patients who may encounter difficulties adapting to digital health using digital technology and service. We developed the Digital Health Technology Literacy Assessment Questionnaire (DHTL-AQ) to assess the ability to use digital health technology, services, and data. The DHTL-AQ was developed in three phases. In the first phase, the conceptual framework and domains and items were generated from a systematic literature review using relevant theory and surveys. In the second phase, a cross-sectional survey with 590 adults age ≥ 18 years was conducted at an academic hospital in Seoul, Korea in January and February 2020 to test face validity of the items. Then, psychometric validation was conducted to determine the final items and cut-off scores of the DHTL-AQ. The eHealth literacy scale, the Newest Vital Sign, and 10 mobile app task ability assessments were examined to test validity. The final DHTL-AQ includes 34 items in two domains (digital functional and digital critical literacy) and 4 categories (Information and Communications Technology terms, Information and Communications Technology icons, use of an app, evaluating reliability and relevance of health information). The DHTL-AQ had excellent internal consistency (overall Cronbach's α = 0.95; 0.87-0.94 for subtotals) and acceptable model fit (CFI = 0.821, TLI = 0.807, SRMR = 0.065, RMSEA = 0.090). The DHTL-AQ was highly correlated with task ability assessment (r = 0.7591), and moderately correlated with the eHealth literacy scale (r = 0.5265) and the Newest Vital Sign (r = 0.5929). The DHTL-AQ is a reliable and valid instrument to measure digital health technology literacy.

Duodenal perforation in a puppy with canine parvovirus infection.

A 2-month-old puppy was brought to a veterinary hospital with diarrhea, vomiting, and anorexia. The test for canine parvovirus was positive, and she was hospitalized for supportive care. Her gastrointestinal symptoms initially improved; however, vomiting and lethargy developed again in the second week of hospitalization. Abdominal ultrasonography results were suspicious of a duodenal perforation. Cytology of the abdominal effusion confirmed septic peritonitis; therefore, emergency exploratory laparotomy was performed. The surgery was successful, and the puppy recovered fully. When symptoms recur or deteriorate in patients with parvoviral infection, surgically curable complications may be disregarded if supportive therapy is continued without additional investigative examinations. This report highlights the usefulness of abdominal ultrasound in conjunction with fluid cytology to identify subsequent complications when the clinical signs of parvovirus deteriorate. Key clinical message: This case report demonstrates duodenal perforation as a complication of parvoviral infection. Abdominal ultrasonography and peritoneal fluid cytology can be crucial for the early recognition of intestinal complications requiring immediate successful perioperative treatment.

Perforation duodénale chez un chiot infecté par le parvovirus canin. Un chiot de 2 mois a été amené dans un hôpital vétérinaire avec de la diarrhée, des vomissements et de l'anorexie. Le test de dépistage du parvovirus canin était positif et l'animal a été hospitalisé pour des soins de soutien. Ses symptômes gastro-intestinaux se sont initialement améliorés; cependant, des vomissements et une léthargie se sont à nouveau développés au cours de la deuxième semaine d'hospitalisation. Les résultats de l'échographie abdominale étaient suspects d'une perforation duodénale. La cytologie de l'épanchement abdominal a confirmé une péritonite septique; par conséquent, une laparotomie exploratrice d'urgence a été réalisée. L'opération a été un succès et le chiot s'est complètement rétabli. Lorsque les symptômes réapparaissent ou s'aggravent chez les patients atteints d'une infection parvovirale, les complications soignables chirurgicalement peuvent être ignorées si le traitement de soutien est poursuivi sans examens d'investigation supplémentaires. Ce rapport souligne l'utilité de l'échographie abdominale en conjonction avec la cytologie du liquide péritonéal pour identifier les complications ultérieures lorsque les signes cliniques associés au parvovirus se détériorent.Message clinique clé :Ce rapport de cas démontre une perforation duodénale comme complication d'une infection parvovirale. L'échographie abdominale et la cytologie du liquide péritonéal peuvent être cruciales pour la détection précoce des complications intestinales nécessitant un traitement per-opératoire immédiat réussi.(Traduit par Dr Serge Messier).

Non-strangulated adhesive small bowel obstruction: CT findings predicting outcome of conservative treatment.

OBJECTIVES: To clarify CT findings that predict outcome of conservative treatment in patients with non-strangulated adhesive small bowel obstruction (SBO). METHODS: Unenhanced and contrast-enhanced abdominopelvic CT studies in 189 patients with adhesive SBO who had initial conservative treatment were reviewed. The CT findings included transition zone, beak signs, maximum bowel diameter, bowel diameter ratio, decreased bowel wall enhancement, increased unenhanced bowel wall attenuation, anterior parietal adhesion, bowel wall thickening, closed-loop obstruction, small bowel feces sign, whirl sign, mesenteric haziness, mesenteric, peritoneal fluid, and submucosal edema. These findings were statistically compared according to the success or failure of treatment. RESULTS: Conservative treatment succeeded in 144 patients (76.2%) and failed in 45 patients (23.8%). At multivariate analysis, the lack of small bowel feces sign, focal, diffuse mesenteric haziness, and moderate amount of mesenteric fluid were independent findings predicting failure of conservative treatment, with odds ratios of 5.23, 5.5, 13.55, and 4.89, respectively. The presence of all significant findings showed a high specificity of 97.2% with positive likelihood ratio of 8.8. If CT scans showed none of the three significant findings, the negative predictive value was 97.6% and negative likelihood ratio was 0.08. CONCLUSIONS: The lack of small bowel feces sign, focal, diffuse mesenteric haziness, and moderate amount of mesenteric fluid are independent CT findings predicting the failure of conservative treatment in patients with non-strangulated adhesive SBO. The combination of all CT findings suggests the need for surgery; absence of two or all CT findings should suggest an attempt for conservative treatment. KEY POINTS: • To minimize delayed operation, it is important to identify non-strangulated adhesive small bowel obstruction patients in whom initial conservative treatment is likely to fail. • The lack of small bowel feces sign, the presence of mesenteric haziness, and a moderate amount of mesenteric fluid are independent factors predicting the failure of conservative treatment in patients with non-strangulated adhesive small bowel obstruction. • The combination of all three CT findings suggests the need for surgery; absence of two or all three CT findings should suggest an attempt for conservative treatment.

Patient-Reported Outcomes Measurement Information System: Translation and Linguistic Validation of Six Profile Domains for Korean Adults.

BACKGROUND: The purpose of the study was to translate and linguistically validate a Korean language version of the PROMIS (K-PROMIS) for the six profile adult domains: Fatigue, Pain Intensity, Pain Interference, Physical Function, Sleep Disturbance, and Ability to Participate in Social Roles and Activities. METHODS: A total of 268 items were translated into Korean according to the Functional Assessment of Chronic Illness Therapy multilingual translation methodology. Participants first completed approximately 27 to 35 items and were then interviewed to evaluate the conceptual equivalence of the translation to the original English language source. The K-PROMIS items that met the a priori threshold of ≥ 20% of respondents with comprehension difficulties in the cognitive interview. RESULTS: 54 of the 268 items were identified as difficult items to comprehend for at least 20% of respondents in Round 1. The most frequently identified K-PROMIS domain on difficult items to comprehend was the Physical function (24.5%). Most items with linguistic difficulties were Fatigue and Physical function. Cultural difficulties were only included the Physical function and Ability to Participate in Social Roles and Activities domains. 25 of 54 items were slightly revised, and then these revised items were tested with additional six participants in Round 2, and most participants had no problems to understand modified items. CONCLUSION: The six profile adult domains of K-PROMIS have been linguistically validated. Further psychometric validation of the K-PROMIS items will provide additional information of meaningful outcomes for chronic disease and clinical setting.

Antegrade and retrograde CT urethrography with virtual urethroscopy in a dog with urethral narrowing after bilateral triple pelvic osteotomy.

An 8-month-old, castrated male Golden Retriever was unable to urinate without catheterization after a single-session bilateral triple pelvic osteotomy. To determine the cause, a retrograde urethrography was performed, but the results were equivocal. Antegrade (voiding by abdominal compression with heavy material) and retrograde CT urethrography were performed with virtual urethroscopy and revealed that the urethral diameter was narrowed near the pubic bone remnants due to pelvic canal narrowing. After corrective surgery, the patient was able to urinate normally. A combination of antegrade and retrograde CT urethrography with virtual urethroscopy was helpful for guiding surgical decision-making in this patient.

The urethra of healthy female dogs can be normally narrowed due to the urethral flexure in retrograde CT urethrography.

Quantitative analysis of urethral size in male dogs by retrograde CT urethrography using a power injector is a recently reported technique. The aim of the current, prospective, analytical study was to apply the same method to six, healthy, intact female Beagle dogs. The proximal (P < .0001) and middle (P = .0010) urethral volumes significantly differed between the empty and distended bladder states, although no significant difference was observed in the distal volume (P = .0971). Unlike male dogs, female dogs showed two patterns of the urethral course: a straight urethra and urethral flexure. The urethral flexure was always related to intrapelvic position of the urinary bladder, and the more caudal the location of the vesicourethral junction beyond the pecten of the pubic bone, the more marked the appearance of the urethral flexure. Analysis of the urethral diameter at five sites (adopted from the previous radiographic study) was performed, and the urethral diameter showed a significant difference between the empty and the distended bladder states at sites 1 (vesicourethral junction, P < .0001), 2 (P < .0001), and 3 (P = .0244). However, there were no significant differences at sites 4 (P = .2516) and 5 (inflatable retention bulb, P = .1260). The urinary bladder may be in part intrapelvically located in clinically healthy female dogs, and urethral flexure and urethral narrowing can result from the intrapelvic location of the bladder. Narrowing of the urethra should be interpreted with caution when the pelvic bladder is identified.

Computed tomographic lymphangiography of the thoracic duct by subcutaneous iohexol injection into the metatarsal region.

OBJECTIVE: To evaluate the efficacy of subcutaneous iohexol injection into the metatarsal region for thoracic duct lymphangiography in dogs and to determine the minimum effective dose. STUDY DESIGN: Experimental study and clinical report. ANIMALS: Five healthy beagle dogs and one dog with chylothorax. METHODS: For the experimental study, iohexol was injected subcutaneously into the metatarsal region of five dogs at three doses (0.5, 0.75, and 1 mL/kg), and the injection sites were massaged gently. Computed tomography (CT) was performed 1, 3, 5, 7, 10, 15, and 20 minutes after iohexol injection. Subjective quality was assessed, and Hounsfield unit values were measured at several regions of interest (T1, T4, T8, T13, and L3). In the dog with chylothorax, iohexol (1.0 mL/kg) was injected into the right metatarsal region prior to CT. RESULTS: The thoracic duct was visualized and enhanced by contrast in all dogs after injection of 0.75 and 1.0 mL/kg of iohexol, and in two dogs after injection of 0.5 mL/kg at 3, 5, and 7 minutes. The thoracic duct was gradually attenuated with increasing doses of iohexol. In the dog with chylothorax, the entire thoracic duct was well enhanced and dilated, and tortuous cranial mediastinal lymphatics were detected. CONCLUSION: The thoracic duct was visualized when at least 0.75 mL/kg of iohexol was injected subcutaneously into the metatarsal region of dogs. CLINICAL SIGNIFICANCE: Subcutaneous injection of iohexol into the metatarsal region offers a simple alternative to conventional thoracic duct lymphangiography.

MRI utricle diameter asymmetry is significantly greater in dogs with idiopathic vestibular syndrome compared with unaffected dogs.

Idiopathic vestibular syndrome (IVS) is the most common cause of acute unilateral peripheral vestibular dysfunction in older dogs. The purpose of this retrospective, cross-sectional study was to characterize morphological changes in the utricle of dogs affected by IVS, using MRI. To evaluate differences between affected and unaffected utricles, the ratio of the largest to the smallest utricle diameter was obtained, as measured on transverse T2-weighted images, and defined as the utricle asymmetricity ratio (UAR). Out of 137 patients diagnosed with IVS after excluding other vestibular diseases by MRI, 101 were eligible for inclusion. Additionally, 31 older dogs with no signs of vestibular disorders or other intracranial diseases were included as a control group. The disease group was divided into two subgroups in which the direction of head tilt and nystagmus symptoms versus the decreased utricle diameters were consistent or inconsistent. The medians of UARs of the IVS and control groups were 0.83 (range 0.37-1.00) and 0.98 (0.70-1.00), respectively. The medians of the UARs of the consistent and inconsistent IVS subgroups were 0.82 (0.37-0.99) and 0.90 (0.74-1.00), respectively. The UAR of the IVS group was significantly decreased than that of the control group and UAR of the consistent sub-group was significantly decreased than that of the inconsistent sub-group (P < .01). In conclusion, significant asymmetry of utricle diameter was identified in dogs with IVS versus unaffected dogs. We propose that canine IVS may possibly be correlated with structural atrophy of the vestibular system.

Retrograde CT urethrography using a power injector quantitatively reveals effects of bladder distension on urethral size in healthy male Beagle dogs.

Quantitative analysis of the normal retrograde urethrogram is well reported in radiography, but studies on CT urethrography are lacking. Recently, a method of retrograde CT urethrography using a power injector was described. The purpose of the current, prospective, analytical study was to quantify the urethral size of five, healthy, intact, male Beagle dogs using retrograde CT urethrography and a power injector. With the injection rate of the power injector set at 0.3 mL/s, 1 mL/kg of diluted contrast medium (15 mg I/mL) was injected, and a CT examination was performed. The state of the initial urethrogram taken was defined as "empty bladder." The same procedures were repeated with the injection of an additional 1 mL/kg of diluted contrast medium until the ureteral reflux was seen (distended bladder). There was a significant difference in volumes between the empty and distended bladder, but the membranous urethra showed the least difference (P = .0044) among the three regions (P < .0001 for the prostatic and penile urethra). Urethral diameters at six sites were measured from sagittal images, and the sites of measurements were adopted from the earlier radiographic studies. The most significant difference in the urethral diameters between the empty and distended bladder occurred at the cranial and middle prostatic urethra (P < .0001). The results of this study can be useful for interpreting the results of retrograde CT urethrography. Care must be taken when narrowing is suspected at the prostatic urethra, and if necessary, further distension of the urinary bladder should be tried.

Canine pyoderma gangrenosum with recurring skin lesions of unknown origin and splenic involvement.

BACKGROUND: Reports of canine pyoderma gangrenosum (PG) are uncommon in the veterinary literature. Rarer still are cases describing dogs with both skin lesions and internal organ involvement. OBJECTIVE: To describe a case of canine PG with skin and internal organ involvement. ANIMALS: A client-owned dog. METHODS AND MATERIALS: Complete blood count, serum chemistry, C-reactive protein and SNAP cPL tests, and abdominal ultrasonography and fine-needle aspiration of the spleen were performed. RESULTS: The dog was treated with oral prednisolone and ciclosporin. After three months of therapy, ultrasonography revealed normalization of the spleen and resolution of skin lesions. CONCLUSION AND CLINICAL IMPORTANCE: Dogs with skin lesions compatible with PG should be screened carefully for internal organ involvement. Ciclosporin may be a useful treatment for the immediate and long-term management of canine PG.

Computed tomographic bronchial collapsibility values over 50% may be detected in healthy dogs.

Bronchomalacia and bronchial collapse are important causes of chronic coughing in dogs. The current reference standard diagnostic tests for these problems are flexible bronchoscopy and biopsy. Previous human studies have also supported inspiration/expiration computed tomography (CT) as a diagnostic test. The current prospective, pilot study aimed to determine whether inspiration/expiration CT is also a feasible test for quantifying bronchial collapsibility in dogs. Thoracic CT images were acquired using a 64-row multidetector CT for 10 healthy Beagle dogs during maximal inspiration and expiration. For each scan, one observer measured transverse sectional areas of the mainstem and lobar bronchi, and the dorsal and ventral segmental bronchi of the left cranial lobar bronchus. Diameters for each bronchus were also measured in transverse, sagittal, and dorsal planes. Bronchial collapsibility (%) was calculated as the difference between inspiration/expiration transverse sectional areas divided by the inspiration transverse sectional areas. Mean bronchial collapsibility of all bronchi was 38.20 ± 15.17%. A collapsibility of over 50% was found in the dorsal (n = 7) and ventral (n = 4) segmental bronchi of the left cranial lobar bronchus, and the left caudal (n = 5) and right middle (n = 2) lobar bronchus. Bronchial collapsibility measurements were greater in the dorsal and ventral segmental bronchi of the left cranial lobar bronchus and the left caudal lobar bronchus (P < 0.001). Findings supported inspiration/expiration CT as a modality to noninvasively assess bronchial collapse in dogs and a bronchial collapsibility value greater than 50% for detecting pathologic bronchial collapse in clinically affected dogs.

A train the trainer program for healthcare professionals tasked with providing psychosocial support to breast cancer survivors.

BACKGROUND: The objective of this study is to develop, implement, and evaluate a training program for healthcare providers to improve ability to provide psychosocial support to breast cancer survivors in Korea. METHODS: Based on a needs assessment survey and in-depth interviews with breast cancer survivors, a multidisciplinary team developed two-day intensive training program as well as education materials and counseling notes. Participants' overall satisfaction was evaluated after the training. RESULTS: The training program included a total of 16 lectures held over the course of seven sessions. Forty-one nurses and 3 social workers participated in the training program. Mean age was 37.5(± 6.4) years, and on average, they had 11.1 (± 5.6) years of experience. Participants' overall satisfaction was good as following: program contents (4.04), trainee guidebook (3.82), location and environment (4.10), and program organization (4.19). Among the participants, 31 (70.4%) received certification after submitting real consultation cases after the training. CONCLUSION: Two day intensive training can provide a comprehensive and coordinated education to healthcare professionals for implementing survivorship care with an emphasis on psychosocial support. Furthermore, the program should resume as a periodic continuing education course for healthcare providers. Similar education for graduate students in oncology nursing would be beneficial.

In vitro and in vivo safety studies of cinnamon extract (Cinnamomum cassia) on general and genetic toxicology.

Cinnamomum cassia has been widely used as a natural product to treat diseases in Asia due to its diverse pharmacological functions including anti-inflammatory, anti-oxidant, anti-microbial, anti-diabetic, and anti-tumor effects. Despite its ethnomedicinal benefits, little information regarding its toxicity is currently available. The aim of this study was to evaluate its potential long-term toxicity and genotoxicity in compliance with test guidelines of the Organization for Economic Cooperation and Development. A 13-week repeat-dose oral toxicity study revealed that body weights of rats were normal after receiving cinnamon extract at up to 2000 mg/kg. High-dose intake of cinnamon extract (2000 mg/kg) showed potential nephrotoxicity and hepatotoxicity to both males and females as evidenced by obvious increases of kidney/liver weight along with a small but statistically elevation of total cholesterol level. Overall findings from genetic toxicity testing battery including Ames test, in vitro mammalian cell micronucleus assay, and in vivo bone marrow micronucleus assay indicated that cinnamon extract was not mutagenic or clastogenic. In conclusion, cinnamon extract may possess potential nephrotoxicity and hepatotoxicity at dose higher than its recommended daily safe dose. Further study is needed to clarify the mechanism involved in its induction of liver and kidney injury.

Enzymatic extract from Ecklonia cava: Acute and subchronic oral toxicity and genotoxicity studies.

Ecklonia cava (EC) is known to have antioxidant, anti-inflammatory, antidiabetic, and anticancer properties. Despite its wide use and beneficial properties, comprehensive toxicological information regarding EC extract is currently limited. Therefore, the purpose of this study was to investigate acute toxicity, subchronic toxicity, and genotoxicity of enzymatic EC extract according to test guidelines published by Organization for Economic Cooperation and Development. The acute oral LD50 values of this EC extract administered to rats and dogs were estimated to be more than 3000 mg/kg BW. In an oral 13-week toxicity study, changes in body weights of rats exposed to the EC extract up to 3000 mg/kg BW were found to be normal. In addition, repeated doses of EC extract failed to influence any systematic parameters of treatment-related toxic symptoms such as food/water consumption, mortality, urinalysis, hematology, serum biochemistry, organ weight, or histopathology. These results indicated that the no-observed-adverse-effect level for the EC extract was 3000 mg/kg/day for male and female rats. Data obtained from Ames test, chromosome aberration assay, and micronucleus assay indicated that EC extract was not mutagenic or clastogenic. Taken together, these results support the safety of enzymatic EC extract as a potential therapeutic for human consumption against various diseases.