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Purpose This study set out to identify the association between the intraperitoneal CO2 concentrations and postoperative pain by dividing the participants into a control group and 2 experimental groups receiving irrigation (1 L and 2 L), and directly measuring their intraperitoneal CO2 concentrations with a CO2 gas detector. Methods A total of 101 patients, American Society of Anesthesiologists physical status classification I and II patients aged 18–65 years were enrolled in the study. Group 1 did not receive irrigation with normal saline, while groups 2 and 3 were administered irrigation with 1 L and 2 L of normal saline, respectively, after laparoscopic cholecystectomy. Intraperitoneal CO2 concentrations were measured with a CO2 gas detector through the port, and postoperative pain was assessed on a visual analogue scale at 6, 12, and 24 hours after surgery. Results The intraperitoneal CO2 concentrations were 1,016.0 ± 960.3 ppm in group 1, 524.5 ± 383.2 ppm in group 2, and 362.2 ± 293.6 ppm in group 3, showing significantly lower concentrations in groups 2 and 3. Postoperative pain was significantly lower in group 3 at 6 hours after surgery, and in groups 2 and 3 at 12 hours after the surgery. However, there was no significant difference between the 3 groups in postoperative pain 24 hours after the surgery. Conclusion This study found a causal relationship between the amount of normal saline used for irrigation and the intraperitoneal CO2 concentrations in that irrigation with normal saline reduces pain on the day of the surgery.

Background: Oxycodone, a semisynthetic thebaine derivative opioid, is widely used for the relief of moderate to severe pain. The aim of this study was to compare the efficacy and side effects of oxycodone and fentanyl in the management of postoperative pain by intravenous patient-controlled analgesia (IV-PCA) in patients who underwent laparoscopic supracervical hysterectomy (LSH). Methods: The 127 patients were randomized to postoperative pain treatment with either oxycodone (n = 64, group O) or fentanyl group (n = 63, group F). Patients received 7.5 mg oxycodone or 100 μg fentanyl with 30-mg ketorolac at the end of anesthesia followed by IV-PCA (potency ratio 75:1) for 48 hours postoperatively. A blinded observer assessed postoperative pain based on the numerical rating scale (NRS), infused PCA dose, patient satisfaction, sedation level, and side effects. Results: Accumulated IV-PCA consumption in group O was less (63.5 ± 23.9 mL) than in group F (85.3 ± 2.41 mL) during the first 48 hours postoperatively (P = 0.012). The NRS score of group O was significantly lower than that of group F at 4 and 8 hours postoperatively (P

This study aimed to develop and psychometrically test an instrument for measuring patient-perceived satisfaction with community-based case management services in Korea. The study was conducted in 4 phases: Phase I, development of the instrument; Phase II, pilot testing of the instrument; Phase III, a large-scale study to test reliability and validity; and Phase IV, conversion of the new instrument from Korean to English. The new instrument was determined to have six factors—advocacy of case manager, outcome of care, communication skills, practice of a healthy lifestyle, referral, and recognition of risk factors—and also shown to be reliable.

This study aimed to evaluate the reliability and validity of a patient safety competency self-evaluation (PSCSE) tool. An exploratory factor analysis (EFA) was used to investigate the compositions of the PSCSE. The internal structure of the PSCSE was schematized using a confirmatory factor analysis (CFA). Three hundred fifty-four students attending six schools of nursing participated in the study. On the basis of the results of the CFA, the PSCSE consisted of 12 factors (four for attitude, six for skill, and two for knowledge) with a good model fit. It was confirmed that the structures of the PSCSE were identical between EFA and CFA. The PSCSE consisted of multidimensional structures of the 12 factors and hierarchical models of three categories. The PSCSE can be used to assess nursing students’ perception of their own competency regarding patient safety and to develop educational strategies integrating patient safety competency into nursing curricula. [ J Nurs Educ. 2014;53(10):550–562.]

Assuming an association between cancer and metabolism, oncogene-directed metabolic reprogramming in cancer has revealed new target strategies. For example, the LKB1-AMPK-mTOR signaling pathway genes are already known to alter the cell metabolism and to play a critical role in the malignant behavior of cancer. Accordingly, based on the assumption that genetic variations in the LKB1-AMPK-mTOR signaling pathway can change the intracellular signal in terms of metabolic reprogramming, the present study analyzed 18 single nucleotide polymorphisms (SNPs) of the STK11, PRKAA1, TSC1/2, and mTOR genes and their impact on the survival of patients with colorectal cancer. Seven hundred seventy-two patients with surgically resected colorectal adenocarcinoma were enrolled in the present study. Eighteen SNPs were selected from an in silico analysis based on previous evidence of association. The SNP genotyping was performed using a SEQUENOM MassARRAY. Among the 18 polymorphisms, three SNPs (STK11 rs741765, PRKAA1 rs461404, and TSC1 rs13295634) were significantly associated with disease-free survival (DFS) or overall survival (OS). In a multivariate analysis, the GG genotype of STK11, TT genotype of PRKAA1, and TG or GG genotype of TSC1 were identified as independent prognostic factors for a worse DFS (hazard ratio = 1.398, 1.408, and 1.388; p = 0.030, 0.013, and 0.002, respectively) and OS (hazard ratio = 1.431, 1.680, and 1.394; p = 0.038, 0.001, and 0.009, respectively). The present results suggest that genetic variants of the STK11, PRKAA1, and TSC1 genes could be used as prognostic biomarkers for patients with surgically resected colorectal cancer.

The purpose of this study was to find optimum treatment conditions for selective photothermolysis by evaluating internal–external heat distributions according to different cooling methods. The 1,064-nm Nd:YAG laser was transmitted into a skin-mimicking phantom with different cooling conditions, and its minimum temperatures and sub-zero times were measured. The cooling methods were classified into a total of eight conditions composed of five cryogen spray cooling conditions and three air cooling conditions. Based on the experimental results, condition 2 was selected as the optimum cooling condition for selective photothermolysis obtained from the cryogen spray cooling method.

The effects of treatment with various complex carbohydrases such as Pectinex, Celluclast, Viscozyme, and Ultraflo on the physiochemical properties, polyphenol extraction yields and antioxidant activities of pear peel and pear core were investigated. When pear peel and pear core were treated with complex carbohydrases, the soluble solid content of peel increased, whereas it did not change significantly in the case of pear core. When pear peel and pear core were treated with Pectinex, significant improvement of soluble solid content was observed along with the highest extraction yield of reducing sugar content. Total sugar content increased in most of the enzyme treatment groups. In the case of pear peel, the Viscozyme treatment group showed the highest total polyphenol contents, total flavonoid contents, DPPH radical scavenging activity, ABTS radical scavenging activity, and SOD-like activity. When the flesh and core of pear were treated with Celluclast, total polyphenol contents increased. All enzyme treatment groups except for the Ultraflo treatment group showed increases in total flavonoid contents. With regard to pear flesh, the Celluclast group showed the highest DPPH radical scavenging activity. When pear core was treated with the four complex carbohydrases, DPPH radical scavenging activity and ABTS radical scavenging activity did not increase significantly. However, the SOD-like activity of all enzyme treatment groups significantly increased. Consequently, dry matter and soluble solid contents, polyphenol content, and antioxidant activity of pear peel and core could be improved by complex carbohydrase treatment.

Aim Systemic inflammatory response (SIR) has been reported to be an important determinant of disease progression and survival in patients with colorectal cancer. This study investigated the prognostic relevance of changes in the platelet count on survival and the predictive value of changes in platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) on the pathological tumor response to preoperative chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC). Patients and methods From 2006 to 2015, 291 consecutive patients with LARC who were treated with preoperative CRT followed by curative surgery at the Kyungpook National University Medical Center (Daegu, Korea) were retrospectively analyzed. A cut-off value of 370×103/μl for the platelet count was used and a PLR ≥235 was defined as high. Any change in the PLR or NLR was calculated based on subtracting the pre-CRT PLR or NLR from the post-CRT values. Results A total of 17.5% patients had stage II and 82.5% had stage III LARC. Initially high NLR and PLR were significantly associated with poor clinical outcomes. Patients who maintained a high platelet count after CRT also had an advanced pathological stage (p=0.028), low pathological complete response rate (p=0.048), and high relapse rate (p=0.021). For patients with an initially low PLR, the multiple logistic regression analysis revealed that a high PLR change (odds ratio (OR)=2.301, 95% confidence interval (CI)=1.269-4.174; p=0.006) and clinical stage II compared to stage III (OR=1.878, 95% CI=1.231-2.865; p=0.003) were significant independent markers predictive of a good response to CRT. Conclusion The present results suggest that platelet and PLR change after preoperative CRT, along with the initial platelet count, can be used as prognostic and predictive markers for the oncological outcomes in patients with LARC.

Importance Hearing loss is a highly prevalent condition with multiple negative associated outcomes, yet few persons with hearing loss have hearing aids (HAs). Personal sound amplification products (PSAPs) could be an alternative low-cost solution to HAs, but data are lacking on the performance of PSAPs. Objective To evaluate the clinical efficacy of a PSAP by comparing its performance with that of a basic HA and a premium HA in participants with mild, moderate, and moderately severe hearing impairment. Design, Setting, and Participants A prospective, single-institution cohort study was performed with a total of 56 participants, including 19 with mild hearing loss, 20 with moderate hearing loss, and 17 with moderately severe hearing loss. All participants underwent 4 clinical hearing tests with each of the PSAP, basic HA, and premium HA, and all completed an evaluative questionnaire. Interventions All hearing devices (PSAP, basic HA, and premium HA) were applied by a clinician to prevent bias and order effects; participants were blinded to the device in use, and sequence of devices was randomized. Main Outcomes and Measures The study used the Korean version of the hearing in noise test, the speech intelligibility in noise test, listening effort measurement using a dual-task paradigm, pupillometry, and a self-rating questionnaire regarding sound quality and preference. These tests were administered under the following 4 hearing conditions: unaided hearing, use of PSAP, use of basic HA, and use of premium HA. Results The study included 56 participants with a mean age of 56 years (interquartile range, 48-59 years); 29 (52%) were women. In the mild and moderate hearing loss groups, there was no meaningful difference between PSAP, basic HA, and premium HA for speech perception (Cohend = 0.06-1.05), sound quality (Cohend = 0.06-0.71), listening effort (Cohend = 0.10-0.92), and user preference (PSAP, 41%; basic HA, 28%; premium HA, 31%). However, for the patients with moderately severe hearing loss, the premium HA had better performance across most tests (Cohend = 0.60-1.59), and 70% of participants preferred to use the premium HA. Conclusions and Relevance The results indicate that basic and premium HAs were not superior to the PSAP in patients with mild to moderate hearing impairment, which suggests that PSAPs might be used as an alternative to HAs in these patient populations. However, if hearing loss is more severe, then HAs, especially premium HAs, should be considered as an option to manage hearing loss.

A spiritual well-being-based nursing intervention may boost older adults’ resilience-based recovery. Its potential contribution may have positive knock-on effects: controlling skyrocketing healthcare costs; reducing the productive population's social burden of supporting the older adults; and alleviating a generational conflict. However, healthcare policy-makers are still skeptical about investing in those healthcare resources which would develop and implement a spiritual well-being-based nursing intervention for older adults. It is time for nurse scientists, as front-line gatekeepers for patients’ omnidirectional well-being, to escape from thinking within the box by actively addressing first the feasibility, then the direct and indirect effectiveness on actual patient outcomes, and finally the cost efficiency of a spiritual well-being-based nursing intervention for the added benefit of easing the decision-making of healthcare policy-makers.

Background Raynaud’s phenomenon (RP) is a reversible vasoconstriction of digital arteries that causes pain and discoloration. Calcium channel blockers (CCB) such as amlodipine are commonly used as the first-line treatment. However, in severe cases, additional vasodilators of other classes are needed. Udenafil, a new reversible selective PDE5 inhibitor, causes smooth muscle relaxation of the macro- and microvascular circulation and is well tolerated. Objectives This study compared the efficacy of the new phosphodiesterase type 5 inhibitor udenafil to the calcium channel blocker amlodipine in the treatment of secondary RP. Methods A total of 29 patients with secondary RP associated with connective tissue diseases were enrolled in this double-blind, randomized, cross-over study. The patients were randomized to receive udenafil 100 mg per day or amlodipine 10 mg per day for 4 weeks. After a washout period, they were crossed over to the other drug for another 4 weeks. The primary outcome was RP frequency before and after treatment. The secondary outcomes were RP condition scores, RP duration, number of digital ulcers, health assessment questionnaire, physician global assessment, and digital artery flow as peak systolic velocity (PSV) before and after treatment. Results Amlodipine and udenafil both decreased the rate of RP attack significantly (Figure A). The drugs did not differ in terms of RP frequency or any of the secondary outcomes except for digital blood flow; udenafil improved it significantly better than amlodipine (p = 0.021) (Figure B). Udenafil was well tolerated without serious adverse effects. Image/graph Conclusions Udenafil has a comparable efficacy to reduce RP attacks as amlodipine. In addition, udenafil is superior to improve resting digital blood flow than amlodipine. Acknowledgements We thank the Medical Research Collaborating Center (MRCC) at Seoul National University for their assistance in the statistical analyses. Disclosure of Interest None Declared

Background The purpose of this study was to evaluate the prognostic significance of the tumor volume reduction rate (TVRR) measured during adaptive definitive radiation therapy (RT) in patients with oropharyngeal cancer. Methods We reviewed the RT records of 59 patients with oropharyngeal cancer who were treated with definitive RT with or without concurrent chemotherapy between January 2006 and October 2010. Adaptive replanning was performed in all patients during RT. The pre-RT and mid-RT gross tumor volumes (GTVs) of the primary and the metastatic lymph nodes were measured and analyzed for their possible impacts on locoregional control. Results After the median follow-up period of 41.3 months (range, 9.3–73.5 months) for survivors, there were 10 treatment failures (8 locoregional recurrences and 2 distant metastases). The locoregional control rate at 3 years in all the patients was 84.1%. The mean pre-RT and mid-RT total GTVs were 27.5 cm3 (±17.9 cm3) and 16.9 cm3 (±12.1 cm3), and the mean GTV reduction rate was 37.9% (±22.6%), respectively. The patients who achieved locoregional control had a higher TVRR than those with locoregional failure (p = .010), and those with the TVRR >35% achieved significantly higher locoregional control at 3 years (94.4% vs 72.4%; p = .018). On multivariate analysis when adjusted with other clinical prognostic factors, the TVRR was found to be a significant factor affecting the locoregional control (hazard ratio = 0.136; 95% confidence interval = 0.022–0.852; p = .033). Conclusion The TVRR measured during adaptive RT proved a significant prognosticator on locoregional disease control in patients with oropharyngeal cancer, based on which a few therapeutic modifications may be considered. © 2013 Wiley Periodicals, Inc. Head Neck 36: 499–504, 2014

In this paper, we propose a subband-based stereo to 5.1-channels upmixing method using deep neural networks (DNNs) in MPEG-H 3D audio framework. In the training stage, DNN models of rear and center channels are respectively trained by using log-spectral magnitudes of quadrature mirror filter (QMF) sub-bands. In the upmixing stage, stereo input signals are converted into rear and center channels by feed-forward decoding with the trained DNN models. The performance of the proposed method is evaluated using both objective and subjective measures and it is compared with those of conventional methods. Consequently, the proposed method outperforms the conventional methods.

This in-depth integrative literature review aimed to investigate comparative effectiveness research (CER) methodologies applicable to nursing research and to propose a CER design relevant to nursing education. Integration and synthesis were conducted from August 20 to December 15, 2013 and from October 20 to December 05, 2015 using electronic databases and refereed published books. The key words were “comparative effectiveness research,” “education,” “patient outcomes,” “effectiveness,” “cost-effectiveness,” and “efficiency.” All selected literatures were initially scrutinized by the principal investigator in terms of scientific rigor and then synthesized on an ongoing basis. CER methodologies in nursing research were presented to be significant in terms of enabling the distinctiveness of the nursing profession to stand out. Three CER methodologies applicable to nursing research—a Pragmatic Clinical Trial, Observational Comparative Effectiveness Research and Cost Effectiveness Research—revealed each of their distinguishable strengths and weaknesses compared to the Randomized Controlled Trial. For ethical considerations, the importance of ensuring “equipoise” was identified. Lastly, in a head to head comparison of two nursing education programs, a single blind, randomized crossover study design was proposed as a type of Pragmatic Clinical Trial utilizing cost-utility analysis. A mixed method Analysis of Covariance and a Doubly Multivariate Repeated Analysis of Covariance were suggested as relevant statistical analyses. Considering that CER is still inchoate in nursing research and nurse scientists’ endeavors to address the gap are urgent, this study is compelling in that it proposed a rigorous CER design not only directly applicable to nursing education, but also to other disciplines in education.

Angioectasias are the most common sources of bleeding in the small bowel. They can be treated using balloon-assisted enteroscopy (BAE). This study aimed to identify the rebleeding rate and associated factors after BAE in patients with small bowel angioectasia bleeding.We retrospectively analyzed the records of patients with bleeding due to small bowel vascular lesion in a multicenter enteroscopy database including 1108 BAEs. Finally, in rebleeding analysis, we analyzed 66 patients with angioectasia on the basis of the Yano-Yamamoto classification. Patients who had undergone endotherapy (ET) were divided into ET (n = 45) and non-ET (n = 21) groups. Rebleeding was defined as evidence of bleeding at least 30 days after BAE.Fifty-three patients (80.4%) underwent only one-side enteroscopy. The most common ET was argon plasma coagulation (87.2%). During a mean follow-up duration of 24.5 months, ET and non-ET groups had rebleeding rates of 15.6% and 38.1% (P = 0.059), respectively. Median rebleeding time of ET and non-ET groups was 32.5 and 62 months, respectively. Liver cirrhosis (LC), low platelet count ( 10ET using BAE did not significantly affect the rebleeding rate in patients with small bowel angioectasia bleeding. An independent rebleeding risk factor was the presence of LC. Regardless of ET, careful long-term follow-up may be needed, especially in LC patients with small bowel angioectasia bleeding.

Genetic polymorphisms in genes involved in the immune response are already known to affect the anti-tumor immune response. This study systematically investigated the association of 14 functional SNPs in a panel of 7 genes (CCL2, CCR2, NT5E, IDO1, LAG3, PDL1, and PDCD1) involved in immune response checkpoints with the survival outcomes of Korean patients with colorectal cancer (CRC). The genomic DNA from 668 patients with curatively resected CRC was analyzed using a Sequenom MassARRAY, along with the association with recurrence-free survival (RFS) and overall survival (OS). Among the 14 SNPs, CCL2 rs4586 and PDCD1 rs10204525 were found to have an influence on the survival outcomes of the patients with resectable CRC. CCL2 rs4586 showed a significant correlation with OS in a recessive model in a univariate analysis, as well as a multivariate analysis. In addition, PDCD1 rs10204525 revealed a significant association with RFS and OS in a recessive model in a univariate analysis and exhibited a significant impact in a multivariate analysis. In conclusion, this results suggest that the genetic predisposition of the host may affect the anti-tumor immune reaction in CRC. The results of this study may also be helpful when selecting targets for novel drug development to promote the anti-tumor immune response.

Purpose: This study was to examine the effects of 3 domains of continuing education (CE) for healthcare managers. Methods: A group of 20 healthcare managers, attending 3 levels of CE, were the subjects. The data were collected by structured questionnaires before and after each education. The data were analyzed by Friedman test, Wilcoxon Signed Ranked Test, and Bonferroni correction. Results: After completing CE, there was significant improvement on the scores of knowledge, attitude, and skills. Conclusion: This study suggests that CE for healthcare managers is an effective strategy to promote the competency of healthcare managers, who take care of the chronically ill patients.

An analytical method based on dispersive liquid–liquid microextraction (DLLME) followed by liquid chromatography (LC)–fluorescence detection was developed to determine endocrine disruptors in environmental water samples. Four endocrine disrupting chemicals (EDCs) including bisphenol A, 4-tert-octylphenol, 4-octylphenol, and 4-nonylphenol were extracted and pre-concentrated by DLLME. Total analysis including extraction and LC analysis was achieved within 15 min. Extraction parameters such as types of extraction and dispersive solvents, volumes of extraction and dispersive solvents, extraction time, and NaCl concentration were optimized. Calibration curves for all EDCs were linear over a wide range with correlation coefficient (r2) ≥ 0.9989. Intra- and inter-day precisions as relative standard deviations were less than 5.4 and 13.3%, respectively. Limit of detection ranged between 0.2 and 1.0 μg/L and limit of quantification ranged between 0.6 and 3.2 μg/L. The proposed method was applied to analysis of the EDCs in various samples including tap water and commercial bottled water and no EDCs were found in the tested samples.

Background/Aims To investigate the predictive factors for complete response (CR) and recurrence after CR in patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). Methods Among 691 newly diagnosed HCC patients, 287 were treated with TACE as a first therapy. We analyzed the predictive factors for CR, recurrence after CR, and overall survival (OS). Results Eighty-one patients (28.2%) achieved CR after TACE, and recurrence after CR was detected in 35 patients (43.2%). In multivariate analyses, tumor size (≤5 cm) and single nodularity were predictive factors for CR, with hazard ratios (HRs) of 0.35 (p=0.002) and 0.41 (p20 ng/mL) level and multinodularity exhibited significant relationships with recurrence after CR, with HRs of 2.220 (p=0.026) and 3.887 (p5 cm), multinodularity, elevated serum AFP (>20 ng/mL) level, Child-Turcotte-Pugh score (B and C), and portal vein thrombosis were significant factors for OS. Conclusions In patients treated with TACE as a first therapy, tumor size (≤5 cm) and single nodularity were predictive factors for CR, and multinodularity and elevated serum AFP (>20 ng/mL) levels were predictive factors for recurrence after CR. These factors were also significant for OS.

Pesticide formulation includes solvents (methanol and xylene) and antifreeze (ethylene glycol) whose metabolites are anions such as formic acid, hippuric acid, and oxalate. However, the effect of the anion gap on clinical outcome in acute pesticide intoxication requires clarification. In this prospective study, we compared the anion gap and other parameters between surviving versus deceased patients with acute pesticide intoxication. The following parameters were assessed in 1,058 patients with acute pesticide intoxication: blood chemistry (blood urea nitrogen, creatinine, glucose, lactic acid, liver enzymes, albumin, globulin, and urate), urinalysis (ketone bodies), arterial blood gas analysis, electrolytes (Na+, K+, Cl- HCO3-, Ca++), pesticide field of use, class, and ingestion amount, clinical outcome (death rate, length of hospital stay, length of intensive care unit stay, and seriousness of toxic symptoms), and the calculated anion gap. Among the 481 patients with a high anion gap, 52.2% had a blood pH in the physiologic range, 35.8% had metabolic acidosis, and 12.1% had acidemia. Age, anion gap, pesticide field of use, pesticide class, seriousness of symptoms (all P < 0.001), and time lag after ingestion (P = 0.048) were significant risk factors for death in univariate analyses. Among these, age, anion gap, and pesticide class were significant risk factors for death in a multiple logistic regression analysis (P < 0.001). In conclusions, high anion gap is a significant risk factor for death, regardless of the accompanying acid-base balance status in patients with acute pesticide intoxication., Graphical Abstract

Blended learning is receiving significant scholarly attention in Korean nursing education for a number of reasons: the downsizing of universities due to low birth rates; the high demand for nurses in a super-aged society; and nursing’s distinctive characteristics, i.e., theory-driven practical scholarship (Park, 2016). However, the lack of scholarly evidence on this subject suggests that current nursing scholarship is not satisfying the needs of the times. This article thus addressed problems in the current literature on Korea’s blended learning in nursing and suggested a way forward for the future. A rigorous literature review and synthesis were conducted from July 01 to August 10, 2016 using an electronic database operated by Korea Education & Research Information Service. The key words were “blended learning” and “nursing.” The search result included twelve publications on “blended learning” and “nursing” in Korea and thirty publications on “blended learning” and “nursing” in other countries. All articles were first scrutinized by the author for relevance to blended learning in nursing and were then compared and synthesized. Korean articles had straight research structures from central casting in contrast to the articles from other countries. Specifically, these structures included 1) an ambiguous definition of the scope of blended learning: i.e., multiple instructional methods or delivery media, rather than an integration of technology-mediated instruction into a face-to-face (F2F) learning environment (Bonk & Graham, 2005); “enhancing blends[1]” rather than “enabling blends” or “transforming blends” (Bonk & Graham, 2005, see Table 1: Different categories of blended learning systems), 2) a very small sample size with a limited location, 3) the use of very basic descriptive statistical analyses, 4) undifferentiated types of a blended learning: i.e., most articles referred to blended learning in nursing education as on-line lectures for a few hours plus face-to-face lectures or practicum. Flipped learning and Virtual-reality-based (VR) education were nonexistent in Korean nursing literature despite the fact that these have already entered US and UK publications, 5) the use of clichéd variables such as “self-efficacy,” “satisfaction,” “motivation,” and “self-directed learning ability,” and 6) a study design lacking in scientific rigor. Blended learning is significantly and rapidly transforming our education environment. This change is accordingly accelerating improved pedagogy toward interactive rather than transmissive learning, increased learner-centered access/flexibility, and enhanced cost savings. Considering that practice is vital in nursing education, “mixed-reality and problem-based embedded training” (Kirkley & Kirkley, 2005, pp. 533-549; Kirkley & Kirkley, 2007, pp. 42-53) such as “Live-Virtual-Constructive Simulations” (Wisher, 2005, pp. 519-532) are expected to play a key role in ensuring well-equipped nurses in the near future. However, scholarly preparations to embrace advanced technology-based innovation in nursing education are, at present, insufficient. Before trying to present empirical study findings on the effects of blended learning in nursing education, 1) a clear definition and scope of blended learning must be established, 2) theories, models, and ethical considerations in the context of nursing education should be developed, and 3) the nursing science community must reach a consensus on the first two points. On this solid foundation, future research can be built.

123 I-FP-CIT and 18 F-FP-CIT are radiotracers which are widely used to diagnose Parkinson's disease (PD). However, to our knowledge, no studies to date have made head-to-head comparisons between 123 I-FP-CIT and 18 F-FP-CIT. Therefore, in this study, 123 I-FP-CIT SPECT/CT was compared with 18 F-FP-CIT PET/CT in the same cohort of subjects. Patients with PD and essential tremor (ET) underwent 123 I-FP-CIT SPECT/CT and 18 F-FP-CIT PET/CT. Visual and semiquantitative analyses were conducted. The specific binding ratio (SBR) and putamen to caudate ratio (PCR) were compared between subjects who underwent 123 I-FP-CIT SPECT/CT and 18 F-FP-CIT PET/CT. Visual analysis showed that the striatal uptake of both radiotracers was decreased in the PD group, whereas striatal uptake was intact in the ET group. The SBR between 123 I-FP-CIT SPECT/CT and 18 F-FP-CIT PET/CT showed a positive correlation (r = .78, p < .01). However, the mean SBRs on 18 F-FP-CIT PET/CT were higher than those on 123 I-FP-CIT SPECT/CT (2.19 ± .87 and 1.22 ± .49, respectively; p < .01). The PCRs in these two modalities were correlated with each other (r = .71, p < .01). The mean PCRs on 18 F-FP-CIT PET/CT were not significantly higher than those on 123 I-FP-CIT SPECT/CT (1.31 ± .19 and 0.98 ± .06, respectively; p = .06). These preliminary results indicate that the uptake of both 123 I-FP-CIT and 18 F-FP-CIT was decreased in the PD group when compared with the ET controls. Visual analyses using both methods did not affect the diagnostic accuracy in this study. However, semiquantitative analysis indicated a better contrast of 18 F-FP-CIT PET/CT relative to 123 I-FP-CIT SPECT/CT.

BACKGROUND: Tumor-related temporal lobe epilepsy (TLE) has a high likelihood of medical intractability and requires surgical treatment. The aims of this study were to analyze the long-term surgical outcomes of and to present appropriate surgical strategies for tumor-related TLE. METHODS: The clinical data of 87 consecutive patients diagnosed with tumor-related TLE were analyzed. The median age at surgery was 22 years. Sixteen patients had a tumor confined to the amygdala or the parahippocampal gyrus, and 10 of them received a tailored lesionectomy without hippocampectomy. The surgical outcome was evaluated based on 3 aspects: seizure control, tumor control, and discontinuation of antiepileptic drugs (AEDs). RESULTS: The actuarial seizure and tumor control rates at the fifth year postoperatively were 79% and 90%, respectively. Seizure control was highly correlated with tumor control. The following factors were found to be significantly associated with poor seizure control: duration of epilepsy >10 years, presence of a remote focus on surface electroencephalography, and incomplete tumor removal. The actuarial AED maintenance rates were 47% at the second year and 11% at the fifth year. The median time to AED discontinuation was 22 months. A younger age at surgery was found to be significantly associated with an increased chance of AED discontinuation. Tailored resection focusing on the tumor resulted in a favorable outcome, even for tumors confined to the amygdala or the parahippocampal gyrus. CONCLUSIONS: Surgical treatment of tumor-related TLE resulted in long-term seizure control in the majority of patients. Maximal tumor removal can be recommended for tumor-related TLE. Cancer 2009. © 2009 American Cancer Society.

Objective To assess the accuracy of transvaginal ultrasound (US) in the prediction of the chorionicity of diamniotic twin pregnancies with a single placental mass at 11 to 14 weeks of gestation. Method From June 2006 to April 2007, we determined chorionicities by depiction of the amnion and chorion at the membrane-to-placental interface using transvaginal US. Pregnancies were classified as monochorionic when two layers of the amnion were identified as dichorionic when either one layer of the chorion and two layers of the amnion or one layer of the chorion and one layer of the amnion were seen. Results In 65 out of 70 (92.9%) diamniotic twin pregnancies with a single placental mass, we were able to determine the chorionicity by depiction of the amnion and chorion at the membrane-to-placental interface using transvaginal US. The predictive accuracy was 100% (95% confidence interval: 92–100%) for 52 twin pregnancies considered to be dichorionic by transvaginal US and 100% (95% CI: 73–100%) for 13 twin pregnancies considered to be monochorionic. Conclusion The chorionicity of diamniotic twin pregnancies with a single placental mass can be reliably predicted by transvaginal US depiction of the amnion and chorion at 11 to 14 weeks of gestation. Copyright © 2008 John Wiley & Sons, Ltd.

Neoadjuvant concurrent chemoradiotherapy combined with total mesorectal excision is the main treatment for patients with locally advanced rectal cancer (LARC). However, because distant metastasis remains the major challenge in the management of LARC, we proposed an additional one cycle of chemotherapy before surgery to improve systemic control. One hundred sixty-eight patients with clinical stage II and III rectal cancer were enrolled at Kyungpook National University Medical Center (Daegu, Korea) between January 2011 and December 2013 and were considered the study group. In addition, 160 patients were retrospectively reviewed as the historical control group. All the patients underwent total mesorectal excision at 8 weeks after completing the radiotherapy and receiving a total of six cycles of 5-fluorouracil plus leucovorin. Overall, 155 (96.9 %) of the 168 patients completed their planned six cycles of study treatment. Dose modification at any cycle was observed in 18 patients (10.7 %). The grade 3 to 4 treatment-related toxicity rate was 27.3 %, and the most common grade 3 to 4 hematologic adverse event was neutropenia. With a median follow-up duration of 38 months, the estimated 3-year disease-free survival and OS rates were 79.5 and 86.9 %, respectively. Adding one cycle of chemotherapy during the resting period between chemoradiotherapy and surgery was found to be feasible in patients with LARC in terms of the chemotherapy-related adverse events and postoperative complications. These results warrant further investigation in future prospective randomized trials.

Policosanol (PC) is a mixture of health promoting bioactive long-chain aliphatic alcohols. Here, we report that green tea (Camellia sinensis) leaves are the exceptionally rich plant-sources of PC. Young and tender leaves and old and turf leaves of C. sinensis were hand-picked in spring and autumn. The total contents of PC in the leaves were in the range of 726.2-1363.6mg/kg as determined by a GC-MS/MS. The compositions of PC in the leaves were different with harvest season and types. The total contents of PC in commercial green tea leaves were found to be in the range of 856.7-1435.1mg/kg. Interestingly, the infused green tea leaves contained the higher PC than the non-infused green tea product, reaching to 1629.4mg/kg. This represents the first report on the contents and compositions of PC in green tea leaves, showing unambiguous evidence of their potential as rich sources of PC.

As a new beta amyloid (Aβ) positron emission tomography (PET) tracer, 18F-FC119S has shown higher cortical uptake in patients with Alzheimer's disease (AD) than that in healthy control subjects without adverse effects in a previous preliminary study. The aim of this study was to compare 18F-FC119S PET and 11C-PiB PET in healthy control (HC) subjects, mild cognitive impairment (MCI) patients, and AD patients. A total of 48 subjects, including 28 HC subjects, 10 MCI patients, and 10 AD patients, underwent static 18F-FC119S PET (30 minutes after intravenous [i.v.] injection) and 11C-PiB PET (40 minutes after i.v. injection) on the same day. Both PET images were visually and quantitatively assessed. Standardized uptake value ratios (SUVRs) were calculated for each brain region using the cerebellar cortex as a reference region. None (0%) of the 28 HC subjects and 4 (40%) of 10 MCI patients had positive scans on both PET images. Of the 10 AD patients, 7 (70%) had positive scans on 11C-PiB PET while 6 (60%) had positive scans on 18F-FC119S PET. Overall, 47 (98%) of 48 participants showed identical results based on visual analysis. Cortical SUVR of 18F-FC119S was higher in AD patients (1.38 ± 0.16), followed by that in MCI patients (1.24 ± 0.10) and in HC subjects (1.14 ± 0.05). Compared with 11C-PiB PET, 18F-FC119S PET yielded a higher effect size (d = 2.02 vs. 1.67) in AD patients and a slightly lower effect size (d = 1.26 vs. 1.38) in MCI patients. In HC subjects, the nonspecific binding of 18F-FC119S to white matter (with the frontal cortex-to-white matter SUV ratio of 0.76) was slightly lower than that of 11C-PiB (ratio of 0.73). There was a significant linear correlation (slope = 0.41, r = 0.78, P

To determine the relationship between the oral ingestion volume of xylene and methyl hippuric acid (MHA) in urine, we measured MHA in 11 patients whose ingested xylene volume was identified. The best-fit equation between urine MHA and ingested amount of xylene was as follows: y (ingested amount of xylene, mL/kg) = −0.052x2 + 0.756x (x = MHA in urine in g/g creatinine). From this equation, we estimated the ingested xylene volume in 194 patients who had ingested pesticide of which the formulation was not available. Our results demonstrated that oxadiazole, dinitroaniline, chloroacetamide, organophosphate, and pyrethroid were xylene-containing pesticide classes, while the paraquat, glyphosate, glufosinate, synthetic auxin, fungicide, neonicotinoid, and carbamate classes were xylene-free pesticides. Sub-group univariate analysis showed a significant association between MHA levels in urine and ventilator necessity in the pyrethroid group. However, this association was not observed in the organophosphate group. Our results suggest that MHA in urine is a surrogate marker for xylene ingestion, and high urine MHA levels may be a risk factor for poor clinical outcome with some pesticide poisoning., Graphical Abstract

This cross-sectional study examines baccalaureate nursing programs in South Korea to determine how and to what extent patient safety education was delivered, and to assess nursing students' patient safety competency. The Quality and Safety Education for Nurses (QSEN) student evaluation survey and a Patient Safety Competency Self-Evaluation tool were used. We distributed 234 surveys to senior students in four nursing schools; 206 (88%) students responded to the survey. The majority of students (81.6%) reported that they had received patient safety education during coursework. Patient safety education was delivered primarily by lecture rather than during laboratory or simulation sessions. The degree of coverage of QSEN competency and the students' self-reported competency in total and attitude scores showed statistical differences among nursing schools. Students' attitude score was significantly higher than skill and knowledge. Our results confirm the need to revise the nursing curriculum and to use various teaching methods to deliver patient safety education more comprehensively and effectively. Furthermore, there is a need to develop an integrated approach to ensuring students' balanced competency.

Neoadjuvant chemoradiotherapy (CRT) followed by total mesorectal excision is considered the standard of care for patients with locally advanced adenocarcinoma of the middle/low rectum. The present study evaluated the feasibility of using modified FOLFOX6 regimen as an adjuvant treatment for high-risk patients with locally advanced rectal cancer (LARC) treated with neoadjuvant CRT. Forty patients with LARC (ypT3–4 or N+) treated with neoadjuvant CRT were enrolled at Kyungpook National University Medical Center (Daegu, Korea) between December 2011 and December 2012. All the patients underwent rectal surgery with curative intent 8 weeks after the end of the neoadjuvant treatment. Adjuvant chemotherapy using modified FOLFOX6 regimen was then delivered for 3 months. The treatments were generally well tolerated. Dose reduction was recorded in 11 of the 40 patients (27.5 %). The incidence of febrile neutropenia was 5 %, the incidence of grade 3 or 4 asthenia was 10 %, and the incidence of grade 3 gastrointestinal adverse events was 5 % during treatment. Treatment discontinuation caused by toxic effects or any other reasons was observed in six patients (15 %). The reasons for discontinuation were asthenia (n = 2, 5 %), diarrhea (n = 2, 5 %), acute renal failure (n = 1, 2.5 %), and relapse during chemotherapy (n = 1, 2.5 %). With a median follow-up duration of 18 months, six patients (15 %) relapsed and one patient (2.5 %) died of disease progression. The estimated 3-year disease-free survival and overall survival rates were 84.2 and 97.3 %, respectively. Postoperative adjuvant modified FOLFOX6 regimen was found to be feasible for patients with LARC treated with neoadjuvant CRT.

Background/Aims: Most pesticide formulations contain both chief and additive ingredients. But, the additives may not have been tested as thoroughly as the chief ingredients. The surfactant, nonyl phenoxypolyethoxylethanol (NP40), is an additive frequently present in pesticide formulations. We investigated the effects of NP40 and other constituents of a validamycin pesticide formulation on cell viability and on the expression of genes involved in cell damage pathways. Methods: The effects of validamycin pesticide ingredients on cell viability and of NP40 on the mRNA expression of 80 genes involved in nine key cellular pathways were examined in the human neuroblastoma SK-N-SH cell line. Results: The chemicals present in the validamycin pesticide formulation were cytotoxic to SK-N-SH cells and NP40 showed the greatest cytotoxicity. A range of gene expression changes were identified, with both up- and down-regulation of genes within the same pathway. However, all genes tested in the necrosis signaling pathway were down-regulated and all genes tested in the cell cycle checkpoint/ arrest pathway were up-regulated. The median fold-change in gene expression was significantly higher in the cell cycle checkpoint/arrest pathway than in the hypoxia pathway category (p = 0.0064). The 70 kDa heat shock protein 4 gene, within the heat shock protein/unfolded protein response category, showed the highest individual increase in expression (26.1-fold). Conclusions: NP40 appeared to be particularly harmful, inducing gene expression changes that indicated genotoxicity, activation of the cell death (necrosis signaling) pathway, and induction of the 70 kDa heat shock protein 4 gene.

Larger biopsy specimens or increasing the number of biopsies may improve the diagnostic accuracy of gastric epithelial neoplasia (GEN). The aims of this study was to compare the diagnostic accuracies between conventional and jumbo forceps biopsy of GEN before endoscopic submucosal dissection (ESD) and to confirm that increasing the number of biopsies is useful for the diagnosis of GEN. The concordance rate between EFB and ESD specimens was not significantly different between the two groups [83.1 % (54/65) in JG vs. 79.1 % (53/67) in CG]. On multivariate analyses, two or four EFBs significantly increased the cumulating concordance rate [coefficients; twice: 5.1 (P = 0.01), four times: 5.9 (P = 0.02)]. But, the concordance rate was decreased in high grade dysplasia (coefficient −40.32, P = 0.006). One hundred and sixty GENs from 148 patients were randomized into two groups and finally 67 GENs in 61 patients and 65 GENs in 63 patients were allocated to the conventional group (CG) or jumbo group (JG), respectively. Four endoscopic forceps biopsy (EFB) specimens were obtained from each lesion with conventional (6.8 mm) forceps or jumbo (8 mm) forceps. The histological concordance rate between 4 EFB specimens and ESD specimens was investigated in the two groups. Before ESD, the diagnostic accuracy of GENs was significantly increased not by the use of jumbo forceps biopsy but by increasing the number of biopsies.

The purpose of this study was to evaluate the prognostic significance of the tumor volume reduction rate (TVRR) measured during adaptive definitive radiation therapy (RT) in patients with oropharyngeal cancer.We reviewed the RT records of 59 patients with oropharyngeal cancer who were treated with definitive RT with or without concurrent chemotherapy between January 2006 and October 2010. Adaptive replanning was performed in all patients during RT. The pre-RT and mid-RT gross tumor volumes (GTVs) of the primary and the metastatic lymph nodes were measured and analyzed for their possible impacts on locoregional control.After the median follow-up period of 41.3 months (range, 9.3-73.5 months) for survivors, there were 10 treatment failures (8 locoregional recurrences and 2 distant metastases). The locoregional control rate at 3 years in all the patients was 84.1%. The mean pre-RT and mid-RT total GTVs were 27.5 cm(3) (±17.9 cm(3) ) and 16.9 cm(3) (±12.1 cm(3) ), and the mean GTV reduction rate was 37.9% (±22.6%), respectively. The patients who achieved locoregional control had a higher TVRR than those with locoregional failure (p = .010), and those with the TVRR35% achieved significantly higher locoregional control at 3 years (94.4% vs 72.4%; p = .018). On multivariate analysis when adjusted with other clinical prognostic factors, the TVRR was found to be a significant factor affecting the locoregional control (hazard ratio = 0.136; 95% confidence interval = 0.022-0.852; p = .033).The TVRR measured during adaptive RT proved a significant prognosticator on locoregional disease control in patients with oropharyngeal cancer, based on which a few therapeutic modifications may be considered.

Background and Purpose There have been a few national population-based epidemiological studies of myasthenia gravis (MG) with wide variation of incidence and prevalence rates worldwide. Herein we report the first nationwide population-based epidemiological study of MG in Korea. Methods We attempted to estimate the incidence and prevalence rates of MG using the Korean National Health Insurance claims database for 2010 to 2013. Cases with MG were defined as those having claim records with a principal diagnosis of MG and the prescription of acetylcholinesterase inhibitors or immunosuppressive agents including corticosteroids and azathioprine within 2 years after the diagnosis. The year 2010 was set as a washout period, such that patients were defined as incident cases if their first records of MG were observed in 2011. Results In 2011 there were 1,236 incident cases, and the standardized incidence rate was 2.44 per 100,000 person-years. The standardized prevalence rates were 9.67 and 10.66 per 100,000 persons in 2010 and 2011, respectively. The incidence and prevalence rates peaked in the elderly population aged 60 to 69 years for both sexes. Conclusions This is one of the largest national population-based epidemiological studies of MG, and it has confirmed the high incidence and prevalence rates of MG in the elderly population of South Korea.