• Clinical Endoscopy
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• v.56 no.4
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• pp.470-478
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• 2023

Background/Aims: Metachronous recurrence incidences and risk factors following endoscopic submucosal dissection (ESD) for gastric adenocarcinoma and dysplasias were investigated. Methods: Retrospective review of electronic medical records of patients who underwent gastric ESD at The Catholic University of Korea, Yeouido St. Mary's Hospital. Results: A total of 190 subjects were enrolled for analysis during the study period. The mean age was 64.4 years and the male sex occupied 73.7%. The mean observation period following ESD was 3.45 years. The annual incidence rate of metachronous gastric neoplasms (MGN) was about 3.96%. The annual incidence rate was 5.36% for the low-grade dysplasia group, 6.47% for the high-grade dysplasia group, and 2.74% for the EGC group. MGN was more frequent in the dysplasia group than in the EGC group (p<0.05). For those with MGN development, the mean time interval from ESD to MGN was 4.1 (±1.8) years. By using the Kaplan-Meier model, the estimated mean MGN free survival time was 9.97 years (95% confidence interval, 8.53-11.40) The histological types of MGN were not related to the primary histology types. Conclusions: MGN following ESD developed in 3.96% annually and MGN was more frequent in the dysplasia group. The histological types of MGN did not correlate with those of primary neoplasm.

• Clinical Endoscopy
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• v.56 no.5
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• pp.604-612
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• 2023

Background/Aims: We developed a new endoscopic submucosal dissection (ESD) simulator and evaluated its efficacy and realism for use training endoscopists. Methods: An ESD simulator was constructed using polyvinyl alcohol hydrogel sheets and compared to a previous ESD simulator. Between March 1, 2020, and December 30, 2021, eight expert endoscopists from three different centers analyzed the procedure-related factors of the simulator. Five trainees performed gastric ESD exercises under the guidance of these experts. Results: Although the two ESD simulators provided overall favorable outcomes in terms of ESD-related factors, the new simulator had several benefits, including better marking of the target lesion's limits (p<0.001) and overall handling (p<0.001). Trainees tested the usefulness of the new ESD simulator. The complete resection rate improved after 3 ESD training sessions (9 procedures), and the perforation rate decreased after 4 sessions (12 procedures). Conclusions: We have developed a new ESD simulator that can help beginners achieve a high level of technical experience before performing real-time ESD procedures in patients.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.27 no.2
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• pp.172-179
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• 2023

Backgrounds/Aims: Cancer stigma (CS), a self-inflicted sense of hopelessness, has been identified as a major factor affecting cancer patients' outcomes. However, few studies have investigated the CS-related outcomes in hepatobiliary and pancreatic (HBP) cancer. Thus, the aim of this study was to investigate effects of CS on quality of life (QoL) of HBP cancer. Methods: From 2017 to 2018, 73 patients who underwent curative surgery for HBP tumor at a single intuitive were enrolled prospectively. The QoL was measured using the European Organization for Research and Treatment of Cancer QoL score, and CS was evaluated in three categories, "impossibility of recovery," "cancer stereotypes," and "social discrimination." the stigma was defined by higher scores of attitudes compared with the median value. Results: The stigma group showed a lower QoL (-17.67, 95% confidence interval [CI]: -26.75 to 8.60, p < 0.001) than the no stigma group. Similarly, most function and symptoms of the stigma group showed worse results than the no stigma group. The difference in function scores between the two groups according to CS was highest in cognitive function (-21.20, 95% CI: -30.36 to 12.04, p < 0.001). Fatigue showed the largest difference between the two groups at 22.84 (95% CI: 12.88-32.07, p < 0.001) and was the most severe symptom in stigma group. Conclusions: CS was an important negative factor affecting the QoL, function, and symptoms of HBP cancer patients. Therefore, appropriate management of CS is crucial for improved postoperative QoL.

• Journal of Hospice and Palliative Care
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• v.27 no.1
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• pp.11-20
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• 2024

Purpose: Advance directives (ADs) are legal documents that outline a person's preferences or decisions regarding end-of-life care ahead of time. In Korea, there is insufficient awareness and knowledge about ADs among patients undergoing hemodialysis. This study explored the relationship between perceptions of a good death, knowledge about ADs, and attitudes toward ADs in this patient population. Methods: This cross-sectional survey enrolled 119 hemodialysis patients from a secondary hospital in 2021. The participants completed a self-administered questionnaire, and the data were analyzed using the t-test, analysis of variance, Pearson correlation coefficients, Spearman rank correlation coefficients, and multiple regression analysis. Results: The average score for perceptions of a good death among hemodialysis patients was 2.80 out of 4, with clinical symptoms identified as the most critical factor. The average scores for knowledge about ADs and attitudes toward ADs were 5.69 out of 9 and 2.79 out of 4, respectively. There was a positive correlation between perceptions of a good death and attitudes toward ADs (r=0.34, P<0.001), as well as between knowledge about Ads and attitudes toward ADs (r=0.19, P=0.037). Factors influencing attitudes toward Ads included employment status (β=0.22, P=0.011), education level (β=0.22, P=0.013), and perceptions of a good death (β=0.29, P=0.001), which accounted for 24.8% of the variance in attitudes toward ADs. Conclusion: A positive perception of a good death among patients undergoing hemodialysis was associated with a positive attitude toward ADs. Educational programs are needed to improve individuals' understanding of a good death and encourage the development of end-of-life care plans.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.27 no.2
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• pp.79-87
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• 2024

Purpose: Recently, the prevalence of eosinophilic gastrointestinal disease (EGID) has shown an increasing trend worldwide. As the diagnosis of EGID requires invasive endoscopy with biopsy, noninvasive markers for detecting EGID in suspected patients, particularly children, are urgently needed. Therefore, this study aimed to evaluate the diagnostic accuracy of serum eosinophil cationic protein (ECP) beyond peripheral eosinophil counts in pediatric patients with EGID. Methods: Overall, 156 children diagnosed with EGID were enrolled and 150 children with functional abdominal pain disorder (FAPD) were recruited as controls. All participants underwent endoscopic biopsy in each segment of the gastrointestinal (GI) tract and serum ECP measurement, as well as peripheral eosinophil percent and absolute eosinophil count. Results: Comparing EGID (n=156) with FAPD (n=150) patients, serum ECP levels were significantly higher in pediatric patients with EGID than in those with FAPD (25.8±28.6 ㎍/L vs. 19.5±21.0 ㎍/L, p=0.007), while there was no significant difference in peripheral eosinophil percent and absolute eosinophil counts between the two groups. Serum ECP levels were correlated with peripheral eosinophil percent (r=0.593, p<0.001) and the absolute eosinophil count (r=0.660, p<0.001). The optimal cutoff value of serum ECP for pediatric EGID was 10.5 ㎍/mL, with a sensitivity of 69.9% and a specificity of 43.4% with an area under the receiver operating characteristic curve of 0.562. Conclusion: The combination of serum ECP levels and peripheral eosinophil counts, when employed with appropriated thresholds, could serve as a valuable noninvasive biomarker to distinguish between EGID and FAPD in pediatric patients manifesting GI symptoms.

• Parasites, Hosts and Diseases
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• v.62 no.1
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• pp.131-138
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• 2024

Halicephalobus gingivalis is a free-living nematode that occasionally causes infections in horses. We report a rare case of limb fracture of horse caused by infection with H. gingivalis. An 8-year-old mare was referred to the Veterinary Hospital of the Federal University of Lavras with claudication grade 5 of the right hind limb, that had been started 3 months ago. The patient had aseptic arthritis in the tarsal joint and edema that extended to the quartile. The radiographic examination showed punctate osteolysis with exacerbation of bone trabeculation along the calcaneus, talus, proximal epiphysis of the third metatarsal and distal epiphysis of the tibia. Treatment for arthritis was initiated, and the animal showed a slight improvement in limb function. However, 21 days after hospitalization, due to a comminuted fracture of the tibia, it was euthanized. At necropsy, yellowish masses were found from the metatarsal to the tibia, and around the tarsal bones and joint. Similar masses were also found in the left kidney. Numerous nematodes compatible with H. gingivalis were identified. This is the first description of a pathological fracture caused by H. gingivalis infection in an equine limb.

• Journal of Trauma and Injury
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• v.37 no.1
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• pp.67-73
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• 2024

Purpose: Posttraumatic stress disorder (PTSD) is prevalent and is associated with protracted recovery and worse outcomes after injury. This study compared PTSD prevalence using the PTSD Checklist for DSM-5 (PCL-5) with the prevalence of PTSD risk using the Injured Trauma Survivor Screen (ITSS). Methods: Adult trauma patients at a level I trauma center were screened with the PCL-5 (sample 1) at follow-up visits or using the ITSS as inpatients (sample 2). Results: Sample 1 (n=285) had significantly fewer patients with gunshot wounds than sample 2 (n=45) (8.1% vs. 22.2%, P=0.003), nonsignificantly fewer patients with a fall from a height (17.2% vs. 28.9%, P=0.06), and similar numbers of patients with motor vehicle collision (40.7% vs. 37.8%, P=0.07). Screening was performed at a mean of 154 days following injury for sample 1 versus 7.1 days in sample 2. The mean age of the patients in sample 1 was 45.4 years, and the mean age of those in sample 2 was 46.1 years. The two samples had similar proportions of female patients (38.2% vs. 40.0%, P=0.80). The positive screening rate was 18.9% in sample 1 and 40.0% in sample 2 (P=0.001). For specific mechanisms, the positive rates were as follows: motor vehicle collisions, 17.2% in sample 1 and 17.6% in sample 2 (P>0.999); fall from height, 12.2% in sample 1 and 30.8% in sample 2 (P=0.20); and gunshot wounds, 39.1% in sample 1 and 80.0% in sample 2 (P=0.06). Conclusions: The ITSS was obtained earlier than PCL-5 and may identify PTSD in more orthopedic trauma patients. Differences in the frequency of PTSD may also be related to the screening tool itself, or underlying patient risk factors, such as mechanism of injury, or mental or social health.

• Korean Journal of Clinical Laboratory Science
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• v.56 no.1
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• pp.85-88
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• 2024

Electroencephalography (EEG) is a test that diagnoses epilepsy and measures brain function. During EEG, the space between the electrode and the skin is filled with a conductive paste to reduce the impedance between the electrode and the scalp, which helps measure the EEG signals. This study compared the artifacts of the two representative conductive pastes (Ten20 and Elefix). The artifacts, noise, and satisfaction were surveyed after using the two conductive pastes. The two conductive pastes had similar artifacts and noise, but the survey results showed that the Elefix conductive paste had better satisfaction and adhesion. This result may be explained by the imprinting effect according to the experience of using the Elefix conductive paste first in the EEG class. Hence, further research is needed.

• Journal of Chest Surgery
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• v.57 no.3
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• pp.291-299
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• 2024

Background: Postoperative pain management following minimally invasive repair of pectus excavatum (MIRPE) remains a critical concern due to severe post-procedural pain. Promising results have been reported for cryoanalgesia following MIRPE; however, its invasiveness, single-lung ventilation, and additional instrumentation requirements remain obstacles. Serratus anterior plane block (SAPB) is a regional block technique capable of covering the anterior chest wall at the T2-9 levels, which are affected by MIRPE. We hypothesized that SAPB would be a superior alternative pain control modality that reduces postoperative pain more effectively than conventional methods. Methods: We conducted a retrospective study of patients who underwent MIRPE between March 2022 and August 2023. The efficacy of pain control was compared between group N (conventional pain management, n=24) and group S (SAPB, n=26). Group N received intravenous patient-controlled analgesia (IV-PCA) and subcutaneous local anesthetic infusion. Group S received bilateral continuous SAPB with 0.3% ropivacaine after a bilateral bolus injection of 30 mL of 0.25% ropivacaine with baseline IV-PCA. Pain levels were evaluated using a Visual Analog Scale (VAS) at 1, 3, 6, 12, 24, 48, and 72 hours postoperatively and total intravenous rescue analgesic consumption by morphine milligram equivalents (MME). Results: Mean VAS scores were significantly lower in group S than in group N throughout the 72-hour postoperative period (p<0.01). Group S showed significantly lower MME at postoperative 72 hours (group N: 108.53, group S: 16.61; p<0.01). Conclusion: SAPB improved immediate postoperative pain control in both the resting and dynamic states and reduced opioid consumption compared to conventional management.

• Journal of Home Health Care Nursing
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• v.31 no.1
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• pp.30-43
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• 2024

Purpose: This study aimed to enhance health management and prevention strategies for precocious puberty by comparing the knowledge, motivation, and behaviors related to reducing exposure to endocrine disrupting chemicals (EDCs) between mothers of children with precocious puberty and those of typically developing children. Methods: Participants were 66 mothers of children with precocious puberty from a hospital and 71 mothers of typically developing children from an elementary school. The research questionnaire assessed knowledge of EDCs, motivation, self-efficacy, and behaviors towards reduced exposure to EDCs, in addition to general characteristics of children with precocious puberty. Data analysis utilized descriptive statistics, chi-square tests, t-tests, ANOVA, and Pearson's correlation. Results: There were statistically significant differences in self-efficacy (p=.015) and behavior (p=.001) regarding reduced exposure to EDCs between the two groups. Behaviors toward reduced exposure to EDCs were positively associated with knowledge of EDCs, motivation, and self-efficacy among mothers of children with precocious puberty. Additionally, these behaviors correlated positively with knowledge of EDCs, motivation, self-efficacy, and the child's birth weight and waist circumference among mothers of typically developing children. Conclusion: The results of this study revealed that mothers of children with precocious puberty exhibited less proactive behavior in reducing exposure to EDCs compared to mothers of typical children. Therefore, it is important to foster interest in the impact of environmental factors, beyond characteristic factors, on behaviors aimed at reducing exposure to EDCs.