Background: To compare the KKU-model rectal tube (KKU-tube) and the conventional rectal tube (CRT) for checking rectal doses during high-dose-rate intracavitary brachytherapy (HDR-ICBT) of cervical cancer. Materials and Methods: Between February 2010 and January 2011, thirty -two patients with cervical cancer were enrolled and treated with external beam radiotherapy (EBRT) and intracavitary brachytherapy (ICBT). The KKU-tube and CRT were applied intrarectally in the same patients at alternate sessions as references for calculation of rectal doses during ICBT. The gold standard references of rectum anatomical markers which are most proximal to radiation sources were anterior rectal walls (ARW) adjacent to the uterine cervix demonstrated by barium sulfate suspension enema. The calculated rectal doses derived from actual anterior rectal walls, CRT and the anterior surfaces of the KKU-tubes were compared by using the paired t-test. The pain caused by insertion of each type of rectal tube was assessed by the visual analogue scale (VAS). Results: The mean dose of CRT was lower than the mean dose of ARW ($Dmean_0-Dmean_1$) by $80.55{\pm}47.33cGy$ (p-value <0.05). The mean dose of the KKU-tube was lower than the mean dose of ARW ($Dmean_0-Dmean_2$) by $30.82{\pm}24.20cGy$ (p-value <0.05). The mean dose difference [($Dmean_0-Dmean_1$)-($Dmean_0-Dmean_2$)] was $49.72{\pm}51.60cGy$, which was statistically significant between 42.32 cGy -57.13 cGy with the t-value of 13.24 (p-value <0.05). The maximum rectal dose by using CRT was higher than the KKU-tube as much as 75.26 cGy and statistically significant with the t-score of 7.55 (p-value <0.05). The mean doses at the anterior rectal wall while using the CRTs and the KKU-tubes were not significantly different (p-value=0.09). The mean pain score during insertion of the CRT was significantly higher than the KKU-tube by a t-score of 6.15 (p-value <0.05) Conclusions: The KKU-model rectal tube was found to be an easily producible, applicable and reliable instrument as a reference for evaluating the rectal dose during ICBT of cervical cancer without negative effects on the patients.
Background: Anaplastic lymphoma kinase (ALK) gene rearrangement in non-small cell lung cancer (NSCLC) has been intensively studied. The gold standard for ALK detection is FISH, but this is not routinely conducted in clinical practice, so that the IHC method has a role. The aim of this study was to identify the incidence of ALK rearrangement and risk or prognostic factors for ALK positivity using both of IHC and FISH methods. Materials and Methods: From January 2008 to December 2012, 267 completely resected NSCLC patients in Chiang Mai University Hospital were enrolled in this study. Clinical and pathological variables and outcomes of treatment were retrospectively reviewed. IHC and FISH were used to evaluate ALK rearrangement. Sensitivity and specificity of IHC were analyzed. Multivariable analysis was used to identify clinico-pathological correlations with positive results of IHC and clinical outcomes. Results: Twenty-two (8.2%) of 267 specimens were IHC-positive for ALK with intense cytoplasmic staining, whereas only 10 (3.8%) were FISH-positive. Sensitivity, specificity and the positive likelihood ratio with IHC were 80.0%, 94.9%, and 15.8 respectively. Age less than 55 years (RR 4.4, 95%CI 1.78-10.73, p value=0.001) and presence of visceral pleural invasion (VPI) (RR 2.9, 95%CI 1.21-6.78, p value =0.017) were identified as risk factors for ALK rearrangement with FISH. There were no statistically significant differences in other clinical and pathological variables. ALK rearrangement was not a prognostic factor for tumor recurrence or overall survival. Conclusions: The incidences of ALK positivity in completely resected NSCLCs in northern Thailand were 8.2% by IHC and 3.8% by FISH. IHC with mouse monoclonal, Ventana D5F3 antibody can be used as a screening tool before FISH method because of high specificity and high positive likelihood ratio. Age less than 55 years and VPI are risk factors for ALK positivity.
This exploratory research investigated the factors that influence foreign tourists' decision to use dental services in Thailand. The questionnaire was used to collect data from foreign tourists who used dental services in a hospital or dental clinic in Thailand. Data from 233 respondents completed questionnaires were analyzed using frequency distribution, percentages, mean, and standard deviation. The findings revealed that respondents were most likely to be Asian (54.5%) followed by European (33.9%), females (64.8%) aged between 26-35 years (39.1%), business owners (45.9%), and came to Thailand with friends (47.6%). Regarding travel purposes and contact with dental services, most of them travel for pleasure (52.89%) and contact the clinic directly through the Internet(63.95%) The health/medical services used included health check-up (34.48%), dental services (29.22%), and day spa/massage (23.23%). The dental treatment that respondents had completed or planned to do included dental check-up (29.87%), tooth cleaning (26.68%), and tooth whitening (11.41%). Based on the influence of $_7P$ factors towards the respondent's decision to use the dental service, it was found that the average mean score range from 4.33-4.15 which were at the high to the very high level of influence to their decisions. The people factor had the highest average mean score (mean 4.33, SD= 0.604)followed by the price factor (mean 4.32, SD= 0.651), which both had the highest level of influence. The physical evidence factor had the lowest mean score (mean 4.15, SD+0.752) which was at the high level of importance. It should be noted that the factor concerning the modern technology and dental equipment (mean 4.33, SD=0.606) and factor on the quality of service (mean 4.43, SD= 0.598) had the highest mean score followed by the total cost of the trip including services being reasonable (mean 4.37, SD=0.582). Regarding the country factor, it was found that this factor also had highest influence level (mean 4.30, SD=0.67) and affordability had the highest mean score (mean 4.39, SD=0.614).
Background: Pemetrexed monotherapy has come to be recognized as one of the standard second-line therapies for advanced non-squamous non-small cell lung cancer (NSCLC). However, there have been no reports of studies that have evaluated the efficacy of pemetrexed according to type of active EGFR mutation, i.e., an exon 19 deletion or an L858R point mutation. Materials and Methods: The records of non-squamous NSCLC patients harboring an EGFR mutation who received pemetrexed monotherapy as a second or later line of chemotherapy at Kitasato University Hospital between March 2010 and October 2015 were retrospectively reviewed, and the treatment outcomes were evaluated. Results: The overall response rate and progression-free survival time (PFS) of the 53 patients with non-squamous NSCLC were 15.1% and 2.3 months, respectively. There were significant differences between the disease control rate (37.5% vs. 76.2%) and PFS time (1.8 months vs. 3.3 months) of the exon 19 deletion group and the L858R point mutation group, and a multivariate analysis identified type of EGFR mutation as well as performance status (PS) as independent predictors of PFS. Conclusions: The clinical data obtained in this study provided a valuable rationale for considering type of EGFR mutation as well as non-squamous histology as predictors of the efficacy of pemetrexed monotherapy.
Han, Seung-A;Yang, Eu Jeen;Kong, Younghwa;Joo, Chan-Uhng;Kim, Sun Jun
Clinical and Experimental Pediatrics
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v.60
no.7
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pp.227-231
/
2017
Purpose: This study aimed to verify the safety of low-dose topiramate on language development in pediatric patients with migraine. Methods: Thirty newly diagnosed pediatric patients with migraine who needed topiramate were enrolled and assessed twice with standard language tests, including the Test of Language Problem Solving Abilities (TOPs), Receptive and Expressive Vocabulary Test, Urimal Test of Articulation and Phonology, and computerized speech laboratory analysis. Data were collected before treatment, and topiramate as monotherapy was sustained for at least 3 months. The mean follow-up period was $4.3{\pm}2.7months$. The mean topiramate dosage was 0.9 mg/kg/day. Results: The patient's mean age was $144.1{\pm}42.3months$ (male-to-female ratio, 9:21). The values of all the language parameters of the TOPs were not changed significantly after the topiramate treatment as follows: Determine cause, from $15.0{\pm}4.4$ to $15.4{\pm}4.8$ (P>0.05); making inference, from $17.6{\pm}5.6$ to $17.5{\pm}6.6$ (P>0.05); predicting, from $11.5{\pm}4.5$ to $12.3{\pm}4.0$ (P>0.05); and total TOPs score, from $44.1{\pm}13.4$ to $45.3{\pm}13.6$ (P>0.05). The total mean length of utterance in words during the test decreased from $44.1{\pm}13.4$ to $45.3{\pm}13.6$ (P<0.05). The Receptive and Expressive Vocabulary Test results decreased from $97.7{\pm}22.1$ to $96.3{\pm}19.9months$, and from $81.8{\pm}23.4$ to $82.3{\pm}25.4months$, respectively (P>0.05). In the articulation and phonology validation in both groups, speech pitch and energy were not significant, and all the vowel test results showed no other significant values. Conclusion: No significant difference was found in the language-speaking ability between the patients; however, the number of vocabularies used decreased. Therefore, topiramate should be used cautiously for children with migraine.
Journal of the Korea Academia-Industrial cooperation Society
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v.19
no.6
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pp.280-290
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2018
This study was a non-equivalence-based Quasi experimental study comparing the difference in communication ability, emotional intelligence (EQ), self-esteem, and interpersonal abilities between an experimental group with communication training and a non-control group. The subjects of the study were nurses working for D university hospital located in C city and comprised an experimental group of 21 people and a control group of 21 people. From April to May 2017, the experimental group took communication training programs, which were designed to improve communication capacity, emotional intelligence, self-esteem, and interpersonal ability for a total of four sessions (for 2 hours a week), and pre-post examination was conducted for the validity of the study. For data analysis, the SPSS for Windows 23 was used for the mean and standard deviation of pre-post tests, and U-test of the independent sample Mann-Whitney and the Wilcoxon code order test of the corresponding sample were carried out. The study results indicate that, compared with the control group, the experimental group showed communication capacity (Z=-3.361, p<.05), emotional intelligence (Z=-2.209, p<.05), self-esteem (Z=-1.633, p<.05), and interpersonal relationship (Z=-2.577, p<.05). After the communication training program, scores of communication capacity, emotional intelligence (EQ), self-esteem, and interpersonal competence of the experimental group increased significantly, and all hypotheses were supported. These results suggest that nurses' use of communication training experience in performing nursing work in a clinical setting would improve communication skills, emotional intelligence (EQ), self-esteem, and interpersonal skills and provide therapeutic communication and effective nursing, thereby enhancing patients' satisfaction and contributing to the improvement of nursing quality.
Background: Among women with haematuria, defining individuals under high risk for bladder cancer based on reproductive factors prior to cystoscopy would be of great benefit in the management of this condition. The aim of this study was to compare age and reproductive factors such as menopausal status, parity, age at first delivery and age at the last delivery between women who have haematuria with or without bladder cancer. Materials and Methods: A total of 463 patients underwent diagnostic cystoscopy in D$\ddot{u}$zce University Faculty of Medicine between 1 June 2008 and 1 June 2013. Female patients who presented with persistent microscopic or macroscopic haematuria and underwent standard evaluation for haematuria including urinalysis, urine culture, urine cytology, urinary tract imaging with excretory urography or computerized tomography with contrast enhancement and endoscopic evaluation of the urethra and bladder were included in this study. Exclusion criteria were tobacco use and high risk occupations for bladder cancer such as textile, dry cleaning, painting and etc. Forteen women had hematuria due to benign conditions, and 18 due to bladder cancer. Data were retrospectively retrieved from the medical records of Duzce University Hospital. Results: Patients with haematuria due to benign reasons did not significantly differ from patients who were found to have bladder cancer in terms of age (p=0.28), menopausal status (p=0.29), mean parity (p=0.38), being nulliparous (p=0.57), parity ${\geq}3$ (p=0.22), age ${\leq}18$ years at first delivery (p=1.00), age ${\geq}30$ years at last delivery (p=0.26), age ${\geq}35$ years at last delivery (p=0.23) and percentage of the patients with advanced age (${\geq}65$ years) (p=0.18). Conclusions: It is difficult to predict a high risk for developing bladder cancer in women with haematuria based solely on reproductive factors.
Recently attention has been focused on the effects of early intervention, or its lack, on both normal and preterm infants. Particularly numerous studies suggest that premature infants are not necessarily understimulated but instead are subjected to inappropriate stimulation. Developmental support and sensory stimulation have become clinical opportunities in which nursing practice can impact on the neurobehavioral outcome of premature infants. Developmental care has been widely accepted and implemented in neonatal intensive care units across the country. Increasingly, attention and concern in caring for low-birth-weight infants and premature infants has led clinicians in the field to explore the effects of a complex of interventions designed to create and maintain a developmentally supportive environment; to provide age-appropriate sensory input; and to protect the infant from inappropriate, excessive and stressful stimulation. The components of developmental care include modifications of the macro-environment to reduce NICU light and sound levels, care clustering, nonnutritive sucking, and containment strategies, such as flexed positioning or swaddling. Sensory stimulation of the premature infants is presented to standardize the modification of a developmental intervention based on physiologic and behavioral cues. The most appropriate type of stimuli are those that are sensitive to infant cues. Evaluation of infant physiological and behavioral responds to specific intervention stimuli may help to identify more appropriate interventions based on infants' cues. A critical question confronting the clinician is that of determining when the evidence supporting a change in practice is sufficient to justify making that change. There are acknowledged limitations in the current studies. Many of the studies examined had small sample sizes; used nonprobability sampling; and used a phase lag design, which introduces the possibility of threats to internal validity and limits the generalizability of the results. Although many issues regarding the effects of developmental interventions remain unresolved, the available research base documents significant benefits of developmental care for LBW infants in consistent outcomes, without significant adverse effects. Particularly, although the individual studies vary somewhat in the definition of specific outcomes measured, instrumentation used, time and method of data collection, and preparaion of the care providers, in all studies, infants receiving the full protocol of individualized developmentally supportive care had improvements in some aspect of four areas of infant functioning: level of respiratory or oxygen support, the establishment of oral feeding; length of hospital stay, and infant behavioral regulation. In summary, based on the available literature, individualized developmental intervention should be incorporated into standard practice in neonatal intensive care. And this implementation needs to be coupled with ongoing research to evaluate the impact of an individualized developmental care programs on the short- and long-tenn health outcomes of LBW infants.
Seo, Yeon Ju;Seo, Jong Cheol;Kim, Shin Young;Yoon, Hyun Min;Jang, Sun Hee;Song, Chun Ho;Lee, Young Jun;Cho, Sung Woo;Kang, Seok Hwan;Kim, Cheol Hong
Journal of Acupuncture Research
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v.33
no.4
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pp.149-163
/
2016
Objectives : The purpose of this study is to determine the effect of Functional Cerebrospinal Therapy(FCST) on patients from traffic accidents with Temporomandibular Joint Disorder. Methods : We reviewed the medical records of 33 patients who were treated for injuries stemming from traffic accidents at the Dong-Eui University Korean Medicine Hospital from December 29th, 2015 to August 29th, 2016. The patients were divided into 2 groups: Group A(n = 15) and Group B(n = 18). In Group A, patients received Korean medical treatments with FCST using an Accurate Balancing Appliance(ABA) - a standard intra-oral appliance. In Group B, patients received Korean medical treatments without FCST. To estimate the efficacy of the treatments in decreasing pain, we analyzed the Visual Analogue Scale(VAS), Neck Disability Index(NDI) and Oswestry Disability Index(ODI). Results : In Group A, VAS of headache(VAS H), VAS of neck & nuchal pain(VAS N), VAS of shoulder pain(VAS S), and VAS of low back pain(VAS L) were significantly improved during each period. In Group B, VAS H was significantly improved during each period, except the period from the first visit to two weeks later. VAS N, S, L were significantly improved during each period, except the period from the first visit to one week later. The total VAS improvement during each period in Group A was significantly higher than Group B. In both groups, NDI and ODI were improved significantly during each period. The improvement of NDI and ODI during each period in Group A was significantly higher than Group B. Conclusion : According to the results, FCST using ABA may be an effective treatment for patients from traffic accidents.
Han, Ji Sun;Kwon, Min Soo;Kim, Jung Hwan;Jo, Dae Hyun;Jo, Hee Jin;Choi, Ji Eun;Kim, Ji Hye;Kim, Hyun Ho;Lee, Sang Hoon;Park, Young Jae;Park, Young Bae
Journal of Acupuncture Research
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v.33
no.4
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pp.101-108
/
2016
Objectives : Among the assessment tools for evaluating facial function, the House-Brackmann scale is used as a standard tool, but it has some shortcomings. The Sunnybrook Facial Grading System can assess the after effects of facial palsy and facial movement by each part of the face. By understanding the application state of this Sunnybrook Facial Grading System, we intend to analyze the relationship between House-Brackmann scale score and Sunnybrook Facial Grading System score so that we can examine the advantages of the Sunnybrook Facial Grading System as a more accurate tool. Methods : We screened both inpatients and outpatients who visited the Facial Palsy Center at Kyung Hee University Hospital for Korean medical treatment and were evaluated with the Sunnybrook Facial Grading System from December 2015 to October 2016. A total of 159 out of 166 patients were studied, including basic characteristics and missing data. We used descriptive statistics for general features of patients and SPSS Ver.18 for statistical analysis. Results : House-Brackmann scale and Sunnybrook Facial Grading System have high negative correlation through Pearson Correlation Coefficient with a score of -0.884. Analyzing outlier data resulting from relation analysis between the House-Brackmann scale and the Sunnybrook Facial Grading System showed many outliers when the damaged state of each part of the face is different. Conclusion : Sunnybrook Facial Grading System can make up for faults of the House-Brackmann scale, which is inferior in accuracy when each damage status of each part of the face is different. Sunnybrook Facial Grading System performs a detailed assessment of facial function and sequelae of facial palsy easier than the House-Brackmann scale.
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