PURPOSE: This study was conducted to investigate how home-based hospice care is provided in Korea. METHODS: From July 2011 through August 2011, 29 hospice facilities that provide home-based hospice care were surveyed using a questionnaire. Items included in the questionnaire were general characteristics of the organization, staff members, service programs, difficulties. RESULTS: Among the surveyed, hospice care was hospital-based for 11 (37.9%) facilities, hospital-independent center-based care for four (13.8%) and home-based care only for 10 (34.5%). Near half the participants were located in Seoul and Gyeonggi-do. Caregivers included nurses for 62.1% of the participants, volunteers 62.0%, pastors 44.8%, social workers 37.9%, coordinators 31.0% and doctors 31.0%. The facilities offered service programs such as family counseling (96.6%), transfer to other facilities (93.1%), psychological support (89.7%), bereavement support (86.2%), dying care (79.3%), clinical care (75.9%) and spiritual support (75.9%). The major obstacles were financial issues (24.1%), lack of trained staff (20.7%) and staff members' lack of awareness of home-based hospice care (13.8%). CONCLUSION: In Korea, home-based hospice care is provided by an insufficient number of facilities. Moreover, the service providers are experiencing difficulties such as lack of trained staff, insufficient financial resource and staff's lack of awareness of home-based hospice care. It is necessary to increase the number of home-based hospice care facilities with consideration of even distribution across regions and standard staffing and service programs and develop related insurance policies.
Bereavement ; Caregivers ; Counseling ; Health Services ; Home Care Services ; Hospice Care ; Hospices ; Humans ; Insurance ; Korea ; Social Workers ; Surveys and Questionnaires

PURPOSE: To evaluate the treatment outcome and prognostic factor of postoperative radiotherapy for extremity soft tissue sarcoma (STS). MATERIALS AND METHODS: Forty three patients with extremity STS were treated with conservative surgery and postoperative radiotherapy from January 1981 to December 2010 at Korea University Medical Center. Median total 60 Gy (range, 50 to 74.4 Gy) of radiation was delivered and 7 patients were treated with chemotherapy. RESULTS: The median follow-up period was 70 months (range, 5 to 302 months). Twelve patients (27.9%) sustained relapse of their disease. Local recurrence occurred in 3 patients (7.0%) and distant metastases developed in 10 patients (23.3%). The 5-year overall survival (OS) was 69.2% and disease free survival was 67.9%. The 5-year local relapse-free survival was 90.7% and distant relapse-free survival was 73.3%. On univariate analysis, no significant prognostic factors were associated with development of local recurrence. Histologic grade (p = 0.005) and stage (p = 0.02) influenced the development of distant metastases. Histologic grade was unique significant prognostic factor for the OS on univariate and multivariate analysis. Severe acute treatment-related complications, Common Terminology Criteria for Adverse Events (CTCAE) grade 3 or 4, developed in 6 patients (14.0%) and severe late complications in 2 patients (4.7%). CONCLUSION: Conservative surgery with postoperative radiotherapy achieved a satisfactory rate of local control with acceptable complication rate in extremity STS. Most failures were distant metastases that correlate with tumor grade and stage. The majority of local recurrences developed within the field. Selective dose escalation of radiotherapy or development of effective systemic treatment might be considered.
Academic Medical Centers ; Disease-Free Survival ; Extremities ; Follow-Up Studies ; Humans ; Korea ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence ; Sarcoma ; Treatment Outcome

OBJECTIVE: The present study was performed to investigate whether apoptosis occur in human embryos by annexin staining and detect the expression of Fas, Fas-ligand (FasL), Bax, and Bcl-2 in human fragmented embryos derived from IVF-ET by immunofluorescence and Western blot analysis. MATERIALS AND METHODS: Using annexin staining, immunofluorescence and Western blot analysis on normal and fragmented embryos, we were able to detect apoptotsis and apoptotic gene products in fragmented embryos. RESULTS: Phosphatidylserine (PS) translocation, the marker for apoptosis, were detected frequently in fragmented embryos. Bcl-2 and Bax protein were detected in both fragmented and non-fragmented embryos. When fragmented embryos compared to normal embryos, immunofluorescent intensity of Bcl-2 tended to be lower in fragmented embryos. Bax gene expression increased in the fragmented embryos compared to the normal embryos. This result supports a model in which the molar ratio of Bcl-2 to Bax determines whether apoptosis induced or inhibited in human embryo. Fas was highly expressed in human preimplantation embryos but not FasL. It suggests that embryo may undergo apoptosis by binding with FasL produced by follicular or immune cells. CONCLUSION: The over expression of Bax and Fas will trigger apoptosis to lead embryo fragmentation and change embryo to be nonviable.
Apoptosis* ; bcl-2-Associated X Protein ; Blastocyst ; Blotting, Western ; Embryonic Structures* ; Fluorescent Antibody Technique ; Gene Expression ; Humans* ; Molar

BACKGROUND: Echocardiography gives a window to mediastinal or paracardiac structures. When mediastinal or paracardiac masses are detected by a routine chest X-ray and thoracic CT, the difference between vascular and nonvascular lesions may be difficult to diagnose. In these situations, echocardiography has been successfully used recently. CT can be easily standardized and allows visualization of the whole chest, but it is less precise in defining highly mobile structures, more expensive and difficult to perform in patients with orthopnea. But echocardiography is easy to perform, gives real time images. We performed this study to evaluate the usefulness of echocardiography in the identification and investigation of the structural and functional effects of paracardiac masses. METHODS: Twenty patients with paracardiac masses detected by chest X-ray and thoracic CT were examined by transthoracic and/or transesophageal echocardiography. We studied the characteristics of masses and compression site by 2-D echocardiographic techniques and also evaluation of functional effects of a paracardiac masses on heart and great vessels by color pulsed waved Doppler echocardiographic techniques. RESULTS: Nine patients(45.0%) had cystic masses, eleven patients(55.0%) had solid masses. All cystic masses revealed benign, and all solid masses revealed malignant. Among metastatic paracardiac tumors, the most frequent primary site were lung. heart chambers were compressed by paracardiac masses in five cases(26.7%) and great vessel compressed in thirteen cases(76.4%). Turbulent flow and peak velocity documented by color and PW dopple suggested that it is hemodynamically significant compression states of the great vessels by masses. CONCLUSIONS: We consider that echocardiography is as useful as other noninvasive radiographic techniques in the evaluation of paracardiac masses and their mechanical effect upon the function of the heart and great vessels.
Echocardiography* ; Echocardiography, Doppler ; Echocardiography, Transesophageal ; Heart ; Humans ; Lung ; Thorax

BACKGROUND: In hypertensive patients, the left ventricular hypertrophy(LVH) is very important as an independent risk factor along with developing complications. The present study was attempted to assess whether LVE assessed by echocardiography is related to diurnal variations of blood pressure in patiens with essential hypertension. METHOD: After 24hr ambulatory blood pressure monitoring, echocardiographic parameters were investigated in 30 healthy normotensive subjects and 17 patients with diurnal variation of blood pressure and 19 patients without diurnal variation respectively. RESULTS: Left ventricular mass index was higher in essential hypertensive patients than normotensive subjects. In patients without nocturnal fall in systolic blood pressure, left ventricular mass tended to be higher than in patients with a nocturnal fall without statistic significance. In the hypertensive patients with nocturnal fall, there was a correlationship between LVMI and changes in systolic blood pressure, but no correlation between left ventricular mass index and changes in diastolic blood pressure. In the hypertensive patients without nocturnal fall, changes of both systolic and diastolic pressure did not affect LVMI. CONCLUSION: It is suggested strongly that left ventricular hypertrophy may occur highly in the hypertensive patients without nocturnal(diurnal) variation in blood pressure and may be associated with changes in diastolic and systolic blood pressure. But in hypertensive patient with nocurnal fall, left ventricular hypertrophy may be associated with changes in systolic blood pressure.
Blood Pressure Monitoring, Ambulatory ; Blood Pressure* ; Echocardiography ; Humans ; Hypertension* ; Hypertrophy, Left Ventricular ; Risk Factors

Homeostasis of multicellular organism is controlled by proliferation and differentiation of cells as well as by cell death. The defects in programmed cell death contribute to the pathogenesis of rheumatoid arthritis (RA) and systemic lupus erythematous. RA is considered to be a proliferating disorder of synovial tissue which is accompanied by inflammatory cell infiltration and bone erosion. The aim of the study was to find whether potent inducers of apoptosis could be induced apoptosis in RA synovial cells. We examined the effects of drugs, such as dexamethasone, methotrexate, hydrogen peroxide, and ceramide on induction of apoptosis in cultured RA synovial cells. Used drugs did not induced apoptosis in RA synovial cells. Finally Fas antigen-mediated apoptosis of RA synovial cells was investigated by the addition of anti-Fas antibody. To examine the ICE (interleukin-1p-convertase; caspase-1) expression in synovial cells, RT-PCR of caspase-1 gene was performed. In synovial cells of RA, Fas induces that caspase-1 activation cause apoptosis.
Apoptosis* ; Arthritis, Rheumatoid* ; Cell Death ; Dexamethasone ; Homeostasis ; Humans ; Hydrogen Peroxide ; Ice ; Methotrexate

PURPOSE: To determine the usefulness of transrectal ultrasonography (TRUS) in diagnosing prostate cancer bycomparing the sensitivity, specificity, accuracy, and positive and negative predictive values of TRUS with thoseof serum prostate-specific antigen (PSA), prostate-specific antigen density (PSAD) and digital rectal examination(DRE). MATERIALS AND METHODS: Two hundred and ten consecutive patients underwent TRUS-guided prostate biopsy dueto elevated PSA and/or abnormal findings on TRUS or DRE. The TRUS findings were analyzed and correlated withpathological diagnosis. PSAD was calculated by dividing the serum PSA level by the prostate volume calculated onTRUS. The sensitivity, specificity, accuracy, and positive and negative predictive values of TRUS were comparedwith those of PSA, PSAD and DRE. Using ROC curve analysis, the combinations of these diagnostic methods were alsoevaluated for the determination of efficacy in diagnosing prostate cancer. RESULTS: The sensitivity andspecificity of serum PSA (cut-off level, 4ng/ml), PSAD (cut-off level, 0.15ng/ml/cm3), DRE, and trus were 96%/17%,96%/37%, 72%/62%, and 89%/68%, respectively. On TRUS, the sensitivity and specificity of low echoic lesions andthose of irregular outer margin were 89%/69%, and 60%/90%, respectively. TRUS was statistically more accurate thanother diagnostic methods. Of the combinations of diagnostic methods, TRUS and PSAD were most accurate. CONCLUSION: TRUS demonstrated lower sensitivity but higher specificity than PSA or PSAD. Although it is an accurate modalityfor the diagnosis of prostate cancer, it cannot be used as a confirmative test due to its relatively low positivepredictive value. A combination of diagnostic methods and random biopsy is needed in patients in whom prostatecancer is suspected.
Biopsy ; Diagnosis ; Humans ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Neoplasms* ; ROC Curve ; Sensitivity and Specificity ; Ultrasonography*

Background: A nationwide anti-parasite control program (1969–1995) successfully reduced soil-transmitted helminth infections; however, fish-borne trematode infections persisted in some areas. Since the 2012 National Parasite Infection Survey, information on the current status of intestinal helminth infections has not been updated. Analysis of the current trends in intestinal helminth infections is necessary to prevent and manage parasitic diseases in Korea. Methods: This retrospective study analyzed the prevalence of intestinal parasites in 1,211,799 individuals who visited 16 regional branches of the Korea Association of Health Promotion between 2011 and 2020. Examinations were performed using microscopy and Kato's method. The results were analyzed according to parasite species, year, sex, age, and region of origin. Results: Intestinal helminth infections remained above 2.0% from 2011 to 2014 but decreased to 1.0% by 2020. Clonorchis sinensis had the highest infection rate (1.3%), followed by Metagonimus yokogawai (0.3%) and Trichuris trichiura (0.2%). Men had a higher infection rate (2.4%) than that of women (1.2%). The infection rate was higher among those in their 50s (2.0%), 60s, and older (1.8%). The highest regional infection rates were observed in Gyeongnam (4.8%), Ulsan (3.1%), Gyeongbuk (2.5%), Busan (1.8%), and Jeonnam (1.6%). Conclusion These results provide valuable insights into the decreasing prevalence and epidemiological characteristics of intestinal helminth infections in the Korean population.Therefore, various control measures are needed to prevent intestinal helminth infections, and continuous monitoring is essential until they are eradicated.

Standardized patients(SPs) are either persons who are trained to simulate a patient's illness in a standardized way or actual patients. Newly established Sungkyunkwan University School of Medicine started problem based learning(PBL) curriculum and SP program has been developed for teaching and evaluating clinical skills in medical education. Standardized patients were recruited from the community. Small-group SP training sessions were operated by two SP trainers and supervised by a clinical faculty. Standardized patients were used in teaching and practicing interviewing and physical examination skills for students. We report the experiences of initial stage of SP program and views of students and SPs. We surveyed 35 first-year medical students after SP encounters. The questionnaire was about effectiveness and realism of SP and general views of students. Another simple survey was conducted on 12 SPs who had participated in SP program for more than 4 months. Most students answered that SP encounters were interesting and more helpful in learning history-taking and clinical skills. The attitude of SPs was enthusiastic and their simulations were rated as appropriate and acceptable. The evaluations of the SP program by students, SPs, and faculty were very favorable. As an alternative to real patients, the SP can offer advantages such as availability, adaptability and controllability. If trained well, they also can provide objective feedback to the students. The SP offers a readily available tool for teaching and evaluating the clinical performance and interpersonal skills of medical students. It is suggested that the use of SP is stimulating and challenging way of teaching and evaluating in medical education.
Clinical Competence ; Curriculum ; Education, Medical* ; Humans ; Learning ; Physical Examination ; Problem-Based Learning ; Students, Medical ; Surveys and Questionnaires

OBJECTIVE: To assess the feasibility of computed tomography (CT) lymphography using ethiodized oil for sentinel node mapping in experimentally induced VX2 carcinoma in the rabbit thigh. MATERIALS AND METHODS: This experiment received approval from the institutional animal use and care administrative advisory committee. Twenty-three rabbits with VX2 carcinoma in the thigh underwent CT before and after (1 hour, 2 hour) peritumoral injection of 2 mL ethiodized oil. After the CT examination, sentinel nodes were identified by peritumoral injection of methylene blue and subsequently removed. The retrieved sentinel and non-sentinel lymph nodes were investigated with radiographic and pathologic examinations. Based on the comparison of CT findings with those of radiographic and pathologic examinations, the diagnostic performance of CT for sentinel node identification was assessed. RESULTS: All 23 rabbits showed 53 ethiodized oil retention nodes on post-injection CT and specimen radiography, and 52 methylene blue-stained nodes at the right femoroiliac area. Of the 52 blue-stained sentinel nodes, 50 nodes demonstrated ethiodized oil retention. Thus, the sentinel node detection rate of CT was 96% (50 of 52). On pathologic examination, 28 sentinel nodes in 17 rabbits (nodes/rabbit, mean +/- standard deviation, 1.7 +/- 0.6) harbored metastasis. Twenty seven of the 28 metastatic sentinel nodes were found to have ethiodized oil retention. CONCLUSION: Computed tomography lymphography using ethiodized oil may be feasible for sentinel node mapping in experimentally induced VX2 carcinoma in the rabbit thigh.
Animals ; Carcinoma/pathology/*radiography/secondary ; Contrast Media/*diagnostic use ; Ethiodized Oil/*diagnostic use ; Feasibility Studies ; Female ; Injections ; Lymph Node Excision/methods ; Lymph Nodes/pathology/*radiography ; Lymphatic Metastasis/radiography ; Lymphography/*methods ; Rabbits ; Thigh ; Tomography, X-Ray Computed/*methods