The present case report describes an unusual variant of a missing medial tarsal artery (MTA) being replaced by the anterior medial malleolar artery (AMMA). The dorsalis pedis artery (DPA) did not give off any branches to the medial foot. The DPA coursed downward in the foot along with the superficial fibular nerve on the foot dorsum at the lateral side of the first metatarsal bone before entering the sole. In the medial malleolus, the AMMA arose from the anterior tibial artery and then ramified several branches, one of which descended to the medial talus. Thus, the possibility of a missing MTA being replaced by the AMMA should be considered by surgeons and radiologists when various surgeries are performed in the medial tarsal area.

Curriculum ; Education ; Humans ; Learning ; Lectures ; Methods ; Oral Hygiene ; Plastics

Purpose: This study aimed to identify the mediating effects of communication skills and pediatric nurse-parent partnership on the relationship between emotional intelligence and job satisfaction among pediatric nurses. Methods: A survey was administered to 205 pediatric nurses working in children’s, general, and tertiary hospitals situated in Chungcheong province and Seoul. Data were collected in August and September 2022. The collected data were analyzed using SPSS Statistics version 26.0 along with the PROCESS macro program. Results: Emotional intelligence had a significant effect, and was a critical factor affecting the job satisfaction of pediatric nurses. Furthermore, communication skills and nurse-parent partnership had a serial double mediating effect. Conclusion These findings underscore the significance of conducting job satisfaction improvement programs, including strategies for augmenting emotional intelligence, bolstering communication skills, and fostering nurse-parent partnership.

Urothelial cancer is the seventh most common cancer among men worldwide. Bacille de Calmette-Guérin is a type of anticancer immunotherapy that has been used to treat targeted bladder cancer, but the number of patients with treatment-refractory advanced urothelial cancer, patients has been increasing recently. To overcome this, enfortumab vedotin (novel nectin-4 targeting antibody-drug conjugate) known as antibody-drug conjugate (ADC), was approved. We describe the clinical development process of ADC and the potential for future development as a bladder cancer treatment.

The digastric muscle is located in the suprahyoid region which consists of anterior belly, intermediate tendon and posterior belly. This muscle is an important landmark when performing an operation of submental and upper neck region. Previous researches have reported about variations of the anterior and posterior belly of digastric muscle. However, there are few studies about the general morphology of the digastric muscle and the relationship with surrounding muscles. The purpose of this study was to analyze the morphology of the anterior belly of digastric muscle and confirm the topographic relationship between the digastric muscle and the stylohyoid muscle of Korean. Thirty-four cadavers (21 males, 13 females; mean age 65 years; range 24~89 years) were used in this study. The skin, subcutaneous tissues, superficial fascia and platysma were removed and a detailed dissection was performed, with extreme care being taken not to damage underlying the muscles of submental and upper neck region. After the dissections, all specimens were sketched and photographed. In 8 specimens, we observed the accessory bellies of the anterior belly of digastric muscle. We classified the accessory bellies into the crossover type (five specimens, 14.7%) that cross the mandibular raphe and unilateral type (three specimens, 8.82%). The findings resulting from observation of the anatomical relationship between the posterior belly of digastric and stylohyoid muscles, the posterior belly of digastric muscle perforated the stylohyoid muscle in 32 cases (65%) out of 49 sides. This case was subdivided into the belly of the stylohyoid muscle lean to the lateral (twenty-one specimens, 42.9%) or medial side (eleven specimens, 22.4%) of the posterior belly of digastric muscle. In 17 specimens (35%), the stylohyoid muscle existed on the medial side of the posterior belly of digastric muscle.
Anatomic Variation ; Cadaver ; Humans ; Male ; Muscles ; Neck ; Skin ; Subcutaneous Tissue ; Tendons

Some parts of Tables 1 and 2 in this paper was described incorrectly.

On page 289 of this paper, the x-axis title in Fig. 3A has been incorrectly spelled.

PURPOSE: Long-term treatment with inhaled steroids (ICS), especially fluticasone that developed lately, may suppress the hypothalamic-pituitary-adrenal (HPA) axis. This study investigated the relationship between ICS use and HPA axis suppression in asthmatics under ICS treatment for average 4.5 years. METHODS: The medical records of 129 adult asthmatics who received ICS treatment for 6 months or more and underwent a corticotropin stimulation test from January 2005 to August 2013 were retrospectively reviewed. RESULTS: The patients received ICS only (n=87) were found to have an abnormal response to the corticotropin test in as high as 32.2%, and those received ICS in combination with oral steroids (n=42) had a significantly higher prevalence of the response (71.4%, P<0.001). Abnormal responses to corticotropin occurred depending on ICS daily doses (low, n=8, 12.5%; medium, n=19, 36.8%; high, n=102, 49.0%; chi2=4.384, P=0.036). Among the subjects received ICS only, nasal steroid doses (P=0.016) but not ICS doses (P=0.159) were significantly higher in those with abnormal responses than the others. Among all the subjects, oral steroid use (odds ratio [OR], 4.27; 95% confidence interval [CI], 2.35-11.80; P<0.001) and nasal steroid dose (OR, 1.02; 95% CI, 1.00-1.04; P=0.015) were significant risk factors for HPA axis suppression. CONCLUSION: One-third of asthmatics under long-term treatment with ICS showed a suppression of the HPA axis in a dose-dependent manner. Oral or nasal steroid use may be a risk factor for the suppression. However, since our results may have been overestimated due to subject selection bias, further prospective case-control studies are warranted.
Adrenal Glands ; Adrenocorticotropic Hormone ; Adult ; Asthma* ; Axis, Cervical Vertebra* ; Case-Control Studies ; Humans ; Medical Records ; Prevalence ; Retrospective Studies ; Risk Factors ; Selection Bias ; Steroids* ; Fluticasone

Purpose: Hyperglycemia accelerates the formation of advanced glycation end products (AGEs), a group of compounds formed via non-enzymatic glycation/glycoxidation. Type 2 diabetes mellitus (T2DM) is related to oxidative stress, resulting in some overgeneration of AGEs. The accumulation of AGEs in T2DM patients leads to increased inflammation, DNA damage, tissue damage, progression of diabetic microvascular disease, and nephropathy. Heme oxygenase-1 (HO-1) is an intracellular enzyme that catalyzes the oxidation of heme. Expression of HO-1 in the endothelium and in muscle monocytes/macrophages was upregulated upon exposure to reactive oxygen species or oxidized low-density lipoprotein. Cells activated by oxidative stress are reported to release HO-1 in the serum. In the current study, we discuss the oxidative status according to the level of AGEs and the association of HO-1 with AGEs or urinary DNA damage marker in type 2 diabetic Korean patients. Methods: This study enrolled 36 diabetic patients. Subjects were classified into two groups by serum AGEs level (Low AGEs group: < 0.85 ng/mL serum AGEs; High AGEs group: > 0.85 ng/ mL serum AGEs). Body composition was measured using bioelectrical impedance analysis. Blood and urinary parameters were measured using commercial kits. Results: No significant differences were observed in the general characteristics and body composition between the two groups. Serum HO-1 concentration was significantly higher in the High AGEs group than in the Low AGEs group. After adjustment of age and gender, a correlation was performed to assess the association between serum HO-1 and serum AGEs or urinary 8-hydroxy-2′-deoxyguanosine (8-OHdG). Our results indicate that serum HO-1 is positively correlated with serum AGEs and urinary 8-OHdG. Conclusion Taken together, our results indicate that in diabetes patients, a high level of HO-1 is associated with a high concentration of AGEs and 8-OHdG, probably reflecting a protective response against oxidative stress.

PURPOSE: Increasing number of older adults are receiving cancer surgeries especially for gastrointestinal cancers, which brings forth attention to age-related postoperative complication prevention. Postoperative delirium (POD) is a common complication that rises after surgical procedures involving general anesthesia, largely in the elderly population. Due to its sudden onset and fluctuating symptoms, POD often goes underdiagnosed and undertreated even though it may lead to various adverse outcomes. POD in GI cancer surgical elderly patients is poorly understood in terms of prevalence, pathophysiology, assessment, treatment and nursing management. We aimed to identify available literature and investigate study results to broaden our understanding of geriatric GI cancer POD. METHODS: The search process involved six databases to identify relevant studies abided by inclusion criteria. RESULTS: Eleven studies were selected for this review. Geriatric POD is closely related to frailty and surgical complications. Frailty increases vulnerability to surgical stress and causes cerebral changes that affect stress-regulating neurotransmitter proportions, brain blood flow, vascular density, neuron cell life and intracellular signal transductions. These conditions of frailty result in increased risks of surgical complications such as blood loss, cardiovascular events and inflammation, which all may lead to the POD. Mini Metal State Examination (MMSE), Confusion Assessment Method (CAM) and Delirium Rating Scale-revised-98 (DRS-R-98) are recommended for POD assessment to identify high-risk patients. CONCLUSION: The POD prevalence ranged from 8.2% to 51.0%. The multifactorial causative mechanism suggests nurses to identify highrisk elderly GI-cancer surgical patients by reviewing patient-specific factors and surgery-specific factors.
Adult ; Aged ; Anesthesia, General ; Brain ; Delirium ; Gastrointestinal Neoplasms ; Humans ; Inflammation ; Methods ; Neurons ; Neurotransmitter Agents ; Nursing ; Postoperative Complications ; Prevalence ; Signal Transduction