Purpose: : The purposes of this study were to examine the relationships between knowledge, awareness, safe environment, and performance of standard precautions and identify factors associated with performance of standard precautions.
Methods: : This study was a descriptive research. A structured questionnaire on knowledge, awareness, safe environment, and performance of standard precautions was used for the survey with a convenience sample of 150 caregivers. Data were collected from July to August 2019 and were analyzed using descriptive statistics, independent t-test, one way ANOVA, Pearson’s correlation coefficient, and multiple regression with SPSS/WIN 25.0 program.
Results: : The mean scores on knowledge, awareness, safe environment, and performance of standard precautions were 15.77±3.34, 7.35±1.91, 4.55±2.05, and 55.20±10.11 respectively. Performance of standard precautions showed a statistically significant positive correlation with knowledge (r=.54, p<.001), awareness (r=.54, p<.001), and safe environment (r=.50, p<.001). Awareness (β=.24, p=.025) and safe environment (β=.35, p<.001) were significantly associated with factors of performance of standard precautions. Also, education level (high school and above college), affiliated institution (private association), and importance of infection control education (moderate) were significantly associated with factors of performance of standard precautions.
Conclusion : The results of the study indicate that factors influencing the performance of standard precautions of caregivers were awareness and safe environment. Therefore, to improve implementation of the standard precautions among caregivers, a safe environment within the hospital must be supported, and appropriate infection management education needs to be provided to caregivers to improve their knowledge and awareness of the standard precautions.

Background: Dickkopf-1 (DKK1) regulates bone formation by inhibiting canonical Wnt/β-catenin pathway signaling, and indirectly enhances osteoclastic activity by altering the expression ratio of receptor activator of nuclear factor-κB ligand (RANKL) relative to osteoprotegerin (OPG). However, it is difficult to explain continued bone loss after allogeneic stem cell transplantation (allo-SCT) in terms of changes in only RANKL and OPG. Few studies have evaluated changes in DKK1 after allo-SCT. Methods: We prospectively enrolled 36 patients with hematologic malignancies who were scheduled for allo-SCT treatment. Serum DKK1, OPG, and RANKL levels were measured before (baseline), and at 1, 4, 12, 24, and 48 weeks after allo-SCT treatment. Bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry before (baseline) and 24 and 48 weeks after allo-SCT treatment. Results: After allo-SCT treatment, the DKK1 level decreased rapidly, returned to baseline during the first 4 weeks, and remained elevated for 48 weeks (P<0.0001 for changes observed over time). The serum RANKL/OPG ratio peaked at 4 weeks and then declined (P<0.001 for changes observed over time). BMD decreased relative to the baseline at all timepoints during the study period, and the lumbar spine in female patients had the largest decline (–11.3%±1.6% relative to the baseline at 48 weeks, P<0.05). Conclusion Serum DKK1 levels rapidly decreased at 1 week and then continued to increase for 48 weeks; bone mass decreased for 48 weeks following engraftment in patients treated with allo-SCT, suggesting that DKK1-mediated inhibition of osteoblast differentiation plays a role in bone loss in patients undergoing allo-SCT.

BACKGROUND: Oxidative stress in primary aldosteronism (PA) is thought to worsen aldosterone-induced damage by activating proinflammatory processes. Therefore, we investigated whether inflammatory markers associated with oxidative stress is increased with negative impacts on heart function as evaluated by echocardiography in patients with PA. METHODS: Thirty-two subjects (mean age, 50.3±11.0 years; 14 males, 18 females) whose aldosterone-renin ratio was more than 30 among patients who visited Severance Hospital since 2010 were enrolled. Interleukin-1β (IL-1β), IL-6, IL-8, monocyte chemoattractant protein 1, tumor necrosis factor α (TNF-α), and matrix metalloproteinase 2 (MMP-2), and MMP-9 were measured. All patients underwent adrenal venous sampling with complete access to both adrenal veins. RESULTS: Only MMP-2 level was significantly higher in the aldosterone-producing adenoma (APA) group than in the bilateral adrenal hyperplasia (BAH). Patients with APA had significantly higher left ventricular (LV) mass and A velocity, compared to those with BAH. IL-1β was positively correlated with left atrial volume index. Both TNF-α and MMP-2 also had positive linear correlation with A velocity. Furthermore, MMP-9 showed a positive correlation with LV mass, whereas it was negatively correlated with LV end-systolic diameter. CONCLUSION: These results suggest the possibility that some of inflammatory markers related to oxidative stress may be involved in developing diastolic dysfunction accompanied by LV hypertrophy in PA. Further investigations are needed to clarify the role of oxidative stress in the course of cardiac remodeling.
Adenoma ; Chemokine CCL2 ; Cytokines ; Echocardiography ; Heart ; Heart Diseases ; Humans ; Hyperaldosteronism* ; Hyperplasia ; Hypertrophy ; Interleukin-6 ; Interleukin-8 ; Male ; Matrix Metalloproteinase 2 ; Oxidative Stress ; Tumor Necrosis Factor-alpha ; Veins

Objectives: Circadian misalignment may increase the risk of obesity and related obstructive sleep apnea (OSA). Considerable young adults have social jetlag (SJL), which is defined as the time discrepancy between workdays and free days. We aim to evaluate the relationship between SJL and sleep and respiratory disturbance in patients with untreated OSA patients. Methods: A total of 180 OSA patients under the age of 50 [mean 38.3±8.0 y, 93.3% male, mean apnea-hypopnea index (AHI) 38.2±27.4 /h] were recruited from the university affiliated sleep clinic and fulfilled sleep-related questionnaires including Munich Chronotype Questionnaire (MCTQ). SJL was defined as the difference in sleep midpoints between work and free days. Patients were divided into three groups with SJL less than 1 hour, 1–2 hours, and 2 hours or more and the clinical and sleep data of each group were compared. Results: 51.6% (n=93) suffered from significant SJL (≥1 h). Patients with ≥2h of SJL (16.6%, n=30) had the largest neck circumference (NC). AHI and sleep parameters were not significantly different among groups except lowest oxygen saturation (LoS) was the lowest in the group of ≥2 h. SJL was positively correlated with body mass index and NC and negatively correlated with LoS after adjusting for age and sex. Conclusions About a half of young adults with OSA have significant SJL more than 1 h. This study suggests that SJL is associated with being overweight, while it seems not increase the severity of OSA nor deteriorate sleep quality in young adults.

Objective: The purpose of this study is to identify personality types that can influence breast cancer screening (BCS) compliance among Korean women with breast cancer using a mixed-method approach. Methods: The participants consisted of 93 women who underwent surgery for breast cancer between July 2010 and March 2012. The demographic and medical characteristics of the participants were evaluated through structured interviews. To identify personality types, in-depth interviews were performed and the transcribed interviews were evaluated using interpretive phenomenological analysis. The participants were categorized into two groups (compliance and non-compliance) based on compliance with the Korean Breast Cancer Society recommendations for BCS. Results: Five personality types were identified through phenomenological analysis. There were significant differences in the chi-square test results for the BCS compliance and non-compliance groups according to age (p=0.048), cancer stage (p<0.001), and personality types (p=0.018). Logistic regression showed that the odds ratio for compliance with BCS was 9.35 (p=0.01) for individuals with a cautious-organized personality type, 9.38 (p=0.02) for those with a cautious-dependent personality, and 10.58 (p=0.04) for those with a sensitive-downcast personality compared to those with a cautious personality type. Conclusion Participants with cautious-organized, cautious-dependent, and sensitive-downcast personality types were less likely to follow the BCS recommendations than those with a cautious personality type. This study provides a basis for the future development of an effective questionnaire to investigate the personality types of individuals with breast cancer in order to predict compliance with BCS.

Objectives: Circadian misalignment may increase the risk of obesity and related obstructive sleep apnea (OSA). Considerable young adults have social jetlag (SJL), which is defined as the time discrepancy between workdays and free days. We aim to evaluate the relationship between SJL and sleep and respiratory disturbance in patients with untreated OSA patients. Methods: A total of 180 OSA patients under the age of 50 [mean 38.3±8.0 y, 93.3% male, mean apnea-hypopnea index (AHI) 38.2±27.4 /h] were recruited from the university affiliated sleep clinic and fulfilled sleep-related questionnaires including Munich Chronotype Questionnaire (MCTQ). SJL was defined as the difference in sleep midpoints between work and free days. Patients were divided into three groups with SJL less than 1 hour, 1–2 hours, and 2 hours or more and the clinical and sleep data of each group were compared. Results: 51.6% (n=93) suffered from significant SJL (≥1 h). Patients with ≥2h of SJL (16.6%, n=30) had the largest neck circumference (NC). AHI and sleep parameters were not significantly different among groups except lowest oxygen saturation (LoS) was the lowest in the group of ≥2 h. SJL was positively correlated with body mass index and NC and negatively correlated with LoS after adjusting for age and sex. Conclusions About a half of young adults with OSA have significant SJL more than 1 h. This study suggests that SJL is associated with being overweight, while it seems not increase the severity of OSA nor deteriorate sleep quality in young adults.

Pseudohypoparathyroidism (PHP) is a rare disorder caused by genetic and epigenetic aberrations in the GNAS complex locus resulting in impaired expression of stimulatory G protein (Gsα). PHP type Ib (PHP-Ib) is characterized by hypocalcemia and hyperphosphatemia due to renal resistance to the parathyroid hormone, and is distinguished from PHP-Ia by the absence of osteodystrophic features. An 11-yr-old boy presented with poor oral intake and cramping lower limb pain after physical activity. Laboratory studies revealed hypocalcemia, hyperphosphatemia, and increased parathyroid hormone levels. The GNAS complex locus was evaluated using the methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) assay. Gain of methylation in the NESP55 domain and loss of methylation in the antisense (AS) transcript, XL, and A/B domains in the maternal allele were observed. Consequently, we present a case of PHP-Ib diagnosed using MS-MLPA.
Alleles ; Epigenomics ; GTP-Binding Proteins ; Humans ; Hyperphosphatemia ; Hypocalcemia ; Lower Extremity ; Male ; Methylation* ; Motor Activity ; Multiplex Polymerase Chain Reaction ; Muscle Cramp ; Parathyroid Hormone ; Pseudohypoparathyroidism*

BACKGROUND/AIMS: Levels of serum apelin (s-apelin), an endogenous ligand for angiotensin-like receptor 1, have been shown to be related to hepatic fibrosis and hemodynamic abnormalities in preclinical studies. We investigated the clinical implications of s-apelin as a noninvasive prognostic biomarker for chronic liver disease (CLD). METHODS: From January 2009 to December 2012, 215 CLD patients were enrolled and underwent clinical data collection, hepatic venous pressure gradient (HVPG) measurement, and liver biopsy. s-apelin was detected with a human total apelin enzyme-linked immunosorbent assay kit. All patients were prospectively observed during the median follow-up period of 23.0±12.9 months for decompensation and mortality. RESULTS: A total of 42 patients (19.5%) died during the follow-up period. s-apelin was significantly correlated with measurements of liver stiffness (R2=0.263, p<0.001) and collagen proportional area (R2=0.213, p<0.001) measured from liver biopsy tissue and HVPG (R2=0.356, p<0.001). In a multivariate analysis using a Cox regression hazard model, s-apelin was a weakly significant predictor of decompensation (hazard ratio [HR], 1.002; p<0.001) and mortality (HR, 1.003; p<0.001). CONCLUSIONS: s-apelin showed a significant relationship with CLD severity. However, its significance as a noninvasive biomarker for disease severity and prognosis was weak.
Adult ; Biomarkers/blood ; Biopsy ; Enzyme-Linked Immunosorbent Assay ; Female ; Follow-Up Studies ; Humans ; Hypertension, Portal/*blood/complications/mortality ; Intercellular Signaling Peptides and Proteins/*blood ; Liver/blood supply/pathology ; Liver Cirrhosis/*blood/etiology/mortality/pathology ; Male ; Middle Aged ; Portal Pressure ; Prognosis ; Proportional Hazards Models ; Prospective Studies

We reviewed our leukemia database to reclassify 610 patients previously diagnosed as having acute myeloid leukemia (AML) according to the updated 2016 WHO classification. Nine patients were categorized as having myelodysplastic syndrome and myeloid neoplasms with germline predisposition. AML with recurrent genetic abnormalities accounted for 57.4% (345/601) of the patients under the 2016 WHO classification. AML with mutated NPM1 was the most common form (16.5%), with the majority associated with monocytic differentiation (63.6%). AML with double CEBPA mutations accounted for 8.3% of these cases, and the majority were previously diagnosed as AML with/without maturation (78.0%). These newly classified mutations were mutually exclusive without overlapping with other forms of AML with recurrent genetic abnormalities. AML with mutated NPM1 and AML with myelodysplasia-related changes comprised the oldest patients, whereas AML with RUNX1-RUNX1T1 included the youngest patients. The leukocyte count was highest in AML with mutated NPM1, and the percentage of peripheral blood blasts was the highest in AML with double CEBPA mutations. Our results indicate that implementation of the 2016 WHO classification of AML would not pose major difficulties in clinical practice. Hematopathologists should review and prepare genetic tests for the new classification, according to their clinical laboratory conditions.
Classification ; Humans ; Leukemia ; Leukemia, Myeloid, Acute ; Leukocyte Count ; Myelodysplastic Syndromes

Objective: To assess the incremental prognostic value of coronary computed tomography angiography (CCTA) in comparison toa clinical risk model (Framingham risk score, FRS) and coronary artery calcium score (CACS) for future cardiac events in ischemicstroke patients without chest pain. Materials and Methods: This retrospective study included 1418 patients with acute stroke who had no previous cardiac diseaseand underwent CCTA, including CACS. Stenosis degree and plaque types (high-risk, non-calcified, mixed, or calcified plaques) wereassessed as CCTA variables. High-risk plaque was defined when at least two of the following characteristics were observed:low-density plaque, positive remodeling, spotty calcification, or napkin-ring sign. We compared the incremental prognosticvalue of CCTA for major adverse cardiovascular events (MACE) over CACS and FRS. Results: The prevalence of any plaque and obstructive coronary artery disease (CAD) (stenosis ≥ 50%) were 70.7% and 30.2%,respectively. During the median follow-up period of 48 months, 108 patients (7.6%) experienced MACE. Increasing FRS, CACS,and stenosis degree were positively associated with MACE (all p< 0.05). Patients with high-risk plaque type showed the highestincidence of MACE, followed by non-calcified, mixed, and calcified plaque, respectively (log-rank p< 0.001). Among theprediction models for MACE, adding stenosis degree to FRS showed better discrimination and risk reclassification compared toFRS or the FRS + CACS model (all p< 0.05). Furthermore, incorporating plaque type in the prediction model significantly improvedreclassification (integrated discrimination improvement, 0.08; p= 0.023) and showed the highest discrimination index(C-statistics, 0.85). However, the addition of CACS on CCTA with FRS did not add to the prediction ability for MACE (p> 0.05). Conclusion Assessment of stenosis degree and plaque type using CCTA provided additional prognostic value over CACS andFRS to risk stratify stroke patients without prior history of CAD better.