PURPOSE: We evaluated whether increased split renal function ratio (%) on the renal scan with Tc-99m diethylenetriamine pinta-acetic acid (DTPA) represent elevated renal function in the obstructed kidney. MATERIALS AND METHODS: From 1994 to 1995, we evaluated 36 patients with unilateral hydronephrosis due to ureteropelvic junction (UPJ) obstruction and split renal function ratios of the affected kidneys were calculated using Tc-99m DTPA renal scan. RESULTS: Of the 36 patients, 7 patients showed that split renal function ratios of the affected kidneys were all over 52%. To assess the significance of the split renal function ratio on the Tc-99m DTPA renal scan, we performed Tc-99m mercaptoacetyltriglycine (MAG3) renal scan with the time interval of 3 days and calculated the split renal function ratios of the affected kidneys on the MAG3 renal scan in all 7 patients. The split renal function ratios of the affected kidneys on the MAG3 renal scan were also higher than those of the normal kidney. And the split renal function ratios of the affected kidneys on the MAG3 renal scan were well correlated with those of DTPA renal scan (r=0.83). CONCLUSIONS: Our results suggest that the increased split renal function ratio in affected kidney due to UPJ obstruction is not an artifact of the DTPA renogram.
Artifacts ; Humans ; Hydronephrosis ; Kidney* ; Pentetic Acid

PURPOSE: An emerging trend in Asian higher education is English-medium instruction (EMI), which uses English as the primary instructional language. EMI prepares domestic students for international leadership; however, students report difficulty in learning, and educators have raised questions concerning the effectiveness of EMI. The flipped learning model (FLM), in which lecture and homework activities for a course are reversed, was applied to an English-medium course offered by a college of nursing in Korea. The aims of this study were to: 1) revise an existing English-medium nursing course using the FLM; 2) explore students' learning experiences and their acceptance of the FLM; and 3) identify key factors in the success of FLM. METHODS: We used a descriptive, cross-sectional, mixed-methods design and the participants were students at one nursing school in Korea. A series of course development meetings with faculties from the nursing school and the center for teaching and learning were used to develop the course format and content. We conducted course evaluations using the Flipped Course Evaluation Questionnaire with open-ended questions and focus group interviews. RESULTS: Students (N=75) in a 15-week nursing course responded to a survey after completing the course. Among them, seven students participated in one of two focus groups. Overall, students accepted and favored the flipped learning strategy, and indicated that the method enhanced lecture content and their understanding of it. Factors associated with effective instruction included structured monitoring systems and motivational environments. CONCLUSION: The FLM requires sufficient preparation to facilitate student motivation and maximize learning outcomes.
Cross-Sectional Studies ; Curriculum ; *Education, Nursing, Baccalaureate ; Female ; Focus Groups ; Humans ; Interviews as Topic ; Male ; *Models, Educational ; Republic of Korea ; Students, Nursing/psychology ; Surveys and Questionnaires ; Young Adult

PURPOSE: Tumor infiltration around the knee joint or skip metastasis, repeated infection sequelae after tumor prosthesis implantation, regional recurrence, and mechanical failure of the megaprosthesis might require combined distal femur and proximal tibia replacement (CFTR). Among the aforementioned situations, there are few reports on the indication, complications, and implant survival of CFTR in temporarily arthrodesed patients who had a massive bony defect on either side of the knee joint to control infection. MATERIALS AND METHODS: Thirty-four CFTR patients were reviewed retrospectively and 13 temporary arthrodesed cases switched to CFTR were extracted. All 13 cases had undergone a massive bony resection on either side of the knee joint and temporary arthrodesis state to control the repeated infection. This paper describes the diagnosis, tumor location, number of operations until CFTR, duration from the index operation to CFTR, survival of CFTR, complications, and Musculoskeletal Tumor Society (MSTS) score. RESULTS: According to Kaplan-Meier plot, the 5- and 10-year survival of CFTR was 69.0%±12.8%, 46.0%±20.7%, respectively. Six (46.2%) of the 13 cases had major complications. Three cases underwent removal of the prosthesis and were converted to arthrodesis due to infection. Two cases underwent partial change of the implant due to loosening and periprosthetic fracture. The remaining case with a deep infection was resolved after extensive debridement. At the final follow-up, the average MSTS score of 10 cases with CFTR was 24.6 (21–27). In contrast, the MSTS score of 3 arthrodesis cases with failed CFTR was 12.3 (12–13). The average range of motion of the 10 CFTR cases was 67° (0°–100°). The mean extension lag of 10 cases was 48° (20°–80°). CONCLUSION: Although the complication rates is substantial, conversion of an arthrodesed knee to a mobile joint using CFTR in a patient who had a massive bony defect on either side of the knee joint to control infection should be considered. The patient's functional outcome was different from the arthrodesed one. For successful conversion to a mobile joint, thorough the eradication of scar tissue and creating sufficient space for the tumor prosthesis to flex the knee joint up to 60° to 70° without soft tissue tension.
Arthrodesis ; Cicatrix ; Debridement ; Diagnosis ; Extremities ; Femur ; Follow-Up Studies ; Humans ; Joints ; Knee Joint ; Knee ; Limb Salvage ; Neoplasm Metastasis ; Osteosarcoma ; Periprosthetic Fractures ; Prostheses and Implants ; Prosthesis Implantation ; Range of Motion, Articular ; Recurrence ; Retrospective Studies ; Tibia

Ultrasonography-guided core needle biopsy has been standard of care for diagnosing suspicious breast lesion. The procedure is safe and has a low rate of complications. Most common complication might be bleeding or hematoma, which could be avoided by careful process or changing it to excisional biopsy or managed by proper management. Rarely, Post-procedural arteriovenous fistula is reported in almost all body fields, which is life quality threatening, not life-threatening. Most of them occur with obvious vessel injury, and their primary end-point of management is the obliteration of fistula by thrombosis. However, we experienced a case of iatrogenic arteriovenous fistula after core needle biopsy for breast lesion with small vessel injury which was not but small ones, and its thrill did not disappear even after thrombosis. We would like to share our clinical learnings from surgical management process of this rare complication.
Arteriovenous Fistula* ; Biopsy ; Biopsy, Large-Core Needle* ; Breast* ; Fistula ; Hematoma ; Hemorrhage ; Iatrogenic Disease ; Quality of Life ; Standard of Care ; Thrombosis

The latissimus dorsi musculocutaneous flap (LDMCF) is widely used for breast reconstruction. However, it has the disadvantage of frequent seroma formation at the donor site, and late seroma has also been reported. The authors report histological findings after the surgical treatment of a late, repeatedly recurrent seroma at 10 years after breast reconstruction with LDMCF. In 2008, a 66-year-old female patient underwent immediate breast reconstruction with LDMCF. In 2015, a late seroma was found at the donor site. After aspiration and drainage, the seroma recurred again in 2018. Total surgical excision of the seroma was performed and bloody-appearing fluid was identified in the capsule. The excised tissue was biopsied. Histological examination revealed no evidence of blood in the fluid, and multinucleated giant cells with amorphous eosinophilic proteinaceous material were identified. The cyst was suggestive of chronic granulomatous inflammation. There was no recurrence at 8 months postoperatively. The patient described herein underwent surgical treatment of late seroma that recurred after immediate breast reconstruction with LDMCF, and histological findings were identified. These results may be helpful for other future studies regarding late seroma after breast reconstruction with LDMCF.

Objective: Various and accurate psychiatric assessments in patients with breast cancer who frequently suffer from psychological problems due to long-term survivors are warranted. This systematic review aimed to investigate the current evidence on psychometric properties of psychiatric assessment for evaluating psychological problems in breast cancer patients. Methods: This systematic review progressed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Four electronic databases such as Web of Science, PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature were searched. This study protocol was registered on Open Science Framework. Results: Of the 2,040 articles, 21 papers were finally included. Among them, only five studies showed the performance of psychiatric assessment tools. Among 13 assessment tools used in the selected articles, the Hospital Anxiety and Depression Scale (HADS), Distress Thermometer (DT), or Mini-Mental Adjustment to Cancer Scale was frequently used for the evaluation of psychological problems. The DT and Psychosocial Distress Questionnaire-Breast Cancer showed acceptable performances for the prediction of depression and anxiety assessed by the HADS. Conclusion This systematic review found psychiatric assessment tools with acceptable reliability and validity for breast cancer patients. However, comparative studies on reliability and validity of various scales are required to provide useful information for the selection of appropriate assessment tools based on the clinical settings and treatment stages of breast cancer. Joint research among the fields of psychiatry and breast surgery is needed for research to establish the convergent, concurrent, and predictive validity of psychiatric assessment tools in breast cancer patients.

Objective: Given the long-term and severe distress experienced during breast cancer treatment, detecting depression among breast cancer patients is clinically crucial. This study aimed to explore a machine-learning model using self-report questionnaires to screen for depression in patients with breast cancer. Methods: A total of 327 patients who visited the breast cancer clinic were included in this study. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9), Beck Depression Inventory (BDI), and Hospital Anxiety and Depression Scale (HADS). The depression was evaluated according to the Diagnostic and Statistical Manual of Mental Disorders 5th edition. The prediction model’s performance based on supervised machine learning was conducted using MATLAB2022. Results: The BDI showed an area under the curve (AUC) of 0.785 when using the logistic regression (LR) classifier.The HADS and PHQ-9 showed an AUC of 0.784 and 0.756 when using the linear discriminant analysis, respectively.The combinations of BDI and HADS showed an AUC of 0.812 when using the LR. The combinations of PHQ-9, BDI, and HADS showed an AUC of 0.807 when using LR. Conclusion The combination model with BDI and HADS in breast cancer patients might be better than the method using a single scale. In future studies, it is necessary to explore strategies that can improve the performance of the model by integrating the method using questionnaires and other methods.

Objective: Given the long-term and severe distress experienced during breast cancer treatment, detecting depression among breast cancer patients is clinically crucial. This study aimed to explore a machine-learning model using self-report questionnaires to screen for depression in patients with breast cancer. Methods: A total of 327 patients who visited the breast cancer clinic were included in this study. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9), Beck Depression Inventory (BDI), and Hospital Anxiety and Depression Scale (HADS). The depression was evaluated according to the Diagnostic and Statistical Manual of Mental Disorders 5th edition. The prediction model’s performance based on supervised machine learning was conducted using MATLAB2022. Results: The BDI showed an area under the curve (AUC) of 0.785 when using the logistic regression (LR) classifier.The HADS and PHQ-9 showed an AUC of 0.784 and 0.756 when using the linear discriminant analysis, respectively.The combinations of BDI and HADS showed an AUC of 0.812 when using the LR. The combinations of PHQ-9, BDI, and HADS showed an AUC of 0.807 when using LR. Conclusion The combination model with BDI and HADS in breast cancer patients might be better than the method using a single scale. In future studies, it is necessary to explore strategies that can improve the performance of the model by integrating the method using questionnaires and other methods.

Objective: Given the long-term and severe distress experienced during breast cancer treatment, detecting depression among breast cancer patients is clinically crucial. This study aimed to explore a machine-learning model using self-report questionnaires to screen for depression in patients with breast cancer. Methods: A total of 327 patients who visited the breast cancer clinic were included in this study. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9), Beck Depression Inventory (BDI), and Hospital Anxiety and Depression Scale (HADS). The depression was evaluated according to the Diagnostic and Statistical Manual of Mental Disorders 5th edition. The prediction model’s performance based on supervised machine learning was conducted using MATLAB2022. Results: The BDI showed an area under the curve (AUC) of 0.785 when using the logistic regression (LR) classifier.The HADS and PHQ-9 showed an AUC of 0.784 and 0.756 when using the linear discriminant analysis, respectively.The combinations of BDI and HADS showed an AUC of 0.812 when using the LR. The combinations of PHQ-9, BDI, and HADS showed an AUC of 0.807 when using LR. Conclusion The combination model with BDI and HADS in breast cancer patients might be better than the method using a single scale. In future studies, it is necessary to explore strategies that can improve the performance of the model by integrating the method using questionnaires and other methods.

Objective: Due to the high frequency of depressive symptoms associated with breast cancer, it is crucial to screen for depression in breast cancer patients. While numerous screening tools are available for depression in this population, there is a need for a brief and convenient tool to enhance clinical use. This study aims to investigate the psychometric properties of the Patient Health Questionnaire-9 (PHQ-9) in patients with breast cancer. Methods: Patients with breast cancer (n=327) who visited the Breast Cancer Clinic were included in this study. The reliability of the PHQ-9 was analyzed by Cronbach’s α, and the construct validity of the PHQ-9 was explored by factor analysis. The concurrent validity of the PHQ-9 was evaluated by Pearson correlation analysis with the Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS). Results: The values of Cronbach’s α ranged from 0.800 to 0.879 was acceptable. The exploratory factor analysis revealed that the one-factor model and two-factor model of the PHQ-9 explained 46% and 57% of the variance, respectively. The PHQ-9 were significantly correlated with those of HADS (r=0.702, p<0.001) and PSS (r=0.466, p<0.001). Consequently, the PHQ-9 demonstrated acceptable reliability and validity in breast cancer patients. Conclusion The findings of this study indicate that the PHQ-9 exhibits acceptable reliability and validity in patients with breast cancer. The convenience of this brief self-report questionnaire suggests its potential as a reliable and valid tool for assessing depression in breast cancer clinics.