PURPOSE: We designed this study to identify and suggest the reasonable timing of adjuvant radiotherapy in the treatment of uterine carcinosarcoma according to the surgical intent and patterns of progression. MATERIALS AND METHODS: We retrospectively analyzed a total of 50 carcinosarcoma patients diagnosed between 1995 and 2010. Among these 50 patients, 32 underwent curative surgery and 13 underwent maximal tumor debulking surgery. The remaining five patients underwent biopsy only. Twenty-six patients received chemotherapy, and 15 patients received adjuvant radiotherapy. RESULTS: The median follow-up period was 17.3 months. Curative resection (p < 0.001) and stage (p < 0.001) were statistically significant factors affecting survival. During follow-up, 30 patients showed progression. Among these, eight patients (16.0%) had loco-regional progression only. The patients who had received adjuvant radiotherapy did not show loco-regional progression, and radiotherapy was a significant negative risk factor for loco-regional progression (p = 0.01). The time to loco-regional progression was much earlier for non-curative than curative resection (range, 0.7 to 7.6 months vs. 7.5 to 39.0 months). CONCLUSION: Adjuvant radiotherapy in the treatment of carcinosarcoma might be related to a low loco-regional progression rate. Radiotherapy should be considered in non-curatively resected patients as soon as possible.
Biopsy ; Carcinosarcoma ; Follow-Up Studies ; Humans ; Radiotherapy, Adjuvant ; Retrospective Studies ; Risk Factors

The increasing number of patients with depression is a serious social issue in contemporary Korean society. To fully understand the pathophysiology of depression, this paper reviewed how depression affects the decision making process of humans. Various recent studies in behavioral economics, mathematics, medicine, and neurobiology have shown how humans make decisions and how emotional disturbances, such as depressive disorder, affect this process. There has been great progress in behavioral economics during this decade, and numerous experiments have been designed to evaluate decision making process in humans. In general, economic decision making is evaluated using the Iowa Gambling Task, and social decision making is assessed using the ultimatum game. Numerous research studies have analyzed the performance and reaction of patients with depression in these games. As a result of the advancement of neurophysiology, research has successfully identified the part of the brain that causes the specific results of tests being conducted on patients with depression. Meanwhile, computational neuroscientists have established decision making models based on bayesian framework. These models also match with the neuroanatomy. Although a large part remains unclear, researchers look forward to achieving a better understanding in depression by analyzing the distinct patterns of responses that patients under depression show in the experiment of behavioral economics.
Affective Symptoms ; Brain ; Decision Making* ; Depression* ; Depressive Disorder ; Economics, Behavioral ; Gambling ; Humans ; Interdisciplinary Studies ; Iowa ; Mathematics ; Neuroanatomy ; Neurobiology ; Neurophysiology

OBJECTIVE: This study examined the overall mental health consequences of the bereaved parents after the Sewol ferry accident. METHODS: Eighty-four bereaved parents participated in the study. Self-report scales assessing the severity of psychiatric symptoms and other related psychosomatic problems were used at 18 months following the accident. Univariate descriptive statistics and regression analyses were performed to report the prevalence, severity, and correlates of psychiatric symptoms. RESULTS: 94% of the participants appeared to suffer from complicated grief based on scores on the Inventory of Complicated Grief (ICG). Half of the participants were categorized as having severe depression and 70.2% reported clinically significant post-traumatic symptoms according to scores on the Patient Health Questionnaire-9 (PHQ-9) and PTSD Check List-5 (PCL-5). No significant differences by gender were observed in the severity of psychiatric symptoms. A higher educational level was associated with more severe psychiatric symptoms in fathers. CONCLUSION: The loss of a child due to a disaster caused by human error may continue to have a substantial impact on parental mental health at 18 months after the event. A longitudinal study following parents' mental health state would be necessary to investigate the long-term effects of the traumatic experience in the future.
Bereavement* ; Child ; Depression ; Disasters ; Fathers ; Grief ; Humans ; Longitudinal Studies ; Mental Health* ; Parents* ; Prevalence ; Stress Disorders, Post-Traumatic ; Weights and Measures

OBJECTIVES: The aim of this study is to investigate the relationship of suicide risk with early-life stress (ELS) and resilience in patients with major depressive disorder (MDD). METHODS: The participants were 60 patients with MDD and 29 healthy volunteers. Each subject was assessed concerning ELS, resilience factors, suicide ideation, and depressive symptom severity using self-report questionnaires. Mann-Whitney test and stepwise multiple linear regression analyses were performed. RESULTS: Emotional abuse, physical abuse, neglect, and exposure to inter-parental violence were higher in the patient group than in the control group. Resilience factors were significantly lower in the patient group. In multiple regression analyses, final regression model including physical abuse, neglect, and self-regulation factor was significant explaining 45.6% variance of suicide ideation score. CONCLUSION: We found that ELS experiences, particularly exposure to inter-parental violence, might be a significant risk factor for development of depression. In particular, experiences of physical abuse and neglect might increase the risk of suicide in depression but resilience may play a protective role in development of depression and prevention of suicide in depressive patients.
Depression ; Depressive Disorder, Major* ; Healthy Volunteers ; Humans ; Linear Models ; Surveys and Questionnaires ; Risk Factors ; Stress, Psychological* ; Suicide* ; Violence

No abstract available.
Carcinoma, Hepatocellular* ; Diagnosis*

An analysis of domestic and foreign cohort studies of disaster victims can suggest directions for domestic cohort studies of disaster. Research papers on disaster cohorts were found with search engines such as PubMed and RISS. The key words used were disaster, trauma, cohort, and posttraumatic stress disorder (PTSD). Foreign research papers on human-made disaster (n=16), technological disaster (n=11), natural disaster (n=12), and domestic research papers on disaster (n=6) were reviewed. Analysis revealed that domestic cohort research on disaster victims is lacking compared to foreign countries. This results in the current limitations in planning for active intervention and support for disaster victims. To establish appropriate crisis intervention and management plans for disaster situations, a cohort study of disaster victims should be actively implemented through epidemiologic survey and assessment of risk factors on mental health, PTSD, depression, anxiety and other deleterious outcomes.
Anxiety ; Cohort Studies* ; Crisis Intervention ; Depression ; Disaster Victims* ; Disasters* ; Mental Health ; Risk Factors ; Search Engine ; Stress Disorders, Post-Traumatic

BACKGROUND: This study purposed to examine how the incidence of the central line-associated bloodstream infection (CLABSI) in a operating room (OR) is affected by bundle application on central line insertion (CLI) practice. METHODS: The study design was a pretest-posttest experimental trial. The subjects were 83 patients before the bundle application on CLI and 70 patients after. RESULTS: The compliance(%) of bundle on CLI of among those who observed all of the five items increased from 7.2% before the intervention to 72.9% after. By items, compliance with the maximal barrier precaution was 100% for the use of a mask and cap before and after the intervention, but increased from 73.5% before the intervention to 88.6% after for the hand hygiene, from 73.5% to 88.6% for the use of a sterile gown, and from 9.6% to 75.7% for the use of a sterile large drape covering the whole body. CLABSI did not happen on CLI either before or after the application of the bundle intervention. CONCLUSION: Bundle application increased compliance with the use of a sterile gown and the use of a sterile large drape. However, its effect in the prevention of CLABSI was not clear probably due to the short period of intervention in a single hospital.
Compliance ; Hand Hygiene ; Humans ; Incidence ; Infection Control ; Masks ; Operating Rooms*

Objective: The present study aimed to explore how the patterns of interaction between stress and positive resources differ according to the severity of depression and which resources play the most important role among the various positive resources. Methods: The study included 1,806 people who had visited a health screening center for a mental health check-up to evaluate the levels of perceived stress, positive resources, and depressive symptoms. The participants were divided into a depressive group (n=1,642, mean age 50.60, female 68%) and a non-depressive group (n=164, mean age 48.42, female 66.6%). We conducted hierarchical regression analyses and simple slope analyses to examine the interaction between perceived stress and positive resources. Results: The interaction between perceived stress and optimism was significantly associated with depression in non-depressive groups. In depressive groups, the interactions between five types of positive resources (optimism, purpose in life, self-control, social support and care) and perceived stress were all significantly related to depression. Conclusion Interventions that promote optimism can be helpful for preventing inevitable stress from leading to depression. A deficiency in positive resources may be a factor in aggravating depression in stressful situations for people reporting moderate to severe depressive symptoms.

Objective: Individual differences in attachment insecurity are important in a broad range of mental health problems. However, few empirical studies have examined the clinical factors that contribute to individual differences in attachment style. This study examines the nature of interrelationships among adult attachment styles, sensitivities of behavioral activation system/behavioral inhibition system (BIS/BAS), and childhood trauma in patients with depressive disorders. Methods: Patients with depressive disorders (n=294) completed self-report questionnaires evaluating adult attachment style, childhood trauma, and BIS/BAS sensitivity. We performed multiple regression analyses to examine the associations between attachment style and other clinical factors, including childhood trauma and BIS/BAS sensitivity. We also conducted hierarchical regression analyses and simple slope analyses to examine the interaction between BIS/BAS sensitivity and childhood trauma. Results: The BAS sensitivity was negatively associated with attachment avoidance. The higher was the BIS/BAS sensitivity, the higher was the level of attachment anxiety. Among childhood trauma, emotional neglect contributed to both dimensions of insecure attachment. The interaction between BAS sensitivity and emotional neglect is significantly associated with attachment anxiety. Conclusion This study used data regarding the interrelationship of childhood trauma and basic motivational systems to contribute to the understanding of adult insecure attachment behaviors, a risk factor for depression.

Cardiac manifestations of hypereosinophilic syndrome rarely include left ventricular thrombosis leading to peripheral emboli. And the cases of thrombectomy in patients with left ventricular thrombus and hypereosinophilic syndrome are extremely rare. Recently we experienced a 58-years-old woman with hypereosinophilic syndrome, the history of thalamic infarction and a huge thrombi in left ventricle. We report this case with literatures.
Female ; Heart Ventricles ; Humans ; Hypereosinophilic Syndrome* ; Infarction ; Thrombectomy ; Thrombosis*