The eradication rate of Helicobacter pylori has been decreasing progressively, primarily due to increased resistance to antibiotics. The widely used standard clarithromycin-based triple therapy regimen is no longer achieving eradication rate of 80% in intent-to-treat analysis in many countries. Due to the primary and secondary resistance to metronidazole, the key antibiotic for second line regimen, eradication rate of standard metronidazole based quadruple therapy is also decreasing. It is rational to check antibiotic resistance for selecting regimens in third-line rescue eradication therapy, but it requires time and resource. Limited studies regarding the efficacy of a dual regimen consisting of high dose proton pump inhibitor and amoxicillin showed controversial results. Efficacy of rescue regimens containing fluoroquinolones, such as levofloxacin and moxifloxacin, were reported to be insufficient due to increasing incidence of primary and secondary resistance. Eradication result of third-line rescue regimens with sitafloxacin, a novel quinolone of which the antibacterial activity towards H. pylori is more than 100-fold that of ciprofloxacin in vitro, is promising. Although prevalence of serious side effect such as myelotoxicity with rifabutin-based rescue regimen is reported to be lower than expected, wider use of rifabutin is still concerned regarding the emergence of resistant mycobacterial species. Rifaximin based rescue regimen is safer and cheaper than rifabuitin based regimen. However, further investigation for better eradication rates by enhancing higher drug concentration in the gastric mucus layer needs to be evaluated.
Amoxicillin ; Anti-Bacterial Agents ; Ciprofloxacin ; Drug Resistance, Microbial ; Fluoroquinolones ; Helicobacter pylori* ; Incidence ; Levofloxacin ; Metronidazole ; Mucus ; Prevalence ; Proton Pumps ; Rifabutin

The role of neoadjuvant chemoradiation therapy in locally advanced pancreatic cancer (LAPC) is still controversial. The aim of this study was to evaluate surgical downstaging after concurrent chemoradiation therapy (CCRT) for LAPC by measuring the objective changes after treatment. From January 2003 through July 2011, 54 patients with LAPC underwent neoadjuvant CCRT. Computed tomography findings of the tumor size, including major vessel invasion, were analyzed before and after CCRT. Among the total recruited patients, 14 had borderline resectable malignancy and another 40 were unresectable before CCRT. After CCRT, a partial response was achieved in four patients. Stable disease and further disease progression were achieved in 36 and 14 patients, respectively. Tumor size showed no significant difference before and after CCRT (3.6 +/- 1.1 vs. 3.6 +/- 1.0 cm, P = 0.61). Vessel invasion showed improvement in two patients, while 13 other patients showed further tumor progression. Thirty-nine patients with unresectable malignancy and 11 patients with borderline resectable malignancy at time of initial diagnosis remained unchanged after CCRT. Four patients with borderline pancreatic malignancy progressed to an unresectable stage, whereas one unresectable pancreatic malignancy improved to a borderline resectable stage. Only one patient with borderline resectable disease underwent operation after CCRT; however, curative resection failed due to celiac artery invasion and peritoneal seeding. The adverse events associated with CCRT were tolerable. In conclusion, preoperative CCRT in LAPC rarely leads to surgical downstaging, and it could lower resectability rates.
Adenocarcinoma/radiography/therapy ; Adult ; Aged ; Aged, 80 and over ; Antimetabolites, Antineoplastic/therapeutic use ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Capecitabine/therapeutic use ; Carcinoma, Pancreatic Ductal/*radiography/*therapy ; Chemoradiotherapy/adverse effects/*methods ; Combined Modality Therapy ; Deoxycytidine/analogs & derivatives/therapeutic use ; Disease Progression ; Female ; Fluorouracil/therapeutic use ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Pancreas/blood supply/pathology ; Pancreatic Neoplasms/*radiography/*therapy ; Retrospective Studies ; Treatment Outcome

PURPOSE: The purpose of this research was to develop and evaluate the effect of a mind map for relief of emotional labor and burnout among nurses in outpatient departments in cancer hospitals. METHODS: We developed a mind map to reduce emotional labor and burnout. A quasi-experimental study was used with a nonequivalent control group pretest-posttest design. Data were collected from December 2012 to April 2013. Participants were 35 nurses working in the outpatient department of a cancer hospital. The experimental group participated in the mind map program biweekly for 10 weeks. Data were analyzed using chi2-test, Mann-Whitney U test, paired t-test, and Wilcoxon sign rank test with the SPSS 21.0 program. RESULTS: The physical burnout and total burnout scores decreased significantly in the intervention group which took the mind map program. CONCLUSION: Findings indicate that the mind map is an effective intervention to reduce burnout in outpatient department nurses.
Cancer Care Facilities* ; Humans ; Outpatients*

An ipsilateral supraclavicular lymph node recurrence of breast cancer after surgery has been considered a predecessor to distant metastases. There still is a debate as to whether breast carcinoma patients with the isolated supraclavicular lymph node recurrence should be considered to have disseminated disease or if aggressive treatment, with curative intent, is justified. We report two cases of an isolated ipsilateral supraclavicular lymph node recurrence following modified radical mastectomy, and multimodality treatments with modified radical neck dissection, systemic chemotherapy and involved field radiotherapy. These patients have lived without locoregional recurrence or distant metastases for 3 and 2 years, respectively. Conclusively, we recommend aggressive combined multimodality treatments, including surgery, such as modified radical neck dissection or complete excision of the involved lymph nodes, systemic chemotherapy, and involved field radiotherapy, in patients with isolated supraclavicular lymph node recurrence, but with no other evidence of distant metastases.
Breast Neoplasms ; Drug Therapy ; Humans ; Lymph Nodes ; Mastectomy, Modified Radical ; Neck Dissection ; Neoplasm Metastasis ; Radiotherapy ; Recurrence

To estimate the manganese (Mn, below) exposure of workers in the ferromanganese manufacture factory and to evaluate its health effects, airborne, blood and urine Mn concentration measurements, questionnaire and other neurologic examinations were performed on 80 Mn-handing productive male workers (exposed group), 47 non-Mn-handling productive male workers (internal control group) and 144 productive male workers in other factory (external control group). The results obtained were as follows; The highest airborne Mn fume concentration among the work process was found at charging (0.42 mg/m3), and ferromanganese crushing process (1.14 mg/m3) was the highest in Mn dust. However all of them were below threshold limit value. Mean Mn concentrations in blood and urine of crushing workers were higher than those of other part workers. Among all of them, workers whose urine Mn concentration were exceed normal reference level (10 microgram/l) were 31 (18.5%). There was statistically significant correlation between airborne and urine Mn concentration (r=0.60), and so between airborne and blood Mn concentration (r=0.49), while there was no statistically significant correlation between blood and urine Mn concentration. Mean Mn concentration in airborne (0.60 mg/m3), urine (6.92 microgram/l) and blood (3.16 microgram/dl) in exposed group were significantly higher than those of control groups (p<0.01). Clinical symptoms such as excessive sweating, hypoesthesia, libido change, anosmia, decreased visual acuity and difficulty in writing showed higher positive rate in exposed group. Positive rate of clinical signs such as eye blinking and masked face in exposed group was higher than external control group. However clinical and laboratory findings such as blood pressure, blood chemistry, grip strength in exposed group were not statistically different from those of control groups. The results suggested that further studies were followed to evaluate the workers whose blood Mn concentration were below normal reference level but urine Mn concentrations above normal reference level, and to establish the questionnaire and the diagnostic tools to detect the Mn poisoning workers early.
Blinking ; Blood Pressure ; Chemistry ; Dust ; Hand Strength ; Humans ; Hypesthesia ; Libido ; Male ; Manganese* ; Masks ; Neurologic Examination ; Olfaction Disorders ; Poisoning ; Questionnaires ; Sweat ; Sweating ; Visual Acuity ; Writing

Popularity of endoscopic screening and advances in high-resolution endoscopic images have led to the detection of early-staged gastric cancer more often than before in Korea. As endoscopic submucosal dissection (ESD) according to the expanded criteria is widely accepted by many Korean endoscopists, the increase in incomplete resection and local recurrence after endoscopic resection are inevitable. Locoreginal recurrences after successful endoscopic resection including regional lymph node metastasis (LNM) and direct invasion to adjacent organs, and distant hematogenous metastasis are very rare because the risk of LNM is minimal in early gastric cancer, especially those indicated for endoscopic therapy. However, local recurrence by residual cancer and metachronous or synchronous recurrence are of clinical importance. Additional endoscopic resection can be considered when pathologic examination of endoscopic mucosal resection (EMR) or ESD reveal differentiated mucosal cancer. Endoscopic ablation therapy such as argon plasma coagulation can reduce the procedure time and is valuable in technically difficult cases and when the risk of post-procedural luminal stricture is high. Radical surgery is mandatory in cases with submucosal invasion or in cases with suspicious large amount of residual cancer. With regard to the synchronous or metachronous recurrent cancers, treatment strategy is the same as primary gastric cancers. The risk of luminal stricture should be considered when choosing the treatment method, especially when the lesion is located at the distal antrum, pyloric channel and esophagogastric junction.
Argon Plasma Coagulation ; Constriction, Pathologic ; Endoscopy ; Esophagogastric Junction ; Korea ; Lymph Nodes ; Mass Screening ; Neoplasm Metastasis ; Neoplasm, Residual ; Phenobarbital ; Pyloric Antrum ; Recurrence ; Stomach Neoplasms

This study was conducted in order to investigate the association between picky eating behaviors of preschool children and growth outcomes. In this study, picky eating behaviors were defined as containing four constructs of 'eating a small amount (ES),' 'neophoic behavior (NB),' 'refusal of specific food groups (RF),' and 'preference for specific food-preparation methods (PP).' A 7-point scale was used for the multi-item questionnaire, which consisted of 21 items (three items for ES, two items for NB, nine items for RF, and seven items for PP), in order to evaluate picky eating behaviors of children. Subjects were recruited among visitors at a medical clinic in Seoul. A total of 150 self-administered survey responses from parents of preschool children were analyzed in order to investigate the association between picky eating behaviors of preschool children and growth outcomes. Height for age (HFA) and weight for height (WFH) z-scores were used for assessment of preschool children's growth. The prevalence of ES, NB, RF, and PP was 44%, 57%, 73%, and 53%, respectively. Children with ES had lower HFA (p < 0.05) and WFH (p < 0.0001) than those without ES, while children with NB, RF, or PP had HFA and WFH were similar to their counterparts. The mean HFA z-score of children with ES was less than 0 (p < 0.05) and the mean WFH z-scores of children with ES, NB, RF, or PP were less than 0 (p < 0.05). According to the study results, related growth outcome differed depending on constructs of picky eating behaviors. In particular, picky eating of ES showed a risk of faltering height growth in preschool children. Further comprehensive studies on the reason for ES and intervention approach is warranted.
Child ; Child, Preschool* ; Eating* ; Feeding Behavior* ; Humans ; Parents ; Prevalence ; Surveys and Questionnaires

With an aging population and the development of surgical techniques, there is a growing demand for bone reconstruction in areas of trauma, arthroplasty, and spinal fusion Although autogenous bone grafting may be the best method for stimulating bone repair and regeneration, there are still problems and complications, including morbidity related to bone harvesting and limitation of harvest amount. Allogeneic bone grafts have a limited supply and risk of transmission of infectious diseases. Over the past several decades, the use of bone substitutes, such as calcium phosphate, has increased; however, they have limited indications. Biomedical research has suggested a possibility of stimulating the self-healing mechanism by locally transmitting the external growth factors or stimulating local production through a gene transfer. In this review, we evaluate recent advances, including bone graft, bone substitutes, and tissue engineering.
Aging ; Allografts ; Arthroplasty ; Bone Substitutes* ; Bone Transplantation ; Calcium ; Communicable Diseases ; Genes, vif ; Intercellular Signaling Peptides and Proteins ; Methods ; Regeneration ; Spinal Fusion ; Tissue Engineering ; Transplants

Fracture of the femoral head is relatively uncommon and usually caused by high energy injury. The femoral head fracture combined with hip dislocation results in severe damage to the hip joint, and therefore has been associated with poor functional outcome. The principle of the treatment is composed of urgent reduction of the dislocated hip and early anatomical reduction, with the goal of restoring a congruent and stable hip. In an effort to reach that goal, several methods have been used for treatment of the fracture after closed reduction of the hip. The purpose of this article is to review the indication of surgery, surgical methods, surgical approach, and clinical outcomes.
Femur ; Head* ; Hip ; Hip Dislocation ; Hip Joint

Background: It has been reported that vitamin D may play an important role in rotator cuff tears. However, there has been limited information about the prevalence of and risk factors for hypovitaminosis D in patients with rotator cuff tears. Therefore, the purpose of current study was to investigate the prevalence of and risk factors for hypovitaminosis D in patients with rotator cuff tears. Methods: One hundred seventy-six patients (age, 61.9 ± 8.90 years) who underwent arthroscopic rotator cuff repair for a fullthickness tear were enrolled in this retrospective study. Preoperative serum vitamin D levels (25-hydroxyvitamin D) were measured.Hypovitaminosis D was defined as a serum concentration of 25-hydroxyvitamin D < 20 ng/mL. We investigated whether age, sex, height, weight, body mass index, bone mineral density, alcohol consumption, smoking status, and outdoor occupation were associated with hypovitaminosis D. Results: The prevalence of hypovitaminosis D in patients with rotator cuff tears was 44.3% (78/176). The mean serum concentration of 25-hydroxyvitamin D of total patients was 24.7 ± 13.7 ng/mL. A higher serum level of vitamin D was significantly associated with older age (p < 0.001). Young age was an independent risk factor for hypovitaminosis D. The prevalence of hypovitaminosis D was also lower in patients with an outdoor occupation than in those with an indoor occupation (19.0% vs. 31.4%,p = 0.001). Conclusions The prevalence of hypovitaminosis D in patients with rotator cuff tears was 44.3%. Age had a significant positive correlation with the serum concentration of 25-hydroxyvitamin D. Young age and indoor working were independent risk factors for hypovitaminosis D in patients with rotator cuff tears. Therefore, the possibility of hypovitaminosis D should be considered for young and indoor working patients who have rotator cuff tears.