PURPOSE: This study aimed to investigate the influence of resilience and symptom experience on quality of life. METHODS: Seventy five patients in an active treatment stage were recruited from 2 hospitals between October and December 2010. A survey including perceived health status, physical functional status, the symptom experience index, resilience, and the functional assessment of cancer therapy-colorectal (FACT-C) was completed. RESULTS: The level of FACT-C was 86.61 (+/-18.91), which was higher than for patients with colostomy, but lower than for patients in a rehabilitation stage. Participants without physical functional limitations showed higher level of both resilience and quality of life. Participants with bad health status showed a lower level of both resilience and quality of life and higher level of symptom experience. The quality of life was related to the level of resilience (beta=.373), symptom experience (beta=-.292), and perceived health status (beta=-3.961). CONCLUSION: Proactive nursing approaches to manage symptoms and to improve perceived health status would enhance the quality of life of colorectal cancer patients. Furthermore, various strategies to strengthen the level of resilience should be developed.
Colorectal Neoplasms ; Colostomy ; Humans ; Quality of Life ; Resilience, Psychological

PURPOSE: This study was performed to evaluate Korean nurses' knowledge about hereditary colorectal cancer (HCRC). METHODS: A modified 15-item HCRC knowledge questionnaire was developed based on previous research. One hundred and forty-eight nurses have completed the questionnaire from February to April, 2011. RESULTS: The average score of nurses' knowledge was 11.25+/-1.54. Ninety-seven percent of nurses knew about colonoscopy check up schedule and family pedigree. However, only 20% of nurses knew about the rate of passing on mutation genes to offspring and risk of developing CRC among carriers. Only 13.5% of nurses had previous genetic education experiences. Working in oncology units, taking care of CRC patients, and participating in genetic education were not associated with nurses' HCRC knowledge. CONCLUSION: Various factors influence nurses' knowledge about HCRC. Repeated study with larger national sample of nurses is recommended to identify the factors affecting nurses' knowledge level in order to develop efficient genetic education programs for HCRC patients and their families by nurses.
Appointments and Schedules ; Colonoscopy ; Colorectal Neoplasms ; Colorectal Neoplasms, Hereditary Nonpolyposis ; Humans ; Pedigree ; Surveys and Questionnaires

OBJECTIVE: This study examined the predictive value of the initial procalcitonin level for bacteremia in patients with pneumonia in the emergency department (ED). METHODS: This study was a single-center, retrospective study conducted from January 2016 to June 2018. The serum procalcitonin and blood cultures were obtained from adult patients with pneumonia in the ED. The patients were categorized into either the bacteremia group or non-bacteremia group, according to the results of the blood cultures. The procalcitonin level in the bacteremia group and non-bacteremia group was compared. The area under the receiver operating curve (AUROC) of procalcitonin was calculated to predict bacteremia. RESULTS: A total of 934 patients were analyzed. Of the eligible patients, 902 patients (96.6%) and 32 patients (3.4%) were assigned to the non-bacteremia group and bacteremia group, respectively. The procalcitonin level was significantly higher in the bacteremia group than the non-bacteremia group (5.06 ng/mL; interquartile range [IQR], 1.88–15.78 vs. 0.29 ng/mL; IQR, 0.12–1.01: P<0.001). The AUROC of procalcitonin was 0.819 (95% confidence interval, 0.734–0.904). CONCLUSION: The initial procalcitonin level might be useful for predicting bacteremia in patients with pneumonia in the ED.
Adult ; Bacteremia ; Emergencies ; Emergency Service, Hospital ; Humans ; Pneumonia ; Retrospective Studies

Purpose: To compare the results of lacrimal syringing performed in clinical practice and under general anesthesia, and the clinical efficacy of lacrimal syringing under general anesthesia before endoscopic dacryocystorhinostomy and dacryoscintigraphy. Methods: The study included 148 eyes of 82 patients who underwent endoscopic dacryocystorhinostomy and silicone tube intubation from August 2018 to April 2019. The patients were examined with lacrimal syringing in clinical practice and re‐examined under general anesthesia. Based on the change in lacrimal syringing, the patients were assigned to inconsistent and consistent groups. The inconsistent group was subclassified into complete (‘regurgitation’ of lacrimal syringing changes to a ‘passage’ pattern) and partial improvement groups (the degree of regurgitation improves under general anesthesia). Results: Twenty (13.5%) eyes showed inconsistent results of lacrimal syringing performed in clinical practice and under general anesthesia; all showed improved passage under general anesthesia. The surgical results did not differ significantly (p = 0.336) between the consistent and inconsistent groups, but did between the complete and partial improvement groups (p < 0.01). Conclusions Lacrimal syringing under general anesthesia may enable an accurate preoperative diagnosis of the degree of obstruction. The combined results of dacryoscintigraphy and lacrimal syringing performed in clinical practice and under general anesthesia allow surgeons to evaluate the lacrimal drainage anatomy precisely and may be useful for predicting the functional success of endoscopic dacryocystorhinostomy.

Background: Rapid triage reduces the patients' stay time at an emergency department (ED). The Korean Triage Acuity Scale (KTAS) is mandatorily applied at EDs in South Korea.For rapid triage, we studied machine learning-based triage systems composed of a speech recognition model and natural language processing-based classification. Methods: We simulated 762 triage cases that consisted of 18 classes with six types of the main symptom (chest pain, dyspnea, fever, stroke, abdominal pain, and headache) and three levels of KTAS. In addition, we recorded conversations between emergency patients and clinicians during the simulation. We used speech recognition models to transcribe the conversation. Bidirectional Encoder Representation from Transformers (BERT), support vector machine (SVM), random forest (RF), and k-nearest neighbors (KNN) were used for KTAS and symptom classification. Additionally, we evaluated the Shapley Additive exPlanations (SHAP) values of features to interpret the classifiers. Results: The character error rate of the speech recognition model was reduced to 25.21% through transfer learning. With auto-transcribed scripts, support vector machine (area under the receiver operating characteristic curve [AUROC], 0.86; 95% confidence interval [CI], 0.81–0.9), KNN (AUROC, 0.89; 95% CI, 0.85–0.93), RF (AUROC, 0.86; 95% CI, 0.82–0.9) and BERT (AUROC, 0.82; 95% CI, 0.75–0.87) achieved excellent classification performance.Based on SHAP, we found “stress”, “pain score point”, “fever”, “breath”, “head” and “chest” were the important vocabularies for determining KTAS and symptoms. Conclusion We demonstrated the potential of an automatic KTAS classification system using speech recognition models, machine learning and BERT-based classifiers.

Background: Rapid triage reduces the patients' stay time at an emergency department (ED). The Korean Triage Acuity Scale (KTAS) is mandatorily applied at EDs in South Korea.For rapid triage, we studied machine learning-based triage systems composed of a speech recognition model and natural language processing-based classification. Methods: We simulated 762 triage cases that consisted of 18 classes with six types of the main symptom (chest pain, dyspnea, fever, stroke, abdominal pain, and headache) and three levels of KTAS. In addition, we recorded conversations between emergency patients and clinicians during the simulation. We used speech recognition models to transcribe the conversation. Bidirectional Encoder Representation from Transformers (BERT), support vector machine (SVM), random forest (RF), and k-nearest neighbors (KNN) were used for KTAS and symptom classification. Additionally, we evaluated the Shapley Additive exPlanations (SHAP) values of features to interpret the classifiers. Results: The character error rate of the speech recognition model was reduced to 25.21% through transfer learning. With auto-transcribed scripts, support vector machine (area under the receiver operating characteristic curve [AUROC], 0.86; 95% confidence interval [CI], 0.81–0.9), KNN (AUROC, 0.89; 95% CI, 0.85–0.93), RF (AUROC, 0.86; 95% CI, 0.82–0.9) and BERT (AUROC, 0.82; 95% CI, 0.75–0.87) achieved excellent classification performance.Based on SHAP, we found “stress”, “pain score point”, “fever”, “breath”, “head” and “chest” were the important vocabularies for determining KTAS and symptoms. Conclusion We demonstrated the potential of an automatic KTAS classification system using speech recognition models, machine learning and BERT-based classifiers.

Successful hematopoietic stem cell transplantation (HSCT) involves the restoration of hematopoietic function after engraftment, arising from the differentiation and proliferation of hematopoietic stem cells. Several factors could influence the course of allogeneic-HSCT (allo-HSCT). Therefore, knowledge of serum proteome changes during the allo-HSCT period might increase the efficacy of diagnosis and disease prevention efforts. This study conducted proteomic analyses to find proteins that were significantly altered in response to allo-HSCT. Sera from five representative patients who underwent allo-HSCT were analyzed by 2-dimensional gel electrophoresis and liquid chromatography tandem mass spectrometry, and were measured on a weekly basis before and after allo-HSCT in additional 78 patients. Fourteen protein spots showing changes in expression were further examined, and most proteins were identified as acute phase proteins (APPs). Studies of 78 additional patients confirmed that C-reactive protein (CRP) and haptoglobin undergo expression changes during allo-HSCT and thus may have the potential to serve as representative markers of clinical events after allo-HSCT. Maximal CRP level affected the development of major transplant-related complications (MTCs) and other problems such as fever of unknown origin. Particularly, an increase in CRP level 21 days after allo-HSCT was found to be an independent risk factor for MTC. Maximal haptoglobin and haptoglobin level 14 days after allo-HSCT were predictive of relapses in underlying hematologic disease. Our results indicated that CRP and haptoglobin were significantly expressed during allo-HSCT, and suggest that their level can be monitored after allo-HSCT to assess the risks of early transplant-related complications and relapse.
Adolescent ; Adult ; Biological Markers ; C-Reactive Protein/*metabolism ; Female ; Haptoglobins/*metabolism ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Humans ; Male ; Middle Aged ; Proteome/*metabolism ; Proteomics ; Transplantation Conditioning ; Transplantation, Homologous ; Young Adult

PURPOSE: To determine the efficacy and safety of oral propranolol as a first-line treatment for superficially located infantile hemangioma (IH) and propose an assessment tool to measure treatment response. METHODS: Patients with superficial IH under 1 year of age were prospectively recruited between May 2012 and December 2013 at the Department of Pediatrics of Chungbuk National University Hospital. Propranolol was administered to 12 infants (median age, 3.8 months) while monitoring cardiovascular and adverse metabolic effects. If a patient showed no adverse events, the dosage was gradually increased up to 3 mg/kg/day and maintained for 1 year. We used our own scoring system to assess treatment response using parameters like change in color, and longest diameter, and thickness of the IH. RESULTS: Eleven out of 12 patients completed the protocol with consistent improvement of hemangiomas during therapy. Patients on propranolol showed a more than 50% involution in the first 3 months, with additional steady involution until 1 year. Patients with the highest scores at 1 month maintained their score and showed better responses until treatment termination. The patient with the lowest score at 1 month did not show any further regression and stopped propranolol treatment 4 months after initiation. In two children with recurrences after successful therapeutic regression, propranolol was effective after being reintroduced. Propranolol treatment was not interrupted in any patient due to adverse events. CONCLUSION: Oral propranolol at 3 mg/kg/day showed a consistent, rapid, and therapeutic effect on superficial IHs without significant adverse events.
Child ; Chungcheongbuk-do ; Hemangioma* ; Humans ; Infant ; Pediatrics ; Propranolol* ; Prospective Studies* ; Recurrence

Microglia play a key role in the immune response and inflammatory reaction that occurs in response to ischemic stroke. Activated microglia promote neuronal damage or protection in injured brain tissue. Extracellular signals polarize the microglia towards the M1/M2 phenotype. The M1/M2 phenotype microglia released pro- and anti-inflammatory cytokines which induce the activation of neural stem/progenitor cells (NSPCs). In this study, we investigated how the cytokines released by microglia affect the activation of NSPCs. First, we treated BV2 cells with a lipopolysaccharide (LPS; 20 ng/ml) for M1 phenotype microglia and interleukin-4 (IL-4; 20 ng/ml) for M2 phenotype microglia in BV2 cells. Mice were subjected to transient middle cerebral artery occlusion (tMCAO) for 1 h. In ex vivo, brain sections containing the subventricular zone (SVZ) were cultured in conditioned media of M1 and M2 phenotype-conditioned media for 3 d. We measured the expression of cytokines in the conditioned media by RT-PCR and ELISA. The M2 phenotype microglia-conditioned media led to the proliferation and neural differentiation of NSPCs in the ipsilateral SVZ after ischemic stroke. The RT-PCR and ELISA results showed that the expression of TGF-α mRNA was significantly higher in the M2 phenotype microglia-conditioned media. These data support that M2 phenotype microglia-derived TGF-α is one of the key factors to enhance proliferation and neural differntiation of NSPCs after ischemic stroke.
Animals ; Brain* ; Culture Media, Conditioned ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Infarction, Middle Cerebral Artery ; Interleukin-4 ; Lateral Ventricles ; Mice ; Microglia ; Neurons* ; Phenotype* ; RNA, Messenger ; Stem Cells* ; Stroke

PURPOSE: We aimed to investigate the triage results and the degree of agreement between prehospital and hospital stages of pediatric patients who visited the emergency department (ED) via emergency medical service providers (EMSP) in comparison with adult patients. METHODS: We retrospectively reviewed 8,152 pediatric patients who visited a regional emergency medical center ED via EMSP from January 2015 to December 2015. Pediatric patients were defined as younger than 15 years according to the Korean Triage and Acuity Scale (KTAS). Given the difference of the triage tools of the prehospital (EMSP) and hospital (KTAS) stages, we performed the re-triage into “critical” and “non-critical” Comparisons of characteristics between pediatric and adult patients were made using chi-square tests. The degree of agreement between the tools was analyzed using κ analysis. RESULTS: Of 8,152 patients, 654 (8.0%) were pediatric patients. Direct medical control was more frequently performed to adult patients (P < 0.001). Critical patients were more common among adults (12.2% by KTAS, 24.8% by EMSP) than children (3.5% by KTAS, 14.1% by EMSP). The κ value of pediatric patients was lower than that of adult patients (0.09 [poor]; 95% confidence interval [CI], 0.01–0.18 vs. 0.38 [fair]; 95% CI, 0.35–0.40). CONCLUSIONS: Pediatric patients transferred by EMSP showed lower severity and degree of agreements of the triage results between prehospital and hospital stages than adult patients. It is necessary to pay particular attention to pediatric triage in a pre-hospital setting.
Adult ; Child* ; Critical Illness ; Emergencies* ; Emergency Medical Services* ; Emergency Service, Hospital* ; Humans ; Observational Study* ; Pediatrics ; Reproducibility of Results ; Retrospective Studies ; Triage*