Background: The PLASMIC score is a convenient tool for predicting ADAMTS13 activity of ＜10%.Lactate dehydrogenase (LDH) is widely used as a marker of haemolysis in thrombotic thrombocytopenic purpura (TTP) monitoring, and could be used as a replacement marker for lysis. We aimed to validate the PLASMIC score in a multi-centre Asia Pacific region, and to explore whether LDH could be used as a replacement marker for lysis. Methods: Records of patients with thrombotic microangiopathy (TMA) were reviewed. Patients’ ADAMTS13 activity levels were obtained, along with clinical/laboratory findings relevant to the PLASMIC score. Both PLASMIC scores and PLASMIC-LDH scores, in which LDH replaced traditional lysis markers, were calculated. We generated a receiver operator characteristics (ROC) curve and compared the area under the curve values (AUC) to determine the predictive ability of each score. Results: 46 patients fulfilled the inclusion criteria, of which 34 had ADAMTS13 activity levels of ＜10%. When the patients were divided into intermediate-to-high risk (scores 5‒7) and low risk (scores 0‒4), the PLASMIC score showed a sensitivity of 97.1% and specificity of 58.3%, with a positive predictive value (PPV) of 86.8% and negative predictive value (NPV) of 87.5%. The PLASMIC-LDH score had a sensitivity of 97.1% and specificity of 33.3%, with a PPV of 80.5% and NPV of 80.0%. Conclusion Our study validated the utility of the PLASMIC score, and demonstrated PLASMIC-LDH as a reasonable alternative in the absence of traditional lysis markers, to help identify high-risk patients for treatment via plasma exchange.

Purpose: The purpose of this research is to assess the communication experiences of nursing students by conducting a simulation using standardized patients and to understand their essential meaning in-depth. Methods: This research was conducted from May to June 2022 and targeted 17 third-year nursing students who were attending K University in Kangwon-do and underwent mental health nursing simulation. In-depth interview was conducted by organizing a focus group, and this the outcomes were analyzed by Colaizzi’s phenomenological method. Results: The communication experiences were derived in four categories, namely, ‘Preoccupation in the situation like it’s real’, ‘Embarrassed by unpredictable communication situation’, ‘Self-reflection on communication’ and ‘The effort to improve communication skills’. Conclusion Based on the results of this research, there is a need to conduct well-designed scenarios and modules, and to provide pre-training so that standardized patients can provide various communication responses. Moreover, it is necessary to provide opportunities for nursing students to acquire nursing ability on their own.

Purpose: Factors associated with invasive recurrence (REC) of ductal carcinoma in situ (DCIS) are less known. This study was aimed at identifying better biomarkers to predict the prognosis of DCIS. Methods: RNA extracted from formalin-fixed paraffin-embedded blocks of twenty-four pure DCIS cases was subjected to differential gene expression analysis. The DCIS cases were selected by matching age and estrogen receptor status. Sixteen REC-free and 8 invasive-REC cases with disease-free interval of > 5 years were analyzed. Immunohistochemistry (IHC) staining was used to validate sixty-one independent pure DCIS cases, including invasive-REC (n = 16) and REC-free (n = 45) cases. Results: Eight differentially expressed genes (DEGs) were statistically significant (log 2-fold change [FC] < –1 or > 1 and p < 0.001). Less than ½ fold expression of CUL1, androgen receptor (AR), RPS27A, CTNNB1, MAP3K1, PRKACA, GNG12, MGMT genes was observed in the REC group compared to the no evidence of disease group. AR and histone deacetylase 1 (HDAC1) genes were selected for external validation (AR: log 2-FC − 1.35, p < 0.001, and HDAC1: log 2-FC − 0.774, p < 0.001). External validation showed that the absence of AR and high HDAC1 expression were independent risk factors for invasive REC (hazard ratio [HR], 5.04; 95% confidence interval [CI], 1.24–20.4; p = 0.023 and HR, 3.07; 95% CI, 1.04–9.04; p = 0.042). High nuclear grade 3 was also associated with long-term invasive REC. Conclusion Comparative gene expression analysis of pure DCIS revealed 8 DEGs among recurring cases. External validation with IHC suggested that the absence of AR and overexpression of HDAC1 are associated with a greater risk of long-term invasive REC of pure DCIS.

OBJECTIVE: To investigate the predictive index of functional recovery after primary pontine hemorrhage (PPH) using the combined motor evoked potential (MEP) and somatosensory evoked potential (SEP) in comparison to the hematoma volume and transverse diameter measured with computerized tomography. METHODS: Patients (n=14) with PPH were divided into good- and poor-outcome groups according to the modified Rankin Score (mRS). We evaluated clinical manifestations, radiological characteristics, and the combined MEP and SEP responses. The summed MEP and SEP (EP sum) was compared to the hematoma volume and transverse diameter predictive index of global disability, gait ability, and trunk stability in sitting posture. RESULTS: All measures of functional status and radiological parameters of the good-outcome group were significantly better than those of the poor-outcome group. The EP sum showed the highest value for the mRS and functional ambulatory category, and transverse diameter showed the highest value for "sitting-unsupported" of Berg Balance Scale. CONCLUSION: The combined MEP and SEP is a reliable and useful tool for functional recovery after PPH.
Evoked Potentials, Motor ; Evoked Potentials, Somatosensory* ; Gait ; Hematoma ; Hemorrhage* ; Humans ; Posture

PURPOSE: The purpose of this study was to examine effects of enneagram group counseling program on self-identification and depression in nursing college students. Three groups, categorized by how the students solve their conflicts, were selected to identify changes from the program. METHODS: A quasi-experimental study with a non-equivalent control group and pre posttest design was used. Participants were assigned to the experimental group (n=30) or control group (n=33). The experimental group participated in enneagram group counseling program for 38 hours through eight sessions covering four different topics. Collected data were analyzed using Chi-square test, Fisher's exact test, t-test, and Wilcoxon signed rank test. RESULTS: Total self-identity score for the experimental group was significantly higher than the control group. However, there was no significant difference between the two groups for depression scores. The Assertive and Compliant groups demonstrated significant change in self-identification while the Withdrawn groups did not reveal any change. CONCLUSION: Results indicate that the enneagram group counseling program is very effective in establishing positive self-identification for nursing college students who face developmental crisis and stressful situations. It is also expected that this program would be useful to enhance the students' confidence through a deeper understanding and acceptance of themselves.
Counseling ; *Depression ; Education, Nursing, Baccalaureate ; Female ; Humans ; Male ; *Program Evaluation ; *Self Concept ; Students, Nursing/psychology ; Universities ; Young Adult

Education, Medical, Graduate ; standards ; General Surgery ; education ; Humans ; Singapore ; Workload ; statistics & numerical data

BACKGROUND: The highly developed endoplasmic reticulum (ER) structure in pancreatic beta cells is heavily involved in insulin biosynthesis. Thus, any perturbation in ER function inevitably impacts insulin biosynthesis. Recent studies showed that the expression of tribbles-related protein 3 (TRB3), a mammalian homolog of Drosophilia tribbles, in various cell types is induced by ER stress. Here, we examined whether ER stress induces TRB3 expression in INS-1 cells and found that TRB3 mediates ER stress-induced suppression of insulin gene expression. METHODS: The effects of tunicamycin and thapsigargin on insulin and TRB3 expression in INS-1 cells were measured by Northern and Western blot analysis, respectively. The effects of adenovirus-mediated overexpression of TRB3 on insulin, PDX-1 and MafA gene expression in INS-1 cells were measured by Northern blot analysis. The effect of TRB3 on insulin promoter was measured by transient transfection study with constructs of human insulin promoter. RESULTS: The treatment of INS-1 cells with tunicamycin and thapsigargin decreased insulin mRNA expression, but increased TRB3 protein expression. Adenovirus-mediated overexpression of TRB3 decreased insulin gene expression in a dose-dependent manner. A transient transfection study showed that TRB3 inhibited insulin promoter activity, suggesting that TRB3 inhibited insulin gene expression at transcriptional level. Adenovirus-mediated overexpression of TRB3 also decreased PDX-1 mRNA expression, but did not influence MafA mRNA expression. CONCLUSIONS: This study showed that ER stress induced TRB3 expression, but decreased both insulin and PDX-1 gene expression in INS-1 cells. Our data suggest that TRB3 plays an important role in ER stress-induced beta cell dysfunction.
Blotting, Northern ; Blotting, Western ; Endoplasmic Reticulum ; Endoplasmic Reticulum Stress ; Gene Expression ; Humans ; Insulin ; Insulin-Secreting Cells ; RNA, Messenger ; Thapsigargin ; Transfection ; Tunicamycin

Growth hormone (GH) and thyroid stimulating hormone (TSH)-secreting pituitary adenomas are very rare and they account for only 0.5% for all pituitary adenomas. These adenomas are usually treated with surgery, but this surgery is not easy because the tumor is usually huge and invasive. We reported here on a case of a GH-TSH-secreting adenoma in a 23-year-old male patient who was initially treated with octreotide LAR. He presented with symptoms of headache, palpitation and a visual defect that he had for the 3 months. He had hypertrophy of the frontal bone and enlargement of both the hands and feet. The visual field test showed bitemporal hemianopsia. The laboratory examinations showed high serum levels of free T4, TSH and free alpha-subunit. Additionally, the serum levels of GH and insulin-like growth factor-I (IGF-I) were increased. GH was not suppressed below 1microg/L by an oral 75g glucose loading test, and TSH was not stimulated by thyrotropin-releasing hormone (TRH). Because sellar MRI showed invasive macroadenoma encasing the vessels, we initially tried octreotide LAR for treatment. A year later, the IGF-I and thyroid function tests were normalized and the size of the tumor was reduced with cystic change. The symptoms of palpitation and headache were improved without a change of the visual field defect.
Acromegaly ; Adenoma ; Foot ; Frontal Bone ; Glucose ; Growth Hormone ; Hand ; Headache ; Hemianopsia ; Humans ; Hypertrophy ; Insulin-Like Growth Factor I ; Male ; Octreotide ; Pituitary Neoplasms ; Thyroid Function Tests ; Thyrotropin ; Thyrotropin-Releasing Hormone ; Visual Field Tests ; Visual Fields ; Young Adult

OBJECTIVES: This study aimed to determine the effects of smoking on alcohol cravings in alcoholdependent individuals. METHODS: Study participants were 123 male smokers, 18 to 65 years of age, diagnosed with alcohol dependence. The study questionnaire consisted of demographic characteristics, alcohol drinking habits, smoking habits, the Korean Obsessive-Compulsive Drinking Scale (OCDS), the 12-item Tobacco Craving Questionnaire (12-item TCQ), and the Fagerstrom Test for Nicotine Dependence (FTND). We divided the subjects into high-OCDS score and low-OCDS score groups. RESULTS: The high-OCDS group had a higher alcohol drinking frequency and greater average amount of alcohol consumed than did the low-OCDS group. Also, the high-OCDS group smoked a higher average number of cigarettes per day and had higher 12-item TCQ scores and FTND scores. Logistic regression analysis showed scores of the 12-item TCQ and the FTND were the most significant variables for predicting alcohol cravings. CONCLUSION: This study shows that alcohol cravings are significantly related to cigarette cravings and to severity of nicotine dependence.
Alcohol Drinking ; Alcoholism ; Drinking ; Humans ; Logistic Models ; Male ; Nicotine ; Surveys and Questionnaires ; Smoke ; Smoking ; Tobacco ; Tobacco Products ; Tobacco Use Disorder

Pancreatic metastasis of gastric cancer almost takes the form of direct continous invasion to the pancreas from the primary lesions or dissemination. Isolated lymphogenous pancreatic metastasis of stomach cancer is rare. A 39-year-old woman was admitted to our institution due to high serum CA 19-9 level. Abdominal computed tomography showed a diffusely enlarged pancreas, and endoscopic retrograde cholangiopancreatography revealed a segmental stricture of pancreatic duct on mid-body. Ultrasonography guided pancreatic biopsy revealed a metastatic poorly differentiated adenocarcinoma with lymphatic tumor emboli. We perfomed esophagogastroduodenoscopy and total colonoscopy. There was a ulcerative lesion at the posterior wall of high body with clubbing change of surrounding mucosal folds. Endoscopic biopsy of the stomach lesion revealed a poorly differentiated adenocarcinoma. Positron emission tomography-computed tomography scan revealed bone metastasis in the sternum. Herein, we report a case of 39 year old female with the diagnosis of gastric adenocarcinoma, with lymphogenous pancreatic metastasis and solitary sternal metastasis detected by elevated serum CA 19-9 level.
Adenocarcinoma ; Adult ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Colonoscopy ; Constriction, Pathologic ; Diagnosis ; Electrons ; Endoscopy, Digestive System ; Female ; Humans ; Neoplasm Metastasis* ; Pancreas ; Pancreatic Ducts ; Sternum ; Stomach ; Stomach Neoplasms* ; Ulcer ; Ultrasonography