Purpose: To report a case of diplopia caused by restrictive strabismus developing after conjunctivodacryocystorhinostomy (CDCR).Case summary: A 61-year-old female presented with persistent epiphora after failure to repair ipsilateral canalicular lacerations of the left eye caused by trauma occurred 25 years ago. CDCR was performed and the epiphora improved. Four months later, the patient presented with diplopia on the left gaze. An abduction limitation of -4 and a supraduction limitation of -3 were observed in the left eye. Therefore, Jones tube removal was performed 5 months after CDCR surgery. Two weeks later, as the limitations persisted, adhesiolysis of the conjunctiva and an amniotic membrane transplantation (AMT) were performed. This exposed a subconjunctival adhesion at the inferonasal conjunctiva; histopathological examination revealed fibrotic tissues. Three months later, the adhesions recurred and the patient was transferred to another hospital. Conjunctival adhesiolysis, AMT, and a 6.5 mm recession of medial rectus (MR) muscle were performed. One week later, exotropia occurred in the primary position, and the MR muscle of the left eye was advanced by 2 mm. Nine months after the final surgery, the primary gaze was orthotropia. The diplopia within the central 20° of visual field had disappeared. However, a levoelevation limitation of -1.5 remained in the left eye. Conclusions CDCR is the only treatment method for patients with occlusion of both the upper and lower proximal lacrimal canaliculi. However, rare complications such as restrictive strabismus with diplopia may occur. As preventing adhesion is difficult, sufficient patient notice is required prior to surgery.

BACKGROUND/OBJECTIVES: Excessive intake of simple sugars induces obesity and increases the risk of inflammation. Thus, interest in alternative sweeteners as a sugar substitute is increasing. The purpose of this study was to determine the effect of saccharin on inflammation in 3T3-L1 adipocytes.MATERIALS/METHODS: 3T3-L1 preadipocytes were differentiated into adipocytes. The adipocytes were treated with saccharin (0, 50, 100, and 200 µg/mL) for 24 h. Inflammation was induced by exposure of treated adipocytes to lipopolysaccharide (LPS) for 18 h and cell proliferation was measured. The concentration of nitric oxide (NO) was measured by using Griess reagent. Protein expressions of nuclear factor kappa B (NF-κB) and inhibitor κB (IκB) were determined by western blot analysis. The mRNA expressions of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), interleukin 1β (IL-1β), interleukin 6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and tumor necrosis factor-α (TNF-α) were determined by real-time PCR.RESULTS: Compared with the control group, the amount of NO and the mRNA expression of iNOS in the LPS-treated group were increased by about 17.6% and 46.9%, respectively, (P < 0.05), and those parameter levels were significantly decreased by saccharin treatment (P < 0.05). Protein expression of NF-κB was decreased and that of IκB was increased by saccharin treatment (P < 0.05). Saccharin decreased the mRNA expression of COX-2 and the inflammation cytokines (IL-1β, IL-6, MCP-1, and TNF-α) (P < 0.05).CONCLUSIONS: The results of this study suggest that saccharin can inhibit LPS-induced inflammatory responses in 3T3-L1 adipocytes via the NF-κB pathway.

Purpose: We evaluated the efficacy and safety of pembrolizumab in patients with recurrent gynecologic cancers in real-world practice. Materials and Methods: We conducted a retrospective, single-institution study of patients with recurrent gynecologic malignancies treated with pembrolizumab. The primary endpoints were the objective response rate (ORR) and safety. Results: Thirty-one patients treated with pembrolizumab were included. The primary disease sites were the uterine cervix (n=18), ovaries (n=8), and uterine corpus (n=5). Fifteen of the 31 patients (48%) had an Eastern Cooperative Oncology Group performance status of ≥2. The median number of prior chemotherapy lines was 2 (range, 1–6), and 14 of 31 patients (45%) had received ≥ 3 prior lines of chemotherapy. The overall ORR was 22.6%: specifically, 22.3% (4 of 18 patients), 12.5% (1 of 8 patients), and 40% (2 of 5 patients) for cervical, ovarian, and endometrial cancers, respectively. During a median follow-up of 4.7 months (range, 0.2–35.3), the median time to response was 1.9 months (range, 1.4–5.7). The median duration of response was not reached (range, 8.8-not reached).The median progression-free survival was 2.5 months (95% confidence interval, 1.7-not reached). Adverse events occurred in 20 patients (64.5%), and only 3 (9.7%) were grade ≥3. There was one case of suspicious treatment-related mortality, apart from which most adverse events were manageable. Conclusion In real-world practice, pembrolizumab was feasible and effective in heavily treated recurrent gynecologic cancer patients with poor performance status who may not be eligible for enrollment in clinical trials.

Purpose: This study aimed to develop a bedside nursing shift report protocol and evaluate the effect of the protocol in a tertiary hospital in South Korea. Methods: The bedside nursing handoff protocol with patient engagement was developed based on the literature review and the validation of an expert group. The effect of the protocol on clinical implication was tested in three medical-surgical units in a tertiary hospital. Outcomes were assessed by patient perception, nurse perception, and reporting time. Data collected from June to August in 2018 and analyzed with descriptive statistics and One-way ANOVA using SPSS version 25.0. Results: The bedside nursing shift report protocol with patient engagement consisted of two steps: nurse to nurse report and bedside report with patients. Nurse’s perception with patient engagement was significantly increased after applying protocol (F=17.85, p<.001). Patient’s perception was significantly improved in the areas of discharge plan (F=7.86, p<.001), health information privacy (F=4.46, p=.012) and identify attending nurse (F=3.19, p=.042). There were no differences in reporting time between the bedside nursing shift report and a traditional shift report (F=0.61, p=.054). Conclusion Patient perception was significantly increased, while nurse perception was not different after applying this protocol. For the change in the perception of nurses, education may be preceded to improve nurses' competence for the bedside shift report. Furthermore, the support in enough nurse staffing should be needed for encouraging the bedside shift report. The bedside shift report may enhance patient engagement. Therefore it may improve patient safety and health outcome in clinics.

PURPOSE: The purpose of this study was to examine the relationships of authentic leadership and nursing organizational culture to the intention of hospital nurses to stay in their current position. METHODS: The participants of this study were 503 nurses in 8 hospitals. We collected data using questionnaires for assessing authentic leadership, nursing organization culture and intention to stay. For data analysis, t-test, ANOVA, Cronbach's α, Pearson's correlation coefficient, Tukey test, Multiple regression were performed using SAS ver.9.4 (SAS Institute Inc., Cary, NC, USA). RESULTS: Authentic leadership (β=.12, p=.008) and relation-oriented culture (β=.13, p=.009) affected the intention of the hospital nurses to stay. These variables accounted for 29% of the variance in the intention to stay among hospital nurses. CONCLUSION: The finding of this study shows that the authentic leadership and nursing organizational culture especially relation-focused can influence nurses' intention to stay in their current position. For retaining nurses, it is suggested to use an authentic leadership training program for nursing leaders and to make efforts to establish a relation-focused culture in the hospital.
Education ; Intention ; Leadership ; Nursing ; Organizational Culture ; Statistics as Topic

PURPOSE: This study aimed to investigate the performance of patient engagement nursing services perceived by nurses and necessity in Korea. METHODS: This study was a descriptive research. A total of 205 nurses participated in the study. The Smart Patient Engagement Assessment Checklist was developed by the investigators to assess patient engagement nursing services performance and necessity. The data were collected using online survey. Descriptive analysis and χ² analysis were performed using SPSS 25.0 program. RESULTS: The mean age of participants was 36.6±8.5 years and the mean working experience was 12.92±9.23 years. Seventy eight percent of participants reported that patients and family participated in care as advisors through customer's suggestion or patient satisfaction assessment. The rate of patients' and family's engagement in care as advisors was significantly higher in tertiary hospitals (χ²=28.54, p<.001). About 89% of participants communicated with patients and family to make clinical decisions with a multidisciplinary approach. The rate of communication for multidisciplinary decision making was significantly higher in tertiary hospitals (χ²=6.30, p=.012). With regards to nurses' bedside patient handoff, 22.0% of participants reported that they were performing bedside patient handoff, and there was no significant difference between type of hospitals. About discharge planning, 72.2% of participants reported utilizing discharge checklist. CONCLUSION: Currently, patient engagement nursing services are applied partially in Korea. It seems that care protocols to be applied for patient engagement nursing services are insufficient. Therefore, patient engagement care protocols need to be developed to improve patient's health outcome and safety.
Checklist ; Decision Making ; Humans ; Korea ; Needs Assessment ; Nursing Services ; Nursing ; Patient Discharge ; Patient Handoff ; Patient Participation ; Patient Satisfaction ; Research Personnel ; Tertiary Care Centers

PURPOSE: The consumption of processed foods has recently been increasing due to changes in the living environment. The purpose of this study was to identify the contribution of processed food to the nutrient intake of adult Koreans. METHODS: A total of 15,760 adult people in the 6(th) National Health and Nutrition Examination Survey (2013 ~ 2015) were included in this study. According to the Korea Food and Drug Administration's classification criteria for processed foods, the 24 hour dietary recall data of the subjects were classified as processed food or natural food. The processed food intake, nutrient intake and major processed food sources by food groups were analyzed. RESULTS: Men consumed more processed foods than did the women. Consumption of processed foods decreased with age, but it increased with the education level and the income level. The total daily processed food intake accounted for 68.1% of the total food intake. The food groups with high processed food intake were beverage, vegetables, cereals and grain products, fruits, and milk and dairy products in this order. The top food source of each food groups were beer, kimchi, bread, processed apple products, and milk. After adjusting for age, gender, and energy intake, all the nutrient intakes and percentage of dietary reference intakes for Koreans, except carbohydrates, were significantly higher in processed foods than in natural foods. The sodium intake from the processed food was 96.3% of total daily sodium intake. The intakes of nutrients from processed foods, excluding vitamins C, dietary fiber, iron, and vitamin A, were higher in men than in women. The intake of sodium from processed foods was highest for people of 30 ~ 49 years of age, and the intake of sodium from processed foods decreased for people over 50. CONCLUSION: Korean adults consumed more processed food than the natural food, consuming more calories and most of the nutrients from the processed food overall total daily intakes. The intake of processed foods is expected to further increase in the future, and nutritional education and research on the ingestion and selection of healthy processed foods are necessary.
Adult ; Beer ; Beverages ; Bread ; Carbohydrates ; Classification ; Dairy Products ; Dietary Fiber ; Eating ; Edible Grain ; Education ; Energy Intake ; Female ; Fruit ; Humans ; Iron ; Korea ; Male ; Milk ; Nutrition Surveys ; Recommended Dietary Allowances ; Sodium ; Vegetables ; Vitamin A ; Vitamins

BACKGROUND: With the globalization of drug development, multi-regional clinical trials (MRCTs) have emerged to facilitate rapid availability of medicines to patients worldwide. The present study aimed to has explored attitudes and perceptions towards adopting the Korean MRCT guideline. METHODS: An online survey, consisting of 16 questions, classified into two subjects, was administered to stakeholders in Korea. Most quantitative components were measured using the Likert scales. A content analysis of the qualitative components was carried out to identify the keywords in open-ended responses. RESULTS: A total of 94 survey responses were analyzed: 51 participants from pharmaceutical companies, 11 from clinical research organizations, and 21 from clinical trial centers. The content of the guideline was rated as appropriate for clarity, acceptability, and applicability (96.8, 96.8, and 93.6%, respectively). The local environmental impact of the systemic/political, academic/technical, and industrial/economical aspects of the guideline was rated as appropriate at 95.7, 97.9, and 91.5%, respectively. The suggested adoption period was 1~2 years (40, 42.6%). The concept and individuals' domestic circumstances were the key problems affecting the clarity, applicability, and local environmental impact of the guideline. CONCLUSION The Korean MRCT guideline was well-developed. Their overall impact on the local environmental impact of MRCTs in Korea was expected to be beneficial, but methods are needed to minimize the negative impacts. The findings of this study can inform the priorities for the future adoption of the guideline in Korea.