Pancreatic pseudocyst can fistulize to adjacent organs such as stomach, duodenum, colon, and esophagus. Fistula formation with bile duct is rare. Reported cases of biliary involvement of pancreatic pseudocyst include fistula formation between the pancreatic pseudocyst and common bile duct. Intrahepatic bile duct dilatation caused by fistula formation with pancreatic pseudocyst is extremely rare. There are no published reports to the best of our knowledge. Herein, we report a case of intrahepatic bile duct dilatation caused by fistulous communication with a pancreatic pseudocyst. The peripheral intrahepatic bile duct surrounding the pseudocyst was dilated without involving the common bile duct. Magnetic resonance cholangiopancreatography image showed a connection between the pancreatic pseudocyst and dilated intrahepatic bile ducts with a multifocal cystic and beaded appearance.

PURPOSE: The aim of this study was to identify the relationships between the difficulty of end-of-life care and moral distress, burnout and job satisfaction of nurses working in intensive care units (ICUs). METHODS: This descriptive study was conducted using self-report questionnaires. Participants were nurses who had more than one year of ICU experience and were recruited from three university hospitals (N=168). RESULTS: The mean scores for ICU nurses' difficulty in end-of-life care, moral distress, burnout and job satisfaction were 3.42, 113.88, 3.16 and 2.58 points, respectively. Difficulty in end-of-life care was positively correlated with moral distress (r=.48, p < .001) and burnout (r=.26, p=.001) and was negatively correlated with job satisfaction (r=−.17, p=.024). Difficulties in end-of-life was identified as a predictor of moral distress (β=.44, p < .001), burnout (β=.26, p=.001) and job satisfaction (β=−.18, p=.024). CONCLUSION: The results of this study suggest the following: it is important to have a deep understanding of ICU nurses who experience various difficulties in end-of-life care and to provide realist support for these nurses. And practical efforts by nursing organizations are needed, including support systems and education programs to alleviate ICU nurses' difficulties in end-of-life care.
Education ; Hospitals, University ; Intensive Care Units ; Job Satisfaction ; Nursing ; Terminal Care

Leiomyoma is a common benign tumor of smooth muscle cells that rarely occurs in the retroperitoneum. Here, we report a retroperitoneal leiomyoma with exophytic growing into the lesser sac incidentally diagnosed in a 69-year-old woman. In this case, the retroperitoneal leiomyoma presented as a well-circumscribed mass with heterogeneous signal intensity and mild progressive enhancement on magnetic resonance imaging. Differential image diagnosis of this retroperitoneal leiomyoma from other retroperitoneal tumors was difficult due to an overlap in imaging appearances with other retroperitoneal tumors.

Purpose: This meta-analysis was conducted to determine the effect size of anxiety and psychological outcomes of virtual reality interventions in patients with anxiety disorders. Methods: A total of 835 studies were initially identified, of which six were found to be suitable according to the PICO (P: Patients with social phobia, I: VR technology, C: non VR technology, O: Variables related to mental health). criteria. Results: An analysis of the effect size of these studies confirmed that virtual reality interventions were not statistically significantly effective for generalized anxiety disorder (standardized mean difference [SMD]=0.16, 95% confidence interval [CI]=-0.84 to 1.15), but exhibited statistically significant effects for social anxiety (SMD=-0.56, 95% CI=-0.87 to -0.25) disorder and relational anxiety disorder (SMD -0.83, 95% CI=-1.49 to -0.16). Although these interventions were not statistically significantly effective for depression (SMD=-0.40, 95% CI=-0.84 to 0.04), they were effective in reducing negative emotions (SMD=-0.75, 95% CI=-1.20 to -0.31). Conclusion Virtual reality interventions based on the desensitization effect may be considered a viable option for reducing anxiety disorders.

Purpose: This meta-analysis was conducted to determine the effect size of anxiety and psychological outcomes of virtual reality interventions in patients with anxiety disorders. Methods: A total of 835 studies were initially identified, of which six were found to be suitable according to the PICO (P: Patients with social phobia, I: VR technology, C: non VR technology, O: Variables related to mental health). criteria. Results: An analysis of the effect size of these studies confirmed that virtual reality interventions were not statistically significantly effective for generalized anxiety disorder (standardized mean difference [SMD]=0.16, 95% confidence interval [CI]=-0.84 to 1.15), but exhibited statistically significant effects for social anxiety (SMD=-0.56, 95% CI=-0.87 to -0.25) disorder and relational anxiety disorder (SMD -0.83, 95% CI=-1.49 to -0.16). Although these interventions were not statistically significantly effective for depression (SMD=-0.40, 95% CI=-0.84 to 0.04), they were effective in reducing negative emotions (SMD=-0.75, 95% CI=-1.20 to -0.31). Conclusion Virtual reality interventions based on the desensitization effect may be considered a viable option for reducing anxiety disorders.

Purpose: This meta-analysis was conducted to determine the effect size of anxiety and psychological outcomes of virtual reality interventions in patients with anxiety disorders. Methods: A total of 835 studies were initially identified, of which six were found to be suitable according to the PICO (P: Patients with social phobia, I: VR technology, C: non VR technology, O: Variables related to mental health). criteria. Results: An analysis of the effect size of these studies confirmed that virtual reality interventions were not statistically significantly effective for generalized anxiety disorder (standardized mean difference [SMD]=0.16, 95% confidence interval [CI]=-0.84 to 1.15), but exhibited statistically significant effects for social anxiety (SMD=-0.56, 95% CI=-0.87 to -0.25) disorder and relational anxiety disorder (SMD -0.83, 95% CI=-1.49 to -0.16). Although these interventions were not statistically significantly effective for depression (SMD=-0.40, 95% CI=-0.84 to 0.04), they were effective in reducing negative emotions (SMD=-0.75, 95% CI=-1.20 to -0.31). Conclusion Virtual reality interventions based on the desensitization effect may be considered a viable option for reducing anxiety disorders.

PURPOSE: This study was planned to determine the efficacy and safety of mycophenolate mofetil (MMF) as a rescue treatment in patients with membranous nephropathy (MN) and focal segmental glomerulosclerosis (FSGS) who were not responsive to standard therapy with steroid and immunosuppressive regimen. METHODS: We planned a prospective, non-randomized study from Oct. 2002 to Aug. 2009, including biopsy-proven MN or FSGS patients in Keimyung university Dongsan hospital. MMF was initiated at 0.5-0.75 g twice daily, and advanced as appropriate or as tolerated to 0.75-1 g twice daily. RESULTS: 14 cases with MN and 5 cases with FSGS was enrolled. The mean age of patients was 51.7+/-12.3 years, and mean treatment duration was 14.4+/-6.5 months. Five patients (26.4%) went into complete remission and the seven (36.8%) into partial remission. The mean value of 24hr total urine protein over the follow-up 6 months' period declined significantly from 7.6+/-6.2 g in pre-treatment, to 4.1+/-3.2 g in 3 months, and 3.1+/-2.1 g in 6 months (p=0.011). The mean 24hr total urine protein decreased from 7.5+/-6.3 g in pre-MMF to 1.9+/-1.8 g in post-MMF (p=0.001). The mean serum albumin rose from 3.2+/-0.8 g/dL in pre-MMF to 3.9+/-0.5 g/dL in post-MMF (p=0.001). There were no significant changes in mean value for WBC, hemoglobin, serum creatinine, and total cholesterol. Side effects of MMF were infrequent and generally mild. CONCLUSION: MMF appears effective in 63% of patients with MN and FSGS who are resistant to other forms of treatment. Studies with more cases and multicenter controlled trials are required to establish the role and standards of MMF in these disorders.
Cholesterol ; Creatinine ; Follow-Up Studies ; Glomerulonephritis, Membranous ; Glomerulosclerosis, Focal Segmental ; Hemoglobins ; Humans ; Mycophenolic Acid ; Prospective Studies ; Serum Albumin

Single nucleotide polymorphisms (SNPs) are the most abundant form of human genetic variation and are a resource for mapping complex genetic traits. A genome is covered by millions of these markers, and researchers are able to compare which SNPs predominate in people who have a certain disease. The International HapMap Project, launched in October, 2002, motivated us to start the Korean HapMap Project in order to support Korean HapMap infrastructure development and to accelerate the finding of genes that affect health, disease, and individual responses to medications and environmental factors. A Korean SNP and haplotype database system was developed through the Korean HapMap Project to provide Korean researchers with useful data- mining information about disease-associated biomarkers for studies on complex diseases, such as diabetes, cancer, and stroke. Also, we have developed a series of software programs for association studies as well as the comparison and analysis of Korean HapMap data with other populations, such as European, Chinese, Japanese, and African populations. The developed software includes HapMapSNPAnalyzer, SNPflank, HWE Test, FESD, D2GSNP, SNP@Domain, KMSD, KFOD, KFRG, and SNP@WEB. We developed a disease-related SNP retrieval system, in which OMIM, GeneCards, and MeSH information were integrated and analyzed for medical research scientists. The kHapMap Browser system that we developed and integrated provides haplotype retrieval and comparative study tools of human ethnicities for comprehensive disease association studies (http://www.khapmap.org). It is expected that researchers may be able to retrieve useful information from the kHapMap Browser to find useful biomarkers and genes in complex disease association studies and use these biomarkers and genes to study and develop new drugs for personalized medicine.
Asian Continental Ancestry Group ; Databases, Genetic ; Genetic Variation ; Genome ; Haplotypes ; HapMap Project ; Humans ; Mining ; Polymorphism, Single Nucleotide ; Stroke ; Biomarkers ; Precision Medicine

The Korean HapMap Project has been carried out for the last 5 years since it started in June, 2003. The project generated data for a sum of 1,764,000 Korean SNPs and formally registered the data to the dbSNP of NCBI (The dbSNP website. 2008). We have developed a series of software programs for association studies as well as for the comparison and analysis of Korean HapMap data with four other populations (CEPH, Yoruba, Han Chinese, and Japanese populations). The KHapmap Browser was developed and integrated to provide haplotype retrieval and comparative study tools of human ethnicities for comprehensive disease association studies (http://www.khapmap.org). On that basis, GBrowse was adopted in the KHapmap Browser for inherent Korean genetic data, and a provision of extended services was pledged with the distributed sequence annotation system (DAS). The dynamic linking service of the KHapmap Browser to other tools in our intranetwork environment provides many enhanced functions over GBrowse without DAS. KHapmap Browser is expected to be an invaluable tool for the study of Korean and international Hapmap data.
4-Acetamido-4'-isothiocyanatostilbene-2,2'-disulfonic Acid ; Asian Continental Ancestry Group ; Haplotypes ; HapMap Project ; Humans ; Polymorphism, Single Nucleotide

BACKGROUND: The incidence of acute rejection has decreased with the introduction of new immunosuppressive agents. However, several studies have shown that allograft survival has not clearly improved over the past few decades. METHODS: We reviewed patients who underwent kidney transplantation between 1982 and 2007. We compared the causes of graft loss for three decades: 1982~1990 (period I),1991~2000 (period II), and 2001~2007 (period III), with the clinical characteristics of patients with functioning grafts and patients who lost their allografts. RESULTS: There were 785 recipients with a mean age of 36.1 years, and 65.2% were male. Graft loss occurred in 329 patients (41.9%), and the most common cause of graft loss was chronic allograft nephropathy (CAN, 52.0%), followed by patient death (17.6%), post-transplant glomerulonephritis (12.8%), and non compliance (7.9%). During the three time periods, 129, 172, and 28 patients lost their grafts, respectively. Five-year graft survival was 61.5%, 78.4%, and 90.8%, respectively, and increased significantly (P<0.000). CAN, as a cause of graft loss, fell from 65.1% (period I) to 32.1% (period III, P<0.000), but patient death increased from 12.4% to 32.1% (P=0.034). A multivariate analysis revealed that significant risk factors for graft loss included an older donor, transplantation at period I, and dual immunosuppression. Use of tacrolimus and mycophenolate mofetil was associated with a significantly reduced risk of graft loss. CONCLUSIONS: Graft survival has increased over the last three decades whereas the proportion of CAN, the most common cause of graft loss, has decreased. Attention to the main causes of graft loss, CAN, and patient death will offer potential improvement in graft survival.
Compliance ; Glomerulonephritis ; Graft Rejection ; Graft Survival ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Incidence ; Kidney ; Kidney Transplantation ; Male ; Multivariate Analysis ; Mycophenolic Acid ; Rejection (Psychology) ; Risk Factors ; Tacrolimus ; Time Factors ; Tissue Donors ; Transplantation, Homologous ; Transplants ; Treatment Outcome