PURPOSE: To evaluate the risk of vertebral compression fracture (VCF) after conventional radiotherapy (RT) for colorectal cancer (CRC) with spine metastasis and to identify risk factors for VCF in metastatic and non-metastatic irradiated spines. MATERIALS AND METHODS: We retrospectively reviewed 68 spinal segments in 16 patients who received conventional RT between 2009 and 2012. Fracture was defined as a newly developed VCF or progression of an existing fracture. The target volume included all metastatic spinal segments and one additional non-metastatic vertebra adjacent to the tumor-involved spines. RESULTS: The median follow-up was 7.8 months. Among all 68 spinal segments, there were six fracture events (8.8%) including three new VCFs and three fracture progressions. Observed VCF rates in vertebral segments with prior irradiation or pre-existing compression fracture were 30.0% and 75.0% respectively, compared with 5.2% and 4.7% for segments without prior irradiation or pre-existing compression fracture, respectively (both p < 0.05). The 1-year fracture-free probability was 87.8% (95% CI, 78.2-97.4). On multivariate analysis, prior irradiation (HR, 7.30; 95% CI, 1.31-40.86) and pre-existing compression fracture (HR, 18.45; 95% CI, 3.42-99.52) were independent risk factors for VCF. CONCLUSION: The incidence of VCF following conventional RT to the spine is not particularly high, regardless of metastatic tumor involvement. Spines that received irradiation and/or have pre-existing compression fracture before RT have an increased risk of VCF and require close observation.
Colorectal Neoplasms* ; Follow-Up Studies ; Fractures, Compression* ; Humans ; Incidence ; Multivariate Analysis ; Neoplasm Metastasis ; Radiotherapy ; Retrospective Studies ; Risk Factors ; Spinal Fractures ; Spinal Neoplasms ; Spine*

PURPOSE: We investigated trends in antibiotic pressure and the antibiotic susceptibility of gram negative bacteria isolated from Korean children over 10 consecutive years. METHODS: From January 2004 to December 2013, the antibiotic susceptibility of Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter baumannii blood isolates obtained from children <18 years of age was determined according to the 2009 Clinical and Laboratory Standards Institute guidelines. Antibiotic consumption data were also analyzed. RESULTS: The prevalence of K. pneumoniae, E. coli, P. aeruginosa, and A. baumannii bacteremia was 4.6, 3.5, 3.4, and 2.2 cases/1,000 blood cultures/year, respectively. In K. pneumoniae, resistance to the third and fourth cephalosporin did not increase significantly. However, carbapenem-resistant K. pneumoniae first appeared in 2010, and the resistance rate increased to 9% between 2012 and 2013. Resistance to 3rd and 4th cephalosporin increased from 10% to 50% in E. coli, and resistance to carbapenem rose abruptly from 11% to 71% in A. baumannii (P for trend <0.01). However, such an increase of resistance was not observed in P. aeruginosa. There is a positive correlation between the resistance rate of cefepime in E. coli and the consumption of cefepime (r=0.900, P=0.037). CONCLUSION: The significant burden of antibiotic consumption and the high prevalence of antibiotic resistance to gram negative pathogen isolated from bacteremic children were observed. Empirical antibiotics should be wisely selected, and continued efforts to decrease the overall antibiotic pressure are mandatory, especially in highly resistant situations.
Acinetobacter baumannii ; Anti-Bacterial Agents ; Bacteremia ; Child* ; Drug Resistance, Microbial ; Escherichia coli ; Gram-Negative Bacteria* ; Humans ; Klebsiella pneumoniae ; Pneumonia ; Prevalence ; Pseudomonas aeruginosa

Skin and soft tissue infections (SSTIs) caused by community-associated (CA)-methicillin-resistant Staphylococcus aureus (MRSA) have become a worldwide concern. An otherwise healthy 16-month-old Korean girl was admitted because of skin abscess on the left chest wall with a history of recurrent SSTIs since the age of 6 months. Immunologic evaluation including serum immunoglobulin level and nitroblue-tetrazolium (NBT) test were normal. Pus and nasal swab cultures revealed CA-MRSA ST714-SCCmec type IV with the Panton-Valentine leukocidin (PVL) genes, which was initially reported in the Netherlands in 2006 and has not been previously reported in Korea. The skin abscesses were successfully treated by needle aspiration and the use of antibiotics. In addition, nasal mupirocin was applied as a decolonization method. No more episodes of SSTI were observed over a follow-up period of 10 months.
Abscess ; Anti-Bacterial Agents ; Child* ; Female ; Follow-Up Studies ; Humans ; Immunoglobulins ; Infant ; Korea* ; Leukocidins ; Mupirocin ; Needles ; Netherlands ; Skin* ; Soft Tissue Infections* ; Staphylococcus aureus ; Suppuration ; Thoracic Wall

PURPOSE: The aim of this study was to identify effects of perceived nurse-nurse collaboration and nurse-physician collaboration on nursing performance in perioperative nurses. METHODS: A cross-sectional survey was used and data were collected in September 2016. Participants were 186 perioperative nurses from three advanced general hospitals and nine general hospitals. Data were analyzed using descriptive statistics, independent t-test, One-way ANOVA, Scheffé test, Pearson correlation coefficients and hierarchical multiple regression with the SPSS/WIN 23.0 program. RESULTS: The mean scores were for nurse-nurse collaboration, 2.92±0.28 out of 4, for nurse-physician collaboration, 3.29±0.65 out of 5, and for nursing performance, 3.85±0.47 out of 5. There were statistically significant positive correlations among nurse-nurse collaboration, nurse-physician collaboration, and nursing performance. Hierarchical multiple regression analysis revealed that nurse-nurse collaboration explained an additional 29%p of nursing performance. Shared processes, conflict management, and professionalism of nurse-nurse collaboration were statistically significant predictors of nursing performance. The nurse-physician collaboration explained an additional 3%p of nursing performance. Sharing of patient information was a statistically significant predictor of nursing performance. CONCLUSION: Findings indicate that intervention programs that integrate and strengthen shared processes, conflict management, professionalism, and sharing of patient information are useful to enhance nursing performance.
Cooperative Behavior ; Cross-Sectional Studies ; Hospitals, General ; Humans ; Nursing ; Perioperative Nursing ; Professionalism ; Work Performance

Epstein-Barr virus (EBV) causes a variety of central nervous system infections, including encephalitis. EBV encephalitis accounts for approximately 5.8% of all viral encephalitis, with fever, headache, convulsions, and decreased consciousness as common symptoms. Brain magnetic resonance imaging (MRI) in EBV encephalitis shows high signal intensity mainly in the parieto-occipital cortex, subcortical white matter, and deep gray matter nuclei with reversibility. In this report, we present a case of bilateral corticospinal tract involvement (wineglass sign) identified on brain MRI in a patient with diagnosed with EBV encephalitis.

Epstein-Barr virus (EBV) causes a variety of central nervous system infections, including encephalitis. EBV encephalitis accounts for approximately 5.8% of all viral encephalitis, with fever, headache, convulsions, and decreased consciousness as common symptoms. Brain magnetic resonance imaging (MRI) in EBV encephalitis shows high signal intensity mainly in the parieto-occipital cortex, subcortical white matter, and deep gray matter nuclei with reversibility. In this report, we present a case of bilateral corticospinal tract involvement (wineglass sign) identified on brain MRI in a patient with diagnosed with EBV encephalitis.

Epstein-Barr virus (EBV) causes a variety of central nervous system infections, including encephalitis. EBV encephalitis accounts for approximately 5.8% of all viral encephalitis, with fever, headache, convulsions, and decreased consciousness as common symptoms. Brain magnetic resonance imaging (MRI) in EBV encephalitis shows high signal intensity mainly in the parieto-occipital cortex, subcortical white matter, and deep gray matter nuclei with reversibility. In this report, we present a case of bilateral corticospinal tract involvement (wineglass sign) identified on brain MRI in a patient with diagnosed with EBV encephalitis.

PURPOSE: To investigate the patterns of locoregional recurrence of pathologic T3N0 (pT3N0) lower rectal cancer omitting postoperative radiotherapy (RT) and explore the potential of modification of a RT field. MATERIALS AND METHODS: From Jan 2003 to Nov 2011, 35 patients omitting preoperative or postoperative RT for pT3N0 lower rectal cancer were included. We defined the lower rectal cancer as the tumor with the inferior margin located below the virtual line-a convergent level between rectal wall and levator ani muscle. All patients had radiologic examinations for recurrence evaluation during the follow-up duration. RESULTS: The median follow-up duration was 66.4 months (range, 1.4 to 126.1 months). Eight (22.9%) of the 35 patients had recurrence. Three (8.6%) was local recurrence (LR) only, 3 (8.6%) was distant metastasis (DM) only, and 2 (5.7%) was LR with DM. All LR were located at primary tumor sites. The overall survival rate, LR-free survival rate, and DM-free survival rate at 5 years was 79.8%, 83%, and 87%, respectively. All LR developed from tumors over 5 cm. However, there was no statistical significance (p = 0.065). There was no other risk factor for LR. CONCLUSION: Even though the patients included in this study had pathologically favorable pT3N0 rectal cancer, LR developed in 14.3% of patients. Most of the LR was located at primary tumor sites prior to surgery. Based on these findings, it might seem reasonable to consider postoperative RT with a smaller radiation field to the primary tumor site rather than the conventional whole pelvic irradiation.
Follow-Up Studies ; Humans ; Muscles ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Radiotherapy, Adjuvant ; Rectal Neoplasms ; Recurrence ; Risk Factors ; Survival Rate

PURPOSE: There is a the great diagnostic challenge in pediatric tuberculosis especially in high burden setting. The purpose of this preliminary study is to evaluate the agreement between tuberculin skin test (TST) and interferon-gamma release assay (IGRA) including T-SPOT®-TB and QuantiFERON®-TB Gold (QFT-G) in Korean children. METHOD: This retrospective study included children and adolescents who visited to Asan Medical Center to evaluate tuberculosis infection using at least two assays of TST, T-SPOT.TB and QFT-G, from January 2014 to April 2015. RESULTS: A total of 20 patients were included, whose median age was 13.3 years (range, 3.8-18.1 years), and all of them had history of BCG vaccination. Eleven patients had underlying diseases including 7 patients with immunosuppressant medication. The concordance rate between T-SPOT.TB and QFT-G was 90%. However, the concordance rate between TST and T-SPOT.TB was 50%, and between TST and QFT-G was 42.9%. Specificity for the diagnosis of tuberculosis infection of T-SPOT.TB, QFT-G, and TST was 93.3%, 86.7%, and 58.3%, respectively. CONCLUSIONS: Although there was a discrepancy between TST and IGRA to diagnose tuberculosis, agreement between T-SPOT.TB and QFT-G was relatively high. Further prospective study to validate the clinical usefulness of each assay for immunologic evidence of tuberculosis infection in Korean children will be mandatory.
Adolescent ; Child* ; Chungcheongnam-do ; Diagnosis* ; Humans ; Interferon-gamma Release Tests* ; Interferon-gamma* ; Latent Tuberculosis ; Mycobacterium bovis ; Prospective Studies ; Retrospective Studies ; Sensitivity and Specificity ; Skin Tests* ; Skin* ; Tuberculin* ; Tuberculosis* ; Vaccination

PURPOSE: The tumor microenvironment is known to be associated with the metabolic activity of cancer cells and local immune reactions. We hypothesized that glucose metabolism measured by 2-deoxy-2-(¹⁸F)fluoro-D-glucose (¹⁸F-FDG) positron emission tomography (PET)-computed tomography (CT) (¹⁸F-FDG PET-CT) would be associated with local immune responses evaluated according to the presence of tumor infiltrating lymphocytes (TILs). MATERIALS AND METHODS: We retrospectively reviewed 56 patients who underwent ¹⁸F-FDG PET-CT prior to gastrectomy. In resected tumor specimens, TIL subsets, including cluster of differentiation (CD) 3, CD4, CD8, Forkhead box P3 (Foxp3), and granzyme B, were subjected to immunohistochemical analysis. The prognostic nutritional index (PNI) was calculated as: (10×serum albumin value)+(0.005×peripheral lymphocyte counts). Additionally, the maximum standard uptake value (SUVmax) was calculated to evaluate the metabolic activity of cancer cells. RESULTS: The SUVmax was positively correlated with larger tumor size (R=0.293; P=0.029) and negatively correlated with PNI (R=−0.407; P=0.002). A higher SUVmax showed a marginal association with higher CD3 (+) T lymphocyte counts (R=0.227; P=0.092) and a significant association with higher Foxp3 (+) T lymphocyte counts (R=0.431; P=0.009). No other clinicopathological characteristics were associated with SUVmax or TILs. Survival analysis, however, indicated that neither SUVmax nor Foxp3 held prognostic significance. CONCLUSIONS: FDG uptake on PET-CT could be associated with TILs, especially regulatory T cells, in gastric cancer. This finding may suggest that PET-CT could be of use as a non-invasive tool for monitoring the tumor microenvironment in patients with gastric cancer.
Fluorodeoxyglucose F18 ; Gastrectomy ; Glucose ; Granzymes ; Humans ; Lymphocyte Count ; Lymphocytes ; Lymphocytes, Tumor-Infiltrating ; Metabolism ; Nutrition Assessment ; Positron-Emission Tomography ; Retrospective Studies ; Stomach Neoplasms ; T-Lymphocytes, Regulatory ; Tumor Microenvironment