Purpose: This study aimed to valuate the reliability and validity of the Korean version of the 5C Psychological Antecedents of Vaccination (K-5C) scale. Methods: The English version of the 5C scale was translated into Korean, following the World Health Organization guidelines. Data were collected from 316 community-dwelling adults. Content validity was evaluated using the content validity index, while construct validity was evaluated through confirmatory factor analysis. Convergent validity was examined by assessing the correlation with vaccination attitude, and concurrent validity was evaluated by examining the association with coronavirus disease 2019 (COVID-19) vaccination status. Internal consistency and test-retest reliability were also evaluated. Results: Content validity results indicated an item-level content validity index ranging from .83 to 1, and scale-level content validity index, averaging method was .95. Confirmatory factor analysis supported the fit of the measurement model, comprising a five-factor structure with a 15-item questionnaire (RMSEA = .05, SRMR = .05, CFI = .97, TLI = .96). Convergent validity was acceptable with a significant correlation between each sub-scale of the 5C scale and vaccination attitude. In concurrent validity evaluation, confidence, constraints, and collective responsibility of the 5C scale were significant independent predictors of the current COVID-19 vaccination status. Cronbach’s alpha for each subscale ranged from .78 to .88, and the intraclass correlation coefficient for each subscale ranged from .67 to .89. Conclusion The Korean version of the 5C scale is a valid and reliable tool to assess the psychological antecedents of vaccination among Korean adults.

PURPOSE: Cardiotoxicity is a serious late complication of breast cancer treatment. Individual treatment risk of specific drugs has been investigated. However, studies on the evaluation of the composite risk of chemotherapeutic agents are limited.METHODS: We retrospectively analyzed the medical records of breast cancer patients who received adjuvant treatment and had available serial echocardiography results. Patients were assigned to subgroups based on chemotherapy containing anthracyclines (A), anthracyclines and taxanes (A+T), and radiotherapy (RT). The development of cardiac disease and serial ejection fraction (EF) were reviewed. EF decline up to 10% from baseline was considered grade 1 cardiotoxicity and EF decline >20% or absolute value < 50% was considered grade 2 cardiotoxicity. The most recent medical records and echocardiography results over 1 year of chemotherapy completion were also reviewed. Late cardiotoxicity was defined as a lack of recovery of EF decline or aggravated EF decline from baseline.RESULTS: In total, 123 patients were evaluated. A small reduction in EF was observed after chemotherapy in both chemotherapy groups. There were no significant differences between groups A and A+T in EF decline following chemotherapy. We could not find any differences in composite risk between the chemotherapy groups and the RT group during follow-up. Late cardiotoxicity was seen in 15.45% of patients. During follow-up, three patients were diagnosed with dilated cardiomyopathy.CONCLUSION: There was no significant composite risk elevation following adjuvant treatment of breast cancer. However, late cardiotoxicity was considerable and further research in this direction is necessary.
Anthracyclines ; Breast Neoplasms ; Breast ; Cardiomyopathy, Dilated ; Cardiotoxicity ; Drug Therapy ; Echocardiography ; Follow-Up Studies ; Heart Diseases ; Humans ; Medical Records ; Radiotherapy ; Retrospective Studies ; Taxoids

Background: Prolotherapy, which stimulates the healing of loosened ligaments and tendons, is a cost-effective and safe treatment modality for chronic musculoskeletal pain. Its benefits may be affected by injection protocols, comparative regimens, and evaluation scales. The aim of this study was to determine the effectiveness of dextrose prolotherapy as a long-term treatment for chronic musculoskeletal pain. Methods: Medline, Embase, Cochrane Central, KoreaMed, and KMbase databases were searched for studies published up to March 2019. We included randomized controlled trials which compared the effect of dextrose prolotherapy with that of other therapies such as exercise, saline, platelet-rich plasma, and steroid injection. The primary outcome was pain score change during daily life. Results: Ten studies involving 750 participants were included in the final analysis. Pain scores from 6 months to 1 year after dextrose prolotherapy were significantly reduced compared to saline injection (standardized mean difference [SMD] –0.44; 95% confidence interval [CI] –0.76 to –0.11, P = 0.008) and exercise (SMD –0.42; 95% CI –0.77 to –0.07, P = 0.02). Prolotherapy yielded results similar to platelet-rich plasma or steroid injection, that it showed no significant difference in pain score. Conclusions Dextrose prolotherapy is more effective in the treatment of chronic pain compared to saline injection or exercise. Its effect was comparable to that of platelet-rich plasma or steroid injection. Adequately powered, homogeneous, and longer-term trials are needed to better elucidate the efficacy of prolotherapy.

BACKGROUND: Thyrotoxic periodic paralysis (TPP) is a rare complication of thyrotoxicosis characterized by acute attacks of muscle weakness and hypokalemia. Recently, variation in several genes was suggested to be associated with TPP. This study evaluated the genetic predisposition to TPP in terms of the β2-adrenergic receptor (ADRB2), androgen receptor (AR), and γ-aminobutyric acid receptor α3 subunit (GABRA3) genes. METHODS: This study enrolled 48 men with Graves disease (GD) and TPP, and 48 GD patients without TPP. We compared the frequencies of candidate polymorphisms between the two groups. RESULTS: The frequency of the Gly16/Gly16 genotype in ADRB2 was not significantly associated with TPP (P=0.32). More CAG repeats (≥26) in the AR gene were not correlated with TPP (odds ratio [OR], 2.46; 95% confidence interval [CI], 0.81 to 8.09; P=0.08). The allele frequency of the TT genotype in the GABRA3 gene was not associated with TPP (OR, 1.83; 95% CI, 0.54 to 6.74; P=0.41). CONCLUSION: The polymorphisms in the ADRB2, AR, and GABRA3 genes could not explain the genetic susceptibility to TPP in Korean men with GD.
Gene Frequency ; Genetic Predisposition to Disease ; Genotype ; Graves Disease* ; Humans ; Hypokalemia ; Male ; Muscle Weakness ; Paralysis* ; Receptors, Androgen ; Thyrotoxicosis

BACKGROUND: Delayed hypersensitivity plays a large role in the pathogenesis of tuberculous pleural effusion (TPE). Macrophages infected with live Mycobacterium tuberculosis (MTB) increase the levels of adenosine deaminase2 (ADA2) in the pleural fluid of TPE patients. However, it is as yet unclear whether ADA2 can be produced by macrophages when challenged with MTB antigens alone. This study therefore evaluated the levels of ADA2 mRNA expression, using monocyte-derived macrophages (MDMs) stimulated with MTB antigens. METHODS: Purified monocytes from the peripheral blood mononuclear cells of healthy volunteers were differentiated into macrophages using granulocyte-macrophage colony-stimulating factor (GM-CSF) or macrophage colony-stimulating factor (M-CSF). The MDMs were stimulated with early secretory antigenic target protein 6 (ESAT6) and culture filtrate protein 10 (CFP10). The mRNA expression levels for the cat eye syndrome chromosome region, candidate 1 (CECR1) gene encoding ADA2 were then measured. RESULTS: CECR1 mRNA expression levels were significantly higher in MDMs stimulated with ESAT6 and CFP10, than in the unstimulated MDMs. When stimulated with ESAT6, M-CSF-treated MDMs showed more pronounced CECR1 mRNA expression than GM-CSF-treated MDMs. Interferon-γ decreased the ESAT6- and CFP10-induced CECR1 mRNA expression in MDMs. CECR1 mRNA expression levels were positively correlated with mRNA expression of tumor necrosis factor α and interleukin 10, respectively. CONCLUSION: ADA2 mRNA expression increased when MDMs were stimulated with MTB antigens alone. This partly indicates that pleural fluid ADA levels could increase in patients with culture-negative TPE. Our results may be helpful in improving the understanding of TPE pathogenesis.
Adenosine Deaminase* ; Adenosine* ; Animals ; Cats ; Granulocyte-Macrophage Colony-Stimulating Factor ; Healthy Volunteers ; Humans ; Hypersensitivity, Delayed ; Interleukin-10 ; Macrophage Colony-Stimulating Factor ; Macrophages* ; Monocytes ; Mycobacterium tuberculosis* ; Mycobacterium* ; Pleural Effusion ; RNA, Messenger* ; Tumor Necrosis Factor-alpha

BACKGROUND AND OBJECTIVES: The relationship between Hashimoto thyroiditis (HT) and papillary thyroid cancer (PTC) is still controversial. Some studies suggested that molecular basis of the association between HT and PTC. BRAF(V600E) mutation is the most common genetic alteration founded in PTC. This study was to determine a role of BRAF(V600E) mutation in PTC with concurrent HT and their association with other clinicopathological factors. MATERIALS AND METHODS: We enrolled 452 patients who underwent thyroid surgery between 2009 and 2012 for classical PTC. The status of BRAF(V600E) mutation was evaluated by direct sequencing. HT was defined as presence of lymphocytic thyroiditis in pathology or positive serum anti-thyroid peroxidase antibody. RESULTS: Total 139 patients (30%) with PTC had coexistence HT. HT was significantly associated female (p=0.006), and younger age (p=0.045). BRAF(V600E) mutation was confirmed in 264 patients (58%). The frequency of BRAF(V600E) mutation was significantly lower in PTC with coexistence HT (48.2%) compared by PTC without HT (62.9%, p=0.004). However, there was no significant difference in clinicopathological feature of PTC according to the presence of HT in patients with BRAF(V600E) mutated PTC. BRAF(V600E) mutation was less frequent in PTC with coexistence HT. CONCLUSION: These findings suggested that HT and BRAF(V600E) mutation might be independent factors in development and progression of PTC.
Female ; Hashimoto Disease* ; Humans ; Pathology ; Peroxidase ; Thyroid Gland ; Thyroid Neoplasms ; Thyroiditis, Autoimmune

BACKGROUND/OBJECTIVES: A dietary restriction on the intake of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) has been reported to be effective in the treatment of gastrointestinal (GI) tract complications. Enteral nutrition (EN) is widely used for patients who cannot obtain their nutritional requirements orally, but many studies have reported EN complications, especially diarrhea, in up to 50% of patients. SUBJECTS/METHODS: We performed a single-center, non-randomized, controlled trial to determine the effects of a low-FODMAP enteral formula on GI complications in patients in intensive care units (ICUs). Patients in the ICU who needed EN (n = 66) were alternately assigned to the low-FODMAP group (n = 33) or the high-FODMAP group (n = 33). RESULTS: Anthropometric and biochemical parameters were measured, and stool assessment was performed using King's Stool Chart. We excluded patients who received laxatives, GI motility agents, proton pump inhibitors, antifungal agents, and antibiotics other than β-lactams. There were no differences in GI symptoms during 7 days of intervention, including bowel sound, abdominal distension, and vomiting between the 2 groups. However, diarrhea was more frequent in the high-FODMAP group (7/33 patients) than the lowFODMAP group (1/33 patients) (P = 0.044). CONCLUSIONS Our results suggest that a low-FODMAP enteral formula may be a practical therapeutic approach for patients who exhibit enteral formula complications. Our study warrants further randomized clinical trials and multicenter trials.

BACKGROUND: Hyperthyroidism relapse in Graves disease after antithyroid drug (ATD) withdrawal is common; however, measuring the thyrotropin receptor antibody (TRAb) at ATD withdrawal in order to predict outcomes is controversial. This study compared measurement of thyroid stimulatory antibody (TSAb) and thyrotropin-binding inhibitory immunoglobulin (TBII) at ATD withdrawal to predict relapse. METHODS: This retrospective study enrolled patients with Graves disease who were treated with ATDs and whose serum thyroid-stimulating hormone levels were normal after receiving low-dose ATDs. ATD therapy was stopped irrespective of TRAb positivity after an additional 6 months of receiving the minimum dose of ATD therapy. Patients were followed using thyroid function tests and TSAb (TSAb group; n=35) or TBII (TBII group; n=39) every 3 to 6 months for 2 years after ATD withdrawal. RESULTS: Twenty-eight patients (38%) relapsed for a median follow-up of 21 months, and there were no differences in baseline clinical characteristics between groups. In the TSAb group, relapse was more common in patients with positive TSAb at ATD withdrawal (67%) than patients with negative TSAb (17%; P=0.007). Relapse-free survival was shorter in TSAb-positive patients. In the TBII group, there were no differences in the relapse rate and relapse-free survivals according to TBII positivity. For predicting Graves disease relapse, the sensitivity and specificity of TSAb were 63% and 83%, respectively, whereas those of TBII were 28% and 65%. CONCLUSION: TSAb at ATD withdrawal can predict the relapse of Graves hyperthyroidism, but TBII cannot. Measuring TSAb at ATD withdrawal can assist with clinical decisions making for patients with Graves disease.
Follow-Up Studies ; Graves Disease* ; Humans ; Hyperthyroidism ; Immunoglobulins ; Immunoglobulins, Thyroid-Stimulating* ; Prognosis ; Receptors, Thyrotropin ; Recurrence* ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Function Tests ; Thyroid Gland* ; Thyrotropin

BACKGROUND: Molecular analysis for common somatic mutations in thyroid cancer can improve diagnostic accuracy of fine-needle aspiration cytology (FNAC) in the nondiagnostic or indeterminate category of thyroid nodules. In this study, we evaluated the feasibility of molecular diagnosis from residual liquid-based cytology (LBC) material after cytological diagnosis. METHODS: This prospective study enrolled 53 patients with thyroid nodules diagnosed as nondiagnostic, atypia of undetermined significance (AUS), or follicular lesion of undetermined significance (FLUS) after FNAC. DNAs and RNAs were isolated from residual LBC materials. BRAF(V600E) and RAS point mutations, PAX8/peroxisome proliferator-activated receptor γ (PPARγ), RET/PTC1, and RET/PTC3 rearrangements were evaluated by real-time polymerase chain reaction and pyrosequencing. RESULTS: All DNAs from 53 residual LBC samples could be analysed and point mutations were detected in 10 samples (19%). In 17 AUS nodules, seven samples (41%) had point mutations including BRAF (n=4), NRAS (n=2), and KRAS (n=1). In 20 FLUS nodules, three samples (15%) had NRAS point mutations. RNA from only one FLUS nodule could be analysed for rearrangements and there was no abnormality. CONCLUSION: Molecular analysis for BRAF and RAS mutations was feasible in residual LBC materials and might be useful for diagnosis of indeterminate thyroid nodules.
Biopsy, Fine-Needle ; Diagnosis* ; DNA ; Humans ; Molecular Diagnostic Techniques ; Point Mutation ; Prospective Studies ; Real-Time Polymerase Chain Reaction ; RNA ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule*

BACKGROUND: The BRAF V600E mutation is the most common genetic alteration identified in papillary thyroid carcinoma (PTC). Because of its costs effectiveness and sensitivity, direct Sanger sequencing has several limitations. The aim of this study was to evaluate the efficiency of immunohistochemistry (IHC) as an alternative method to detect the BRAF V600E mutation in preoperative and postoperative tissue samples. METHODS: We evaluated 71 patients who underwent thyroid surgery with the result of direct sequencing of the BRAF V600E mutation. IHC staining of the BRAF V600E mutation was performed in 49 preoperative and 23 postoperative thyroid specimens. RESULTS: Sixty-two patients (87.3%) had PTC, and of these, BRAF V600E was confirmed by direct sequencing in 57 patients (91.9%). In 23 postoperative tissue samples, the BRAF V600E mutation was detected in 16 samples (70%) by direct sequencing and 18 samples (78%) by IHC. In 24 fine needle aspiration (FNA) samples, BRAF V600E was detected in 18 samples (75%) by direct sequencing and 16 samples (67%) by IHC. In 25 core needle biopsy (CNB) samples, the BRAF V600E mutation was detected in 15 samples (60%) by direct sequencing and 16 samples (64%) by IHC. The sensitivity and specificity of IHC for detecting the BRAF V600E mutation were 77.8% and 66.7% in FNA samples and 99.3% and 80.0% in CNB samples. CONCLUSION: IHC could be an alternative method to direct Sanger sequencing for BRAF V600E mutation detection both in postoperative and preoperative samples. However, application of IHC to detect the BRAF V600E mutation in FNA samples is of limited value compared with direct sequencing.
Biopsy, Fine-Needle ; Biopsy, Large-Core Needle ; Humans ; Immunohistochemistry* ; Methods ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Neoplasms*