BACKGROUND/AIMS: Dyslipidemia is one of the major causes of cardiovascular disease in end-stage renal disease (ESRD) patients. Most of them are dyslipidemic despite the use of lipid-lowering agents. Ezetimibe is a novel chemical entity that inhibits the intestinal absorption of dietary and biliary cholesterol. This study evaluated the effects of ezetimibe on the lipid profile, inflammation markers, endothelial injury, and thrombogenesis in ESRD patients. METHODS: Sixty-five patients with serum low-density lipoprotein (LDL)-cholesterol levels > or =100 mg/d were recruited: 33 patients were on hemodialysis and 32 patients were on peritoneal dialysis. They were assigned randomly to the ezetimibe (10 mg) monotherapy group and the ezetimibe (10 mg) plus simvastatin (10 mg) combination therapy group. Both drugs were administered for 8 weeks. RESULTS: There were no significant differences in the baseline demographic and laboratory characteristics between the two groups. In the monotherapy group, the total and LDL-cholesterol levels were reduced by 14.7 and 21.9%, respectively. There were no changes in the high-density lipoprotein (HDL)-cholesterol or triglyceride levels. Fibrinogen increased significantly (p=0.04). In the combination therapy group, the total and LDL-cholesterol levels were reduced by 29.8 and 42.4%, respectively. There was an additional 15.1% reduction in total cholesterol and an additional 20.5% reduction in LDL cholesterol compared with monotherapy. Several patients complained of minor adverse effects and only one patient in the ezetimibe monotherapy group discontinued medication, because of diarrhea. CONCLUSIONS: In ESRD patients, ezetimibe used as combination therapy with a statin is more effective than ezetimibe monotherapy in ESRD patients.
Azetidines ; Cardiovascular Diseases ; Cholesterol ; Cholesterol, LDL ; Dyslipidemias ; Fibrinogen ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Inflammation ; Intestinal Absorption ; Kidney Failure, Chronic ; Lipoproteins ; Peritoneal Dialysis ; Renal Dialysis ; Simvastatin ; Ezetimibe

OBJECTIVE: To assess the feasibility and safety of polyvinyl alcohol (PVA) embolization adjuvant to transarterial oily chemoembolization (P-TACE) in advanced hepatocellular carcinoma (HCC) with arterioportal shunts (APS). MATERIALS AND METHODS: Nineteen patients who underwent PVA embolization for APS before a routine chemoembolization (TACE) procedure were retrospectively reviewed. 10 of these 19 patients underwent follow-up TACE or P-TACE after P-TACE (Group A), but nine patients underwent only initial P-TACE because of progression of HCC and/or underlying liver cirrhosis (Group B). Hepatic function tests, APS grades, and portal flow directions were evaluated before and after P-TACE sessions. Complications after procedures and survival days were also evaluated. RESULTS: In group A, APS grade was improved in eight patients and five of six patients with hepatofugal flow showed restored hepatopetal flow postoperatively. No immediate complication was developed in either group. Transient hepatic insufficiency developed in eight (42.1%) of 19 patients after P-TACE, and seven (87.5%) of these eight recovered within two weeks under conservative care. The mean and median survival time all study subjects was 280 days and 162 days. CONCLUSION: P-TACE is feasible and safe in advanced HCC patients with APS.
Adult ; Aged ; Aged, 80 and over ; Antibiotics, Antineoplastic/administration & dosage ; Arteriovenous Fistula/therapy ; Carcinoma, Hepatocellular/mortality/*therapy ; *Chemoembolization, Therapeutic ; Contrast Media/administration & dosage ; Feasibility Studies ; Female ; Humans ; Iodized Oil/administration & dosage ; Liver Circulation ; Liver Neoplasms/mortality/*therapy ; Male ; Middle Aged ; Mitomycin/administration & dosage ; Polyvinyl Alcohol/*administration & dosage ; Retrospective Studies ; Treatment Outcome

PURPOSE: This study was conducted in order to analyze themes, concepts, research methods and results of previous domestic research on the nursing of hematologic patients conducted through the last 10 yr, to find trends in the research, and to provide basic materials for setting the direction of future research on the nursing of hematologic patients. METHODS: This study analyzed a total of 72 nursing theses related to hematology sampled from domestic theses for a master's or doctoral degree and papers published in six nursing journals registered in Korea Research Foundation from January 2000 to July 2009. RESULTS: Of the 72 theses, 51 were for a master's degree, 7 for a doctoral degree, and 14 not for an academic degree. The concept covered most frequently in correlation research was 'quality of life' and concepts found in comparative research were stress and quality of life. In experimental research, the most common nursing intervention was oral care. The scale used most frequently was Spielberger's Anxiety Scale. CONCLUSION: It is necessary to expand experimental research applying nursing interventions, and to use objective physiological indexes for more effective assessment in experimental research. Furthermore, interdisciplinary research is required for enhancing the quality of clinical nursing research.
Anxiety ; Clinical Nursing Research ; Hematology ; Hematopoietic Stem Cell Transplantation ; Humans ; Korea ; Nursing Research ; Quality of Life

PURPOSE: Asthma is one of the most common chronic childhood disease. Education of asthmatic children and their families about asthma and its management may improve disease control, reduce symptoms, and improve school performance. The aim of the study was to evaluate the effects of an intensive asthma education program in asthmatic children and their families on outcome measure of asthma management behavior scale, knowledge about asthma, self efficacy scale and quality of life. METHODS: Fifteen asthmatic children and their families were invited the intensive asthma education program which including allergen avoidance, management of asthma, correct use of the inhalation devices and control of exercise-induced asthma (study group). Fifteen asthmatic children and their families those who did not participate this program were served as control group. Participants were asked to complete a written questionnaire before and 3-month after the program. RESULTS: After completing the intensive education program, significant improvement of the childrens asthma management behavior scale (27.1 vs. 32.2, P=0.011), belief and knowledge about asthma (14.2 vs. 17.9, P<0.001), self efficacy (47.9 vs. 49.7, P=0.091) and quality of life (79.6 vs. 88.6, P<0.001) was noted in the study group by measuring questionnaires. There are increasing tendencies in parental asthma management behavior scale and knowledge about asthma. CONCLUSION: This intensive asthma education program is effective in improving asthma control, self efficacy and quality of life of asthmatic children. This should serve as a national model for family-based programs for asthmatic children and their families.
Asthma ; Asthma, Exercise-Induced ; Caregivers ; Child ; Disease Management ; Humans ; Nebulizers and Vaporizers ; Outcome Assessment (Health Care) ; Parents ; Patient Education as Topic ; Quality of Life ; Surveys and Questionnaires ; Self Efficacy

Drug reaction with eosinophilia and systemic symptoms(DRESS), which occurs 2–8 weeks after taking a medication is a rare and potentially life-threatening drug-induced hypersensitivity reaction, which includes skin eruption, hematologic abnormalities, lymphadenopathy, and internal organ such as liver, lung, kidney involvement. Antiepileptic agents (e.g., carbamazepine, lamotrigine, phenytoin, and phenobarbital) and allopurinol are the most commonly reported causes. However, new antiepileptic agents, such as oxcarbazepine, rarely cause drug reaction with eosinophilia and systemic symptoms. A 11-year-old boy who was administered oxcarbazepine for 34 days developed widespread rashes, facial edema, fever, cough, nasal stuffiness, tonsillitis, and cervical lymphadenopathy. Laboratory test results showed leukocytosis, eosinophilia, thrombocytosis, elevated c-reactive protein, and elevated liver transaminase levels. As we suspected drug reaction with eosinophilia and systemic symptoms, we immediately withdrew oxcarbazepine and commenced corticosteroid therapy. The patient's skin lesions and abnormal laboratory results slowly improved. Before change the antiepileptic agents, we performed human leukocyte antigen (HLA) typing to assess the genetic risk factors of the drug reaction and the result was positive for HLA DRB1*04:03 known to cause severe acute drug hypersensitivity, such as Stevens-Johnson syndrome by oxcarbazepine in Koreans. We have presented the first report of drug reaction with eosinophilia and systemic symptoms associated with oxcarbazepine in a patient with HLA DRB1*04:03. Although DRESS by oxcarazepine is extremely rare and unpredictable, when suspected clinical symptoms occur, it is necessary to interrupt the causative drug rapidly and confirming the patient's HLA typing may help to select a safer alternative drug.
Allopurinol ; Anticonvulsants ; C-Reactive Protein ; Carbamazepine ; Child ; Cough ; Drug Eruptions ; Drug Hypersensitivity ; Drug Hypersensitivity Syndrome* ; Edema ; Eosinophilia ; Exanthema ; Fever ; Histocompatibility Testing ; Humans ; Hypersensitivity ; Kidney ; Leukocytes ; Leukocytosis ; Liver ; Lung ; Lymphatic Diseases ; Male ; Palatine Tonsil ; Phenytoin ; Risk Factors ; Skin ; Stevens-Johnson Syndrome ; Thrombocytosis ; Tonsillitis

BACKGROUND: Diabetes self-management education and reinforcement are important for effective management of the disease. We investigated the effectiveness of interactive small-group education on glycemic, blood pressure, and lipid levels. METHODS: For this study, 207 type 2 diabetes patients with suboptimal glycemic control (HbA1c levels >6.5%) were enrolled. The conventional education group received an existing education program from April to November in 2006, and the interactive education group received a new small-group education program from December 2006 to July 2007. The two groups were comparatively analyzed for changes in blood sugar, glycated hemoglobin, lipid, and blood pressure at baseline, 3, 6, and 12 months and the proportion of patients achieving target goals at 12 months. RESULTS: After 12 months of follow-up, HbA1c levels in the interactive education group were significantly lower than in the conventional education group (6.7% vs. 6.4%, P<0.001). Fasting and 2 hour postprandial glucose concentrations, total cholesterol, and low density lipoprotein cholesterol were significantly lower in the interactive education group than in the conventional education group. The proportion of patients that achieved target goals was significantly higher in the interactive education group. CONCLUSION: The small-group educational method improved and re-established the existing group educational method. This finding suggests that the importance of education appears to be related to the method by which it is received rather than the education itself. Thus, the use of small-group educational methods to supplement existing educational methods established for diverse age levels should be considered in the future.
Achievement ; Blood Glucose ; Blood Pressure ; Cholesterol ; Cholesterol, LDL ; Diabetes Mellitus ; Fasting ; Follow-Up Studies ; Glucose ; Hemoglobins ; Humans ; Lipoproteins ; Reinforcement (Psychology) ; Self Care

The tumor embolism is defined as tumor cells within the vascular system such as pulmonary artery that is not contiguous with the other metastatic foci. The incidence of tumor embolism varies widely ranging from 3% to 26% among several studies; whereas lung cancer, prostate cancer, colorectal cancer, breast cancer, pancreas cancer are associated with high risks for tumor embolism. However thyroid cancer is rarely associated with tumor embolism. Among the rare cases, tumor embolism was reported as being mostly of follicular carcinoma or undifferentiated carcinoma, but few of papillary carcinoma. We report an unusual presentation that pulmonary tumor embolism from thyroid papillary carcinoma was diagnosed with positron emission tomography/computed tomography (CT) and chest CT.
Breast Neoplasms ; Carcinoma ; Carcinoma, Papillary ; Colorectal Neoplasms ; Electrons ; Incidence ; Lung Neoplasms ; Neoplastic Cells, Circulating ; Pancreatic Neoplasms ; Prostatic Neoplasms ; Pulmonary Artery ; Thorax ; Thyroid Gland ; Thyroid Neoplasms

Helicobacter pylori is a causative agent of type B gastritis and plays a central role in the pathogenesis of gastroduodenal ulcer and gastric cancer. To elucidate the host-parasite relationship of the H. pylori infection on the basis of molecular biology, we tried to evaluate the genomic diversity of H. pylori. An ordered overlapping bacterial artificial chromosome (BAC) library of a Korean isolate, H, pylori 51 was constructed to set up a genomic map. A circular physical map was constructed by aligning ApaI, Notl and SfiI-digested chromosomal DNA. When the physical map of H. pylori 51 was compared to that of unrelated strain, H. pylori 26695, completely different restriction patterns were shown. Fifteen known genes were mapped on the chromosome of H. pylori 51 and the genetic map was compared with those of strain 26695 and J99, of which the entire genomic sequences were reported. There were some variability in the gene location as well as gene order among three strains. For further analysis on the genomic diversity of H. pylori, when comparing the genomic structure of 150 H. pylori Korean isolates with one another, genomic macrodiversity of H. pylori was characterized by several features: whether or not susceptible to restriction digestion of the chromsome, variation in chromosomal restriction fingerprint and/or high frequency of gene rearrangement. We also examined the extent of allelic variation in nucleotide or deduced amino acid sequences at the individual gene level. fucT, cagA and vacA were confirmed to carry regions of high variation in nucleotide sequence among strains. The plasticity zone and strain-specific genes of H. pylori 51 were analyzed and compared with the former two genomic sequences. It should be noted that the H. pylori 51-specific sequences were dispersed on the chromosome, not congregated in the plasticity zone unlike J99- or 26695-specific genes, suggesting the high frequency of gene rearrangement in H. pylori genome. The genomc of H. pylori 51 shows differences in the overall genomic organization, gene order, and even in the nucleotide sequences among the H. pylori strains, which are far greater than the differences reported on the genomic. diversity of H. pylori.
Amino Acid Sequence ; Base Sequence ; Chromosomes, Artificial, Bacterial ; Dermatoglyphics ; Digestion ; DNA ; Gastritis ; Gene Order ; Gene Rearrangement ; Genome ; Helicobacter pylori* ; Helicobacter* ; Host-Parasite Interactions ; Molecular Biology ; Peptic Ulcer ; Plastics ; Stomach Neoplasms

Background: Data on the status of long-term follow-up (LTFU) care for childhood cancer survivors (CCSs) in Korea is lacking. This study was conducted to evaluate the current status of LTFU care for CCSs and relevant physicians’ perspectives. Methods: A nationwide online survey of pediatric hematologists/oncologists in the Republic of Korea was undertaken. Results: Overall, 47 of the 74 board-certified Korean pediatric hematologists/oncologists currently providing pediatric hematology/oncology care participated in the survey (response rate = 63.5%). Forty-five of the 47 respondents provided LTFU care for CCSs five years after the completion of primary cancer treatment. However, some of the 45 respondents provided LTFU care only for CCS with late complications or CCSs who requested LTFU care. Twenty of the 45 respondents oversaw LTFU care for adult CCSs, although pediatric hematologists/ oncologists experienced more difficulties managing adult CCSs. Many pediatric hematologists/oncologists did not perform the necessary screening test, although CCSs had risk factors for late complications, mostly because of insurance coverage issues and the lack of Korean LTFU guidelines. Regarding a desirable LTFU care system for CCSs in Korea, 27 of the 46 respondents (58.7%) answered that it is desirable to establish a multidisciplinary CCSs care system in which pediatric hematologists/oncologists and adult physicians cooperate. Conclusion The LTFU care system for CCS is underdeveloped in the Republic of Korea. It is urgent to establish an LTFU care system to meet the growing needs of Korean CCSs, which should include Korean CCSs care guidelines, provider education plans, the establishment of multidisciplinary care systems, and a supportive national healthcare policy.

Objective: Machine learning is emerging as a new alternative in various scientific fields and is potentially a new method of interpretation. Using the Light Gradient Boosting Machine (LightGBM), we analyzed the factors that influence the rechoice of emergency medicine responders. The survey is a cross-sectional study which provides an accurate understanding of a responder's current status. However, the results may vary depending on the composition, format, and question, and the relationship between the answers may be unclear. Methods: This study evaluated the modified 2020 Korean Emergency Physician Survey raw data. We applied the preferred model for random relationship check, random forest, support vector machine, and LightGBM models. The stacking ensemble model was used for the final decision process. Results: ‘It is fun working in an emergency room’was the most selected response factor for re-choice, followed by ‘interesting major’. The physical burden of age and lack of identity had a negative impact, whereas burnout and emotional stress factors had a lesser effect. Anxiety caused by the coronavirus disease 2019 (COVID-19) is thought to have a significant impact on this decision making. Conclusion Establishing the identity of emergency medicine and being faithful to its fundamental mission is a way to increase the rate of re-choice. Decreasing the burden of workload modified according to age is recommended to establish career longevity. The method of machine learning presents us with a new possibility of checking the relevance of survey results quickly and easily.