Purpose: This study investigated the incidence of secondary malignancy in multiple myeloma (MM) patients compared with that in the general population using a population-based database covering all residents in Korea. Materials and Methods: Based on the national health insurance system in Korea, all people primarily diagnosed with MM between January 1, 2010 to December 31, 2018 were identified. A total of 9,985 MM patients aged ≥ 20 years in Korea were included. Results: Among them, 237 (2.4%) developed secondary malignancies by 2018. The standardized incidence rates (SIRs) of all secondary malignancies in MM patients were 0.87 (95% confidence interval [CI], 0.76 to 0.98), with a higher incidence of hematologic malignancies than in the general population with an SIR of 3.80 (95% CI, 2.61 to 5.00). The incidence rates of both lymphoid malignancy (SIR, 3.56; 95% CI, 2.31 to 4.82) and myeloid malignancy (SIR, 3.78; 95% CI, 1.16 to 6.39) were higher in MM patients than in the general population. In contrast, a lower incidence of solid cancer was observed in MM patients than in the general population (SIR, 0.76, 95% CI, 0.65 to 0.86). There was no significant difference in survival in MM patients without secondary malignancies, with hematologic malignancy, and with solid cancer (p=0.413). Conclusion MM patients had a greater risk of secondary malignancies, especially hematologic malignancies, than the general population. Future studies with a focus on analyzing patients’ history, treatment details, and genetic information in various stages of MM patients are needed to better understand the mechanism behind this increased risk.

PURPOSE: There is evidence supporting the concept of tumor progression from pulmonary adenocarcinoma in situ (formerly bronchioloalveolar carcinoma, BAC) to adenocarcinoma with varying degrees of invasion. The aim of this study was to investigate the role of transforming growth factor beta1 (TGFbeta1) in tumor invasiveness in lung adenocarcinoma, and to determine the potential relationships between its expression and immunophenotypes of cell adhesion molecules. MATERIALS AND METHODS: Tumor samples from adenocarcinoma in situ (n=13), minimally invasive adenocarcinoma (formerly BAC with < or =5 mm invasion, n=2), and lepidic predominant invasive adenocarcinoma (formerly mixed adenocarcinoma showing non-mucinous BAC features with >5 mm invasion, n=25) were examined for the expression of TGFbeta1, E-cadherin, N-cadherin, and H-cadherin proteins using immunohistochemistry. RESULTS: Of a total of 40 cases, 25 (63%) were positive for TGFbeta1. The frequency of immunoreactivity in patients with adenocarcinoma in situ, minimally invasive adenocarcinoma, and lepidic predominant invasive adenocarcinoma was 23% (3/13), 50% (1/2), and 84% (21/25), respectively (p=0.001). TGFbeta1 correlated with T classification (p=0.006) and stage (p=0.001). Loss of E-cadherin expression was more frequently observed in invasive adenocarcinomas than in adenocarcinomas in situ (p=0.034). E-cadherin expression inversely correlated with T classification (p=0.009). TGFbeta1 expression showed a statistically significant correlation with H-cadherin expression (p=0.040), but not with E-cadherin expression (p=0.752). CONCLUSION: These results suggest that TGFbeta1 and E-cadherin may play an important role in invasive progression of lung adenocarcinoma through regulating epithelial-to-mesenchymal transition.
Adenocarcinoma ; Adenocarcinoma, Bronchiolo-Alveolar ; Cadherins ; Cell Adhesion ; Humans ; Lung ; Lung Neoplasms ; Proteins ; Transforming Growth Factor beta1 ; Transforming Growth Factors

PURPOSE: This study was conducted to comprehensively investigate nursing students' experience of their first encounter with death of a patient during clinical practice. METHODS: This study took place from January 27 through March 6, 2012 with eight female senior nursing students enrolled at Pusan National University located in Y city who have experienced patient death. We collected their experience of their first death encounter during their clinical rotation by asking, "What is your first experience of patient's death during the clinical practice?" Husserl's phenomenological approach was applied in this study. RESULTS: In this study, 17 themes, 15 clusters of themes and eight categories were derived. The categories included "Desire to avoid the reality of death", "Powerlessness", "Anticipation for recovery shifted to fear of death", "Various interpretations of death", "Limitations in their nursing practice", "Resentment of lack of nurses", "Longing to better understand death", and "Motivation for inner growth". CONCLUSION: Through their first encounter with death of a patient, nursing students experienced various emotions and viewed their role as hospice caregiver by projecting themselves as fully trained nurses in future. Participants considered terminal care as a part of nursing care. The result of this study indicates the need to include education of death in the nursing school curriculum.
Busan ; Caregivers ; Curriculum ; Education ; Female ; Hospices ; Humans ; Nursing Care ; Nursing* ; Schools, Nursing ; Students, Nursing ; Terminal Care

OBJECTIVE: The aims of this study were to investigate a simple method for assessing anterior-posterior jaw relationships via cone-beam computed tomography (CBCT) images taken in the natural head position (NHP) relative to the nasion true vertical plane (NTVP), and measure normative data in Korean adults with normal profiles. METHODS: Subjects were selected from patients presenting for third molar extraction and evaluated as having normal profiles by three examiners. The CBCT images of 80 subjects (39 males, 41 females) were taken in the NHP according to Solow and Tallgren's method. Linear measurements of the A-point, B-point, and Pog were calculated relative to the NTVP. Student's t-test was used to assess sexual differences in these measurements. RESULTS: The mean linear measurements of the A-point, B-point, and Pog relative to the NTVP were 0.18 mm (standard deviation [SD], 4.77 mm), -4.00 mm (SD, 6.62 mm), and -2.49 mm (SD, 7.14 mm) respectively in Korean males, and 1.48 mm (SD, 4.21 mm), -4.07 mm (SD, 6.70 mm) and -2.91 mm (SD, 7.25 mm) in Korean females respectively. There were no statistically significant differences between Korean males and females (p < 0.05). CONCLUSIONS: Three-dimensional CBCT analysis using the NTVP is a simple and reliable method for assessing anterior-posterior skeletal relationships.
Adult* ; Cone-Beam Computed Tomography* ; Female ; Head ; Humans ; Jaw* ; Male ; Methods ; Molar, Third

PURPOSE: In elderly and patients with underlying diseases, mortality rate is increased when compared to rib fractures which occurred in other patients. Because there is a shortage of emergency physicians or real-time consultation with radiologists in many countries, it is necessary to receive a formal image reading remotely from an expert. We suggested the use of iPad in X-ray reading and compared the diagnostic validity of iPad, which was highly portable, with that of liquid crystal display (LCD) monitor. METHODS: Fifty four X-ray cases of rib fracture and 54 cases without rib fracture were randomized and reviewed by 10 emergency physicians. A total of 108 cases were divided 1st to 54th and 55th to 108th. Two sessions were separated with a four-week interval. If the reviewer interpreted the 1st to 54th with iPad, they did 55th to 108th with LCD monitor. Reviewers reported the presence of rib fracture, the number of fractured ribs, and diagnostic confidence of 5-scale. RESULTS: The interobserver agreement among reviewers in LCD and iPad was 0.551, 0.524 in Fleiss-kappa value. The intraobserver agreement between tools for each reviewer was 0.410-0.859 (Mean=0.628+/-0.150). Reviewers showed sensitivity over 0.810 regardless of the tool; 0.810- 0.966 (Mean=0.879+/- 0.054) in LCD, 0.828-1.000 (Mean=0.898+/-0.052) in iPad. The specificity was 0.520- 0.860 (Mean=0.750+/-0.117) in LCD and 0.560-0.880 (Mean=0.708+/-0.111) in iPad. Therefore, remote consultation of X-ray by iPad with a specialist was possible with minimized temporal and spatial limits in the emergency room. CONCLUSION: In our study, there was no statistical difference in the diagnosis of rib fracture by X-ray via iPad or LCD. Therefore, remote consultation of X-ray by iPad with a specialist in the emergency room was possible, with temporal and spatial limits by iPad.
Aged ; Diagnosis* ; Emergencies ; Emergency Service, Hospital ; Humans ; Liquid Crystals ; Mortality ; Remote Consultation ; Rib Fractures* ; Ribs* ; Sensitivity and Specificity ; Specialization ; Teleradiology

PURPOSE: This study was conducted in order to investigate the significance of transforming growth factor beta1 (TGFbeta1) and E-cadherin proteins in tumor progression of lung adenocarcinoma and to evaluate their differential expression in association with morphologic characteristics. MATERIALS AND METHODS: A total of 65 pulmonary adenocarcinomas were reclassified according to the new classification system proposed by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society. Tumor samples from 20 adenocarcinomas in situ (AIS, formerly bronchioloalveolar carcinoma [BAC]), 9 minimally invasive adenocarcinomas (MIA, formerly BAC with < or = 5 mm invasion), 17 lepidic predominant adenocarcinomas (LPA, formerly mixed adenocarcinoma showing nonmucinous BAC features with >5 mm invasion), and 19 invasive adenocarcinomas with no BAC features were analyzed by immunohistochemistry for expression of TGFbeta1 and E-cadherin proteins. RESULTS: TGFbeta1 expression was detected in 46% (21/46) of noninvasive elements and 87% (39/45) of invasive elements (p=0.001). E-Cadherin expression was less frequent in invasive components than in noninvasive components (38% vs. 65%, p=0.009). Negative correlation was identified between TGFbeta1 expression and E-cadherin expression in noninvasive elements (p=0.022). More importantly, significantly higher frequency of TGFbeta1 expression was observed in noninvasive components of LPA (14/17, 82%), compared with those of either AIS (5/20, 25%) or MIA (2/9, 22%) (p=0.008). CONCLUSION: Our data indicate involvement of both TGFbeta1 and E-cadherin proteins in tumor progression of pulmonary adenocarcinoma. It is noteworthy that TGFbeta1 up-regulation precedes alveolar destruction by invasion of tumor cells. TGFbeta1 may thus have the potential to improve lung adenocarcinoma diagnostics and therapeutics.
Adenocarcinoma ; Adenocarcinoma, Bronchiolo-Alveolar ; Cadherins ; Immunohistochemistry ; Lung ; Lung Neoplasms ; Proteins ; Transforming Growth Factor beta1 ; Transforming Growth Factors ; Up-Regulation

No abstract available.

BACKGROUND AND OBJECTIVES: Epidermal characteristics of cholesteatoma such as invasion, migration, uncoordinated proliferation, and altered differentiation may arise as a result of defectiVe wound healing process, induction of preneoplastic transformation or genetic alteration. To date, a number of genes haVe been shown to be differentially regulated in cholesteatoma, which might be responsible for these clinical characteristics. HoweVer, it is still unclear whether these phenomena is only oVert when cholesteatoma is under specific conditions such as inflammation or infection. If these genetic alterations in the deVelopment of cholesteatoma are transient, the pathology of cholesteatoma may be reVersible. We hypothesized that once cholesteatoma is in the normal environment, the cellular or molecular pathology of cholesteatoma can return to normal epidermal characteristics. The aim of this study was to determine whether common molecular characteristics are reVersible or not after removal of inductive factors in aural cholesteatoma induced gerbils. MATERIALS AND METHODS: We induced canal ligation cholesteatoma using Mongolian gerbils. The treated group was untied and managed for 2 weeks. We examined differences between treated cholesteatoma and untreated cholesteatoma by using a TUNEL staining and immunohistochemical technique with proliferation markers (PCNA, cytokeratin 13/16). RESULTS: With PCNA and CK 13/16, untreated group showed positive staining in the suprabasal cells as well as in the basal cells, but the treated group showed weakly positive staining only in the basal cell layer. With TUNEL staining, positive cells increased more in the untreated group than in the treated group. CONCLUSION: These results encourage our belief that some cholesteatomas, especially cholesteatoma in early stages, might be managed with only minimal treatments such as control of inflammation and maintenance of adequate Ventilation.
Cell Differentiation ; Cholesteatoma* ; Cholesteatoma, Middle Ear ; Gerbillinae* ; In Situ Nick-End Labeling ; Inflammation ; Keratins ; Ligation ; Pathology ; Pathology, Molecular ; Proliferating Cell Nuclear Antigen ; Ventilation ; Wound Healing

BACKGROUND AND OBJECTIVES: When screened using cord blood, congenital hearing loss are detected more frequently than other congenital metabolic diseases such as phenylketonuria or congenital hypothyroidism. Newborn hearing screening is important because the early identification and intervention of neonatal hearing loss is beneficial for the language development. We aimed to analyze clinical characteristics including associated diseases and present hearing state, and the effects of speech rehabilitation in the hearing-impaired infants detected by newborn hearing screening program of Ajou University Hospital. SUBJECTS AND METHOD: Seventy nine hundred twelve neonates (6915 well babies and 997 NICU babies) were screened by transient evoked otoacoustic emission (TEOAE) and auditory brainstem response (ABR). Medical records of infants with bilateral hearing loss of more than 60 dB were evaluated, and they were further studied with temporal bone CT scan and follow-up hearing tests using ABR. The exon2 of the connexin26 gene was sequenced to detect the mutation. RESULTS: Fourteen of 7912 infants initially had bilateral hearing loss of more than 60 dB. Associated diseases were prematurity, hyperbilirubinemia, sepsis, low birth weight, chromosomal anomaly, cleft palate, congenital nevus, and congenital aural atresia. Three of 14 infants were revealed to have normal hearing after follow-up hearing test, which were associated with cleft palate, hyperbilirubinemia or prematurity. One of them had 235delC mutation of the connexin26, and the temporal bone CT scan demonstrated the finding of enlarged vestibular aqueduct syndrome (EVAS) in one infant. Two infants participated in the connected speech rehabilitation program and showed significant development of language. CONCLUSION: Follow-up hearing tests are important in case of failures of newborn hearing screening test. The establishment of auditory and speech rehabilitation program connected with newborn hearing screening is essential in treating hearing-impaired neonates.
Cleft Palate ; Congenital Hypothyroidism ; Evoked Potentials, Auditory, Brain Stem ; Fetal Blood ; Follow-Up Studies* ; Hearing Loss ; Hearing Loss, Bilateral ; Hearing Tests ; Hearing* ; Humans ; Hyperbilirubinemia ; Infant* ; Infant, Low Birth Weight ; Infant, Newborn* ; Language Development ; Mass Screening* ; Medical Records ; Metabolic Diseases ; Neonatal Screening ; Nevus ; Phenylketonurias ; Rehabilitation ; Sepsis ; Speech Therapy ; Temporal Bone ; Tomography, X-Ray Computed ; Vestibular Aqueduct

OBJECTIVES: Cases of human brucellosis in Korea have recently increased due to the increasing incidence of bovine brucellosis. The authors conducted this study to elucidate the status of brucellosis through seroepidemiologic study. METHODS: We selected our study population from a high risk group. We conducted a questionnaire survey and obtained blood samples to determine the seroprevalence of brucellosis antibodies for 10 days in February, 2005. The titers of brucellosis were measured by the combination of standard tube agglutination test (STA) and enzyme-linked immunosorbent assay (ELISA) test. RESULTS: Our study subjects comprised 1,075 cases: 971 livestock workers, 51 veterinarians, and 53 artificial inseminators. In the STA test, 27 cases (2.5%) had titers of greater than or equal to 1:20. Of 1,068 cases (7 cases were excluded due to previous brucellosis), 7 cases of brucellosis were diagnosed with titers of 1:160, giving a seroprevalence of brucellosis of 0.66%. The seroprevalence in the male group was 0.95%, and that of livestock workers, veterinarians, and artificial inseminators was 0.52%, 4.17%, and 0.00%, respectively. The Spearman's correlation coefficient between the positive rate of bovine brucellosis per capita and household and human brucellosis was 0.806 and 0.744, respectively. The concordance rate between the Korea National Institute of Health and the Gyeongsangbuk-do Institute of Health and Environment by the STA and ELISA tests was 94.7% and 100.0%, respectively. CONCLUSIONS: The study results indicated in higher seroprevalence rate among veterinarians than among livestock workers and artificial inseminators. Because veterinarians may be exposed to this high risk, effective working guidelines for veterinarians to guard against brucellosis must be developed. Moreover, more extensive epidemiologic research for laboratory workers and meat handlers is needed.
Adult ; Aged ; Agriculture ; Animal Husbandry ; Animals ; Brucellosis/*epidemiology ; Brucellosis, Bovine/epidemiology ; Cattle ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Korea/epidemiology ; Middle Aged ; Occupational Diseases/*epidemiology ; Seroepidemiologic Studies ; Veterinarians