An esophageal perforation is one of the most fatal clinical events, with a mortality rate of up to 21%. This may arise postoperatively or post-endoscopically. In the past, surgical treatment, such as an esophagectomy, was performed these cases. However, the procedure was challenging and had a high risk of postoperative complications. Recently, advancements in endoscopic techniques have been made, and endoscopic procedures became a common treatment modality for patients with esophageal perforation, even in those with underlying diseases. Among the endoscopic procedures, endoscopic vacuum-assisted closure (E-VAC) has been known to be safe and effective. We present the case of a 64-year-old female with advanced liver cirrhosis and an overtube-induced esophageal perforation during esophageal variceal ligation. She was successfully treated with E-VAC.

Purpose: The aim of this study was to identify factors related to the vaccination intentions of nursing students before clinical practice. Methods: A descriptive correlational study design was used. The participants were 129 nursing students who were enrolled in one college of nursing in Seoul and were scheduled for clinical training. Data collection was conducted from February 28 to March 7, 2022. The data were analyzed using descriptive statistics, a t-test, ANOVA, Pearson’s correlation coefficient, and a latitudinal regression analysis using the IBM SPSS statistics version 26.0 program. Results: The intention to vaccinate showed a significant correlation with vaccination attitude (r=.72, p<.001), subjective norms (r=.68, p<.001), and perceived behavioral control (r=.63, p<.001). The influencing factors on three intent to vaccinate were vaccination attitude (β=.36 p<.001), subjective norms (β=.31, p<.001), and perceived behavioral control (β=.36, p<.001). The explanatory power of these variables was 69.6%. Conclusion The vaccination rate before the clinical training of nursing students was related to economic burden, a lack of time, and transportation problems that nursing college students experienced during the vaccination process. Therefore, administrative and financial support is needed for improving the vaccination rates of nursing students.

Quadrivalent human papillomavirus (HPV) vaccine has been reported to be significantly associated with Behçet's disease (BD). However, no reports have described HPV infection as a possible cause for the development of BD. The objective of this study was to evaluate whether anti-HPV immunoglobulin G (IgG) antibody titer is increased in BD. Serum samples from 93 Korean BD patients, who fulfilled the diagnostic criteria of the International Study Group for BD, were used in an enzyme-linked immunosorbent assay (ELISA). The clinical activity of BD was evaluated at the time of blood sampling. HPV-16 L1 virus-like particle (VLP) antigen was used in this study for the ELISA. Patients with BD had significantly higher antibody titers against HPV-16 (optical density [OD], 0.210–3.675; mean 0.992) than that of healthy controls (OD, 0.248–0.762; mean 0.517; P < 0.001). Using a receiver operating characteristic (ROC) analysis, a cut-off value of 0.578 OD for the anti-HPV antibody titer was determined that differentiated BD patients from healthy controls. When we compared the clinical features of BD between the 2 groups, articular involvement of BD was more likely in patients with an anti-HPV-16 antibody titer < 0.578 OD (P = 0.035). In addition, patients with an anti-HPV-16 antibody titer < 0.578 were significantly younger than those with a titer ≥ 0.578 OD. HPV itself may be a possible extrinsic triggering infectious agent causing the development of BD.

Food is an essential component of good health and a high quality of life. This is especially true for the elderly, where health and quality of life can vary due to eating issues. This study attempts to measure the satisfaction with food-related life in the elderly of South Korea, while examining differences in social support, depression, isolation, and life satisfaction based on the level of satisfaction with food-related life. Data collection was conducted using one-on-one surveys from December 2011 to January 2012. A total of 390 elderly (aged 65 and over) who live in Korea participated in this study. The results showed that the satisfaction with food-related life was high (3.52 out of 5). The elderly who had company during a meal or a meal preparer showed a higher satisfaction with their food-related life. Social support was high (5.32 out of 7) and the feelings of isolation were low (3.85 out of 5). The average satisfaction with life was 4.42 out of 7, indicating a fair satisfaction with life, while the average depression score was relatively low (8.77 out of 26). In general, the elderly with a higher satisfaction with food-related life had a higher social support and overall satisfaction with their life. On the other hand, the elderly with a lower satisfaction with food-related life generally reported higher levels of depression and isolation. A positive correlation was observed between satisfaction with food-related life, social support, and satisfaction of life, while a negative correlation was found between satisfaction with food-related life, isolation, and depression. The results of this study indicate that managing the satisfaction with food-related life is an important component of mental health in the elderly.
Aged ; Data Collection ; Depression ; Eating ; Hand ; Humans ; Korea ; Meals ; Mental Health ; Quality of Life ; Republic of Korea ; Social Isolation

Objective: Cognitive functions have been shown to become impaired due to alcoholism. Recently, neuroinflammation gained attention for playing a role in the neurotoxic effect of alcohol. However, there is limited data on the relationship between alcohol and cognitive function, based on the mechanism of inflammation. This study examined whether the interaction between alcohol use and pro-inflammatory biomarkers is related to cognitive function in Korean male firefighters. Methods: A total of 474 firefighters were assessed for alcohol-related problems using CAGE, cognitive functions, and pro-inflammatory biomarkers (CRP, IL-6, TNF-α). Sequential multiple regression analyses were conducted to determine if inflammatory markers moderate the relationship between alcohol use and cognitive function. Results: Only a decreased attentional function was associated with the interaction of alcohol use and inflammatory markers, after controlling for age, sex, body mass index, lipid profiles, smoking, depression, fatigue, self-reported hypertension, diabetes, and musculoskeletal problems. Conclusion This study revealed that the interaction between alcohol use and inflammation is related to attentional function in Korean male firefighters. Additionally, this cross-sectional study suggests that diminishing attention, related to alcohol use, may be based on the mechanism of inflammation.

Objective: Cognitive functions have been shown to become impaired due to alcoholism. Recently, neuroinflammation gained attention for playing a role in the neurotoxic effect of alcohol. However, there is limited data on the relationship between alcohol and cognitive function, based on the mechanism of inflammation. This study examined whether the interaction between alcohol use and pro-inflammatory biomarkers is related to cognitive function in Korean male firefighters. Methods: A total of 474 firefighters were assessed for alcohol-related problems using CAGE, cognitive functions, and pro-inflammatory biomarkers (CRP, IL-6, TNF-α). Sequential multiple regression analyses were conducted to determine if inflammatory markers moderate the relationship between alcohol use and cognitive function. Results: Only a decreased attentional function was associated with the interaction of alcohol use and inflammatory markers, after controlling for age, sex, body mass index, lipid profiles, smoking, depression, fatigue, self-reported hypertension, diabetes, and musculoskeletal problems. Conclusion This study revealed that the interaction between alcohol use and inflammation is related to attentional function in Korean male firefighters. Additionally, this cross-sectional study suggests that diminishing attention, related to alcohol use, may be based on the mechanism of inflammation.

Background/Aims: Several noninvasive scoring systems have been developed to determine the risk of advanced fibrosis in nonalcoholic fatty liver disease (NAFLD). We examined the diagnostic accuracy of the fibrosis-4 (FIB-4) score and NAFLD fibrosis score (NFS) in patients with biopsy-proven NAFLD. Methods: For this meta-analysis, various databases including PubMed (MEDLINE), EMBASE, OVID Medline and the Cochrane Library were systematically searched. After the acquired abstracts were reviewed by two investigators, manuscripts were chosen for a full-text examination. Results: Thirty-six studies evaluating biopsy-proven NAFLD were selected for meta-analysis. A total of 14,992 patients were analyzed. The lower cutoff sensitivity of the FIB-4 score predicting histological fibrosis stage 3 or more (≥F3) was 69%, with specificity of 64%, positive likelihood ratio (LR+) of 1.96, and negative likelihood ratio (LR–) of 0.47. The low baseline sensitivity of the NFS score predicting ≥F3 was 70%, with a specificity of 61%, LR+ of 1.83, and LR– of 0.48. The area under the receiver operating characteristic curve (AUC) values of the FIB-4 score predicting ≥F3 and ≥F2 were 76% and 68%, respectively. The AUC values of the NFS score predicting ≥F3 and ≥F2 were 74% and 60%, respectively. Conclusions The FIB-4 or NFS test can be used to predict the degree of liver fibrosis in NAFLD, and the diagnostic accuracy resulted as relatively high in fibrosis stages of F3 or higher.

Background/Aims: Although gastric neuroendocrine tumors (NETs) are uncommon neoplasms, their prevalence is increasing. The clinical importance of the World Health Organization (WHO) classification of gastric NETs, compared with NETs in other organs, has been underestimated.This study aimed to systematically evaluate the clinical and pathologic characteristics of gastric NETs based on the 2019 WHO classification and to assess the survival outcomes of patients from a single-center with a long-term follow-up. Methods: The medical records of 427 patients with gastric NETs who underwent endoscopic or surgical resection between January 2000 and March 2020 were retrospectively reviewed. All specimens were reclassified according to the 2019 WHO classification. The clinicopathologic characteristics, treatment, and oncologic outcomes of 139 gastric NETs were analyzed. Results: The patients’ median age was 53.0 years (interquartile range [IQR], 46.0 to 63.0 years). The median follow-up period was 36.0 months (IQR, 15.0 to 63.0 months). Of the patients, 92, 44, and 3 had grades 1, 2, and 3 NETs, respectively. The mean tumor size significantly increased as the tumor grade increased (p=0.025). Patients with grades 2 and 3 gastric NETs more frequently had lymphovascular invasion (29.8% vs 10.9%, p=0.005) and deeper tissue invasion (8.5% vs 0%, p=0.012) than those with grade 1 tumors. The overall disease-specific survival rate was 100%. Two patients with grades 2-3 gastric NETs experienced extragastric recurrence. Conclusions Although gastric NETs have an excellent prognosis, grade 2 or grade 3 gastric NETs are associated with a larger size, deeper invasion, and extragastric recurrence, which require active treatment.

Background/Aims: To overcome the technical limitations of classic endoscopic resection for gastric gastrointestinal stromal tumors (GISTs), various methods have been developed. In this study, we examined the role and feasibility of clip-and-cut procedures (clip-and-cut endoscopic full-thickness resection [cc-EFTR]) for gastric GISTs. Methods: Medical records of 83 patients diagnosed with GISTs after endoscopic resection between 2005 and 2021 were retrospectively reviewed. Moreover, clinical characteristics and outcomes were analyzed. Results: Endoscopic submucosal dissection (ESD) and cc-EFTR were performed in 51 and 32 patients, respectively. The GISTs were detected in the upper third of the stomach for ESD (52.9%) and cc-EFTR (90.6%). Within the cc-EFTR group, a majority of GISTs were located in the deep muscularis propria or serosal layer, accounting for 96.9%, as opposed to those in the ESD group (45.1%). The R0 resection rates were 51.0% and 84.4% in the ESD and cc-EFTR groups, respectively. Seven (8.4%) patients required surgical treatment (six patients underwent ESD and one underwent cc-EFTR,) due to residual tumor (n=5) and post-procedure adverse events (n=2). Patients undergoing R0 or R1 resection did not experience recurrence during a median 14-month follow-up period, except for one patient in the ESD group. Conclusions cc-EFTR displayed a high R0 resection rate; therefore, it is a safe and effective therapeutic option for small gastric GISTs.