PURPOSE: The purpose of this study is to compare the treatment outcomes for locally advanced resectable hypopharyngeal cancer between organ-preserving chemoradiotherapy (CRT) and surgery followed by radiotherapy (SRT). MATERIALS AND METHODS: We reviewed 91 patients with stage III/IV hypopharyngeal squamous cell carcinoma treated with radiotherapy (RT). In the CRT group (n=34), 18 patients were treated with concurrent CRT and 16 patients with induction chemotherapy plus concurrent CRT. In the SRT group (n=57), six patients were treated with total laryngopharyngectomy, 34 patients with total laryngectomy (TL) and partial pharyngectomy (PP), and 17 patients with PP, which were followed by adjuvant radiotherapy (n=41) or CRT (n=16). The median RT dose was 70 Gy for CRT and 59.4 Gy for SRT. RESULTS: Five-year local control (84.1% vs. 90.9%), and disease-free survival (DFS, 51.0% vs. 52.7%) and overall survival (OS, 58.6% vs. 56.6%) showed no significant difference between the CRT and SRT groups. The functional larynx-preservation rate was higher in the CRT group (88.2% vs. 29.8%). Treatment-related toxicity, requiring surgical intervention, occurred more frequently in the SRT group (37% vs. 12%). In the SRT group, TL resulted in a significantly higher DFS than larynx-sparing surgery (63.9% vs. 26.5%, p=0.027). Treatment outcome of the SRT group improved when only patients with TL were considered (n=40); however, 5-year OS (67.1% vs. 58.6%, p=0.830) and DFS (63.9% vs. 51.0%, p=0.490) did not improve significantly when compared to the CRT group. CONCLUSION: Organ preserving CRT provided a treatment outcome that is comparable to SRT for locally advanced hypopharyngeal cancer, while offering an opportunity for functional larynx-preservation and reduced treatment-related toxicity.
Carcinoma, Squamous Cell ; Chemoradiotherapy* ; Disease-Free Survival ; Humans ; Hypopharyngeal Neoplasms* ; Induction Chemotherapy ; Laryngectomy ; Organ Preservation ; Pharyngectomy ; Radiotherapy ; Radiotherapy, Adjuvant* ; Treatment Outcome

BACKGROUND/OBJECTIVES: Athletes generally desire changes in body composition in order to enhance their athletic performance. Often, athletes will practice chronic energy restrictions to attain body composition changes, altering their energy needs. Prediction of resting metabolic rates (RMR) is important in helping to determine an athlete's energy expenditure. This study compared measured RMR of athletic and non-athletic adolescents with predicted RMR from commonly used prediction equations to identify the most accurate equation applicable for adolescent athletes. SUBJECTS/METHODS: A total of 50 athletes (mean age of 16.6 +/- 1.0 years, 30 males and 20 females) and 50 non-athletes (mean age of 16.5 +/- 0.5 years, 30 males and 20 females) were enrolled in the study. The RMR of subjects was measured using indirect calorimetry. The accuracy of 11 RMR prediction equations was evaluated for bias, Pearson's correlation coefficient, and Bland-Altman analysis. RESULTS: Until more accurate prediction equations are developed, our findings recommend using the formulas by Cunningham (-29.8 kcal/day, limits of agreement -318.7 and +259.1 kcal/day) and Park (-0.842 kcal/day, limits of agreement -198.9 and +196.9 kcal/day) for prediction of RMR when studying male adolescent athletes. Among the new prediction formulas reviewed, the formula included in the fat-free mass as a variable [RMR = 730.4 + 15 x fat-free mass] is paramount when examining athletes. CONCLUSIONS: The RMR prediction equation developed in this study is better in assessing the resting metabolic rate of Korean athletic adolescents.
Adolescent* ; Athletes ; Athletic Performance ; Bias (Epidemiology) ; Body Composition ; Calorimetry, Indirect ; Energy Metabolism ; Humans ; Male ; Sports*

PURPOSE: The purpose of this study was to explore the direction for development of the Korean Journal of Adult Nursing toward becoming an international journal through analysing the accepted and rejected papers during the last three years (2007-2009). METHODS: Two hundred and ten accepted papers were analyzed focusing on research methodology and key words using descriptive statistics. In addition, rejected papers were reviewed to analyze their study designs and key words. RESULTS: The proportion of quantitative research was 86.4% while the proportion of qualitative research was 9.5%. The majority of the qualitative research design was survey (71.8%). Sixty percent of the research had verbal consent and 32.7% had written consent from the participants. The prevailing data collection settings were hospitals (52.1%), and community (22.7%). The most frequently used research domain was health. It was noted that theoretical framework was rarely presented. The paper rejection rate was 31.5% and among the rejected paper, 75.3% was survey. CONCLUSION: The results of this analysis suggest that published studies have been improved and diversified compared with the papers published before the year 2007. However, translation research, clinical trials by nurses, and more detailed evaluation process for ethics in research need to be facilitated.
Adult ; Data Collection ; Humans ; Nursing Research ; Qualitative Research ; Rejection (Psychology) ; Research Design

This study compared activity factor, predicted resting metabolic rate (RMR), and nutrient intakes between athletic and non-athletic high school students in Gangwon-do. Fifty soccer players (30 males and 20 females; mean ages 16.7+/-1.0 years and 16.4+/-1.1 years, respectively) and 50 non-athletic (30 males and 20 females; mean ages 17.5+/-0.4 years and 16.4+/-1.1 years respectively) high school students were included. Anthropometric measurements included: weight and height, triceps skinfold, mid-arm circumference, and body fat. Prediction equations consisted of those from the Harris-Benedict, FAO/WHO/UNU, IMNA, Cunningham, Mifflin et al., and Owen et al. A one-day activity diary was collected by interview, and the 24-hour recall method was used to analyze nutrient intakes of subjects. The activity factors of the male and female athletic groups (2.23 and 2.16, respectively) were significantly higher than those (1.52 and 1.46, respectively) of the non-athletic group. There was only a significant difference in RMR by use of the Cunningham's equation between two groups. For the males, almost all nutrient intakes of the athletic group (except carbohydrate, iron, vitamin B1, B6, and niacin) of athletic group were significantly higher than those of the non-athletic group. The female athletic group showed significantly higher nutrient intakes with the exception of most vitamins. These results suggest that assessments of energy balance between energy intake and energy expenditure by employing RMR and activity factors would be useful to prevent and treat obesity in high school athletes. In addition, the Cunningham's equation would be appropriate for predicting their energy needs.
Adipose Tissue ; Athletes ; Energy Intake ; Energy Metabolism ; Female ; Humans ; Iron ; Male ; Obesity ; Soccer ; Sports ; Thiamine ; Vitamins

This study compared activity factor, predicted resting metabolic rate (RMR), and nutrient intakes between athletic and non-athletic high school students in Gangwon-do. Fifty soccer players (30 males and 20 females; mean ages 16.7+/-1.0 years and 16.4+/-1.1 years, respectively) and 50 non-athletic (30 males and 20 females; mean ages 17.5+/-0.4 years and 16.4+/-1.1 years respectively) high school students were included. Anthropometric measurements included: weight and height, triceps skinfold, mid-arm circumference, and body fat. Prediction equations consisted of those from the Harris-Benedict, FAO/WHO/UNU, IMNA, Cunningham, Mifflin et al., and Owen et al. A one-day activity diary was collected by interview, and the 24-hour recall method was used to analyze nutrient intakes of subjects. The activity factors of the male and female athletic groups (2.23 and 2.16, respectively) were significantly higher than those (1.52 and 1.46, respectively) of the non-athletic group. There was only a significant difference in RMR by use of the Cunningham's equation between two groups. For the males, almost all nutrient intakes of the athletic group (except carbohydrate, iron, vitamin B1, B6, and niacin) of athletic group were significantly higher than those of the non-athletic group. The female athletic group showed significantly higher nutrient intakes with the exception of most vitamins. These results suggest that assessments of energy balance between energy intake and energy expenditure by employing RMR and activity factors would be useful to prevent and treat obesity in high school athletes. In addition, the Cunningham's equation would be appropriate for predicting their energy needs.
Adipose Tissue ; Athletes ; Energy Intake ; Energy Metabolism ; Female ; Humans ; Iron ; Male ; Obesity ; Soccer ; Sports ; Thiamine ; Vitamins

BACKGROUND: Cigarette smoke exposure accelerates the release of leukocytes from the bone marrow, which is postulated to be mediated by inflammatory cytokines and haematopoietic growth factors released from the lung. METHODS: The study population consisted of 2,270 healthy men above 20 years of age who had visited a health promotion center in a university hospital from January 2005 to December 2005. Baseline health check, self- reported cigarette smoking habit and blood sample were evaluated. The mean count of leukocytes and the leukocytosis prevalence according to smoking amounts were investigated. RESULTS: As the daily smoking amount was increased and as pack years smoked was increased, the mean total WBC count values and the prevalence of leukocytosis were higher (P=0.000). The odds ratio (OR) for leukocytosis according to daily smoking amount compared to no smokers was 1.98 (95% confidence interval (CI) 1.01~3.88) in those who smoked 1/2~1 pack per day and 4.17 (95% CI 1.83~9.48) in those who smoked more than 1 pack per day. The OR for leukocytosis according to smoking pack years compared to no smokers was 2.58 (95% CI 1.22~5.42) in those who smoked 20~30 pack years, 3.31 (95% CI 1.38~7.93) in those who smoked 30~40 pack years and 5.17 (95% CI 2.00~13.32) in those who smoked more than 40 pack years. CONCLUSION: The mean count of leukocytes and the prevalence of leukocytosis were higher in current smokers than no smokers and ex-smokers.
Bone Marrow ; Cytokines ; Health Promotion ; Humans ; Intercellular Signaling Peptides and Proteins ; Leukocyte Count ; Leukocytes ; Leukocytosis* ; Lung ; Male ; Odds Ratio ; Prevalence* ; Smoke* ; Smoking* ; Tobacco Products

OBJECTIVES: This study was to assess management outcome of patient undergoing decompressive craniectomy for space-occupying cerebral infarction refractory to medical treatment and to identify risk factors associated with unfavorable outcomes. PATIENTS AND METHODS: Between January 1999 and June 2004, total 20 patients were analyzed. The preoperative consciousness was rated using Glasgow Coma Scale (GCS). The clinical outcome was rated using Glasgow Outcome Scale (GOS) at 3 months follow up and divided into 2 groups;favorable outcome group (GOS> or =3) and unfavorable outcome group (GOS<3). The prognostic factors were analyzed multivariately. RESULTS: Fourteen patients were men and six patients were women (mean age, 58.7 yrs). Seventeen patients had right hemispheric infarction, and three patients had left hemispheric infarction. 16 patients had only middle cerebral artery (MCA) infarction, and 2 patients had combined anterior cerebral artery (ACA) or posterior cerebral artery (PCA) infarction respectively. Eleven patients showed anisocoria preoperatively. The mean time interval between symptom onset of infarction and operation was 61.5 hrs. 8 patients showed favorable outcome, and 12 patients showed unfavorable outcome. CONCLUSIONS: The existence of preoperative anisocoria and low preoperative GCS score were statistically significant prognostic factor related to unfavorable outcome.
Anisocoria ; Anterior Cerebral Artery ; Cerebral Infarction* ; Consciousness ; Decompressive Craniectomy* ; Female ; Follow-Up Studies ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Humans ; Infarction ; Male ; Middle Cerebral Artery ; Posterior Cerebral Artery ; Risk Factors

PURPOSE: This study aims to abstract the differences of scores between the clinical instructors and standardized patients (SPs) in a clinical performance examination (CPX) using SPs and to correlate the concordance between the evaluation scores and the school records. METHODS: The CPX was administered in 2003 to a total of thirty-six fifth year medical students at Gachon Medical School. The examination consisted of four cases, and four stations were duplicated, each requiring a total of 7.5 minutes per station. Evaluation of the student' s performances was conducted by both clinical instructors and SPs using a formatted checklist. Results were analysed by t-test, agreement rates, and Pearson correlation. RESULT: The mean scores given out by the clinical instructors and the SPs for the newly developed case were significantly different, while those scores for pre-existing cases were not in the old cases. The correlation coefficients between these two evaluation groups were relatively high. And agreements between the two evaluation groups were 0.37~0.72. The mean scores among clinical instructors were not significantly different, but the correlation coefficients and agreement rates were relatively high. The correlation between the evaluation scores and school records did not correlate significantly. CONCLUSION: It is concluded that the CPX is a useful tool to measure the students' essential competences in areas of knowledge, skills and attitude during the subinternship stage. In conducting a successful CPX, it is crucial to reconsider the recycling of cases and the selection and training of SPs aside from the development of an objective checklist.
Checklist ; Clinical Competence ; Humans ; Recycling ; Schools, Medical* ; Students, Medical

PURPOSE: A single institute trial of combination chemotherapy, with paclitaxel and cisplatin, in patients with metastatic breast cancer, having failed previous combination chemotherapy, was performed. MATERIALS AND METHODS: Patients were only eligible for this study if there disease had progressed, following treatment with previous chemotherapy, in either an adjuvant or a metastatic setting. Paclitaxel 175 mg/m2 was administered as a 3-hour continuous infusion on day 1, and cisplatin 80 mg/m2 was administered for 2 hours on day 2, with adequate hydration. This was repeated every 3 weeks, and continued until one of the following events occurred: disease progression, unacceptable adverse effect or treatment refusal by the patient. Intercurrent palliative radiotherapy, or concurrent hormonal therapy, was permitted, depending on each patient's status. All the endpoints were evaluated under the principle of intention to treat analysis. RESULTS: A total of 24 patients entered the study, and 18 had at least one measurable lesion, but 6 did not. The objective response rate of the 18 patients was 50%(9/18). Two were complete responses and seven showed partial responses. The median response duration, progression free and overall survival were 5.3 months (range, 4~18), 6 months (95% CI, 5~7) and 12 months (95% CI, 7~17), respectively. 67% of the planned dose was administered. Out of a total 135 cycles administered, about 20% of cycles showed grade 3 or 4 leukopenia and 7% showed grade 3 thrombocytopenia. Two patients suffered from pneumonia, and one experienced neutropenic fever. Mucositis, greater than grade 3, existed in three cases. No treatment related deaths were reported. CONCLUSION: The combination chemotherapy, with paclitaxel and cisplatin, was active in the treatment of metastatic breast cancer patients having failed previous chemotherapy.
Breast Neoplasms* ; Breast* ; Cisplatin* ; Disease Progression ; Drug Therapy ; Drug Therapy, Combination* ; Fever ; Humans ; Intention to Treat Analysis ; Leukopenia ; Mucositis ; Paclitaxel* ; Pneumonia ; Radiotherapy ; Thrombocytopenia ; Treatment Refusal

We performed a phase II trial to evaluate the efficacy and the safety of gemcitabine monotherapy, a pyrimidine antimetabolite, in patients, who had previously failed anthracycline and taxane-based chemotherapy for the treatment of metastatic breast cancer. MATERIALS AND METHODS: Twenty-one patients with metastatic breast cancer, which was unresponsive to previous chemotherapy, were entered into this study. Gemcitabine was administered at 850 mg/m2, as a 60- minute intravenous infusion on days 1, 8 and 15. This regimen was repeated every 28 days with G-CSF support, but without dose reduction. RESULTS: Objective responses were seen in 6 of the 20 patients who were able to be evaluated (1 complete response and 5 partial responses), with an objective response rate of 30%. The median time to progression was 5 (1~20) months, and the median overall survival duration was 11 (2~21) months. The actual dose intensity was 566.7 mg/m2/wk (range; 340~637.5 mg/m2/wk) and the relative dose intensity was 0.89 (range; 0.40~1.00). Toxicity was mainly hematological. Toxicities included: grade 3 neutropenia in 20% and anemia in 5%. Grades 3 and 4 thrombocytopenia occurred in 15% of the patients. CONCLUSION: Gemcitabine monotherapy is an effective and safe treatment for refractory breast cancer patients heavily treated with the anthracycline and taxane- based regimen.
Anemia ; Breast Neoplasms* ; Breast* ; Drug Therapy ; Granulocyte Colony-Stimulating Factor ; Humans ; Infusions, Intravenous ; Neutropenia ; Thrombocytopenia