Objective: To investigate the feasibility of using a deep learning-based analysis of auscultation data to predict significant stenosis of arteriovenous fistulas (AVF) in patients undergoing hemodialysis requiring percutaneous transluminal angioplasty (PTA). Materials and Methods: Forty patients (24 male and 16 female; median age, 62.5 years) with dysfunctional native AVF were prospectively recruited. Digital sounds from the AVF shunt were recorded using a wireless electronic stethoscope before (pre-PTA) and after PTA (post-PTA), and the audio files were subsequently converted to mel spectrograms, which were used to construct various deep convolutional neural network (DCNN) models (DenseNet201, EfficientNetB5, and ResNet50). The performance of these models for diagnosing ≥ 50% AVF stenosis was assessed and compared. The ground truth for the presence of ≥ 50% AVF stenosis was obtained using digital subtraction angiography. Gradient-weighted class activation mapping (Grad-CAM) was used to produce visual explanations for DCNN model decisions. Results: Eighty audio files were obtained from the 40 recruited patients and pooled for the study. Mel spectrograms of “pre-PTA” shunt sounds showed patterns corresponding to abnormal high-pitched bruits with systolic accentuation observed in patients with stenotic AVF. The ResNet50 and EfficientNetB5 models yielded an area under the receiver operating characteristic curve of 0.99 and 0.98, respectively, at optimized epochs for predicting ≥ 50% AVF stenosis. However, GradCAM heatmaps revealed that only ResNet50 highlighted areas relevant to AVF stenosis in the mel spectrogram. Conclusion Mel spectrogram-based DCNN models, particularly ResNet50, successfully predicted the presence of significant AVF stenosis requiring PTA in this feasibility study and may potentially be used in AVF surveillance.

Long-term outcomes of live kidney donors remain controversial, although this information is crucial for selecting potential donors. Thus, this study compared the long-term risk of all-cause mortality between live kidney donors and healthy control. Methods: We performed a retrospective cohort study including donors from seven tertiary hospitals in South Korea. Persons who underwent voluntary health screening were included as controls. We created a matched control group considering age, sex, era, body mass index, baseline hypertension, diabetes, estimated glomerular filtration rate, and dipstick albuminuria. The study outcome was progression to end-stage kidney disease (ESKD), and all-cause mortality as identified in the linked claims database. Results: We screened 1,878 kidney donors and 78,115 health screening examinees from 2003 to 2016. After matching, 1,701 persons remained in each group. The median age of the matched study subjects was 44 years, and 46.6% were male. Among the study subjects, 2.7% and 16.6% had underlying diabetes and hypertension, respectively. There were no ESKD events in the matched donor and control groups. There were 24 (1.4%) and 12 mortality cases (0.7%) in the matched donor and control groups, respectively. In the age-sex adjusted model, the risk for all-cause mortality was significantly higher in the donor group than in the control group. However, the significance was not retained after socioeconomic status was included as a covariate (adjusted hazard ratio, 1.82; 95% confidence interval, 0.87–3.80). Conclusion: All-cause mortality was similar in live kidney donors and matched non-donor healthy controls with similar health status and socioeconomic status in the Korean population.

Purpose: The purpose of this study is to clearly classify the roles of Physician assistants and to identify obstacle factors and necessary factors for the operation of the system when they are performing the roles of Physician assistants. Methods: This is a descriptive research study to analyze the roles of Physician assistants and to understand the expected roles of Physician assistants according to each medical personnel (doctor, nurse, Physician assistants). Results: The obstacles to work are the lack of legal protection, and unclear work guidelines, and the matter necessary for the operation of the system is the legal protection. There were statistically significant differences in health collection ability, physical examination, drug response monitoring, and reporting in terms of the differences in role expectations considered by medical professionals regarding the roles of Physician assistants. Conclusion Physician assistants need to develop various educational programs and materials, cultivate the ability to perform Physician assistants, and develop an advisory role through effective problem-solving between departments and increase the quality and satisfaction of Nursing care.

Background: Considering the growing prevalence of Western lifestyles and related chronic diseases occurring in South Korea, this study aimed to explore the progression of metabolic risk factors in living kidney donors compared to a control group. Methods: This study enrolled living kidney donors from seven hospitals from 1982 to 2016. The controls were individuals that voluntarily received health check-ups from 1995 to 2016 that were matched with donors according to age, sex, diabetes status, baseline estimated glomerular filtration rate, and date of the medical record. Data on hyperuricemia, hypertension, hypercholesterolemia, and overweight/obesity were collected to determine metabolic risks. The proportion of individuals with three or more metabolic risk factors was evaluated. Logistic regressions with interaction terms between the medical record date and donor status were used to compare the trends in metabolic risks over time in the two groups. Results: A total of 2,018 living kidney donors and matched non-donors were included. The median age was 44.0 years (interquartile range, 34.0–51.0 years) and 54% were women. The living kidney donors showed a lower absolute prevalence for all metabolic risk factors, except for those that were overweight/obese, than the non-donors. The proportion of subjects that were overweight/obese was consistently higher over time in the donor group. The changes over time in the prevalence of each metabolic risk were not significantly different between groups, except for a lower prevalence of metabolic risk factors ≥ 3 in donors. Conclusion Over time, metabolic risks in living kidney donors are generally the same as in non-donors, except for a lower prevalence of metabolic risk factors ≥ 3 in donors.

Background: Smoking is a well-known risk factor for respiratory diseases, cardiovascular diseases, and many types of cancers, but there is little information about the effects of smoking on muscle strength. Hand grip strength (HGS) is a simple way to measure muscle power. We compared the mean HGS according to smoking status and smoking level in Korean male and female smokers. Methods: We obtained data from the Korea National Health and Nutrition Examination Survey VII and included adults aged 20–79 years. We identified factors that affect HGS and after adjusting for these factors, we compared the mean HGS of smokers, ex-smokers, and nonsmokers. We also compared the mean HGS of smokers according to the smoking level. ANOVA and ANCOVA analyses were performed to compare the mean HGS. In addition, we examined the relationship between smoking, and mean main HGS, which is the mean HGS of the dominant hand. Results: A total of 9,848 people were analyzed after excluding those with uncertain smoking status and those who did not respond to the study variables. After adjusting for all cofactors, the mean HGS and the mean main HGS were higher in smokers and ex-smokers than in both male and female nonsmokers with no previous history of smoking. In smokers, the amount of smoking did not affect the mean HGS or mean main HGS. Conclusion Smokers and ex-smokers have higher mean HGS and mean main HGS than nonsmokers, and the amount of smoking does not affect the mean HGS and mean main HGS in smokers.

Background: ; Liver transplantation usually requires blood transfusion, and a red blood cell (RBC) antibody screen is essential for the prevention of a hemolytic reaction. Since proper ABO-compatible grafts are lacking, ABO-incompatible living donor liver transplantation (ABO-i LDLT) with desensitization is a feasible therapy. Desensitization includes intravenous rituximab injection and plasmapheresis before surgery.Case: A 60-year-old female was diagnosed with hepatitis B virus-related hepatocellular carcinoma and planned for ABO-i LDLT. She tested positive in a RBC antibody screen over two years; however, she tested negative for the test after desensitization. Clinicians noted the seroconversion during induction, and thus, a delay in the preparation of adequate packed RBC was unavoidable. Conclusions Even when the latest RBC antibody screen is negative after immunosuppression, clinicians should consider the possibility of a prior positive result to promote safer medical treatment and management.

Although various studies on predictive markers in the use of PD-1/PD-L1 inhibitors are in progress, only PD-L1 expression levels in tumor tissues are currently used. In the present study, we investigated whether baseline serum levels of IL-6 can predict the treatment response of patients with advanced non-small cell lung cancer (NSCLC) treated with PD-1/PD-L1 inhibitors. In our cohort of 125 NSCLC patients, the objective response rate (ORR) and disease control rate (DCR) were significantly higher in those with low IL-6 (<13.1 pg/ml) than those with high IL-6 (ORR 33.9% vs. 11.1%, p=0.003; DCR 80.6% vs. 34.9%, p<0.001). The median progression-free survival was 6.3 months (95% confidence interval [CI], 3.9–8.7) in the low IL-6 group, significantly longer than in the high IL-6 group (1.9 months, 95% CI, 1.6–2.2, p<0.001). The median overall survival in the low IL-6 group was significantly longer than in the high IL-6 group (not reached vs. 7.4 months, 95% CI, 4.8–10.0). Thus, baseline serum IL-6 levels could be a potential biomarker for predicting the efficacy and survival benefit of PD-1/PD-L1 inhibitors in NSCLC.

For the data represented in Fig. 4B, we have generated a new figure from one of these repeat experiments.

PURPOSE: This study aimed to identify the influence of nurses' resilience and anger expression styles on their nursing work performance in emergency departments. METHODS: The study included 107 nurses from 5 hospitals in Seoul and Gyeonggi-do who consented to participate. Data ware collected from March to April 2016. Multiple regression analysis was used to identify factors influencing nurses' performance. RESULTS: Nurses' performance was higher when resilience was high and anger expression was low. The result of the multiple regression indicated that present working years in the emergency room, work satisfaction, anger expression, anger control, and resilience predicted 39.4%(F=7.27, p < .001) of the nursing performance of hospital nurses in emergency departments. The most powerful predictor was resilience (β=.45, p < .001), followed by anger-out (β=−.25, p=.006). CONCLUSION: This study showed that the most influential variables of work performance in emergency nurses ware resilience and anger expression. To enhance the nursing performance of hospital nurses in emergency departments, it is necessary to develop and implement mentorship programs that enhance resilience and educational programs that help them manage their anger.
Anger ; Emergencies ; Emergency Service, Hospital ; Gyeonggi-do ; Humans ; Job Satisfaction ; Mentors ; Nursing ; Seoul ; Work Performance

PURPOSE: This study was aimed to identify the difference in satisfaction and importance of nursing care between patients in comprehensive nursing care unit (CNCU) and general nursing care unit (GNCU). It also confirms the difference between practice environment of nursing work and nurse's intention to work. METHODS: Nursing care satisfaction and importance levels were measured from 202 patients. Practice environment of nursing work and nurse's intention to work were measured from 54 nurses. RESULTS: The satisfaction level was higher in the CNCU in comparison to the GNCU (p < .001). There was no significant difference between the importance and satisfaction level of nursing care for patients at the CNCU (p=.973), whereas in the GNCU, patients' satisfaction level was lower than the importance level (p < .001). The score for practice environment for nursing work was higher in the CNCU than in the GNCU (t=3.34, p=.002). The nurse's intention to work in the CNCU was higher than that of the GNCU, but there was no statistically significant difference. CONCLUSION: Through the survey, the paper suggests that comprehensive nursing care is a service type that satisfies the nursing demand (importance) that patients consider important. Results from nurses showed no significant differences.
Humans ; Intention ; Nursing Care ; Nursing ; Patient Satisfaction