40 years or new hires with less than 1 year of service.]]>
Brain ; Cardiovascular Diseases ; Cohort Studies ; Firefighters ; Follow-Up Studies ; Health Surveys ; Hospitals, University ; Humans ; Killer Cells, Natural ; Korea ; Magnetic Resonance Imaging ; Mental Disorders ; Mental Health ; Neuropsychological Tests ; Polycyclic Hydrocarbons, Aromatic ; Prospective Studies ; Republic of Korea ; Risk Factors

PURPOSE: Head and neck squamous cell carcinoma (HNSCC) is a deadly disease in which precision medicine needs to be incorporated. We aimed to implement next-generation sequencing (NGS) in determining actionable targets to guide appropriate molecular targeted therapy in HNSCC patients. MATERIALS AND METHODS: Ninety-three tumors and matched blood samples underwent targeted sequencing of 244 genes using the Illumina HiSeq 2500 platform with an average depth of coverage of greater than 1,000×. Clinicopathological data from patients were obtained from 17 centers in Korea, and were analyzed in correlation with NGS data. RESULTS: Ninety-two of the 93 tumors were amenable to data analysis. TP53 was the most common mutation, occurring in 47 (51%) patients, followed by CDKN2A (n=23, 25%), CCND1 (n=22, 24%), and PIK3CA (n=19, 21%). The total mutational burden was similar between human papillomavirus (HPV)–negative vs. positive tumors, although TP53, CDKN2A and CCND1 gene alterations occurred more frequently in HPV-negative tumors. HPV-positive tumors were significantly associated with immune signature-related genes compared to HPV-negative tumors. Mutations of NOTCH1 (p=0.027), CDKN2A (p < 0.001), and TP53 (p=0.038) were significantly associated with poorer overall survival. FAT1 mutations were highly enriched in cisplatin responders, and potentially targetable alterations such as PIK3CA E545K and CDKN2A R58X were noted in 14 patients (15%). CONCLUSION: We found several targetable genetic alterations, and our findings suggest that implementation of precision medicine in HNSCC is feasible. The predictive value of each targetable alteration should be assessed in a future umbrella trial using matched molecular targeted agents.
Biomarkers ; Carcinoma, Squamous Cell* ; Cisplatin ; Epithelial Cells* ; Head* ; Humans ; Korea ; Molecular Targeted Therapy ; Neck* ; Precision Medicine ; Statistics as Topic

OBJECTIVE: In this study, we evaluated the prevalence of allergic disease in offsprings delivered via the delivery modes of vaginal delivery vs. planned Cesarean section vs. Cesarean section with labor. METHODS: This study included 175 mother-neonate pairs from Severance Hospital who were enrolled in the Cohort for Childhood Origin of Asthma and allergic diseases study. Information regarding prenatal environmental factors, delivery, and diagnosis of allergic diseases was obtained from a questionnaire and medical record review. Patients with at least 3 years of follow-up data were included in this study. Results were adjusted for sex, birth weight, gestational age at birth, season of birth, neonatal intensive care unit admission, parity, breastfeeding, and maternal factors. RESULTS: A total of 175 offsprings were eligible for analysis. Among the subjects, 52.0% were delivered by vaginal delivery, 34.3% by planned Cesarean section, and 16.6% by Cesarean section with labor. Fifty-nine offsprings (33.7%) were diagnosed with allergic disease at a median age of 1 year (range 0.5–3 years). The prevalence of allergic disease was not associated with delivery mode after adjusting for confounding variables. Time period from membrane rupture to delivery, duration of the active phase, and the beginning of the pelvic division prior to Cesarean section were not associated with allergic disease development in offsprings. CONCLUSION: Cesarean section, irrespective of the occurrence of labor before surgery, did not increase the prevalence of allergic disease in infants up to 3 years of age.
Asthma ; Birth Weight ; Breast Feeding ; Cesarean Section* ; Cohort Studies ; Confounding Factors (Epidemiology) ; Diagnosis ; Female ; Follow-Up Studies ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Medical Records ; Membranes ; Parity ; Parturition ; Pregnancy ; Prevalence* ; Rupture ; Seasons

The purpose of this study was to investigate the feasibility and therapeutic effects of a novel concept hand rehabilitation device based on magnetics for subacute stroke patients with hand motor impairment. We developed an end effector type device that can induce various movements of the fingers in accordance with a magnetic field direction using electromagnets and permanent magnets. Subacute stroke patients with hand motor impairments were recruited and divided into two rehabilitation groups. Conventional rehabilitation therapies were also conducted equally in both groups. Active-assisted training of the affected hand was additionally administered for 30 minutes per day for 4 weeks using the developed equipment in the intervention group. Hand motor function and the activities of daily living were evaluated before and after the intervention. The Manual Function Test score significantly increased in the intervention group after 4 weeks of treatment (p = 0.039), and there was a significant difference in the degree of improvement between the two groups (p = 0.016). The scores of the motor Fugl-Meyer Assessment of the upper limb, the Wolf Motor Function Test score and time, and the motor Functional Independence Measure also improved in both groups (all p < 0.05). In addition, the patients in the intervention group showed greater improvements in these outcome measures than those in the control group did (all p < 0.05). An adjuvant rehabilitation therapy using a magnetic based device can be helpful to improve the hand motor function and activities of daily life in subacute stroke patients.
Activities of Daily Living ; Fingers ; Hand ; Humans ; Magnetic Fields ; Magnets ; Outcome Assessment (Health Care) ; Pilot Projects ; Rehabilitation ; Robotics ; Stroke ; Therapeutic Uses ; Upper Extremity ; Wolves

BACKGROUND: Postoperative nausea and vomiting (PONV) frequently occurs following bimaxillary orthognathic surgeries. Compared to opioids, Nefopam is associated with lower incidences of PONV, and does not induce gastrointestinal tract injury, coagulopathy, nephrotoxicity, or fracture healing dysfunction, which are common side effects of Nonsteroidal anti-inflammatory drugs. We compared nefopam- and fentanyl-induced incidence of PONV in patients with access to patient-controlled analgesia (PCA) following bimaxillary orthognathic surgeries. METHODS: Patients undergoing bimaxillary orthognathic surgeries were randomly divided into nefopam and fentanyl groups. Nefopam 120 mg or fentanyl 700 µg was mixed with normal saline to a final volume of 120 mL. Patients were given access to nefopam or fentanyl via PCA. Postoperative pain intensity and PONV were measured at 30 minutes and 1 hour after surgery in the recovery room and at 8, 24, 48, and 72 hours after surgery in the ward. The frequency of bolus delivery was compared at each time point. RESULTS: Eighty-nine patients were enrolled in this study, with 48 in the nefopam (N) group and 41 in the fentanyl (F) group. PONV occurred in 13 patients (27.7%) in the N group and 7 patients (17.1%) in the F group at 8 hours post-surgery (P = 0.568), and there were no significant differences between the two groups at any of the time points. VAS scores were 4.4 ± 2.0 and 3.7 ± 1.9 in the N and F groups, respectively, at 8 hours after surgery (P = 0.122), and cumulative bolus delivery was 10.7 ± 13.7 and 8.6 ± 8.5, respectively (P = 0.408). There were no significant differences in pain or bolus delivery at any of the remaining time points. CONCLUSION: Patients who underwent bimaxillary orthognathic surgery and were given nefopam via PCA did not experience a lower rate of PONV compared to those that received fentanyl via PCA. Furthermore, nefopam and fentanyl did not provide significantly different postoperative pain control.
Analgesia, Patient-Controlled ; Analgesics, Opioid ; Fentanyl ; Fracture Healing ; Gastrointestinal Tract ; Humans ; Incidence ; Nefopam ; Orthognathic Surgery ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Prospective Studies ; Recovery Room

Among metastatic pancreatic tumors, malignant melanomas are rare. Here, we report a very rare case of a malignant melanoma that involved only the pancreas and liver, and was difficult to differentiate from a neuroendocrine tumor of the pancreas with a liver metastasis. A 65-year-old- male with no history of a malignant melanoma exhibited hypervascular hepatic and pancreatic tumors on computed tomography and contrast-enhanced endoscopic ultrasonography. He lacked lesions of the skin, eye, and gastrointestinal tract on physical examination, upper endoscopy, and a whole-body positron emission tomography-computed tomography scan; these sites are common primary sites of malignant melanoma. Finally, endoscopic ultrasound-guided pancreatic core biopsy and percutaneous ultrasonography-guided liver biopsy confirmed malignant melanoma of the pancreas and liver.
Biopsy ; Electrons ; Endoscopy ; Endosonography ; Gastrointestinal Tract ; Humans ; Liver ; Male ; Melanoma ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Pancreas ; Pancreatic Neoplasms ; Physical Examination ; Skin

Mucopolysaccharidosis (MPS) is an inherited metabolic disorder caused by a deficiency in enzymes that participate in the degradation of glycosaminoglycans (GAGs) such as heparin sulfate and dermatan sulfate. Left untreated, patients show progressive mental and physical deterioration due to deposition of GAGs in organs. Death often occurs due to cardiac or respiratory failure before patients reach their early twenties. MPS has several oral and dental manifestations. An enlarged head, short neck, and open mouth associated with a large tongue are major characteristics of MPS patients. Dental complications can be severe, including unerupted dentition, dentigerous cyst-like follicles, malocclusions, condylar defects, and gingival hyperplasia. A 21-year-old female patient with MPS was described in this article, with special emphasis on oral manifestations and dental treatment.
Dental Pulp Cavity ; Dentition ; Dermatan Sulfate ; Female ; Gingival Hyperplasia ; Glycosaminoglycans ; Head ; Heparin ; Humans ; Malocclusion ; Mouth ; Mucopolysaccharidoses ; Neck ; Oral Manifestations ; Respiratory Insufficiency ; Root Canal Therapy ; Tongue ; Young Adult

BACKGROUND/AIMS: Despite the many reports of colonoscopy complications worldwide, few studies have been performed at the population level in Korea. In this study, a population-based study was performed to evaluate the incidence of post-colonoscopy perforations compared to a control group. METHODS: Between January 2011 and December 2011, data for all cases (age over 45) who underwent a colonoscopy were collected from National Health Insurance Service using a random sampling method. The clinical characteristics and perforation incidence (within 30 days after the colonoscopy) of cases were identified, and cases were then compared with controls who had not undergone a colonoscopy. RESULTS: Among 1,380,000 subjects, 31,177 cases and 62,354 controls were identified. Perforation occurred in 14 patients (0.04%) in the case group and one patient (<0.01%) in the control group (RR, 28.0; 95% CI 3.7–212.9, p<0.001). Subgroup analysis was followed according to the endoscopic procedure, gender and age. In subgroup analysis, colonoscopy-associated perforations occurred more in the therapeutic procedure (RR, 26; 95% CI 1.46–461.46), male (RR, 50; 95% CI 2.96–844.41), and age of 45–60 years (RR, 30; 95% CI 1.71–525.23). CONCLUSIONS: A colonoscopy procedure is related to an increased risk of perforation at the population level. In addition, the therapeutic procedure, male, and age of 45-60 years appeared to be associated with an increased risk of perforation.
Case-Control Studies ; Cohort Studies ; Colonoscopy ; Humans ; Incidence ; Intestinal Perforation ; Korea ; Male ; Methods ; National Health Programs ; Retrospective Studies

PURPOSE: This study aimed to identify the difficulties with end-of-life care (EOLC) experienced by intensive care unit (ICU) nurses and to investigate their educational needs for EOLC. METHODS: This study aimed to identify the difficulties with end-of-life care (EOLC) experienced by intensive care unit (ICU) nurses and to investigate their educational needs for EOLC. RESULTS: The mean score on the difficulty of EOLC was 3.41 out of 5. The education needs derived from the qualitative analysis was categorized into four themes: 1) guidelines on professional EOLC, 2) spiritual care, 3) a program to take care of feelings of patients, families and nurses, and 4) activities to think about death. CONCLUSION: This study confirmed that ICU nurses were experiencing an extreme difficulty in providing EOLC. In addition, a qualitative analysis confirmed that they needed an EOL nursing program. To mitigate the difficulties experienced by nurses involved in EOLC, there is an urgent need to develop an education program for EOLC tailored to nurses' needs.
Critical Care ; Education ; Humans ; Intensive Care Units ; Methods ; Needs Assessment ; Nursing ; Terminal Care

PURPOSE: The purpose of this study is to investigate the safety of nursing students during fundamentals of nursing practicum in Korea. METHODS: This study used a descriptive design. A total of 106 nursing instructors teaching fundamentals of nursing longer than one year participated in this study. Data were collected using self-report questionnaires from July 24 to August 28, 2018. The questionnaires consisted of general characteristics, characteristics of fundamentals of nursing course, physical and emotional safety issues during fundamentals of nursing practicum, and obtaining an informed consent prior to practicum. RESULTS: The average number of physical safety accidents during practicum of fundamentals of nursing in the past 5 years was 1.12±2.44. The most common safety accident was punctured wound. The mean score of the participants' stress on physical safety accidents was 3.53±1.12 out of 5. The average number of emotional safety accidents of fundamentals of nursing practicum in the past 5 years was 1.05±2.72. The mean score of stress on emotional safety accident was 3.00±1.09 out of 5. We found that 47.2% of the participants obtained an oral consent or a written consent for safety of fundamentals of nursing practicum. CONCLUSION: The results of this study indicate that it is necessary to establish safety strategies for fundamentals of nursing practicum for nursing students.
Human Body ; Humans ; Informed Consent ; Korea ; Nursing ; Students, Nursing ; Wounds and Injuries