We report a genetically confirmed case of adult-onset Alexander disease (AOAD) presenting with progressive dysarthria and palatal tremor. Brain magnetic resonance imaging revealed medullary atrophy and olivary hyperintensities. A pathogenic variant of the glial fibrillary acidic protein gene (p.R416W) was identified. The palatal tremor indicated involvement of the Guillain-Mollaret triangle. This case underscores the diagnostic value of bulbar signs and neuroimaging in AOAD and highlights the importance of integrating clinical, radiological, and genetic findings for early definitive diagnosis.

Purpose: The purpose of this study was to examine the influential factors on retention intention among nurses in small-medium sized hospitals. Methods: This study was conducted with 185 nurses of 6 small-medium sized general hospitals located in B metropolitan city. Data were collected from July 10 to July 19, 2022 using on-line self-report questionnaires. A descriptive analysis and hierarchical multiple regression were used for data analysis utilizing IBM SPSS Statistics for Windows version 25.0. Results: The variables influencing the retention intention of the subjects were perceived value of work (β=.36, p<.001), nurse manager ability, leadership, and support of nurses (β=.22, p=.024), positive psychological capital (β=.15, p=.042), and subjective health status (β=.14, p=.035), and the total explanatory power (R2 ) of these variables was 38.0% (F=12.24, p<.001). Conclusion Based on the results, in order to increase the retention intention for nurses in small and medium-sized hospitals, it is necessary to create an environment and culture as well as educational strategies for fostering a sense of work value and positive psychological capital. In addition, proactive organizational efforts are required to strengthen nurses’ subjective health and nurse managers’ supporting capabilities and leadership in small-medium sized hospitals.

Purpose: The purpose of this study was to examine the influential factors on retention intention among nurses in small-medium sized hospitals. Methods: This study was conducted with 185 nurses of 6 small-medium sized general hospitals located in B metropolitan city. Data were collected from July 10 to July 19, 2022 using on-line self-report questionnaires. A descriptive analysis and hierarchical multiple regression were used for data analysis utilizing IBM SPSS Statistics for Windows version 25.0. Results: The variables influencing the retention intention of the subjects were perceived value of work (β=.36, p<.001), nurse manager ability, leadership, and support of nurses (β=.22, p=.024), positive psychological capital (β=.15, p=.042), and subjective health status (β=.14, p=.035), and the total explanatory power (R2 ) of these variables was 38.0% (F=12.24, p<.001). Conclusion Based on the results, in order to increase the retention intention for nurses in small and medium-sized hospitals, it is necessary to create an environment and culture as well as educational strategies for fostering a sense of work value and positive psychological capital. In addition, proactive organizational efforts are required to strengthen nurses’ subjective health and nurse managers’ supporting capabilities and leadership in small-medium sized hospitals.

Purpose: The purpose of this study was to examine the influential factors on retention intention among nurses in small-medium sized hospitals. Methods: This study was conducted with 185 nurses of 6 small-medium sized general hospitals located in B metropolitan city. Data were collected from July 10 to July 19, 2022 using on-line self-report questionnaires. A descriptive analysis and hierarchical multiple regression were used for data analysis utilizing IBM SPSS Statistics for Windows version 25.0. Results: The variables influencing the retention intention of the subjects were perceived value of work (β=.36, p<.001), nurse manager ability, leadership, and support of nurses (β=.22, p=.024), positive psychological capital (β=.15, p=.042), and subjective health status (β=.14, p=.035), and the total explanatory power (R2 ) of these variables was 38.0% (F=12.24, p<.001). Conclusion Based on the results, in order to increase the retention intention for nurses in small and medium-sized hospitals, it is necessary to create an environment and culture as well as educational strategies for fostering a sense of work value and positive psychological capital. In addition, proactive organizational efforts are required to strengthen nurses’ subjective health and nurse managers’ supporting capabilities and leadership in small-medium sized hospitals.

Purpose: The purpose of this study was to examine the influential factors on retention intention among nurses in small-medium sized hospitals. Methods: This study was conducted with 185 nurses of 6 small-medium sized general hospitals located in B metropolitan city. Data were collected from July 10 to July 19, 2022 using on-line self-report questionnaires. A descriptive analysis and hierarchical multiple regression were used for data analysis utilizing IBM SPSS Statistics for Windows version 25.0. Results: The variables influencing the retention intention of the subjects were perceived value of work (β=.36, p<.001), nurse manager ability, leadership, and support of nurses (β=.22, p=.024), positive psychological capital (β=.15, p=.042), and subjective health status (β=.14, p=.035), and the total explanatory power (R2 ) of these variables was 38.0% (F=12.24, p<.001). Conclusion Based on the results, in order to increase the retention intention for nurses in small and medium-sized hospitals, it is necessary to create an environment and culture as well as educational strategies for fostering a sense of work value and positive psychological capital. In addition, proactive organizational efforts are required to strengthen nurses’ subjective health and nurse managers’ supporting capabilities and leadership in small-medium sized hospitals.

Background: Research regarding cervical metastasis from an unknown primary tumor (CUP) according to human papillomavirus (HPV) and Epstein-Barr virus (EBV) status in Korea has been sporadic and small-scale. This study aims to analyze and understand the characteristics of CUP in Korea according to viral and p16 and p53 status through a multicenter study. Methods: Ninety-five cases of CUP retrieved from six hospitals in Korea between January 2006 and December 2016 were subjected to high-risk HPV detection (DNA in situ hybridization [ISH] or real-time polymerase chain reaction), EBV detection (ISH), and immunohistochemistry for p16 and p53. Results: CUP was HPV-related in 37 cases (38.9%), EBV-related in five cases (5.3%), and unrelated to HPV or EBV in 46 cases (48.4%). HPV-related CUP cases had the best overall survival (OS) (p = .004). According to the multivariate analysis, virus-unrelated disease (p = .023) and longer smoking duration (p < .005) were prognostic factors for poor OS. Cystic change (p = .016) and basaloid pattern (p < .001) were more frequent in HPV-related cases, and lymphoepithelial lesion was frequent in EBV-related cases (p = .010). There was no significant association between viral status and p53 positivity (p = .341), smoking status (p = .728), or smoking duration (p = .187). Korean data differ from Western data in the absence of an association among HPV, p53 positivity, and smoking history. Conclusions Virus-unrelated CUP in Korea had the highest frequency among all CUP cases. HPV-related CUP is similar to HPV-mediated oropharyngeal cancer and EBVrelated CUP is similar to nasopharyngeal cancer in terms of characteristics, respectively.

Purpose: This study was performed to explore and describe the overall clinical practice adaptation experiences among nursing students during the COVID-19 pandemic. Methods: This qualitative study applied the grounded theory method by Corbin and Strauss. Data were collected from May to August 2021 through individual in-depth interviews with 14 nursing students from three universities in B metropolitan city. Results: From open coding, 20 sub-categories and 10 categories were identified. Analysis revealed that the core category was the process of “keeping the place of learning while adhering to the restrictions of the era of pandemic” and that it consisted of four phases: confusion, withdrawal, adjustment, and growth. Through this process, participants utilized various action/interactional strategies such as “shifting to positive thinking,” “building a shield to protect oneself,” and “focusing on learning.” The consequences of these strategies were “adapting to the reality of the infectious disease situation” and “strengthening a foothold to grow as a future nurse.” Conclusion An in-depth understanding of nursing students’ experiences of adapting to clinical practice during the COVID-19 pandemic will guide nursing educators to promote effective teaching strategies to better support nursing students in a time of infectious disease crisis.

Purpose: This study aimed to evaluate the cumulative recurrence rate and risk factors for recurrent abdominal wall endometriosis (AWE) after surgical treatment. Materials and Methods: A retrospective cohort study was conducted at a single gynecological surgery center between January 2004 and December 2020. Patients who were surgically treated and followed up for at least 6 months after surgery were selected. Results: Eighteen patients with pathologically diagnosed AWE were included in this study. The median follow-up duration was 22.5 months (range, 6–106). The median age was 37 years (range, 22–48), and 33.3% of the patients were nulliparous. Among the patients included in our study, 55.6% complained of a mass with cyclic pain, and 27.8% had a palpable mass. In addition, 22.2% of patients experienced recurrence with 17.5±9.7 months of mean time to recurrence. The cumulative recurrence rates at 24 and 60 months after surgical treatment of AWE were 23.8% and 39.1%, respectively. There were no statistically significant risk factors for the recurrence of AWE, including postoperative medical treatment. Conclusion The recurrence rate of AWE appears to be correlated with the follow-up duration. There was no statistically significant risk factor for the recurrence of AWE. Unlike ovarian endometriosis, postoperative hormonal treatment does not seem to lower the recurrence of AWE. The findings of the current study may help healthcare providers in counselling and managing patients with AWE.

Background: and Purpose This study aimed to investigate the applicability of deep learning (DL) model using diffusion-weighted imaging (DWI) data to predict the severity of aphasia at an early stage in acute stroke patients. Methods: We retrospectively analyzed consecutive patients with aphasia caused by acute ischemic stroke in the left middle cerebral artery territory, who visited Asan Medical Center between 2011 and 2013. To implement the DL model to predict the severity of post-stroke aphasia, we designed a deep feed-forward network and utilized the lesion occupying ratio from DWI data and established clinical variables to estimate the aphasia quotient (AQ) score (range, 0 to 100) of the Korean version of the Western Aphasia Battery. To evaluate the performance of the DL model, we analyzed Cohen’s weighted kappa with linear weights for the categorized AQ score (0–25, very severe; 26–50, severe; 51–75, moderate; ≥76, mild) and Pearson’s correlation coefficient for continuous values. Results: We identified 225 post-stroke aphasia patients, of whom 176 were included and analyzed. For the categorized AQ score, Cohen’s weighted kappa coefficient was 0.59 (95% confidence interval [CI], 0.42 to 0.76; P<0.001). For continuous AQ score, the correlation coefficient between true AQ scores and model-estimated values was 0.72 (95% CI, 0.55 to 0.83; P<0.001). Conclusions DL approaches using DWI data may be feasible and useful for estimating the severity of aphasia in the early stage of stroke.

Purpose: This study aimed to evaluate the risk of cervical cancer diagnosed within 1 year after the last of multiple consecutive normal Papanicolau (Pap) tests. Materials and Methods: The database of the National Health Insurance Service was used. We obtained Pap test data for 11,052,116 women aged 30-79 between 2007-2012. The cumulative incidence rates and 5-year overall survival rates of cervical cancer diagnosed within 1 year after the last normal Pap test were compared between women with one (N1), two (N2), and three consecutive normal Pap tests (N3). Women who did not receive a Pap test during the study period were assigned in the N0 group. Results: The 1-year cumulative incidence rates of cervical cancer were 58.9, 24.6, 20.3, and 14.2 per 105 in the N0, N1, N2, and N3 groups, respectively. Compared to the N1 group, the risk of cervical cancer diagnosed within 1 year of the last normal Pap test decreased by 17% (relative risk [RR], 0.825; 95% confidence interval [CI], 0.716 to 0.951) in the N2 group and 42% (RR, 0.578; 95% CI, 0.480 to 0.695) in the N3 group. However, the 5-year survival rate in women diagnosed with cervical cancer within 1 year of the last normal Pap test in the N3 group was not higher than that of the N1 group (79.6% vs. 81.3%, p=0.706). Conclusion As normal Pap tests are consecutively repeated, cervical cancer risk significantly decreases. However, previous consecutive normal Pap tests are not associated with improving survival outcomes in women shortly diagnosed with cervical cancer after the last normal Pap test.