Objectives: Bone mineral density (BMD) is measured in the hip and posteroanterior spine; moreover, according to the 2019 International Society for Clinical Densitometry guidelines, unilateral hip can be used. This study aimed to determine whether there is a difference between the BMD of both the femurs in postmenopausal women. Methods: A total of 343 postmenopausal women were enrolled in this study from January 1, 2010, to December 31, 2019 at a single tertiary hospital. By using the Hologic® Horizon W DXA System, the femur and spine BMD was measured; BMD was recorded in g/cm 2 .Following regions were analyzed in both the femurs: the femur neck, the trochanter area, and total femur. Results: Mean age at imaging was 62 ± 9.7 years, and significant difference in the total BMD of both the femurs (P = 0.003) was observed. In secondary analysis, patients with osteoporosis showed significant contralateral BMD discrepancies in trochanter and total proximal femur BMD (P = 0.041 and P = 0.011, respectively). However, in women with normal BMD, no significant difference between the right and left femur BMD was observed. Furthermore, measurement of solely the unilateral hip can lead to a 16.9% of underdiagnosis in postmenopausal women. Conclusions In conclusion, it is necessary to check BMD in both hips, particularly in patients suspected of osteoporosis.

Purpose: We assessed prenatal detection rates of congenital heart disease (CHD) and associations between maternal serum biomarkers and non-chromosomal CHD in singleton pregnancies. Materials and Methods: This study was conducted as a secondary analysis of data obtained during a multicenter prospective cohort study that investigated the cost-effectiveness of prenatal testing for fetal aneuploidy. We analyzed the prenatal detection rate and accuracy for CHD screening via ultrasound during the second trimester, as well as associations between serum biomarkers and CHDs, in singleton newborns without chromosomal abnormalities. Results: Among 6715 women, 142 (2.1%) newborns were born with CHDs, of which 67 (1.0%) newborns had major CHDs. The prenatal detection rate for all CHDs and major CHDs were 34.5% and 58.2%, respectively. After excluding isolated ventricular septal defects, the detection rate for critical CHDs was 85.9%. Women with low pregnancy-associated plasma protein A (PAPP-A) (<0.4 multiples of the median, MOM) face increased risks of non-chromosomal CHDs [adjusted odds ratio (aOR) 2.76; 95% confidence interval (CI) 1.36–5.13] and major CHDs (aOR 7.30; 95% CI 3.18–15.59), compared to those without CHDs. A higher inhibin A level (≥2.5 MOM; aOR 4.84; 95% CI 1.42–12.46) was associated with non-chromosomal major CHDs. Conclusion Ultrasonography performed during the second trimester by obstetricians detected over 85% of critical CHDs. Low maternal serum PAPP-A or high inhibin-A was associated with non-chromosomal CHDs. These results may contribute to an improvement in prenatal diagnosis of CHDs.

Objective: In this video, we present our novel technique for myometrial defect closure following robot-assisted laparoscopic adenomyomectomy. Methods: A narrated video demonstration of our technique. Our patient was a 47-year-old single woman with severe dysmenorrhea, who did not respond to medical therapy and wished to preserve her uterus. Surgery was performed after thorough counseling and obtaining informed consent from the patient (Institutional Review Board number: KC17OESI0238; approval date: March 19, 2018). After removal of the adenomyotic tissue during surgical intervention, the myometrial defect was closed in three steps. First, the defect between the anterior and posterior innermost myometrial layers was closed using a 2-0 Stratafix suture, CT-1 (circle taper) needle (Ethicon, Somerville, NJ, USA). Next, the two sides were approximated using a 2-0 PDS® (polydioxanone) Suture (Ethicon, Somerville, NJ, USA) and V-34 (TAPERCUT®) surgical needle (Ethicon, Somerville, NJ, USA). Finally, the serosa was sutured in a baseball fashion using a 2-0 PDS suture, slim half-circle [SH] needle (Ethicon, Somerville, NJ, USA). Results: The patient had no postoperative complications, and her pain was greatly improved. The CA125 level decreased from 434 U/mL to 45.99 U/mL, and the transvaginal ultrasound showed a reduction in posterior myometrial thickness from 5.61 cm to 2.69 cm. Conclusion This technique maintained the integrity of the endometrial cavity, posterior myometrial thickness, and uterine layer alignment. We believe that it is a feasible technique and may be a solution for adenomyosis in patients seeking for fertility preservation.

Objectives: The aim of this study is to determine whether there is a difference between right and left femur bone mineral density (BMD) in postmenopausal women. Methods: We performed a retrospective chart review of postmenopausal women who underwent bone mineral density (BMD) measurement from 2010 to 2019 at a single center using dual-energy X-ray absorptiometry (DXA). Data, including BMD and T-scores of bilateral hip and lumbar spine, was gathered for all postmenopausal women above the age of 50 years. The continuous variables were expressed as means with standard deviation for normal distribution and analyzed with a two-sample t-test. Multiple regression analysis was used to test the effect of underlying medical conditions on T-score of bilateral hips. For all analyses, a p-value of ＜0.05 was considered significant. Results: 346 patients were included in the study with a mean age at imaging of 62 + 9.7 years and body mass index (BMI) of 23.4 + 6.1 kg/m2 . There were no significant differences between right and left femoral BMDs in all patients. There were significant differences in BMD of both total femurs in women in their 60s and women with normal BMD. There was no difference in both femur BMDs between those taking hormone therapy and those not taking hormone therapy. In patients undergoing osteoporosis treatment, there was a difference in the BMD of both femur neck. Calcium and vitamin D intake were not associated with differences between both femur BMD. We found a significant correlation between the BMD measures at lumbar spine and both femur (p ＜ 0.01). Conclusion There were no significant differences between right and left femoral BMDs in postmenopausal women. Therefore, BMD may be measured at either hip. The correlation of bone density between lumbar spine and femur neck is shown to be statistically meaningful. Based on the knowledge of the correlation coefficients between lumbar spine and femur neck, it seems possible to predict the BMD result of one location through the measurement of another.

Objective: In this video, we present our novel technique for myometrial defect closure following robot-assisted laparoscopic adenomyomectomy. Methods: A narrated video demonstration of our technique. Our patient was a 47-year-old single woman with severe dysmenorrhea, who did not respond to medical therapy and wished to preserve her uterus. Surgery was performed after thorough counseling and obtaining informed consent from the patient (Institutional Review Board number: KC17OESI0238; approval date: March 19, 2018). After removal of the adenomyotic tissue during surgical intervention, the myometrial defect was closed in three steps. First, the defect between the anterior and posterior innermost myometrial layers was closed using a 2-0 Stratafix suture, CT-1 (circle taper) needle (Ethicon, Somerville, NJ, USA). Next, the two sides were approximated using a 2-0 PDS® (polydioxanone) Suture (Ethicon, Somerville, NJ, USA) and V-34 (TAPERCUT®) surgical needle (Ethicon, Somerville, NJ, USA). Finally, the serosa was sutured in a baseball fashion using a 2-0 PDS suture, slim half-circle [SH] needle (Ethicon, Somerville, NJ, USA). Results: The patient had no postoperative complications, and her pain was greatly improved. The CA125 level decreased from 434 U/mL to 45.99 U/mL, and the transvaginal ultrasound showed a reduction in posterior myometrial thickness from 5.61 cm to 2.69 cm. Conclusion This technique maintained the integrity of the endometrial cavity, posterior myometrial thickness, and uterine layer alignment. We believe that it is a feasible technique and may be a solution for adenomyosis in patients seeking for fertility preservation.

Background: and PurposeImpulse-control disorder is an important nonmotor symptom of Parkinson's disease (PD) that can lead to financial and social problems, and be related to a poor quality of life. A nationwide multicenter prospective study was performed with the aim of validating the Korean Version of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease Rating Scale (K-QUIP-RS). Methods: The K-QUIP-RS was constructed using forward and backward translation, and pretesting of the prefinal version. PD patients on stable medical condition were recruited from 27 movement-disorder clinics. Participants were assessed using the K-QUIP-RS and evaluated for parkinsonian motor and nonmotor statuses and for PD-related quality of life using a predefined evaluation battery. The test–retest reliability of the K-QUIP-RS was assessed over an interval of 10–14 days, and correlations between the KQUIP-RS and other clinical scales were analyzed. Results: This study enrolled 136 patients. The internal consistency of the K-QUIP-RS was indicated by a Cronbach's α coefficient of 0.846, as was the test–retest reliability by a Guttman split-half coefficient of 0.808. The total K-QUIP-RS score was positively correlated with the scores for depression and motivation items on the Unified PD Rating Scale (UPDRS), Montgomery-Asberg Depression Scale, and Rapid-Eye-Movement Sleep-Behavior-Disorders Questionnaire. The total K-QUIP-RS score was also correlated with the scores on part II of the UPDRS and the PD Quality of Life-39 questionnaire, and the dopaminergic medication dose. Conclusions The K-QUIP-RS appears to be a reliable assessment tool for impulse-control and related behavioral disturbances in the Korean PD population.

PURPOSE: The purpose of this study was to describe what critical care nurses perceived about life-sustaining treatment at end of life.METHODS: A qualitative content analysis method was utilized. The unit of analysis was interview text obtained from fifty critical care nurses of a general hospital.RESULTS: Seven categories in two content areas were abstracted. In the negative perception area, the following five categories were abstracted: patients' suffering, dying with damaged dignity, patients' isolation from family members, regret about choosing life-sustaining treatment, and family members' burden. In the positive perception area, the following two categories were abstracted: willingness to sustain life and duty as family members.CONCLUSIONS: Nurses have better competencies pertaining to understanding patients' responses and suffering than any other health care professions do. Nurses should play an important role in advocating for patients and their family in the process of end-of-life care decision making.
Critical Care ; Decision Making ; Delivery of Health Care ; Hospitals, General ; Humans ; Methods

PURPOSE: This study was to examine the effects of intergenerational social support exchange (providing social support, receiving social support) and self-efficacy on the level of depression among elderly women. METHODS: A cross-sectional survey design was used. The participants were 247 elderly women, over 60, living in Seoul. Data were collected by convenience sampling using self-reported questionnaires that consisted of items on general characteristics, depression, intergenerational social support exchange and self-efficacy. Data were analyzed with descriptive statistics, t-test, ANOVA, correlation, and multiple regression. RESULTS: Self-efficacy had the greatest impact on the level of depression among elderly women, followed by perceived health status and providing social support toward adult children. The model explained 39% of the variance. CONCLUSION: Results of the study suggest that as a way to prevent depression, the health administration needs to develop programs to enhance self-efficacy and to promote the supportive role of elderly women within the family.
Adult Children ; Aged* ; Cross-Sectional Studies ; Depression* ; Female ; Humans ; Surveys and Questionnaires ; Seoul

PURPOSE: Due to the increased prevalence of thyroid cancer, it has been frequently detected in breast cancer patients recently. The aim of this study was to evaluate the clinicopathologic characteristics of thyroid cancer in breast cancer patients with respect to prognosis and treatment. METHODS: From August 1998 to September 2012, 101 breast cancer patients were diagnosed with thyroid cancer (BT group). One hundred ninety-three female patients with a thyroid malignancy that underwent thyroidectomy in 2008 were recruited as controls (oT group). The clinicopathologic results of these two groups were compared. RESULTS: Patients were older (51.40 vs. 47.16, P < 0.001), mean tumor size was smaller (0.96 cm vs. 1.43 cm, P < 0.001), and extrathyroidal extension was less common in the BT group. In both groups, papillary thyroid carcinoma was the most common type of thyroid malignancy. T and N classifications of thyroid cancer were less severe in the BT group, but group TNM stages were similar. Endoscopic thyroid surgery was performed in 12.9% of patients in the BT group and in 6.7% of patients in the oT group. Postoperative radioactive iodine ablation was performed less often in the BT group (P < 0.001). Group recurrence rates were not significantly different. CONCLUSION: Thyroid cancer in breast cancer patients was diagnosed at earlier status than ordinary thyroid cancer. However, the prognosis of thyroid cancer in breast cancer patients was not superior to that in patients with thyroid cancer alone. Radioactive iodine ablation was performed less often and endoscopic surgery could be performed in breast cancer patients.
Breast Neoplasms* ; Breast* ; Classification ; Female ; Humans ; Iodine ; Neoplasms, Second Primary ; Prevalence ; Prognosis* ; Recurrence ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: This study was done to identify the mediating effect of emotional dissonance in the relationship between emotional labor and burnout among clinical nurses. METHODS: A cross-sectional survey design was used. The participants were 257 nurses working at three general hospitals located in Seoul and Gyeonggi Province. Data were collected by convenience sampling using self-report questionnaires that consisted of general characteristics, and measures of emotional labor, emotional dissonance and burnout. Data were analyzed with descriptive statistics, t-test, ANOVA, correlation, and multiple regression. RESULTS: The findings of the multiple regression were as follows. First, surface acting of emotional labor showed significant positive effects on emotional dissonance and burnout. Second, when surface acting and emotional dissonance were entered into the regression model at the same time, surface acting showed an insignificant effect on burnout, however, emotional dissonance showed a significant effect. Finally, emotional dissonance had a mediating effect only between surface acting of emotional labor and burnout, not between deep acting and burnout. CONCLUSION: Results of the study suggest that as a way to reduce burnout, nursing administrators should develop educational programs for nurses to perform deep acting of emotional labor instead of surface acting at the moment of truth.
Administrative Personnel ; Cross-Sectional Studies ; Gyeonggi-do ; Hospitals, General ; Humans ; Negotiating* ; Nursing ; Surveys and Questionnaires ; Seoul