Purpose: Circulating tumor DNA (ctDNA) is emerging as a valuable non-invasive tool to identify tumor heterogeneity and tumor burden. This study investigated ctDNA dynamics in metastatic colorectal cancer patients treated with regorafenib. Materials and Methods: In this prospective biomarker study, plasma cell-free DNA (cfDNA) samples obtained at baseline, at the first response evaluation after 2 cycles of treatment, and at the time of progressive disease were sequenced using a targeted next-generation sequencing platform which included 106 genes. Results: A total of 285 blood samples from 110 patients were analyzed. Higher baseline cfDNA concentration was associated with worse progression-free survival (PFS) and overall survival (OS). After 2 cycles of treatment, variant allele frequency (VAF) in the majority of ctDNA mutations decreased with a mean relative change of –31.6%. Decreases in the VAF of TP53, APC, TCF7L2, and ROS1 after 2 cycles of regorafenib were associated with longer PFS. We used the sum of VAF at each time point as a surrogate for the overall ctDNA burden. A reduction in sum (VAF) of ≥ 50% after 2 cycles was associated with longer PFS (6.1 vs. 2.7 months, p=0.002), OS (11.3 vs. 5.9 months, p=0.001), and higher disease control rate (86.3% vs. 51.1%, p < 0.001). VAF of the majority of the ctDNA mutations increased at the time of disease progression, and VAF of BRAF increased markedly. Conclusion Reduction in ctDNA burden as estimated by sum (VAF) could be used to predict treatment outcome of regorafenib.

PURPOSE: The purpose of this study was to examine the relationships of authentic leadership and nursing organizational culture to the intention of hospital nurses to stay in their current position. METHODS: The participants of this study were 503 nurses in 8 hospitals. We collected data using questionnaires for assessing authentic leadership, nursing organization culture and intention to stay. For data analysis, t-test, ANOVA, Cronbach's α, Pearson's correlation coefficient, Tukey test, Multiple regression were performed using SAS ver.9.4 (SAS Institute Inc., Cary, NC, USA). RESULTS: Authentic leadership (β=.12, p=.008) and relation-oriented culture (β=.13, p=.009) affected the intention of the hospital nurses to stay. These variables accounted for 29% of the variance in the intention to stay among hospital nurses. CONCLUSION: The finding of this study shows that the authentic leadership and nursing organizational culture especially relation-focused can influence nurses' intention to stay in their current position. For retaining nurses, it is suggested to use an authentic leadership training program for nursing leaders and to make efforts to establish a relation-focused culture in the hospital.
Education ; Intention ; Leadership ; Nursing ; Organizational Culture ; Statistics as Topic

PURPOSE: This study was to determine the impacts of traumatic events and resilience on the professional quality of life (ProQoL) among clinical nurses. METHODS: In this cross-sectional correlational descriptive study, 325 nurses completed questionnaires of traumatic events, resilience, and ProQoL consisted of compassion satisfaction (CS) and compassion fatigue (CF). Data were analyzed by Spearman correlation analysis and hierarchical regression. RESULTS: Traumatic events positively correlated with CF. Resilience positively correlated with CS and negatively correlated with CF. In this study, multivariate analysis showed that traumatic events and resilience explained 24% of the variance in CS and 7% of the variance in CF. CONCLUSION: A nursing education to enhance resilience and recognition of CS and CF from stressful work-related traumatic events may benefit to improve the professional quality of life for clinical nurses.
Compassion Fatigue ; Education, Nursing ; Empathy ; Multivariate Analysis ; Quality of Life

Gastrodia elata (GE) is traditionally used for treatment of various disorders including neurodegenerative diseases such as Alzheimer's disease. To investigate the neuroprotective effect of GE, amyloid-beta peptide (Abeta)-treated PC12 cells were cultured with GE aqueous extract. In vitro assay demonstrated that 50 microM of pre-aggregated Abeta was lethal to about a half portion of PC12 cells and that Abeta aggregate-induced cell death was significantly decreased with GE treatment at < or =10 mg/mL in a dose-dependent manner. To further examine in vivo cognitive-improving effects, an artificial amnesic animal model, scopolamine-injected Sprague-Dawley rats, were orally administered the extract for 6 weeks followed by behavioral tests (the passive avoidance test and Morris water maze test). The results showed that an acute treatment with scopolamine (1 mg/kg of body weight) effectively induced memory impairment in normal rats and that the learning and memory capability of scopolamine-treated rats improved after prolonged administration of GE extract (50, 250 and 500 mg/kg of body weight for 6 weeks). These findings suggest that a GE regimen may potentially ameliorate learning and memory deficits and/or cognitive impairments caused by neuronal cell death.
Administration, Oral* ; Alzheimer Disease ; Animals ; Body Weight ; Cell Death ; Gastrodia* ; Learning* ; Memory Disorders ; Memory* ; Models, Animal ; Neurodegenerative Diseases ; Neurons ; Neuroprotective Agents ; PC12 Cells ; Rats* ; Rats, Sprague-Dawley ; Scopolamine Hydrobromide

Oxaliplatin is a third-generation platinum derivative used for metastatic or advanced colorectal cancer treatment. Although myelosuppression is the most common cause of oxaliplatin-induced thrombocytopenia, rare cases of oxaliplatin-induced immune-mediated thrombocytopenia are reported. We report a case of a 57-year-old woman with colon cancer who developed gum bleeding and petechiae after oxaliplatin infusion. Laboratory tests revealed grade 4 thrombocytopenia and grade 4 neutropenia. She recovered from the thrombocytopenia and accompanying neutropenia within 4 days with no recurrence following discontinuation of oxaliplatin. Physicians need to be aware of the risk of severe acute thrombocytopenia following oxaliplatin administration.
Colonic Neoplasms ; Colorectal Neoplasms ; Female ; Gingiva ; Hemorrhage ; Humans ; Middle Aged ; Neutropenia ; Platinum ; Purpura ; Recurrence ; Thrombocytopenia*

BACKGROUND: Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae are main pathogens of bloodstream infection. We compared the epidemiology of ESBL-producing E. coli and K. pneumoniae. METHODS: From January 2003 through March 2007, we retrospectively investigated the clinical characteristics and comorbidities of patients with bloodstream infection by ESBL-producing E. coli and K. pneumoniae. RESULTS: During the study period, 79 patients (54 with E. coli and 25 with K. pneumoniae) with blood cultures positive for ESBL-producing E. coli or K. pneumoniae were studied. When comparing the source of bloodstream infections, urinary tract infections (UTIs) were more commonly caused by E. coli (24% vs. 0; P=0.007), and respiratory tract and soft tissue infection (36% vs. 15%; P=0.04, 12% vs. 0; P=0.03, respectively) were more commonly associated with K. pneumoniae. Among hospital-acquired bloodstream infection, third-generation cephalosporin was more commonly used in patients with E. coli than patients with K. pneumoniae (81% vs. 24%, P<0.001). Medical devices (central venous catheter and urinary catheter) were more commonly used in patients with K. pneumoniae. CONCLUSION: ESBL-producing E. coli bloodstream infection is more common in urinary tract infections. ESBL-producing K. pneumoniae is more common in respiratory tract infections and in skin and soft tissue infections. In hospital-acquired infections, ESBL-producing E. coli bloodstream infection is more common in biliary tract infection. ESBL-producing E. coli was more commonly associated with prior frequent antibiotics use and K. pneumoniae was more commonly associated with use of medical devices.
Anti-Bacterial Agents ; beta-Lactamases ; Biliary Tract ; Catheters ; Comorbidity ; Epidemiology* ; Escherichia coli* ; Humans ; Klebsiella pneumoniae* ; Pneumonia ; Respiratory System ; Respiratory Tract Infections ; Retrospective Studies ; Skin ; Soft Tissue Infections ; Urinary Tract Infections

PURPOSE: The purpose of this study was to evaluate bone response to anodized titanium implants coated with the extract of black cohosh, Asarum Sieboldii, and pharbitis semen. MATERIALS AND METHODS: Forty anodized titanium implants were prepared as follows: group 1 was for control; group 2 were implants soaked in a solution containing triterpenoids extracted from black cohosh for 24 hours; group 3 were implants soaked in a solution containing extracts of black cohosh and Asarum Sieboldii for 24 hours; group 4 were implants soaked in a solution containing extracts of pharbitis semen for 24 hours. The implants from these groups were randomly and surgically implanted into the tibiae of ten rabbits. After 1, 2, and 4 weeks of healing, the nondecalcified ground sections were subjected to histological observation, and the percentage of bone-to-implant contact (BIC%) was calculated. RESULTS: All groups exhibited good bone healing with the bone tissue in direct contact with the surface of the implant. Group 2 (52.44 +/- 10.98, 25.54 +/- 5.56) showed a significantly greater BIC% compared to that of group 3 (45.34 +/- 5.00, 22.24 +/- 2.20) with respect to the four consecutive threads and total length, respectively. The BIC% of group 1 (25.22 +/- 6.00) was significantly greater than that of group 3 (22.24 +/- 2.20) only for total length. CONCLUSION: This study did not show any remarkable effects of the extract of black coshosh and the other natural products on osseointegration of anodized titanium implants as coating agents. Further studies about the application method of the natural products on to the surface of implants are required.
Animals* ; Asarum ; Biological Products ; Bone and Bones ; Cimicifuga* ; Methods ; Osseointegration ; Rabbits ; Semen ; Tibia ; Titanium*

PURPOSE: Implant stability quotient (ISQ) values have been supposed to predict implant stability. However, the relationship between ISQ values and bone-to-implant contact ratio (BIC%) which is one of the predictors of implant stability is still unclear. The aim of the present study was to evaluate initial ISQ values in relation to BIC% using rabbit model. MATERIALS AND METHODS: Four New Zealand white rabbits received a total of 16 implants in their tibia. Immediately after implant placement ISQ values were assessed. The measurements were repeated at the time of sacrifice of the rabbits after 4 weeks. Peri-implant bone regeneration was assessed histomorphometrically by measuring BIC% and bone volume to total volume values (bone volume %). The relationships between ISQ values and the histomorphometric output were assessed, and then, the osseointegration prediction model via the initial ISQ values was processed. RESULTS: Initial ISQ values showed significant correlation with the BIC%. The bone volume % did not show any significant association with the ISQ values. CONCLUSION: In the limitation of this study, resonance frequency analysis is a useful clinical method to predict the BIC% values and examine the implant stability.
Bone Regeneration ; Osseointegration ; Rabbits ; Tibia

Mandible fractures belong to the most common fractures encountered in maxillofacial trauma. Because mandible is such a unique structure with hinge joint and masticatory muscles attached to the body of mandible, attention must be paid to avoid displacement during treatment. Displacement during fracture reduction leads to malocclusion. Many TMJs function with complete comfort and apparent normalcy in adapted centric posture, even though they have undergone deformation caused by trauma. This clinical report describes the patient with post traumatic malocclusion and its prosthetic treatment. His fractured mandible was openly reduced in changed position, as a result his occlusion has been changed. He was treated by prosthetic method in so-called adapted centric posture.
Displacement (Psychology) ; Humans ; Joints ; Malocclusion ; Mandible ; Masticatory Muscles ; Posture ; Temporomandibular Joint

BACKGROUND: A ureteropelvic junction (UPJ) obstruction is a congenital anomaly commonly afflicting the pediatric population. However, it occurs more frequently in adults than is generally appreciated. To assess their characteristics, we have here compared and analyzed the clinical manifestations, causes, and outcomes of UPJ obstruction found in children and adults. MATERIALS AND METHODS: 102 patients (118 renal units) out of 182 patients (218 renal units), with diagnosed UPJ obstruction, were available for follow up. The follow-ups were retrospectively reviewed to determine the presenting symptoms, treatments, and clinical outcomes. Patients who were younger than 18 years of age were assigned to the pediatric group (44 patients), others the adult group (58 patents). RESULTS: The majority of the patients presented with flank pain (pediatric group: 68%, adult group: 76%). The majority of patients underwent a pyeloplasty (pediatric group: 50.9%, adult group: 62.3%). And the major cause of the UPJ obstruction was an intrinsic stenosis (pediatric group: 53%, adult group: 56%). CONCLUSION: The prevalence of bilateral UPJ obstruction in adults is evidently less prevalent than in pediatrics, and despite the late diagnosis, the surgical outcome is similar. A further investigation of UPJ obstruction will lead us to a more comprehensive understanding of the disease.
Adult* ; Child ; Constriction, Pathologic ; Delayed Diagnosis ; Flank Pain ; Follow-Up Studies ; Humans ; Pediatrics ; Prevalence ; Retrospective Studies