KRAS activating mutations, which are present in more than 90% of pancreatic cancers, drive tumor dependency on the RAS/ mitogen-activated protein kinase (MAPK) and phosphoinositide 3-kinase (PI3K)/AKT signaling pathways. Therefore, combined targeting of RAS/MAPK and PI3K/AKT signaling pathways may be required for optimal therapeutic effect in pancreatic cancer.However, the therapeutic efficacy of combined MAPK and PI3K/AKT signaling target inhibitors is unsatisfactory in pancreatic cancer treatment, because it is often accompanied by MAPK pathway reactivation by PI3K/AKT inhibitor. Therefore, we developed an inRas37 antibody, which directly targets the intra-cellularly activated GTP-bound form of oncogenic RAS mutation and investigated its synergistic effect in the presence of the PI3K inhibitor BEZ-235 in pancreatic cancer. In this study, inRas37 remarkably increased the drug response of BEZ-235 to pancreatic cancer cells by inhibiting MAPK reactivation. Moreover, the co-treatment synergistically inhibited cell proliferation, migration, and invasion and exhibited synergistic anticancer activity by inhibiting the MAPK and PI3K pathways. The combined administration of inRas37and BEZ-235 significantly inhibited tumor growth in mouse models. Our results demonstrated that inRas37 synergistically increased the antitumor activity of BEZ-235 by inhibiting MAPK reactivation, suggesting that inRas37 and BEZ-235 co-treatment could be a potential treatment approach for pancreatic cancer patients with KRAS mutations.

Objective: This study was carried out to establish a basis for understanding and correcting the problems of the emergency physicians (EP) in Korea by examining the current status through the 2020 emergency physician survey conducted by the Korean Society of Emergency Medicine (KSEM). Methods: An online survey was conducted from January 15 to February 26, 2021, through a website and mobile application. The final questionnaire was classified into three types based on the clinical work in the emergency department (ED), current position, and the year of board certification. The contents of the questionnaire were organized into eight themes, and a subcommittee was put in charge of each. Results: Of the 400 emergency medical institutions surveyed, 295 hospitals (74.2%) had board-certified EPs, and 1,453 EPs (72.5%) out of 2,000 were working in the ED. Of these, on average, 7.2 EPs worked together, and they worked 11.6 days/153.1 hours per month and did night shifts 5.9 days per month. 30.7% showed excessive sleepiness during the day, and only 9.6% said that they could adhere to mealtimes. 27.1% responded that they suffered from depression. The level of satisfaction was 3.2 points, and 43.0% responded that they would choose emergency medicine (EM) again as their major. The most important factor in choosing EM was the availability of adequate free time. Their responses indicated that the retirement age was 59.7 years, and the upper age limit for the night shift was 54.3 years. Conclusion Though there have been improvements since the first survey in 2010, there was no notable increase in EP satisfaction. Therefore, appropriate future policies should be formulated and implemented based on these survey results.

PURPOSE: Nurses' knowledge regarding advance directives may affect their administration of and confidence towards end of life care. This study aimed to describe the relationships of knowledge, confidence, and learning needs with advance directives among hospital nurses.METHOD: This cross-sectional study was performed at a tertiary university hospital in Seoul between September 25 and October 14, 2017. Convenience sampling was used to recruit nurses who provided bedside care and had at least 1 year of clinical experience. We used a validated self-report questionnaire.RESULTS: The mean score of knowledge, confidence and learning needs were 5.00±1.73, 29.81±7.52, and 64.54±8.48 respectively. Hospital nurses' knowledge, confidence and learning needs were significantly different according to age, job position, educational level and perceived advance directives. Knowledge regarding advance directives was significantly associated with confidence (r = .27, p < .001) and learning needs (r = .16, p = .005).CONCLUSION: Knowledge regarding advance directives was relatively low compared to the findings of previous studies. Therefore, nurses should be knowledgeable and encouraged to initiate advance directives. It is necessary to develop a standardized educational program regarding advance directives based on Korean cultures.
Advance Directives ; Cross-Sectional Studies ; Learning ; Methods ; Seoul ; Terminal Care

BACKGROUND: Skin laser treatment has improved significantly and has become an effective treatment approach for many skin diseases while also having applications for beauty treatments. However, since skin laser transfers energy directly to the skin, the misuse of such treatment may result in permanent damage to skin tissues. OBJECTIVE: This survey of Korean adults, conducted to obtain their perspectives on and their treatment experience with skin laser treatment, will be used to determine the current status of skin laser treatment and to identify necessary changes to ensure proper and safe conduct of skin laser treatment. METHODS: From April 5th to April 12th, 2016, a survey was conducted to obtain information regarding the perspectives and the treatment experience of adults aged 20~59 years. RESULTS: Approximately 50% of the participants had experience with skin laser treatment, and among these, 24.7% had not received treatment at a dermatology clinic. Compared to treatment at a dermatology clinic, the danger of side effects was 1.7 times higher at a non-dermatology clinic, 2 times higher at a skin care shop, and 5.3 times higher at an Oriental medical clinic. Among patients who received skin laser treatment, 16.1% experienced side effects, and among these, 1 out of 4 patients visited a non-dermatologist for treatment of these side effects. CONCLUSION: The results of the survey showed that in order for the public to receive safe and effective skin laser treatment based on professional diagnosis, there is a definitive need to provide correct information to the public and to implement changes to ensure proper understanding of skin laser treatment among this population.
Adult ; Beauty ; Dermatology ; Diagnosis ; Humans ; Skin Care ; Skin Diseases ; Skin*

PURPOSE: To quantitatively and qualitatively compare fat-suppressed MRI quality using iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) with that using frequency selective fat-suppression (FSFS) T2- and postcontrast T1-weighted fast spin-echo images of the head and neck at 3T. MATERIALS AND METHODS: The study was approved by our Institutional Review Board. Prospective MR image analysis was performed in 36 individuals at a single-center. Axial fat suppressed T2- and postcontrast T1-weighted images with IDEAL and FSFS were compared. Visual assessment was performed by two independent readers with respect to; 1) metallic artifacts around oral cavity, 2) susceptibility artifacts around upper airway, paranasal sinus, and head-neck junction, 3) homogeneity of fat suppression, 4) image sharpness, 5) tissue contrast of pathologies and lymph nodes. The signal-to-noise ratios (SNR) for each image sequence were assessed. RESULTS: Both IDEAL fat suppressed T2- and T1-weighted images significantly reduced artifacts around airway, paranasal sinus, and head-neck junction, and significantly improved homogeneous fat suppression in compared to those using FSFS (P < 0.05 for all). IDEAL significantly decreased artifacts around oral cavity on T2-weighted images (P < 0.05, respectively) and improved sharpness, lesion-to-tissue, and lymph node-to-tissue contrast on T1-weighted images (P < 0.05 for all). The mean SNRs were significantly improved on both T1- and T2-weighted IDEAL images (P < 0.05 for all). CONCLUSIONS: IDEAL technique improves image quality in the head and neck by reducing artifacts with homogeneous fat suppression, while maintaining a high SNR.
Artifacts* ; Ethics Committees, Research ; Head* ; Lymph Nodes ; Magnetic Resonance Imaging* ; Mouth ; Neck* ; Pathology ; Prospective Studies ; Signal-To-Noise Ratio ; Water

PURPOSE: The aims of the current study were to evaluate the effects of superficial cold and heat after spine surgery on pain, satisfaction with pain control and comfort level, and to identify subjective responses and adverse effects. METHODS: A prospective, single-blind, randomized controlled trial was utilized. The intervention group (n=36) received superficial cooling until the wound drain was removed and thereafter followed by superficial heating until discharge, while the control group (n=34) received only superficial cooling until wound drain was removed. Data were collected from August 4 to November 11 2014. RESULTS: There was significant difference in pain according to time within groups (F=71.87, p<.001). However, we found no difference in pain between groups. The intervention group reported higher patient satisfaction with pain control (4 vs 3, z=-2.83, p=.005) and higher comfort level (5 vs 4, z=-4.12, p<.001) than the control group. CONCLUSION: Results indicate that sequential application of superficial cold and heat is a useful method in clinical practice for management of pain after spine surgery.
Cryotherapy ; Heating ; Hot Temperature* ; Humans ; Methods ; Pain, Postoperative ; Patient Satisfaction* ; Personal Satisfaction ; Prospective Studies ; Spine* ; Wounds and Injuries

BACKGROUND AND PURPOSE: In a recent pooled analysis of randomized clinical trials (RCTs), intravenous tissue plasminogen activator (TPA) improves the outcome in patients aged > or =80 years. However, it is uncertain whether the findings are applicable to clinical practice in Asian populations. METHODS: From a multicenter stroke registry database of Korea, we identified patients with acute ischemic stroke who were aged > or = 80 years. Using multivariable analysis and propensity score (PS)-matched analyses, we assessed the effectiveness and safety of intravenous TPA within 4.5 hours. RESULTS: Among 2,334 patients who met the eligible criteria, 236 were treated with intravenous TPA (mean age, 83+/-5; median NIHSS, 13 [IQR, 8-17]). At discharge, the TPA group compared to the no-TPA group had a favorable shift on the modified Rankin Scale (mRS) score (multivariable analysis, OR [95% CI], 1.51 [1.17-1.96], P=0.002; PS-matched analysis, 1.54 [1.17-2.04], P=0.002) and was more likely to achieve mRS 0-1 outcome (multivariable analysis, 2.00 [1.32-3.03], P=0.001; PS-matched analysis, 1.59 [1.04-2.42], P=0.032). TPA treatment was associated with an increased risk of symptomatic intracranial hemorrhage (multivariable analysis, 5.45 [2.80-10.59], P<0.001; PS-matched analysis, 4.52 [2.24-9.13], P<0.001), but did not increase the in-hospital mortality (multivariable analysis, 0.86 [0.50-1.48], P=0.58; PS-matched analysis, 0.88 [0.52-1.47], P=0.61). CONCLUSIONS: In the setting of clinical practice, intravenous TPA within 4.5 hours improved the functional outcome despite an increased risk of symptomatic intracranial hemorrhage in very elderly Korean patients. The findings, consistent with those from pooled analysis of RCTs, strongly support the use of TPA for this population.
Aged* ; Asian Continental Ancestry Group ; Hospital Mortality ; Humans ; Intracranial Hemorrhages ; Korea ; Propensity Score ; Stroke* ; Thrombolytic Therapy ; Tissue Plasminogen Activator*

On page 47, the definition of stroke progression was erroneously described in the previous version of article.

Characteristics of stroke cases, acute stroke care, and outcomes after stroke differ according to geographical and cultural background. To provide epidemiological and clinical data on stroke care in South Korea, we analyzed a prospective multicenter clinical stroke registry, the Clinical Research Center for Stroke-Fifth Division (CRCS-5). Patients were 58% male with a mean age of 67.2+/-12.9 years and median National Institutes of Health Stroke Scale score of 3 [1-8] points. Over the 6 years of operation, temporal trends were documented including increasing utilization of recanalization treatment with shorter onset-to-arrival delay and decremental length of stay. Acute recanalization treatment was performed in 12.7% of cases with endovascular treatment utilized in 36%, but the proportion of endovascular recanalization varied across centers. Door-to-IV alteplase delay had a median of 45 [33-68] min. The rate of symptomatic hemorrhagic transformation (HT) was 7%, and that of any HT was 27% among recanalization-treated cases. Early neurological deterioration occurred in 15% of cases and were associated with longer length of stay and poorer 3-month outcomes. The proportion of mRS scores of 0-1 was 42% on discharge, 50% at 3 months, and 55% at 1 year after the index stroke. Recurrent stroke up to 1 year occurred in 4.5% of patients; the rate was higher among older individuals and those with neurologically severe deficits. The above findings will be compared with other Asian and US registry data in this article.
Asian Continental Ancestry Group ; Humans ; Korea ; Length of Stay ; Male ; National Institutes of Health (U.S.) ; Stroke ; Tissue Plasminogen Activator