Background: This study aimed to investigate the cardiac manifestations of coronavirus disease 2019 (COVID-19). Methods: From February to March 2020, we prospectively and retrospectively enrolled consecutive patients diagnosed with COVID-19. Patient's data such as the demographic characteristics, symptoms, vital signs, laboratory and radiologic findings, electrocardiographic, and echocardiographic data, including the global longitudinal strain (GLS) of both ventricles, were obtained. Results: Forty patients (median age, 58 years; 50% men) were enrolled in the initial analysis. Patients were classified into severe and nonsevere groups based on the current guidelines. The 13 patients in the severe group were significantly older, had a greater prevalence of bilateral pneumonia and leukocytosis, and higher aspartate transaminase levels than patients in the nonsevere group. Patients in the severe group had a slightly lower left ventricular ejection fraction (LVEF) than those in the nonsevere group (median [interquartile range], 61.0% [58.5%, 62.3%] vs. 66.7% [60.6%, 69.8%], P = 0.015). In a subgroup of 34 patients in whom GLS could be analyzed, patients in the severe group had a significantly impaired left ventricular GLS (LVGLS) than those in the nonsevere group (−18.1% [−18.8%, −17.1%] vs. −21.7% [−22.9%, −19.9%], P = 0.001). There were no significant differences in total wall (RVGLS total , −19.3% [−23.9%, −18.4%] vs. −24.3% [−26.0%, −22.6%], P = 0.060) and free wall (RVGLS fw , −22.7% [−27.2%, −18.6%] vs. −28.8% [−30.4%, −24.1%], P = 0.066) right ventricle GLS (RVGLS). Conclusion Patients with severe COVID-19 had lower LVEF and LVGLS. RVGLS was not different between patients with severe and nonsevere COVID-19.

PURPOSE: The purpose of this study was to investigate the experience of uncertainty in cancer patients undergoing chemotherapy in South Korea. METHODS: Data were obtained from in-depth interviews with ten cancer patients conducted from Mar. 21 to Nov. 11, 2017. The data were collected until saturation and analyzed via Colazzi's phenomenological method. RESULTS: In this study, 6 categories were extracted: Four categories contributed to uncertainty including ‘Confusion about cancer and course of treatment’, ‘Inner conflicts’, ‘Being overwhelmed by treatment’, and ‘Unknown future’. Two categories facilitated coping with uncertainty including ‘Seeking knowledge’ and ‘Need for spiritual peace’. CONCLUSION: Uncertainty experiences for cancer patients undergoing chemotherapy in different societies is largely similar. However, some experiences seemed unique to Korean patients. Also, there is a great deal of uncertainty about the treatment outcomes and loss of treatment opportunities in cancer patients undergoing chemotherapy. The results of this study will help oncology professionals develop patient-centered psychological interventions by improving understanding of the uncertainty of cancer patients undergoing chemotherapy.
Drug Therapy* ; Humans ; Korea ; Methods ; Qualitative Research ; Uncertainty*

PURPOSE: To develop end-of-life care training programs for nurses who provide in a tertiary hospital, we examined the mediating effects of empathy and resilience on the relationship between their stress and job performance. METHODS: This study was conducted with 218 participants at a hospital in B city in South Korea from August 15 through August 30, 2017. Data collected from the participants were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficients, and multiple regression using the IBM SPSS/WIN 21.0 software. RESULTS: Terminal care stress was found to be negatively correlated with empathy competence (r=−0.345, P < 0.001), resilience (r=−0.223, P=0.001) and terminal care performance (r=−0.260, P < 0.001), whereas empathy (r=0.467, P < 0.001) and resilience (r=0.358, P < 0.001) were positively correlated with terminal care performance. Empathy had a complete mediating effect (β=0.409, P < 0.001) on the relationship between terminal care stress and performance, and resilience a partial mediating effect (β=0.294, P < 0.001). CONCLUSION: Based on the findings of this study, development of training programs with a focus on empathy and resilience are highly recommended to improve job performance of nurses who provide terminal care in a tertiary hospital.
Education ; Empathy* ; Korea ; Mental Competency ; Negotiating* ; Terminal Care* ; Tertiary Care Centers* ; Work Performance

OBJECTIVE: This study was conducted to assess the surgical results of one-stage posterior minimal laminectomy and video-assisted thoracoscopic surgery (VATS) for the treatment of thoracic dumbbell tumor and to describe its precise technique. In addition, we investigated the technique's usefulness and limitations. METHODS: Seven cases of thoracic dumbbell tumor (two men and five women, mean age, 43 years) were analyzed retrospectively. Pathological findings included schwannoma in four patients, neurofibroma in two patients, and hemangioma in one patient. The location of tumors varied from T2/3 to T12/L1. Dumbbell tumors were resected by one-stage operation using posterior laminectomy followed by VATS without instrumentation. Clinical data were reviewed. RESULTS: The mean follow-up period was 25 months (range, 3–58 months), and the operative time ranged from 255 to 385 min (mean, 331 min), with estimated blood loss ranging from 110 to 930 mL (mean, 348 mL). The tumor was completely resected without instrumentation and postoperative instability in all cases. Postoperative complications included atelectasis and facial anhydrosis in one case each. CONCLUSION: One-stage posterior minimal laminectomy and VATS may be a safe and less invasive technique for removal of thoracic dumbbell tumor without instability. This method has the advantage of early ambulation and rapid recovery because it reduces blood loss and postoperative pain.
Early Ambulation ; Female ; Follow-Up Studies ; Hemangioma ; Humans ; Laminectomy* ; Male ; Methods ; Neurilemmoma ; Neurofibroma ; Operative Time ; Pain, Postoperative ; Postoperative Complications ; Pulmonary Atelectasis ; Retrospective Studies ; Thoracic Surgery, Video-Assisted*

Sweet's syndrome is an uncommon reactive dermatoses characterized by fever, polymorphonuclear leukocytosis, painful erythematous plaques, and dense dermal infiltrate of neutrophils. Sweet's syndrome can be associated with several diseases, including infectious diseases, malignant tumors, and autoimmune diseases. However, no case of Sweet's syndrome associated with Sjogren's syndrome (SjS) has been reported in Korea. A 44-year-old woman presented with acute pustular rashes and fever. The patient had multiple papulopustular skin rashes, and complained of fever, chills, and headache. Our patient had the characteristic clinical and histopathological features of Sweet's syndrome, in association with SjS, diagnosed by salivary gland scan, positive anti-SS-A/SS-B antibody, and sicca symptoms simultaneously. Thus, we report on a case of a patient with Sweet's syndrome with concomitant diagnosis of SjS.
Adult ; Autoimmune Diseases ; Chills ; Communicable Diseases ; Diagnosis ; Exanthema ; Female ; Fever ; Headache ; Humans ; Korea ; Leukocytosis ; Neutrophils ; Salivary Glands ; Sjogren's Syndrome* ; Skin Diseases ; Sweet Syndrome*

BACKGROUND: Metabolic health is an emerging concept that is highly correlated with various metabolic complications, and adipocytokines have been causally linked to a wide range of metabolic diseases. Thus, this study compared serum adipocytokine levels according to metabolic health and obesity status. METHODS: Four hundred and fifty-six nondiabetic subjects (mean age, 40.5 years) were categorized into four groups according to metabolic health and obesity status: metabolically healthy nonobese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy nonobese (MUHNO), and metabolically unhealthy obese (MUHO). Being metabolically healthy was defined as the presence of fewer than two of the following five metabolic abnormalities: high blood pressure, high fasting blood glucose, high triglyceride, low high density lipoprotein cholesterol, and being in the highest decile of the homeostatic model assessment of insulin resistance index. Obesity status was assessed using body mass index (BMI), with obesity defined as a BMI higher than 25 kg/m2. Levels of serum interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor alpha (TNF-alpha), and adipocyte fatty acid binding protein (A-FABP) were also evaluated. RESULTS: Of the 456 subjects, 247 (54.2%) were in the MHNO group, 66 (14.5%) were in the MHO group, 66 (14.5%) were in the MUHNO group, and 77 (16.9%) were in the MUHO group. There were no significant differences in IL-6 or MCP-1 levels among the groups, but levels of TNF-alpha and A-FABP were significantly higher in the MUHNO group compared to the MHNO group. CONCLUSION: High TNF-alpha and A-FABP levels are significantly associated with metabolically unhealthiness in nonobese Korean individuals.
Adipocytes ; Adipokines ; Blood Glucose ; Body Mass Index ; Carrier Proteins ; Chemokine CCL2 ; Cholesterol, HDL ; Fasting ; Hypertension ; Insulin Resistance ; Interleukin-6 ; Metabolic Diseases ; Obesity* ; Triglycerides ; Tumor Necrosis Factor-alpha

BACKGROUND: Chronic kidney disease (CKD) is considered one of the most common risk factors for cardiovascular disease. Coronary artery calcification (CAC) is a potential mechanism that explains the association between renal function and cardiovascular mortality. We aimed to evaluate the association between renal function and CAC in apparently healthy Korean subjects. METHODS: A total of 23,617 participants in a health-screening program at Kangbuk Samsung Hospital were included in the study. Estimated glomerular filtration rate (eGFR) was assessed using the Cockcroft-Gault equation. Coronary artery calcium score (CACS) was measured via multidetector computed tomography. Subjects were divided into three groups according to the CKD Staging system with eGFR grade: stage 1, eGFR > or =90 mL/min/1.73 m2; stage 2, eGFR 60 to 89 mL/min/1.73 m2; and stage 3, eGFR 30 to 59 mL/min/1.73 m2. RESULTS: The mean age of the participants was 41.4 years and the mean eGFR was 103.6+/-21.7 mL/min/1.73 m2. Hypertension and diabetes were noted in 43.7% and 5.5% of the participants, respectively. eGFR showed a weakly negative but significant association with CACS in bivariate correlation analysis (r=-0.076, P<0.01). Mean CACS significantly increased from CKD stage 1 to 3. The proportion of subjects who had CAC significantly increased from CKD stage 1 to 3. Although the odds ratio for CAC significantly increased from stage 1 to 3 after adjustment for confounding factors, this significance was reversed when age was included in the model. CONCLUSION: In early CKD, renal function negatively correlated with the degree of CAC in Korean subjects. Age was the strongest effector for this association.
Adult* ; Calcium ; Cardiovascular Diseases ; Coronary Vessels* ; Glomerular Filtration Rate* ; Humans ; Hypertension ; Mortality ; Multidetector Computed Tomography ; Odds Ratio ; Renal Insufficiency, Chronic ; Risk Factors

BACKGROUND: The hypertriglyceridemic waist (HTGW) phenotype is a simple and inexpensive screening parameter to identify people at increased risk of cardiovascular disease. We evaluated whether the HTGW phenotype predicts diabetes in urban Korean adults. METHODS: A total of 2,900 nondiabetic subjects (mean age 44.3 years), comprising 2,078 males (71.7%) and 822 females (28.3%) who underwent annual medical check-ups at our center between January 2005 and December 2009, were recruited. The subjects were divided into four groups according to baseline serum triglyceride (TG) level and waist circumference (WC): normal WC-normal TG (NWNT) level, normal WC-high TG level, enlarged WC-normal TG level, and enlarged WC-high TG (EWHT) level. High serum TG level was defined as > or =150 mg/dL and enlarged WC was defined as > or =90 cm for men and > or =85 cm for women. New cases of diabetes were determined according to questionnaires filled in by participants and the diagnostic criteria of the American Diabetes Association. Cox proportional hazards model analysis was used to assess the association of HTGW phenotype with the incidence of diabetes. RESULTS: A total of 101 (3.5%) new diabetes cases were diagnosed during the study period. The EWHT group had a higher incidence of diabetes (8.3%) compared with the NWNT group (2.2%). The adjusted hazard ratio for diabetes for subjects with the EWHT phenotype at baseline was 4.113 (95% confidence interval [CI], 2.397 to 7.059) after adjustment for age, and 2.429 (95% CI, 1.370 to 4.307) after adjustment for age, sex, total cholesterol, systolic blood pressure, and alcohol drinking history. It was attenuated by inclusion of baseline fasting glucose level in the model. CONCLUSION: Subjects with the HTGW phenotype showed the highest risk of incident diabetes. This tool could be useful for identifying individuals at high risk of diabetes.
Adult ; Alcohol Drinking ; Blood Pressure ; Cardiovascular Diseases ; Cholesterol ; Fasting ; Female ; Glucose ; Humans ; Hypertriglyceridemia ; Hypertriglyceridemic Waist* ; Incidence ; Longitudinal Studies* ; Male ; Mass Screening ; Phenotype* ; Proportional Hazards Models ; Triglycerides ; Waist Circumference ; Surveys and Questionnaires

BACKGROUND/AIMS: Adenoma detection rate (ADR) is widely used as an index of colonoscopy quality management. Although advanced adenomas can be found less frequently than non-advanced adenomas, advanced adenomas have a higher clinical significance during screening for colorectal cancer. The aim of this study was to investigate the correlation between advanced and non-advanced ADR among colonoscopists. METHODS: This study is an observational study of a cohort of patients undergoing screening colonoscopy between 2009 and 2010. We collected the data on patients' characteristics and colonoscopic findings. The detection rates of adenoma and advanced adenoma were calculated. Logistic regression was used to determine the effects of variables on advanced adenoma detection, and spearman's rank-order correlation was used to evaluate the relationship between advanced ADR and ADR. RESULTS: A total of 561 patients underwent screening colonoscopy by 18 experienced colonoscopists. Most colonoscopists had adequate (>20%) ADRs. Logistic regression showed that increased patient age (OR 1.07 per 1 year increase, 95% CI 1.009-1.133, p=0.023) and male gender (OR 1.860, 95% CI 0.764-4.529, p=0.171) were associated with advanced ADR. When colonoscopists were divided into two groups on the basis of advanced ADR of 5%, ADR was also significantly higher in the group having higher level of advanced ADR. However, there was no correlation between advanced ADR and ADR among colonoscopists as an individual. CONCLUSIONS: Colonoscopists' advanced ADRs were independent of their ADRs, indicating that advanced ADR could be quite low even among colonoscopists with acceptable ADRs. Thus, there seems to be a limitation in using ADR as an adequate index of colonoscopy quality management.
Adenoma/*diagnosis ; Adult ; Aged ; Cohort Studies ; Colonoscopy ; Colorectal Neoplasms/*diagnosis ; Early Detection of Cancer ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Neoplasm Staging ; Odds Ratio

BACKGROUND: Smoking is a major risk factor of stroke, but not all smokers develop stroke. This individual difference could be explained by the variation of detoxification capacity. We investigated the relationship of smoking with the genetic polymorphism of a detoxification enzyme (glutathione S-transferase: GST). METHODS: This study was conducted as a case-control study. Conventional risk factors for stroke and 3 genetic polymorphisms of GST (GSTM1, GSTT1, and GSTP1) were studied in both 290 acute ischemic stroke patients and 290 age and sex matched controls. Smoking status was determined by urinary cotinine level. The effect of interaction of GST polymorphisms and smoking on stroke risk was investigated. RESULTS: Stroke patients had higher cotinine level compared to that of control (P<0.01). There was little difference between the patient group and control group with regard to the GST polymorphism alone, but significant interaction was noticed between the GST polymorphism and the smoking status. When we stratified the group according to the smoking status by cotinine level, stroke was significantly more frequent in GSTM1 null type and GSTT1, GSTP1 wild type of the high cotinine level group (OR and 95% CI: 2.115, 1.219-3.670; 2.620, 1.480-4.638; 2.212, 1.343-3.644 respectively). CONCLUSION: GST polymorphisms interact with the smoking and confer an increased risk of ischemic stroke, indicating that genetic polymorphism of GST might reveal smokers who are more susceptible to the ischemic stroke.
Case-Control Studies ; Cotinine ; Glutathione ; Glutathione Transferase ; Humans ; Individuality ; Polymorphism, Genetic ; Risk Factors ; Smoke ; Smoking ; Stroke