Purpose: Interpersonal competence, a key competence for patient-centered care by nurses, should be understood. Therefore, factors influencing the interpersonal competence of nursing students should be identified to explore and enhance their interpersonal relationships during the undergraduate educational curriculum for nursing educators. In this study factors influencing interpersonal competence, especially on self-assertiveness and empathy in nursing students were identified and analysed. Methods: A cross-sectional study design was used for the study in two Korean nursing colleges with similar baccalaureate nursing curricula. A total of 251 nursing students from freshman to senior year completed a questionnaire to measure related factors that were assumed to influence nursing students’ interpersonal competence. Data were collected from October 11~31, 2016. Study variables included self-assertiveness, empathy, interpersonal competence, and socio-demographic status. Multiple regression analysis was used for data analysis. Results: Nursing students’ interpersonal competence was explained by personality (β=.22), self-assertiveness (β=.16) and empathy (β=.38). The explanatory power of these predictors was 26.8% (p<.001). Conclusions Nursing students’ interpersonal competence during the undergraduate nursing years can be enhanced by educational strategies that improve their interpersonal relationship as patient-centered care providers. Simultaneously, the attitude of the nurse educator is also important for nursing students who are to be treated as valuable learners and to improve students' empathy and self-assertiveness ability.

Background: and Purpose: The myelin oligodendrocyte glycoprotein (MOG) antibody is detected at a high rate in childhood acquired demyelinating syndrome (ADS). This study aimed to determine the diagnostic value of the MOG antibody in ADS and the spectrum of MOGantibody-positive demyelinating diseases in children. Methods: This study included 128 patients diagnosed with ADS (n=94) or unexplained encephalitis (n=34). The MOG antibody in serum was tested using an in-house live-cell-based immunofluorescence assay. Results: The MOG antibody was detected in 48 patients (46 ADS patients and 2 encephalitis patients, comprising 23 males and 25 females). Acute disseminated encephalomyelitis (ADEM) (35.4%) was the most-common diagnosis, followed by the unclassified form (17.4%), isolated optic neuritis (ON) (15.2%), neuromyelitis optica spectrum disorder (13.0%), multiple sclerosis (MS) (10.8%), other clinically isolated syndromes [monophasic event except ADEM, isolated ON, or transverse myelitis (TM)] (8.7%), and unexplained encephalitis (4.3%). At the initial presentation, 35 out of the 46 patients with ADS had brain lesions detected in magnetic resonance imaging, and 54% of these 35 patients had encephalopathy. Nine of the 11 patients without brain lesions exhibited only ON. Thirty-nine percent of the patients experienced a multiphasic event during the mean follow-up period of 34.9 months (range 1.4–169.0 months). Encephalopathy at the initial presentation was frequently confirmed in the monophasic group (p= 0.011). Conclusions MOG antibodies were identified in all pediatric ADS phenotypes except for monophasic TM. Therefore, the MOG antibody test is recommended for all pediatric patients with ADS, especially before a diagnosis of MS and for patients without a clear diagnosis.

Limb-girdle muscular dystrophy (LGMD) is a group of muscular dystrophies that has extremely heterogeneous clinical features and genetic background. The caveolin-3 gene (CAV3) is one of the causative genes. LGMD appears as a clinical continuum, from isolated skeletal muscle involvement to long QT syndrome. Here we report two patients without apparent muscle weakness in a family with CAV3 mutation.A 7-month-old Korean boy visited our muscle clinic because of an incidental finding of elevated serum creatine kinase (CK) concentration (680 IU/L, reference range, 20-270 IU/L) without clinical symptoms. The patient was born after an uneventful pregnancy and showed normal developmental milestones. He developed pseudohypertrophy of his calf muscle during the follow-up. We obtained a muscle biopsy at age 14 months, which showed size variations and degenerating/regenerating myofibers with endomysial fibrosis and immunohistochemical evidence of normal dystrophin. Under the impression of LGMD, we performed target panel sequencing and identified a heterozygous in-frame mutation of CAV3, c.307_312delGTGGTG (p.Val103_Val104del). Immunohistochemical staining of muscle indicated complete loss of caveolin-3 compared with normal control muscle, which supported the variant's pathogenicity. We performed segregation analysis and found that the patient's mother had the same variant with elevated serum CK level (972 IU/L).We report on autosomal dominant familial caveolinopathy caused by a pathogenic variant in CAV3, which was asymptomatic until the fourth decade. This case highlights the utility of next generation sequencing in the diagnosis of muscular dystrophies and the additive role of muscle biopsy to confirm the variants.

A 19-year-old girl with immunosuppressive agents of tacrolimus and mychophenolate mofetil following liver transplantation due to glycogen storage disease visited hospital due to lower extremity motor weakness and blurred vision. Motor power was checked as grade II in the upper extremities and grade 0 in the lower extremities with absence of deep tendon reflexes and anal sphincter dysfunction. The magnetic resonance imaging (MRI) showed increased T2 high signal intensity lesions from C4 to L2 level of spinal cord, cerebral cortex, and the left optic nerve. The cerebrospinal fluid (CSF) analysis showed pleocytosis. Epstein-Barr virus (EBV) deoxyribonucleic acid (DNA) was detected as 5,954 copies/mL in CSF whereas all other microbiologic tests were negative. Anti-aquaporin 4 antibody and oligoclonal band were not detected. Intravenous immunoglobulin, methylprednisolone pulse therapy and 3-week course of acyclovir were administered. Although motor power in the upper extremities recovered to grade V, motor power in the lower extremities did not show any improvement. The EBV viral load was not detected in the follow-up CSF examination. EBV infection in an immune-compromised patient could cause extensive demyelinating diseases in central nervous system and result in severe disability.
Acyclovir ; Anal Canal ; Brain* ; Central Nervous System ; Cerebral Cortex ; Cerebrospinal Fluid ; Demyelinating Diseases ; DNA ; Epstein-Barr Virus Infections ; Female ; Follow-Up Studies ; Glycogen Storage Disease ; Herpesvirus 4, Human* ; Humans ; Immunocompromised Host ; Immunoglobulins ; Immunosuppressive Agents ; Leukocytosis ; Liver Transplantation ; Lower Extremity ; Magnetic Resonance Imaging ; Methylprednisolone ; Myelitis, Transverse* ; Optic Nerve ; Reflex, Stretch ; Spinal Cord ; Tacrolimus ; Upper Extremity ; Viral Load ; Young Adult

PURPOSE: Cerebral venous thrombosis (CVT) is a rare cause of pediatric stroke. Our goal was to describe the clinical CVT features among pediatric patients presenting at a tertiary referral center. METHODS: Patient data was retrospectively collected from the charts of all pediatric patients (newborn to 18 years old) who were diagnosed with CVT at Seoul National University Children's Hospital between 2000 and 2016. Magnetic resonance imaging or venography was conducted for diagnostic confirmation. Modified Rankin Scale (mRS) was used to evaluate neurologic outcome. RESULTS: Twenty patients were diagnosed with CVT during the study period (16 male, 4 female). Median age was 4 years. The most common risk factor was systemic infection (6/20, 30.0%). Twelve patients initially presented with headache or vomiting (12/20, 60.0%). Seizure was in only 3 patients within 48 hours of symptom onset; however, as the clinical course progressed, seizure was the symptom that most frequently led to brain imaging (12/20, 60.0%). Thrombosis in the superior sagittal sinus was frequently associated with intracranial hemorrhage (4/11, 36.4%) and clinical seizure (9/11, 81.8%). Anticoagulation and/or antiplatelet agents were used in 16 patients (16/20, 80%). At the 3-month follow-up, 14 patients (14/20, 70%) had an mRS of 0 or 1, showing that most of these patients had no neurologic impairment. CONCLUSION: Seizure and signs of increased intracranial pressure are the most common manifestation of pediatric CVT. However, clinical features are diverse and include age at symptom onset and underlying risk factors. Despite diagnostic delay, neurologic outcome is favorable in most patients.
Follow-Up Studies ; Headache ; Humans ; Intracranial Hemorrhages ; Intracranial Pressure ; Korea* ; Magnetic Resonance Imaging ; Male ; Neuroimaging ; Pediatrics ; Phlebography ; Platelet Aggregation Inhibitors ; Retrospective Studies ; Risk Factors ; Seizures ; Seoul ; Stroke ; Superior Sagittal Sinus ; Tertiary Care Centers ; Thrombosis ; Venous Thrombosis* ; Vomiting

PURPOSE: The aim of this study is to investigate the anesthetic effect on a modified subcutaneous single-injection digital block in accordance with the location of the finger. METHODS: We recruited volunteers from the workshop training course. We injected less than 5 mL of 2% lidocaine at the volar side, between the 3rd metacarpal and proximal phalangeal joint, until the swelling in the dorsal side of the finger increased. At 10 minutes post the modified subcutaneous single-injection digital block, we recorded the pain score (0-10) using 11-point numeric rating pain scale (NRPS) according to the location of the finger (volar proximal phalanx, VPP; volar middle phalanx, VMP; volar distal phalanx, VDP; dorsal distal phalanx, DDP; dorsal middle phalanx, DMP; dorsal proximal phalanx, DPP) via a pinprick test. We analyzed and compared the NRPS on the location of the finger by the Friedman test with a Pairwise comparison. RESULTS: Fifty-eight volunteers of healthy adult were enrolled in this study. The pain scales on DPP and DMP were 7.00 (4.00-8.00) and 2.00 (1.00-4.00), respectively. The pain scales on DDP, VDP, VMP and VDP were 0.00 (0.00-2.00), 0.00 (0.00-0.00), 0.00 (0.00-1.00) and 0.00 (0.00-1.00), respectively. The pain scales on DPP and DMP were significantly different among DDP, VPP, VMP and VPP (p<0.05). There were no significant differences of pain scale on DDP, VDP, VMP and VPP (DDP vs. VDP, p=0.592; DDP vs. VMP, p=0.749; DDP vs. VPP, p>0.999; VDP vs. VMP, p>0.999; VMP vs. VPP, >0.999). CONCLUSION: A modified subcutaneous single-injection digital block should be considered useful in regional anesthesia at the volar side of the finger and the dorsal side of the distal phalanx.
Adult ; Anesthesia, Conduction ; Anesthesia, Local ; Anesthetics* ; Education ; Finger Injuries ; Fingers ; Humans ; Injections, Subcutaneous ; Joints ; Lidocaine ; Nerve Block ; Pain Measurement ; Volunteers ; Weights and Measures

PURPOSE: Bone loss resulting from cancer treatment is an emerging problem among cancer survivors. However, the mechanism and treatment of cancer treatment-induced bone loss (CTIBL) is not fully understood. The purpose of this article was to review the recent advances in CTIBL. METHODS: A comprehensive review of the literature was conducted. RESULTS: Risk factors for CTIBL that are unique to or commonly found in cancer survivors include chemotherapy-induced menopause, anti-estrogen and anti-androgen therapies, gonadotropin-releasing hormone suppression of gonadal function, and use of glucocorticoids. Assessment of CTIBL is performed using dual X-ray absorptiometry testing for measurement of BMD levels, Fracture Risk Assessment Tool, and bone turnover markers. Initial strategies for prevention of CTIBL include lifestyle modifications such as exercise, an adequate intake of calcium and vitamin D, avoiding tobacco use, and limiting alcohol intake. Pharmacologic therapy should be considered for patients at high risk for bone loss or fracture. CONCLUSIONS: Prevention of CTIBL may be the best way to decrease morbidity and financial costs associated with osteoporosis and/or fractures. Oncology nurses should be well prepared to identify cancer survivors at risk of CTIBL, and to provide them with education regarding prevention and treatment of CTIBL.
Absorptiometry, Photon ; Breast Neoplasms ; Breast* ; Calcium ; Education ; Female ; Fractures, Bone ; Glucocorticoids ; Gonadotropin-Releasing Hormone ; Gonads ; Health Promotion ; Humans ; Life Style ; Menopause ; Osteoporosis ; Prostate* ; Prostatic Neoplasms* ; Risk Assessment ; Risk Factors ; Survivors ; Tobacco ; Vitamin D

OBJECTIVE: To determine the reliable perfusion parameters in dynamic contrast-enhanced MRI (DCE-MRI) for the monitoring antiangiogenic treatment in mice. MATERIALS AND METHODS: Mice, with U-118 MG tumor, were treated with either saline (n = 3) or antiangiogenic agent (sunitinib, n = 8). Before (day 0) and after (days 2, 8, 15, 25) treatment, DCE examinations using correlations of perfusion parameters (Kep, Kel, and AH from two compartment model; time to peak, initial slope and % enhancement from time-intensity curve analysis) were evaluated. RESULTS: Tumor growth rate was found to be 129% +/- 28 in control group, -33% +/- 11 in four mice with sunitinib-treatment (tumor regression) and 47% +/- 15 in four with sunitinib-treatment (growth retardation). Kep (r = 0.80) and initial slope (r = 0.84) showed strong positive correlation to the initial tumor volume (p < 0.05). In control mice, tumor regression group and growth retardation group animals, Kep (r : 0.75, 0.78, 0.81, 0.69) and initial slope (r : 0.79, 0.65, 0.67, 0.84) showed significant correlation with tumor volume (p < 0.01). In four mice with tumor re-growth, Kep and initial slope increased 20% or greater at earlier (n = 2) than or same periods (n = 2) to when the tumor started to re-grow with 20% or greater growth rate. CONCLUSION: Kep and initial slope may a reliable parameters for monitoring the response of antiangiogenic treatment.
Angiogenesis Inhibitors/therapeutic use ; Animals ; Contrast Media/*diagnostic use ; Female ; Heterografts ; Indoles/*therapeutic use ; Longitudinal Studies ; Magnetic Resonance Imaging/*methods ; Mice ; Mice, Inbred BALB C ; Neoplasm Transplantation ; Neoplasms, Experimental/*diagnosis/drug therapy/pathology ; Pyrroles/*therapeutic use ; Reproducibility of Results ; Tumor Burden

BACKGROUND: This study was designed to examine the prevalence of aberrant promoter methylation in a selected panel of genes potentially involved in lymphoid tumors. METHODS: The promoter hypermethylation status of MGMT, DAPK1, hMLH1, CDH1, SHP1, and HIC1 was measured by methylation-specific PCR for 82 cases of B-cell lymphoma. Immunohistochemical staining using MGMT and SHP1 antibodies was conducted on 43 out of 82 cases. RESULTS: The number of MGMT aberrant methylations was lower in diffuse large B-cell lymphoma (DLBCL) than in other malignant lymphomas. The methylation of DAPK1 was frequently detected in follicular lymphoma (FL), marginal zone B-cell lymphoma (MZL) and DLBCL. With one exception, methylation of hMLH1 was not observed in B-cell lymphomas. The methylation frequency of CDH1, and HIC1 was similar in B-cell lymphomas. However, the methylation of SHP1 gene was more frequently observed in cases of FL, DLBCL, and MZL than in chronic lymphocytic lymphoma. MGMT and SHP1 promoter methylation were inversely correlated with the protein expression observed upon immunohistochemical staining. CONCLUSIONS: Aberrant promoter methylation of multiple genes occurs with variable frequency throughout the B-cell lymphomas, and methylation of hMLH1 is rarely observed in B-cell lymphomas.
Antibodies ; B-Lymphocytes ; DNA ; DNA Methylation ; Leukemia, Lymphocytic, Chronic, B-Cell ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, B-Cell, Marginal Zone ; Lymphoma, Follicular ; Methylation ; Polymerase Chain Reaction ; Prevalence

Claudin-7 has recently been suggested to be a distal nephron marker. We tested the possibility that expression of claudin-7 could be used as a marker of renal tumors originating from the distal nephron. We examined the immunohistochemical expression of claudin-7 and parvalbumin in 239 renal tumors, including 179 clear cell renal cell carcinoma (RCC)s, 29 papillary RCCs, 20 chromophobe RCCs, and 11 renal oncocytomas. In addition, the methylation specific-PCR (MSP) of claudin-7 was performed. Claudin-7 and parvalbumin immunostains were positive in 3.4%, 7.8% of clear cell RCCs, 34.5%, 31.0% of papillary RCCs, 95.0%, 80.0% of chromophobe RCCs, and 72.7%, 81.8% of renal oncocytomas, respectively. The sensitivity and specificity of claudin-7 in diagnosing chromophobe RCC among subtypes of RCC were 95.0% and 92.3%. Those of parvalbumin were 80.0% and 88.9%. The expression pattern of claudin-7 was mostly diffuse in chromophobe RCC and was either focal or diffuse in oncocytoma. All of the cases examined in the MSP revealed the presence of unmethylated promoter of claudin-7 without regard to claudin-7 immunoreactivity. Hypermethylation of the promoter might not be the underlying mechanism for loss of its expression in RCC. Claudin-7 can be used as a useful diagnostic marker in diagnosing chromophobe RCC and oncocytoma.
Tumor Markers, Biological/metabolism ; Tumor Cells, Cultured ; Tissue Distribution ; Sensitivity and Specificity ; Reproducibility of Results ; Nephrons/metabolism ; Neoplasm Proteins/metabolism ; Membrane Proteins/analysis/*metabolism ; Kidney Neoplasms/*diagnosis/*metabolism ; Humans ; Carcinoma, Renal Cell/*diagnosis/*metabolism ; Adenoma, Oxyphilic/*diagnosis/*metabolism