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Background@#CDKN2A is a tumor suppressor gene that encodes the cell cycle inhibitor protein p16. Homozygous deletion of the CDKN2A gene has been associated with shortened survival in isocitrate dehydrogenase (IDH)–mutant gliomas. This study aimed to analyze the prognostic value of p16 and to evaluate whether p16 immunohistochemical staining could be used as a prognostic marker to replace CDKN2A genotyping in diffuse gliomas. @*Methods@#p16 immunohistochemistry was performed on tissue microarrays of 326 diffuse gliomas with diagnoses that reflected IDH-mutations and 1p/19q codeletion status. The results were divided into three groups (negative, focal expression, overexpression) according to the presence and degree of p16 expression. Survival analysis was performed to assess the prognostic value of p16 expression. @*Results@#A loss of p16 expression predicted a significantly worse outcome in all glioma patients (n=326, p<.001), in the IDH-mutant glioma patients (n=103, p=.010), and in the IDH-mutant astrocytoma patients (n=73, p=.032). However, loss of p16 expression did not predict the outcome in the IDH-wildtype glioma patients (n=223, p=.121) or in the oligodendroglial tumor patients with the IDH-mutation and 1p/19q codeletion (n=30, p=.457). Multivariate analysis showed the association was still significant in the IDH-mutant glioma patients (p=.008; hazard ratio [HR], 2.637; 95% confidence interval [CI], 1.295 to 5.372) and in the IDH-mutant astrocytoma patients (p=.001; HR, 3.586; 95% CI, 1.649 to 7.801). Interestingly, patients who presented with tumors with p16 overexpression also had shorter survival times than did patients with tumors with p16 focal expression in the whole glioma (p< .001) and in IDH-mutant glioma groups. (p=.046). @*Conclusions@#This study suggests that detection of p16 expression by immunohistochemistry can be used as a useful surrogate test to predict prognosis, especially in IDH-mutant astrocytoma patients.
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Purpose@#Sentinel lymph node biopsy (SLNB) alone following neoadjuvant chemotherapy (NAC) remains controversial in patients with breast cancer who are initially lymph nodepositive. The present study aimed to evaluate the impact of SLNB and axillary lymph node dissection (ALND) on breast cancer recurrence and survival in patients who converted from lymph node-positive to pathological node-negative (ypN0) after NAC. @*Methods@#This single-center retrospective study included 223 patients who converted to axillary lymph node-negative status after NAC and underwent breast and axillary surgery between January 2006 and December 2015. This study compared the overall survival (OS), disease-free survival (DFS), ipsilateral axillary lymph node recurrence rates and incidence of postoperative complications, especially, arm lymphedema and shoulder stiffness between SLNB and ALND. @*Results@#This study included 223 patients with axillary pathological complete response (pCR) after NAC and surgery. The SLNB and ALND groups included 94 and 129 patients, respectively. The median follow-up time was 57 (range, 6–155) in the SLNB group and 99 (range 2–159) months in the ALND group. The corresponding 5-year OS and DFS rates were 96.3% and 94.2% (p = 0.392), and 89.2% and 86.4% (p = 0.671), respectively. Four patients (4.3%) in the SLNB group and nine (7.0%) in the ALND group developed locoregional recurrences. Ipsilateral axillary lymph node recurrence and distant metastasis were observed in one (1.1%) and three (2.3%) patients, and in 10 (10.6%) and 11 (8.5%) patients, respectively. Patients in the ALND group were more likely than their SLNB counterparts to experience complications, such as shoulder stiffness (9 [7.0%] vs. 4 [4.3%] patients, p = 0.57). The rate of lymphedema in the ALND group was three times that in the SLNB group (35 [27.1%] vs. 8 [8.5%] patients, p < 0.001). @*Conclusion@#As an alternative to ALND, SLNB has oncological safety in patients with axillary pathological complete response after NAC.
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PURPOSE: This study was conducted to identify the effects of organizational culture for the infection control and self-efficacy on compliance with standard precautions of emergency room nurses. METHODS: This cross-sectional descriptive study was conducted from 1st July to 3rd August, 2017. The participants were 200 nurses working in emergency rooms. The data was collected using structured self-report questionnaires. RESULTS: The average scores for the organizational culture for infection control, self-efficacy and compliance with standard precautions were 5.54, 3.65, and 4.31, respectively. The organizational culture for infection control (r=.59, p<.001) and self-efficacy (r=.28, p<.001) were found to have a positive, meaningful correlation with compliance with the standard precautions. Multiple regression analysis showed that compliance with standard precautions was significantly affected by the organizational culture for infection control (β=0.55, p<.001) and self-efficacy (β=0.13, p=.033). CONCLUSION: The results for this study indicate that the organizational culture for infection control and self-efficacy were highly influential factors affecting compliance with standard precautions of emergency room nurses. Therefore, in order to improve the nurses' use of the standard precautions, it was necessary to develop and evaluate a program that considers the environmental factors and self-efficacy.
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Compliance , Emergencies , Emergency Nursing , Emergency Service, Hospital , Infection Control , Organizational CultureABSTRACT
Sustainable practices of school foodservices are gaining more attentions. The study aimed to investigate dietitians' performance levels of sustainable practices in school foodservice settings in Gyeonggi Provinces. Using a survey method was used, and data were collected from 358 participants (response rate 59.7%) to be analyzed using the SPSS program. The evaluation tool for sustainable practices of school foodservices consisted of four sections and 34 criteria with 100 points. Employment status of the respondents was as follows: nutrition teachers 40.9%, dietitians (permanent) 45.1%, and temporary position dietitians 13.2%. Dietitians' performance for sustainable practices marked 65.67 points out of 100 (performance rate 66%) and were in the following order by section: sustainable foodservice management criteria (69%), support activities (69%), planning and evaluation (68%), and outcome management (52%). Regarding sub-sections, criteria that acquired higher performance rates were labelling of food origin (99%), use of seasonal vegetables and fruits (98%), food waste management by contract dealer (98%), and planning for reducing of food waste and solid waste (91%). Meanwhile, criteria that showed the lowest scores were installing water conservation devices on equipment (19%), operating food donation programs for communities (21%), use of sensor lights for electricity conservation (24%), planning for annual energy conservation (40%), and implementation of education programs for foodservice workers on sustainable activities (42%). Performance scores differed according to school levels and working experience of dietitians, indicating that dietitians at elementary school foodservices or with work experience of 15 to 20 years showed higher performance than those at high schools or with less than 5 years of work experience (P < 0.001, P < 0.05). Based on the results, action plans for improvement were suggested.
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Humans , Attention , Education , Electricity , Employment , Fruit , Nutritionists , Seasons , Solid Waste , Surveys and Questionnaires , Vegetables , Waste Management , WaterABSTRACT
BACKGROUND/OBJECTIVES: Increased mass of adipose tissue in obese persons is caused by excessive adipogenesis, which is elaborately controlled by an array of transcription factors. Inhibition of adipogenesis by diverse plant-derived substances has been explored. The aim of the current study was to examine the effects of the aqueous methanol extract of laver (Porphyra yezoensis) on adipogenesis and apoptosis in 3T3-L1 adipocytes and to investigate the mechanism underlying the effect of the laver extract. MATERIALS/METHODS: 3T3-L1 cells were treated with various concentrations of laver extract in differentiation medium. Lipid accumulation, expression of adipogenic proteins, including CCAAT enhancer-binding protein alpha, peroxisome proliferator-activated receptor gamma, fatty acid binding protein 4, and fatty acid synthase, cell viability, apoptosis, and the total content and the ratio of reduced to oxidized forms of glutathione (GSH/GSSG) were analyzed. RESULTS: Treatment with laver extract resulted in a significant decrease in lipid accumulation in 3T3-L1 adipocytes, which showed correlation with a reduction in expression of adipogenic proteins. Treatment with laver extract also resulted in a decrease in the viability of preadipocytes and an increase in the apoptosis of mature adipocytes. Treatment with laver extract led to exacerbated depletion of cellular glutathione and abolished the transient increase in GSH/GSSG ratio during adipogenesis in 3T3-L1 adipocytes. CONCLUSION: Results of our study demonstrated that treatment with the laver extract caused inhibition of adipogenesis, a decrease in proliferation of preadipocytes, and an increase in the apoptosis of mature adipocytes. It appears that these effects were caused by increasing oxidative stress, as demonstrated by the depletion and oxidation of the cellular glutathione pool in the extract-treated adipocytes. Our results suggest that a prooxidant role of laver extract is associated with its antiadipogenic and proapoptotic effects.