Clinical Characteristics of Cytomegalovirus Disease of the Upper Gastrointestinal Tract: A 10-Year Multicenter Retrospective Study

Objectives@#Gastrointestinal cytomegalovirus (CMV) disease is a major contributor to mortality in immunocompromised patients. Few studies have discussed upper gastrointestinal CMV (UGICMV) disease in immunocompetent patients. We compared the clinical outcomes of UGI-CMV between immunocompromised and immunocompetent patients. @*Methods@#This retrospective study included patients with UGI-CMV disease from five tertiary hospitals across Korea (2010– 2022). Patients’ clinical data and outcomes were recorded. @*Results@#UGI-CMV was diagnosed in 54 patients; 27 (50.0%) had esophageal, 24 (44.4%) had gastric, and 3 patients (5.6%) had duodenal involvement. Patients’ median age was 64 years (interquartile range 53–75 years), and the most common comorbidities included hypertension (57.4%) and diabetes (38.9%). The predominant symptom was abdominal pain (46.3%), and the most common endoscopic finding was ulcers (70.4%). Antiviral treatment was administered to 31 patients, and 23 patients underwent observation without treatment. We investigated 32 immunocompromised (59.3%) and 22 immunocompetent (40.7%) patients and observed no intergroup differences in comorbidities and in laboratory and endoscopic findings. Immunocompromised patients had longer length of hospitalization (median 46.2 days vs. 20.0 days, p=0.001). However, treatment outcomes, including the need for intensive care unit admission and mortality did not significantly differ. The overall mortality rate was 13.0%; one patient from the immunocompromised group died of UGI-CMV disease. The treatment success rate was higher in immunocompromised patients who received antiviral therapy (p=0.011). @*Conclusions@#UGI-CMV disease is not uncommon in immunocompetent patients, although symptoms are milder than those in immunocompromised patients. Our findings emphasize the importance of clinical vigilance for accurate diagnosis of CMV infection, particularly in susceptible symptomatic patients and highlight the need for active antiviral treatment for management of immunocompromised patients.

Implementation of a Nurse-Delivered Cognitive Behavioral Therapy for Adherence and Depression of People Living with HIV in Korea / 감염과화학요법

Background@#Cognitive behavioral therapy for adherence and depression (CBT-AD) performed by clinical psychologists is an effective treatment for improving the depression in people living with HIV (PLWH). However, because access to clinical psychologists is limited in most clinics, CBT-AD is rarely performed for PLWH in Korea. This pilot study evaluates whether CBT-AD can be effectively performed by a nurse trained and supervised by a clinical psychologist, with a view to the wider provision of CBT-AD. @*Materials and Methods@#One clinical psychologist developed manuals, educated and supervised one nurse. PLWH with depression or adherence to self-reported antiretroviral therapy <90% were enrolled, and CBT-AD was conducted once weekly for 12 sessions. PLWH were assessed for adherence by visual analog scale, Beck depression inventory (BDI) for depression, PozQoL for quality of life, and Berger’s 40-item stigma scale for stigma at baseline, after the 6th, 12th session, at 4-, and 8-months after CBT-AD. Acceptability for PLWH and feasibility for providers were evaluated through surveys. @*Results@#Five male PLWH have completed the study protocols (mean age 29.2 years). All study participants showed improving depression (mean BDI at baseline 33.0 ± 7.0, and after the 12th session 13.4 ± 3.5), and the effect was maintained at the 8-month follow-up (BDI 15.4 ± 6.4). Quality of life showed a tendency to improve (mean PozQoL at baseline 28.0 ± 7.7, after 12th session 36.8 ± 4.4, and at the 8-month follow-up 38.2 ± 7.9), but stigma did not show clear improvement (Berger’s 40-item stigma scale at baseline 121.0 ± 3.9, after 12th session 107.6 ± 8.8. and at the 8-month follow-up 107.6 ± 5.0). All study participants received great help from CBT-AD and expressed their desire to continue. All providers agreed that nursedelivered CBT-AD could be implemented in routine clinical practice. @*Conclusion@#Our findings suggest that a nurse-delivered CBT-AD could be feasible and acceptable for PLWH through structured interventions. It has been shown to have the potential to help PLWH, especially for their depression and quality of life.

Effects of genistein on anti-tumor activity of cisplatin in human cervical cancer cell lines

OBJECTIVE: To investigate the effect of genistein on the anticancer effects of chemotherapeutic agents, we examined the effect of a genistein and cisplatin combination on CaSki human cervical cancer cells. METHODS: After the cervical cancer cells (HeLa cells, CaSki cells) had been cultured, cisplatin and genistein were added to the culture medium, and the cell activity was measured using MTT assay. The CaSki cells were cultured in a medium containing cisplatin and genistein, and then, the cells were collected in order to measure p53, Bcl2, ERK, and caspase 3 levels by western blotting. RESULTS: Both the HeLa and CaSki cells had decreased cell viabilities when the cisplatin concentration was 10 μM or higher. When combined with genistein, the cell viabilities of the HeLa and CaSki cells decreased at cisplatin concentrations of 8 μM and 6 μM, respectively. The administration of genistein increased the toxicity of cisplatin in the HeLa and CaSki cells. In the CaSki cells, the p-ERK1/2 level decreased by 37%, the p53 expression level increased by 304%, and the cleaved caspase 3 level increased by 115% in the cisplatin+genistein group compared to that in the cisplatin group. Bcl2 expression was reduced by 69% in the cisplatin+genistein group compared to that in the cisplatin group. CONCLUSION: Genistein enhances the anticancer effect of cisplatin in CaSki cells, and can be used as a chemotherapeutic adjuvant to increase the activity of a chemotherapeutic agent.

Effect of quercetin on the anti-tumor activity of cisplatin in EMT6 breast tumor-bearing mice

OBJECTIVE: The purpose of this study was to determine the effect of quercetin on the antitumor activity of cisplatin and its side-effects. METHODS: EMT6 cells, a mouse breast cancer cell line, were injected subcutaneously in mice to generate a breast tumor-bearing mouse model. Experimental groups were divided into four groups: control (C), quercetin (Q), cisplatin (CP), and cisplatin+quercetin (CP+Q). RESULTS: The tumor volume of the CP+Q group was significantly lower than that of the CP group. Serum blood urea nitrogen and creatinine levels in the CP+Q group were lower than those in the CP group. Renal γ-glutamyltranspeptidase and alkaline phosphatase activities were significantly higher in the CP+Q group than in the CP group, and the content of renal thiobarbituric acid reactive substance was significantly lower in the CP+Q group than that in the CP group. These results suggested that quercetin and cisplatin synergistically increased cellular toxicity in breast cancer cells and mediated cancer growth inhibition, thereby enhancing the antitumor effect of cisplatin compared to when only cisplatin was administered. Quercetin also reduced renal toxicity, which arose as a potential a side effect of cisplatin. CONCLUSION: The enhanced antitumor effect of cisplatin and decreased renal toxicity after quercetin treatment suggested the applicability of quercetin as an adjuvant for chemotherapeutic agents.

Urinary Albumin Excretion Reflects Cardiovascular Risk in Postmenopausal Women without Diabetes: The 2011 to 2013 Korean National Health and Nutrition Examination Survey

BACKGROUND: The objective of the current study was to determine whether there was an association between urinary albumin excretion and cardiovascular disease (CVD) risk by estimating the Framingham Risk Score (FRS) in postmenopausal women without diabetes. METHODS: This study was based on data from the Korea National Health and Nutrition Examination Survey, which was conducted by the Korean Ministry of Health and Welfare in 2011 to 2013. Data on 2,316 postmenopausal women from a total of 24,594 participants was included in the analysis. RESULTS: The mean FRS was significantly different in each of the urinary albumin to creatinine ratio (UACR) subgroups, and it increased with UACR. The FRS was 12.69±0.12 in the optimal group, 14.30±0.19 in the intermediate normal group, 14.62±0.26 in the high normal group, and 15.86±0.36 in the microalbuminuria group. After fully adjusting for potential confounding factors, high normal levels and microalbuminuria were significantly associated with the highest tertile of FRS ([odds ratio (OR), 1.642; 95% confidence interval (CI), 1.124 to 2.400] and [OR, 3.385; 95% CI, 2.088 to 5.488], respectively) compared with the optimal subgroup. High normal levels and microalbuminuria were also significantly associated with a ≥10% 10-year risk of CVD ([OR, 1.853; 95% CI, 1.122 to 3.060] and [OR, 2.831; 95% CI, 1.327 to 6.037], respectively) after adjusting for potential confounding covariates. CONCLUSION: Urinary albumin excretion reflects CVD risk in postmenopausal women without diabetes, and high normal levels and microalbuminuria were independently associated with a higher risk of CVD.

Factors Associated with Anxiety and Depression in Korean Patients with Inactive Inflammatory Bowel Disease

BACKGROUND/AIMS: Psychological distress is highly prevalent in patients with inflammatory bowel disease (IBD). We evaluated the disease characteristics and socioeconomic factors associated with anxiety and depression in Korean patients with quiescent IBD. METHODS: In total, 142 IBD patients (67 with Crohn's disease [CD] and 75 with ulcerative colitis [UC]) completed self-report questionnaires, including the Hospital Anxiety and Depression Score, the Modified Morisky Adherence Scale-8, the socioeconomic deprivation score, and the Crohn's and Colitis Knowledge Score questionnaires. RESULTS: In the CD group, 30 patients (44%) were anxious, and 10 patients (15%) were depressed; in the UC group, 31 patients (41%) were anxious, and 18 patients (24%) were depressed. Using multivariate analysis, in the CD group, socioeconomic deprivation was associated with anxiety (p=0.03), whereas disease duration (p=0.04) and socioeconomic deprivation (p=0.013) were associated with depression. In the UC group, there was no significant independent predictor of anxiety and/or depression; however, low income tended to be associated with depression (p=0.096). CONCLUSIONS: Despite clinical remission, a significant number of IBD patients present with anxiety and depression. IBD patients in remission, particularly those who are socioeconomically deprived, should be provided with appropriate psychological support.

The Difference of the Nurses' Perception on the Importance and Performance of Rehabilitation Nursing Service / 재활간호학회지

PURPOSE: The purpose of this study was to compare the rehabilitation nursing services what nurses recognize to be important and what they do in practice of the industrial workers. METHOD: The subjects were 150 nurses who were working at the industrial hospital. The questionnaire was made up with 43 items about the perception on importance and performance of rehabilitation services. RESULT: The highest services in the perception on importance and performance subscale were physical and therapeutic services. The highest difference between perception on importance and performance was the social and occupational services. The perception on importance of rehabilitation services had positive correlation with performance. The group take care of general patients had a higher level of perception on importance than the other group, and level of performance had significant difference with age and position. CONCLUSION: We need to develop the strategy for promoting the performance of services that recognize it will be important services, but not to do. Further study on system for promoting the nurse practitioner who responsible for rehabilitation nursing.

Effects of Treadmill Walking Exercise on BMD and BMI in Middle-Aged Women / 기본간호학회지

PURPOSE: The purpose of this study was to examine the effects of treadmill walking exercise on the BMD (Bone Mineral Density) and BMI (Body Mass Index) of middle-aged women in their forties. METHOD: A nonequivalent control group pretest-posttest design was used for this study. The experiment was conducted for 10 weeks from May 17 to July 25, 2004 with 29 middle-aged women in their forties, who were assigned to a walking exercise group (16) or a control group (13). The experimental group had not exercised regularly before participating in this program. The control group received no exercise treatment during the research period. The BMD and BMI were measured with peripheral dual energy x-ray absorptiometry and bioelectrical impidence analysis, respectively. chi-square-test and Mann-Whitney U test with the SPSS version 11.0 program were used to analyze the data. RESULT: Treadmill walking exercise was effective for middle-aged women in increasing BMD and decreasing BMI. CONCLUSION: The findings of this study indicate a need to develop walking exercise protocols for middle-aged women to help them achieve a healthy life.

A Study on Aging Anxiety, Depression, and Self-esteem of Middle-aged People / 기본간호학회지

PURPOSE: The purpose of this study was to investigate the relationship among aging anxiety, depression, and self-esteem of middle-aged people. METHOD: The study was designed as a descriptive correlation study. Data were collected using a structured questionnaire which included general characteristics, and measures of aging anxiety, depression, and self-esteem. Data collection was done between March 15 and June 10. 2006 with 184 middle-aged participants. RESULTS: The average score of the participants for aging anxiety was 48.38, for depression 16.49, and for self-esteem 29.08. There were positive correlations between aging anxiety and depression, aging anxiety and self-esteem. There was a negative correlation between depression and self-esteem. The correlations were statistically significant. CONCLUSION: Therefore, nursing program should be developed to improve the mental health and increase the qualitative life of middle-aged people.

Effects of Walking Exercise Intensities on Fatigue, Serum Lipids and Immune Function among Middle-Aged Women / 간호학회지

PURPOSE: The purpose of this study was to confirm the effects of a moderate and fast walking exercise program on middle-aged women's fatigue, serum lipids and immunoglobulins. METHOD: A non-equivalent control group pretest-posttest design was used for this study. The experiment was conducted for 10 weeks from May 17th to July 25th, 2004 with 44 middle-aged women, consisting of 16 for the moderate walking group, 15 for the fast walking group and 13 for the control group. RESULT: Walking exercise at both a moderate and fast speed was effective in middle-aged women in reducing fatigue and serum lipids. It was also revealed that extended periods of exercise was more effective in decreasing fatigue while for reducing serum lipid, high intensity exercise was more effective. In this study, serum immunoglobulins were reduced after moderate and fast walking exercise but its cause was not fully understood so further research is needed. CONCLUSION: This study helps us recognize the importance of regular exercise and promotes motivation to exercise for a healthy life among middle-aged women.

Effects of Walking Exercise Intensities on Fatigue, Serum Lipids and Immune Function among Middle-Aged Women / 간호학회지

PURPOSE: The purpose of this study was to confirm the effects of a moderate and fast walking exercise program on middle-aged women's fatigue, serum lipids and immunoglobulins. METHOD: A non-equivalent control group pretest-posttest design was used for this study. The experiment was conducted for 10 weeks from May 17th to July 25th, 2004 with 44 middle-aged women, consisting of 16 for the moderate walking group, 15 for the fast walking group and 13 for the control group. RESULT: Walking exercise at both a moderate and fast speed was effective in middle-aged women in reducing fatigue and serum lipids. It was also revealed that extended periods of exercise was more effective in decreasing fatigue while for reducing serum lipid, high intensity exercise was more effective. In this study, serum immunoglobulins were reduced after moderate and fast walking exercise but its cause was not fully understood so further research is needed. CONCLUSION: This study helps us recognize the importance of regular exercise and promotes motivation to exercise for a healthy life among middle-aged women.

The Effect of the Continuous Intravenous Infusion of Magnesium for the Treatment of Postherpetic Neuralgia -A case report- / 대한마취과학회지

Postherpetic neuralgia (PHN) is a chronic pain syndrome associated with the reactivation of a primary varicella zoster virus infection and is one of the most serious complication of herpetic zoster. The clinical features of PHN are ongoing pain accompanied by allodynia, hyperalgesia, and paresthesia. Current treatment options aimed at relieving the symptoms of PHN include oral agents, such as, opioid, NSAIDs, antidepressants, anticonvulsants. And local anesthetics with steroids are used for subcutaneous infiltration, somatic nerve block, sympathetic nerve block and epidural nerve block. However, in some cases, the pain does not respond to this treatment. We report a case in which a patient suffering from PHN did not respond to conventional therapy, but in whom continuous intravenous infusion of magnesium and physiologic N-methyl-D-aspartate (NMDA) receptor antagonist, reduced severe pain.

Spontaneous Intracranial Hypotension and Epidural Blood Patch: A case report / 대한마취과학회지

Spontaneous intracranial hypotension (SIH), a syndrome of low CSF pressure, occurs without preceeding events such as lumbar puncture, back trauma, an operative procedure, or medical illness. Postural headache, the most characteristic symptom, usually resolves spontaneously or with bed rest, hydration, and medication. Autologous epidural blood patch is an effective management of headache in SIH patients, and here we describe a one case successfully treated 5 times with an epidural blood patch. The patient had a cardinal feature of a postural headache, low CSF pressure, and showed CSF leakages on RI cisternography. The first three epidural blood patches improved the patient's headache markedly, but the headache recurred in one month. On her second RI cisternography, we found other CSF leakage sites. After a fifth epidural blood patch the patient became asymptomatic and remained so throughout 4 months of follow up. Epidural blood patches are considered the treatment of choice in SIH patients.

The Analgesic Effects of Intercostal Nerve Block in Patients Undergoing Total Ear Reconstruction / 대한마취과학회지

BACKGROUND:Patients usually complain of severe postoperative pain at the rib cartilage recession site after total ear reconstruction surgery. We evaluated the postoperative analgesic effects of an intercostal nerve block (ICNB) in patients undergoing total ear reconstruction. METHODS: We injected normal saline (2 ml/rib space) in the control group (n = 15), and 0.75% ropivacaine (2 ml/rib space) in the ICNB group (n = 15) respectively into the 6th, 7th and 8th intercostal spaces following the induction of general anesthesia for surgery. Mean arterial pressures and heart rates were measured pre-ICNB, post-ICNB, pre-surgical incision, 10, 30 and 60 minutes after incision. Numerical rating scales (NRS: 0 = no pain, 10 = most severe pain) were measured at a postoperative 6, 12, 24, 36 and 48 hours by NRS-resting and NRS-coughing, respectively. RESULTS: Mean arterial pressures and heart rates were significantly more stable (P < 0.05) in the ICNB group at 10, 30 and 60 min after incision, than in the control group. NRS were low in all of the ICNB group throughout the postoperative period versus the control group. CONCLUSIONS: We conclude that ICNB induce stable vital signs during rib recession and has excellent postoperative analgesic effects. Thus, we recommend periop-ICNB for total ear reconstruction surgery for the management of anesthesia and postop-analgesia.

Fatigue and Quality of Life in Clinical Nurses / 기본간호학회지

PURPOSE: This study was done to identify correlations between fatigue and quality of life in clinical nurses. METHOD: A sample of 294 nurses working in 3 general hospitals answered a questionnaire containing Yoshitake's fatigue scale and WHOQOL-BREF. Data were analyzed using t-test, ANOVA and Pearson correlation coefficients. The SPSS/WIN 11.0 version program was used. RESULTS: The score for level of fatigue was 2.11 (52.7%) and quality of life, 2.89 (57.8%). The level of fatigue was highest in the physical domain followed by psychical and nervous-sensual domain in that order. There were statistically significant differences in scores of fatigue depending on the nurse's age, marital status, career, position, health status and present illness. Quality of life had the highest score in the social domain followed by physical, overall, psychological, and environmental domain in that order. There were statistically significant differences in scores on quality of life depending on nurse's age, marital status, career, position, health status and present illness. CONCLUSION: The relationship between fatigue and quality of life revealed a significant negative correlation. Based on this study, nursing administrators need to reduce the level of nurse fatigue by providing various programs, which improve quality of life.

Reliability and Validity Tests for the Fatigue Assessment Instrument(FAI) / 기본간호학회지

PURPOSE: The purpose of this study was to test the reliability and validity of FAI and to apply it in Korea. METHOD: Data were collected from 180 middle-age women. The questionnaire, which was originally developed by Schwartz, Jandorf & Krupp, was analyzed using Cronbach's a and factor analysis. RESULTS: Cronbach's a for the FAI was .9198. As a result of item analysis, 27 items were selected from the total of 29 items. Items that showed low correlation with the total scale were excluded. Six factors were fixed from the data analysis performed using principle component analysis and varimax rotation. These six factors account for 65.3% of total variance. The first factor was global fatigue severity, and the second one was fatigue consequences. The other factors were method of fatigue reduction, fatigue caused by exercise, fatigue caused by routine activity, and fatigue caused by stress and depression, sequentially. CONCLUSION: The reliability and validity of FAI were verified.

Severe Hypotension Caused by Valve Malfunction in the Self-Inflating Bag-Valve Unit: A case report / 대한마취과학회지

Mishaps related to valve malfunction in a self-inflating bag-valve unit can lead to fatal complications. We report a case of severe hypotension that resulted from the locking of the Laerdal valve in the inspiratory position during transport in the operating room. A 36 year old man had undergone an off-pump coronary artery bypass graft. Immediately before leaving the operating room, severe hypotension developed abruptly. But an EKG showed only a reduction of heart rate. We started closed cardiac massage with an intravenous bolus injection of epinephrine 0.5 microgram and reconnected the anesthesia breathing circuit. The patient was manually ventilated using the anesthesia reservoir bag. Vital signs immediately recovered. At that time, the patient's abdomen was distended and we suspected an expiratory abnormality. The self-inflating bag-valve unit was tested with an anesthesia reservoir bag as a test lung. Expiration did not occur. Another self-inflating bag-valve unit was substituted and normal ventilation was restored. It is essential that before use, a self-inflating bag-valve unit should be tested for proper function during both expiration and inspiration using a test lung such as, an anesthesia reservoir bag.

Anesthetic Management of a Child with Tracheomalacia for Aortopexy: A Case Report / 대한마취과학회지

Tracheomalacia is an uncommon disease but an important cause of respiratory distress in children. Tracheomalacia is often associated with other defects, such as esophageal atresia, tracheoesophageal fistula or paratracheal tumor. Rigid bronscopy is used to confirm tracheomalacia, and aortopexy may be applied for surgical intervention. We experienced a case of a 10 month old male infant with tracheomalacia who had undergone tracheoesophageal fistula correction 2 days after birth. Tracheomalacia was diagnosed under rigid bronchoscopy, and the tracheal wall was compressed in accordance with respiration. After aortopexy, the patient breathed smoothly and was discharged after 9 days uneventfully. Aortopexy does not seem to be familiar with pediatric anesthesiologists. We report this case with references as we were unable to find any case report about this maneuver.

Stress and Constipation in Female High School Students / 기본간호학회지

PURPOSE: The purpose of this study was to investigate the relationship between stress and constipation in female high school students. METHOD: Data were collected using a structural questionnaire which included general characteristics, stress and the status of stool elimination. Data collection was done between May 27th and 29th with 331 female high school students. RESULT: The degree of stress for the participants was 3.52 and 51.7% reported constipation. This result shows that stress was significantly related to constipation. CONCLUSION: Nursing education program should be developed to prevent serious health problem in female high school students.

Depression and Life Satisfaction of Middle-aged Man / 성인간호학회지

PURPOSE: The purpose of this study was to investigate the relationship between depression and life satisfaction of the middle aged man. METHOD: The study was designed as a descriptive correlation study. Data were collected using a structured questionnaire which included general characteristics, depression, and life satisfaction. Data collection was done between Oct. 28 and Nov. 28 on the 145 middle aged man. RESULT: The degree of depression of the subjects was 8.98 and life satisfaction was 10.52 on the average. About 8% of the subjects was included in the depression group. There was a negative correlation between depression and life satisfaction of the subjects and it was statistically significant. CONCLUSION: Therefore, it should be developed the nursing program for qualitative life of middle aged man.