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Background@#Radioactive iodine (RAI) therapy is a successful therapeutic modality for Graves’ disease. However, RAI therapy can fail, and RAI therapy after antithyroid drugs (ATDs) has a lower remission rate. Therefore, many patients require repeated RAI therapy. This study investigated the clinical outcomes of repeated RAI therapy for Graves’ disease. @*Methods@#Patients who underwent RAI therapy as second-line therapy after failure of ATD treatment between 2001 and 2015 were reviewed. Remission was defined as hypothyroid or euthyroid status without ATD, and with or without levothyroxine at 12 months after RAI therapy. @*Results@#The 1-year remission rate after 2nd RAI therapy (66%, 152/230) is significantly higher than that after 1st RAI therapy (48%, 393/815) or long-term ATD treatment after 1st RAI therapy failure (42%). The clinical response to 2nd RAI therapy was more rapid. The median time intervals from the 2nd RAI therapy to ATD discontinuation (1.3 months) and to the start of levothyroxine replacement (2.5 months) were significantly shorter than those for the 1st RAI therapy. A smaller goiter size, a longer time interval between the 1st and 2nd RAI therapies, and a longer ATD discontinuation period predicted remission after the 2nd RAI therapy. Finally, in 78 patients who failed the 2nd RAI therapy, the mean ATD dosage significantly reduced 5.1 mg over 12 months. @*Conclusion@#Repeated RAI therapy can be a good therapeutic option, especially in patients with smaller goiters and those who are more responsive to the 1st RAI therapy.
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Background@#The management of cytologically indeterminate thyroid nodules is challenging for clinicians. This study aimed to compare the diagnostic performance of the Korean Thyroid Imaging Reporting and Data Systems (K-TIRADS) with that of the American College of Radiology (ACR)-TIRADS for predicting the malignancy risk of indeterminate thyroid nodules. @*Methods@#Thyroid nodules diagnosed by fine-needle aspiration (FNA) followed by surgery or core needle biopsy at a single referral hospital were enrolled. @*Results@#Among 200 thyroid nodules, 78 (39.0%) nodules were classified as indeterminate by FNA (Bethesda category III, IV, and V), and 114 (57.0%) nodules were finally diagnosed as malignancy by surgery or core needle biopsy. The area under the curve (AUC) was higher for FNA than for either TIRADS system in all nodules, while all three methods showed similar AUCs for indeterminate nodules. However, for Bethesda category III nodules, applying K-TIRADS 5 significantly increased the risk of malignancy compared to a cytological examination alone (50.0% vs. 26.5%, P=0.028), whereas applying ACR-TIRADS did not lead to a change. @*Conclusion@#K-TIRADS and ACR-TIRADS showed similar diagnostic performance in assessing indeterminate thyroid nodules, and K-TIRADS had beneficial effects for malignancy prediction in Bethesda category III nodules.
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Background@#Di-2-ethylhexyl phthalate (DEHP) is known to disrupt thyroid hormonal status. However, the underlying molecular mechanism of this disruption is unclear. Therefore, we investigated the direct effects of DEHP on the thyroid gland. @*Methods@#DEHP (vehicle, 50 mg/kg, and 500 mg/kg) was administered to Sprague-Dawley rats for 2 weeks. The expression of the thyroid hormone synthesis pathway in rat thyroid tissues was analyzed through RNA sequencing analysis, quantitative reverse transcription-polymerase chain reaction (RT-PCR), and immunohistochemical (IHC) staining. DEHP was treated to FRTL-5 rat thyroid cells, and an RT-PCR analysis was performed. A reporter gene assay containing the promoter of thyroid stimulating hormone receptor (TSHR) in Nthy-ori 3-1 human thyroid cells was constructed, and luciferase activity was determined. @*Results@#After DEHP treatment, the free thyroxine (T4) and total T4 levels in rats significantly decreased. RNA sequencing analysis of rat thyroid tissues showed little difference between vehicle and DEHP groups. In the RT-PCR analysis, Tshr expression was significantly lower in both DEHP groups (50 and 500 mg/kg) compared to that in the vehicle group, and IHC staining showed that TSHR expression in the 50 mg/kg DEHP group significantly decreased. DEHP treatment to FRTL-5 cells significantly down-regulated Tshr expression. DEHP treatment also reduced luciferase activity in a reporter gene assay for TSHR. @*Conclusion@#Although overall genetic changes in the thyroid hormone synthesis pathway are not clear, DEHP exposure could significantly down-regulate Tshr expression in thyroid glands. Down-regulation of Tshr gene appears to be one of potential mechanisms of thyroid disruption by DEHP exposure.
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Background@#Di-2-ethylhexyl phthalate (DEHP) is known to disrupt thyroid hormonal status. However, the underlying molecular mechanism of this disruption is unclear. Therefore, we investigated the direct effects of DEHP on the thyroid gland. @*Methods@#DEHP (vehicle, 50 mg/kg, and 500 mg/kg) was administered to Sprague-Dawley rats for 2 weeks. The expression of the thyroid hormone synthesis pathway in rat thyroid tissues was analyzed through RNA sequencing analysis, quantitative reverse transcription-polymerase chain reaction (RT-PCR), and immunohistochemical (IHC) staining. DEHP was treated to FRTL-5 rat thyroid cells, and an RT-PCR analysis was performed. A reporter gene assay containing the promoter of thyroid stimulating hormone receptor (TSHR) in Nthy-ori 3-1 human thyroid cells was constructed, and luciferase activity was determined. @*Results@#After DEHP treatment, the free thyroxine (T4) and total T4 levels in rats significantly decreased. RNA sequencing analysis of rat thyroid tissues showed little difference between vehicle and DEHP groups. In the RT-PCR analysis, Tshr expression was significantly lower in both DEHP groups (50 and 500 mg/kg) compared to that in the vehicle group, and IHC staining showed that TSHR expression in the 50 mg/kg DEHP group significantly decreased. DEHP treatment to FRTL-5 cells significantly down-regulated Tshr expression. DEHP treatment also reduced luciferase activity in a reporter gene assay for TSHR. @*Conclusion@#Although overall genetic changes in the thyroid hormone synthesis pathway are not clear, DEHP exposure could significantly down-regulate Tshr expression in thyroid glands. Down-regulation of Tshr gene appears to be one of potential mechanisms of thyroid disruption by DEHP exposure.
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Anti-leucine-rich glioma-inactivated 1 (LGI-1) encephalitis is clinically characterized by subacute cognitive decline and frequent seizures including fasciobrachial dystonic seizures. A 67-year-old man visited the emergency department due to the recurrent episodes of seizures of 4 days duration. At the time of the visit, he showed hyponatremia at Na 121 mg/dL. His symptoms were relieved by 3% sodium chloride and water restriction. Here we report a case of anti-LGI-1 encephalitis with worsening symptoms associated with hyponatremia.
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Background@#The value of the Fracture Risk Assessment Tool (FRAX) and the trabecular bone score (TBS) for assessing osteoporotic fracture risk has not been fully elucidated in Koreans. We conducted this study to clarify the predictive value of FRAX adjusted by TBS for osteoporotic fractures in Korean women. @*Methods@#After screening 7,192 eligible subjects from the Ansung cohort, 1,165 women aged 45 to 76 years with available bone mineral density (BMD) and TBS data were enrolled in this study. We assessed their clinical risk factors for osteoporotic fractures and evaluated the predictive value of FRAX with or without BMD and TBS. @*Results@#During the mean follow-up period of 7.5 years, 99 (8.5%) women suffered major osteoporotic fractures (MOFs) and 28 (2.4%) experienced hip fractures. FRAX without BMD, BMD-adjusted FRAX, and TBS-adjusted FRAX were significantly associated with the risk of MOFs (hazard ratio [HR] per percent increase, 1.08; 95% confidence interval [CI], 1.03 to 1.14; HR, 1.09; 95% CI, 1.03 to 1.15; and HR, 1.07; 95% CI, 1.02 to 1.13, respectively). However, BMD-adjusted FRAX and TBS-adjusted FRAX did not predict MOFs better than FRAX without BMD based on the Harrell’s C statistic. FRAX probabilities showed limited value for predicting hip fractures. The cut-off values of FRAX without BMD, FRAX with BMD, and FRAX with BMD adjusted by TBS for predicting MOFs were 7.2%, 5.0%, and 6.7%, respectively. @*Conclusion@#FRAX with BMD and TBS adjustment did not show better predictive value for osteoporotic fractures in this study than FRAX without adjustment. Moreover, the cut-off values of FRAX probabilities for treatment might be lower in Korean women than in other countries.
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BACKGROUND: The Internet has advantages in terms of accessibility and amount of information, and the search for health information over the Internet is increasing exponentially. The purpose of this study is to analyze the information generated about some dental treatment on the internet by year. METHODS: Naver Knowledge (JisikIn in Korean) which is an interactive search service was selected as the first search site in Korea. Scaling, wisdom tooth extraction, and endodontic treatment that can be paid by Korean health insurance were selected. Finally, 4,729 questions about scaling, 23,963 wisdom teeth extraction questions and 17,733 endodontic treatment questions were extracted. The question contents, the information about the questioner and the answerer, and an error of answers were investigated. Frequency analysis was used and chi-square test was used if necessary. RESULTS: The most frequently asked questions were discomfort and dissatisfaction after the treatment. The need for treatment was the second in questions of the wisdom tooth extraction and endodontic treatment, but the health insurance benefit was the second in dental scaling. Most of the questioners didn't disclose personal information. The public answered the most in 2013~2014, but the highest percentage of the respondents was experts in 2017. Responses were mostly personal experience, but showed a tendency to decrease with years, and professional knowledge showed an increasing tendency. The error of the answer has also gradually decreased. CONCLUSION: Questions about dental care over the Internet are increasing exponentially, experts are responding increasingly, and errors in answers are decreasing. Nevertheless, it is necessary to pay attention to the related expert group to prevent misinformation.
Subject(s)
Humans , Dental Care , Dental Scaling , Insurance, Health , Internet , Korea , Molar, Third , Surveys and QuestionnairesABSTRACT
There are some errors in the published article.
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BACKGROUND: Thyroid-stimulating hormone (TSH) suppression is recommended for patients who undergo thyroidectomy for differentiated thyroid cancer (DTC). However, the impact of TSH suppression on clinical outcomes in low-risk DTC remains uncertain. Therefore, we investigated the effects of postoperative TSH levels on recurrence in patients with low-risk DTC after thyroid lobectomy. METHODS: Patients (n=1,528) who underwent thyroid lobectomy for papillary thyroid carcinoma between 2000 and 2012 were included in this study. According to the mean and dominant TSH values during the entire follow-up period or 5 years, patients were divided into four groups (<0.5, 0.5 to 1.9, 2.0 to 4.4, and ≥4.5 mIU/L). Recurrence-free survival was compared among the groups. RESULTS: During the 5.6 years of follow-up, 21 patients (1.4%) experienced recurrence. Mean TSH levels were within the recommended low-normal range (0.5 to 1.9 mIU/L) during the total follow-up period or 5 years in 38.1% or 36.0% of patients. The mean and dominant TSH values did not affect recurrence-free survival. Adjustment for other risk factors did not alter the results. CONCLUSION: Serum TSH levels did not affect short-term recurrence in patients with low-risk DTC after thyroid lobectomy. TSH suppression should be conducted more selectively.
Subject(s)
Humans , Follow-Up Studies , Recurrence , Risk Factors , Thyroid Gland , Thyroid Neoplasms , Thyroidectomy , ThyrotropinABSTRACT
In recent decades, attention has been directed toward the effects of bisphenol A (BPA) on human health. BPA has estrogenic activity and is regarded as a representative endocrine disruptor. In addition, mounting evidence indicates that BPA can disrupt thyroid hormone and its action. This review examined human epidemiological studies to investigate the association between BPA exposure and thyroid hormone levels, and analyzed in vivo and in vitro experiments to identify the causal relationship and its mechanism of action. BPA is involved in thyroid hormone action not only as a thyroid hormone receptor antagonist, but also through several other mechanisms. Since the use of bisphenols other than BPA has recently increased, we also reviewed the effects of other bisphenols on thyroid hormone action.
Subject(s)
Humans , Endocrine Disruptors , Epidemiologic Studies , Estrogens , In Vitro Techniques , Receptors, Thyroid Hormone , Thyroid Gland , Thyroid HormonesABSTRACT
BACKGROUND: Chronic exposure to elevated levels of free fatty acids contributes to pancreatic β-cell dysfunction. Although it is well known that metformin induces cellular energy depletion and a concomitant activation of AMP-activated protein kinase (AMPK) through inhibition of the respiratory chain, previous studies have shown inconsistent results with regard to the action of metformin on pancreatic β-cells. We therefore examined the effects of metformin on pancreatic β-cells under lipotoxic stress.METHODS: NIT-1 cells and mouse islets were exposed to palmitate and treated with 0.05 and 0.5 mM metformin. Cell viability, glucose-stimulated insulin secretion, cellular adenosine triphosphate, reactive oxygen species (ROS) levels and Rho kinase (ROCK) activities were measured. The phosphorylation of AMPK was evaluated by Western blot analysis and mRNA levels of endoplasmic reticulum (ER) stress markers and NADPH oxidase (NOX) were measured by real-time quantitative polymerase chain reaction analysis.RESULTS: We found that metformin has protective effects on palmitate-induced β-cell dysfunction. Metformin at a concentration of 0.05 mM inhibits NOX and suppresses the palmitate-induced elevation of ER stress markers and ROS levels in a AMPK-independent manner, whereas 0.5 mM metformin inhibits ROCK activity and activates AMPK.CONCLUSION: This study suggests that the action of metformin on β-cell lipotoxicity was implemented by different molecular pathways depending on its concentration. Metformin at a usual therapeutic dose is supposed to alleviate lipotoxic β-cell dysfunction through inhibition of oxidative stress and ER stress.
Subject(s)
Animals , Mice , Adenosine Triphosphate , AMP-Activated Protein Kinases , Blotting, Western , Cell Survival , Electron Transport , Endoplasmic Reticulum , Endoplasmic Reticulum Stress , Fatty Acids, Nonesterified , Insulin , Insulin-Secreting Cells , Metformin , NADPH Oxidases , Oxidative Stress , Phosphorylation , Polymerase Chain Reaction , Reactive Oxygen Species , rho-Associated Kinases , RNA, MessengerABSTRACT
Anti-programmed cell death-1 (PD-1) humanized monoclonal antibody inhibits PD-1 activity by binding to the PD-1 receptor on T-cells and blocking PD-1 ligands and induces immune tolerance of cancer cells. It has been widely used for various kinds of cancer treatment. However, many immune-related adverse events (irAEs) have been reported because it modulates our immune system. In this case study, we reported a case of 42-year-old woman with Hashimoto's thyroiditis who showed rapid aggravation of thyroid goiter and acute hyperventilation syndrome after treatment with PD-1 inhibitor as a neoadjuvant chemotherapy for breast cancer.
Subject(s)
Adult , Female , Humans , Breast Neoplasms , Breast , Drug Therapy , Goiter , Hyperventilation , Immune System , Immune Tolerance , Ligands , Programmed Cell Death 1 Receptor , T-Lymphocytes , Thyroid Gland , ThyroiditisABSTRACT
As the detection of thyroid nodules increases, it is important to differentiate whether thyroid nodules are malignant or not. Ultrasonography-guided fine-needle aspiration cytology is the standard method to diagnose thyroid nodules. Ultrasonographic findings of thyroid nodules can predict the risk of malignancy, and fine-needle aspiration allows the examination of cytopathology of thyroid nodules. However, both are not perfect, with a certain degree of false negative or false positive results. Therefore, we can face thyroid nodules with discordant results of ultrasonographic and fine-needle aspiration findings. In the case of benign features on ultrasonography with malignant cytology, follicular thyroid cancer, follicular variant papillary thyroid cancer, cystic or degenerative changes of thyroid cancer, and thyroiditis are candidates for diagnosis. In contrast, for the nodules with ultrasonographic features of highly suspicious of malignancy but benign cytology, we can consider the possibility of thyroiditis, changes of benign nodule, and cystic changes of thyroid cancer. These various conditions may result in discordant results of ultrasonographic features and fine-needle aspiration cytology, which need special attention not to miss the diagnosis of malignant nodules.
Subject(s)
Biopsy, Fine-Needle , Diagnosis , Methods , Thyroid Gland , Thyroid Neoplasms , Thyroid Nodule , Thyroiditis , UltrasonographyABSTRACT
PURPOSE: This study assessed the effect of chemotherapy over stage II colon cancer in terms of presence of high-risk factors.METHODS: Data were retrospectively reviewed for 364 patients with stage II colon cancer who underwent curative surgery between January 2007 and December 2012. High-risk factors of stage II colon cancer were examined, and the overall survival (OS) rates were analyzed. Survival benefit of adjuvant chemotherapy was also analyzed.RESULTS: One hundred and fifteen cases had exclusively single high-risk factor and 194 cases were negative for high-risk factors. Postoperative chemotherapy was performed in 262 of 364 patients (72.0%). The 5-year OS was 79.4% and 86.6% for patients without adjuvant chemotherapy and those with chemotherapy, respectively. The 5-year OS was 88.2% and 83.3% for patients having exclusively single high-risk factor with adjuvant chemotherapy and those without chemotherapy, respectively.CONCLUSION: Adjuvant chemotherapy for patients with stage II colon cancer having exclusively single high-risk factor could be omitted, weighing up the survival benefit and side effect of chemotherapy.
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Humans , Chemotherapy, Adjuvant , Colon , Colonic Neoplasms , Colorectal Neoplasms , Drug Therapy , Retrospective Studies , Survival AnalysisABSTRACT
BACKGROUND: After initial radioactive iodine (RAI) treatment in differentiated thyroid cancer patients, we sometimes observe a star-shaped region of intense uptake of 131I on whole body scans (WBSs), called a ‘star artifact.’ We evaluated the clinical implications of star artifacts on the success rate of remnant ablation and long-term prognosis. METHODS: Total 636 patients who received 131I dose of 1.1 GBq for the initial RAI therapy and who did not show distant metastasis at the time of diagnosis were retrospectively evaluated. A negative second WBS was used for evaluating the ablation efficacy of the RAI therapy. Among them, 235 patients (36.9%) showed a star artifact on their first WBS. RESULTS: In patients with first stimulated thyroglobulin (sTg) levels ≤2 ng/mL, patients with star artifacts had a higher rate of negative second WBS compared with those without star artifacts (77.8% vs. 63.9%, P=0.044), and showed significantly higher recurrence-free survival (P=0.043) during the median 8.0 years (range, 1.0 to 10.0) of follow-up. The 5- and 10-year recurrence rates (5YRR, 10YRR) were also significantly lower in patients with star artifacts compared with those without (0% vs. 4.9%, respectively, P=0.006 for 5YRR; 0% vs. 6.4%, respectively, P=0.005 for 10YRR). However, ablation success rate or recurrence-free survival was not different among patients whose first sTg levels >2 ng/mL regardless of star artifacts. CONCLUSION: Therefore, star artifacts at initial RAI therapy imply a good ablation efficacy or a favorable long-term prognosis in patients with sTg levels ≤2 ng/mL.
Subject(s)
Humans , Artifacts , Diagnosis , Follow-Up Studies , Iodine , Neoplasm Metastasis , Prognosis , Recurrence , Retrospective Studies , Therapeutic Uses , Thyroglobulin , Thyroid Neoplasms , Whole Body ImagingABSTRACT
BACKGROUND: The ongoing Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Microcarcinoma (MAeSTro) aims to observe the natural course of papillary thyroid microcarcinoma (PTMC), develop a protocol for active surveillance (AS), and compare the long-term prognosis, quality of life, and medical costs between the AS and immediate surgery groups. METHODS: This multicenter prospective cohort study of PTMC started in June 2016. The inclusion criteria were suspicious of malignancy or malignancy based on fine needle aspiration or core needle biopsy, age of ≥18 years, and a maximum diameter of ≤1 cm. If there was no major organ involvement, no lymph node/distant metastasis, and no variants with poor prognosis, the patients were explained of the pros and cons of immediate surgery and AS before selecting AS or immediate surgery. Follow-up visits (physical examination, ultrasonography, thyroid function, and questionnaires) are scheduled every 6 months during the first 2 years, and then every 1 year thereafter. Progression was defined as a maximum diameter increase of ≥3, ≥2 mm in two dimensions, suspected organ involvement, or lymph node/distant metastasis. RESULTS: Among 439 enrolled patients, 290 patients (66.1%) chose AS and 149 patients (33.9%) chose immediate surgery. The median follow-up was 6.7 months (range, 0.2 to 11.9). The immediate surgery group had a larger maximum tumor diameter, compared to the AS group (7.1±1.9 mm vs. 6.6±2.0 mm, respectively; P=0.014). CONCLUSION: The results will be useful for developing an appropriate PTMC treatment policy based on its natural course and risk factors for progression.
Subject(s)
Humans , Biopsy, Fine-Needle , Biopsy, Large-Core Needle , Cohort Studies , Follow-Up Studies , Neoplasm Metastasis , Prognosis , Prospective Studies , Quality of Life , Risk Factors , Thyroid Gland , Thyroid Neoplasms , UltrasonographyABSTRACT
As the detection of thyroid nodules increases, it is important to differentiate whether thyroid nodules are malignant or not. Ultrasonography-guided fine-needle aspiration cytology is the standard method to diagnose thyroid nodules. Ultrasonographic findings of thyroid nodules can predict the risk of malignancy, and fine-needle aspiration allows the examination of cytopathology of thyroid nodules. However, both are not perfect, with a certain degree of false negative or false positive results. Therefore, we can face thyroid nodules with discordant results of ultrasonographic and fine-needle aspiration findings. In the case of benign features on ultrasonography with malignant cytology, follicular thyroid cancer, follicular variant papillary thyroid cancer, cystic or degenerative changes of thyroid cancer, and thyroiditis are candidates for diagnosis. In contrast, for the nodules with ultrasonographic features of highly suspicious of malignancy but benign cytology, we can consider the possibility of thyroiditis, changes of benign nodule, and cystic changes of thyroid cancer. These various conditions may result in discordant results of ultrasonographic features and fine-needle aspiration cytology, which need special attention not to miss the diagnosis of malignant nodules.
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No abstract available.
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BACKGROUND AND OBJECTIVES: This study was designed to review our experience with patients undergoing revision septoplasty and to evaluate the causes of persistent nasal obstruction and treatment outcomes of revision septoplasty. SUBJECTS AND METHOD: The medical records of 58 patients (53 men) who underwent revision septoplasty by the author of this study between 2006 and 2012 at our institute were retrospectively reviewed. Data on demographics, symptoms, anatomic site of deviation, surgical techniques performed, and postoperative complications were collected. Patient satisfaction scores were graded with a grading scale from 1 (excellent) to 4 (poor). RESULTS: All of the patients visited our hospital for persistent nasal obstruction after prior septoplasty. Forty-seven patients (81%) showed caudal septal deviation and 11 (19%) showed some other forms of septal deviation. Twenty-one cases (36.2%) were treated with the batten graft with cutting and suture technique, 20 (34.5%) with a batten graft alone, 10 (17.3%) with resection of remnant deviated septal bone and cartilage, 4 (6.8%) with the cutting and suture technique, 2 (3.5%) with a relocation suture, and 1 (1.7%) with a spreader graft. The median patient satisfaction score for 31 patients who answered the telephone interview was 2.06±0.93. CONCLUSION: A considerable number of patients who undergo revision septoplasty have remnant or recurrent caudal septal deviation that was not properly corrected in previous surgery. We recommend the batten grafting and the cutting and suture technique for the correction of caudal septal deviation in revision septoplasty.
Subject(s)
Humans , Cartilage , Demography , Interviews as Topic , Medical Records , Methods , Nasal Obstruction , Patient Satisfaction , Postoperative Complications , Retrospective Studies , Suture Techniques , Sutures , Transplants , Treatment OutcomeABSTRACT
BACKGROUND: The Korea Centers for Disease Control and Prevention (KCDC) has been providing a nationwide, one-day training program for workers of hospital blood centers once a year since 2013. We evaluated the achievement levels of the program through surveys. METHODS: The survey was conducted immediately after the program in 2015, 2016, and 2017. Respondents' occupations, institutions, program contents, and operational aspects were asked. RESULTS: The response rate was 56.2%∼73.2%. The occupations of respondents were medical technologists 66.9%∼75.7%, nurses 16.1%∼22.1%, and others (administrators, et al.) 1.5%∼11.3%. About 86.1%∼88.2% of respondents answered that the program as a whole was satisfactory or very satisfactory; 88.9%∼94.7% thought that it is necessary or very necessary; 77.9%∼84.1% answered that the appropriate length of the program was one day; 53.8%∼69.1% answered that the appropriate number of program is once per year; and 23.4%∼53.8% or 40.3%∼61.4% answered that the appropriate season for the program by the KCDC should be the first or the second quarter, respectively. CONCLUSION: This study suggests that the training program plays a useful role in meeting the needs of workers for hospital blood centers.