The effects of academic stress, social network service addiction tendency, and upward social comparison on depression in nursing students / 한국간호교육학회지

Purpose@#The aim of this descriptive study was to identify the factors influencing depression risk among South Korean nursing students. @*Methods@#The data were collected from nursing students attending two universities through web-based questionnaires that surveyed them about depression, academic stress, social network service (SNS) addiction tendency, and upward social comparison from August 22 to September 4, 2021. The collected data from 196 nursing students were analyzed by t-test, one-way ANOVA, Pearson’s correlation coefficients, and multiple linear regression. @*Results@#The mean score of depression (using CES-D Korean version) among nursing students was 13.91, which denotes probable depression. Concerning the variance with regard to depression among nursing students, 20.2% was explained by clinical practice period, academic stress, and upward social comparison. @*Conclusion@#Programs to relieve academic stress and depression should be developed in a simple way and systematically provided at the organizational level so that nursing students secure sufficient support during the initial and continuing period of clinical practicums. Concomitantly, an attempt to reduce the upward social comparison should be highly considered.

Treatment for subarachnoid hemorrhage due to ruptured posterior cerebral arterial dolichoectasia with aortic arch anomaly

Subarachnoid hemorrhage (SAH) due to ruptured posterior cerebral artery (PCA) intracranial arterial dolichoectasia (IADE) is very rare. As these lesions are difficult to treat microsurgically, neurointervention is preferred because the dolichoectatic artery does not have a clear neck, and the surgical field of view was deep seated with the SAH. However, in some cases, neurointervention is difficult due to anatomical variation of the blood vessel to access the lesion. In this case, a 30-year-old male patient presented with a ruptured PCA IADE and an aortic arch anomaly. Aortic arch anomalies render it difficult to reach the ruptured PCA IADE via endovascular treatment. The orifice of the vertebral artery (VA) was different from the usual cases, so it was difficult to find the entrance. After only finding the VA and arriving at the lesion along the VA, trapping was performed. Herein, we report the PCA IADE with aortic arch anomaly endovascular treatment methods and results.

Environmental measures and healthcare service utilization against laboratory animal allergy in Korean laboratory animal researchers

Purpose@#This study aimed to evaluate the environmental measures and healthcare service utilization against laboratory animal allergy (LAA) in Korea. @*Methods@#A total of 213 subjects who attended the 2018 Korean Association for Laboratory Animal Science Annual Symposium were enrolled in the study. The participants were given questionnaires on work practice controls, environmental measures, and healthcare service utilization for LAA, and underwent skin prick tests with mouse and rat epithelial allergens. Those parameters were compared between the LAA and non-LAA groups. @*Results@#The LAA group more frequently minimized the time of exposure to all laboratory animals, frequency of exposure to allergic laboratory animals, and exposure time to allergic laboratory animals than the non-LAA group (22.9% vs. 8.4%, P < 0.003; 12.9% vs. 2.1%, P = 0.001; 14.3% vs. 1.4%, P < 0.001, respectively). However, in the LAA group, wet preparation before shaving was performed less frequently (10.0% vs. 21.7%, P< 0.025), so was animal handling permission only at LAA-preventing facilities (2.9% vs. 11.9%, P < 0.030). Over 30% of the LAA group was referred to the physicians. Meanwhile, about half of them did not use any healthcare service for LAA. @*Conclusion@#Korean laboratory researchers with LAA tried to reduce exposure to allergic laboratory animals. However, they missed some potentially critical points, with half of them not using healthcare services for LAA. Further efforts are warranted to focus on the nationwide surveillance, prevention, and control for LAA in Korea.

The effect of curcumin on blood pressure and cognitive impairment in spontaneously hypertensive rats

BACKGROUND/OBJECTIVES@#It is known that the renin-angiotensin system (RAS) in the brain could regulate cognitive functions as well as blood pressure. Inhibition of RAS for the improvement of cognitive function may be a new strategy, but studies so far have mostly reported on the effects of RAS inhibition by drugs, and there is no research on cognitive improvement through RAS inhibition of food ingredients. Therefore, this study investigated the effect of curcumin on blood pressure and cognitive function and its related mechanism in spontaneously hypertensive rat/Izm (SHR/Izm).MATERIALS/METHODS: Six-week-old SHR/Izm rats were divided into 5 groups: control group (CON), scopolamine group (SCO, drug for inducing cognitive deficits), positive control (SCO and tacrine [TAC]), curcumin 100 group (CUR100, SCO + Cur 100 mg/kg), and curcumin 200 group (CUR200, SCO + Cur 200 mg/kg). Changes in blood pressure, RAS, cholinergic system, and cognitive function were compared before and after cognitive impairment. @*RESULTS@#The SCO group showed increased blood pressure and significantly reduced cognitive function based on the y-maze and passive avoidance test. Curcumin treatments significantly improved blood pressure and cognitive function compared with the SCO group.In both the CUR100 and CUR200 groups, the mRNA expressions of angiotensin-converting enzyme (ACE) and angiotensin II receptor type1 (AT1), as well as the concentrations of angiotensin II (Ang II) in brain tissue were significantly decreased. The mRNA expression of the muscarinic acetylcholine receptors (mAChRs) and acetylcholine (ACh) content was significantly increased, compared with the SCO group. @*CONCLUSIONS@#The administration of curcumin improved blood pressure and cognitive function in SCO-induced hypertensive mice, indicating that the cholinergic system was improved by suppressing RAS and AT1 receptor expression and increasing the mAChR expression.

Long-term Comparison of Choroidal Thickness between Scleral Encircling and Combined with Trans-pars Plana Vitrectomy in Retinal Detachment

Purpose@#To compare the subfoveal choroidal thickness (SFCT) before and after scleral encircling (SE), with or without trans-pars plana vitrectomy (TPPV), in patients with monocular primary rhegmatogenous retinal detachment (RRD). @*Methods@#We retrospectively analyzed patients who underwent SE for monocular primary RRD between January 2019 and June 2021 and underwent optical coherence tomography during follow-up. SFCT was measured independently at three regions before the surgery and 1, 2, 3, and 6 months after the surgery. The values were manually analyzed by two independent ophthalmologists. @*Results@#Of the 33 eyes included in the study, 18 (54%) underwent SE alone, while 15 (46%) underwent SE with TPPV. SFCT gradually decreased after surgery in all patients (p < 0.05). The SFCT was significantly greater 6 months postoperatively in the SE alone group (260.51 ± 78.30 μm) compared to the SE with TPPV group (225.55 ± 75.24 μm) (p < 0.05). Macular detachment patients had significantly greater preoperative SFCTs (276.46 ± 20 μm) compared to others (223.93 ± 20 μm) (p < 0.05). Preoperative SFCT was significantly related to visual acuity (p < 0.05), while the remaining SFCT values did not have any significant effects. @*Conclusions@#In primary RRD eyes, SFCT decreased over time after SE, more so when TPPV was also performed. Further studies are required to investigate the mechanism of SFCT change and its impact on RRD.

Immune Responses After Vaccination With Primary 2-Dose ChAdOx1 Plus a Booster of BNT162b2 or Vaccination With Primary 2-Dose BNT162b2 Plus a Booster of BNT162b2 and the Occurrence of Omicron Breakthrough Infection

Background@#Before the omicron era, health care workers were usually vaccinated with either the primary 2-dose ChAdOx1 nCoV-19 (Oxford-AstraZeneca) series plus a booster dose of BNT162b2 (Pfizer-BioNTech) (CCB group) or the primary 2-dose BNT162b2 series plus a booster dose of BNT162b2 (BBB group) in Korea. @*Methods@#The two groups were compared using quantification of the surrogate virus neutralization test for wild type severe acute respiratory syndrome coronavirus 2 (SVNT-WT), the omicron variant (SVNT-O), spike-specific IgG, and interferon-gamma (IFN-γ), as well as the omicron breakthrough infection cases. @*Results@#There were 113 participants enrolled in the CCB group and 51 enrolled in the BBB group. Before and after booster vaccination, the median SVNT-WT and SVNT-O values were lower in the CCB (SVNT-WT [before-after]: 72.02–97.61%, SVNT-O: 15.18–42.29%) group than in the BBB group (SVNT-WT: 89.19–98.11%, SVNT-O: 23.58–68.56%; all P < 0.001). Although the median IgG concentrations were different between the CCB and BBB groups after the primary series (2.677 vs. 4.700 AU/mL, respectively, P < 0.001), they were not different between the two groups after the booster vaccination (7.246 vs. 7.979 AU/mL, respectively, P = 0.108). In addition, the median IFN-γ concentration was higher in the BBB group than in the CCB group (550.5 and 387.5 mIU/mL, respectively, P = 0.014). There was also a difference in the cumulative incidence curves over time (CCB group 50.0% vs. BBB group 41.8%; P = 0.045), indicating that breakthrough infection occurred faster in the CCB group. @*Conclusion@#The cellular and humoral immune responses were low in the CCB group so that the breakthrough infection occurred faster in the CCB group than in the BBB group.

Comparison of dominant and nondominant C3 deposition in primary glomerulonephritis

Alternative complement pathway dysregulation plays a key role in glomerulonephritis (GN) and is associated with C3 deposition. Herein, we examined pathological and clinical differences between cases of primary GN with C3-dominant (C3D-GN) and nondominant (C3ND-GN) deposition. Methods: We extracted primary GN data from the Korean GlomeruloNEphritis sTudy (KoGNET). C3D-GN was defined as C3 staining two grades greater than C1q, C4, and immunoglobulin via immunofluorescence analysis. To overcome a large difference in the number of patients between the C3D-GN and C3ND-GN groups (31 vs. 9,689), permutation testing was used for analysis. Results: The C3D-GN group exhibited higher serum creatinine (p ≤ 0.001), a greater prevalence of estimated glomerular filtration rate of <60 mL/min/1.72 m2 (p ≤ 0.001), higher (but not significantly so) C-reactive protein level, and lower serum C3 level (p ≤ 0.001). Serum albumin, urine protein/creatinine ratio, number of patients who progressed to end-stage renal disease, and all-cause mortality were comparable between groups. Interstitial fibrosis and mesangial cellularity were greater in the C3D-GN group (p = 0.04 and p = 0.01, respectively) than in the C3ND-GN group. C3 deposition was dominant in the former group (p < 0.001), in parallel with increased subendothelial deposition (p ≤ 0.001). Conclusion: Greater progression of renal injury and higher mortality occurred in patients with C3D-GN than with C3ND-GN, along with pathologic differences in interstitial and mesangial changes.

A Case of Subacute Psychosis in a Patient With Germ Cell Tumor / 생물치료정신의학

We report a case of subacute psychotic symptoms in a patient with germ cell tumor (GCT). The 32-year-old male patient showed progressive psychotic symptoms with diagnosis of GCT. His psychotic symptoms included delusions of reference and persecution. Brain magnetic resonance imaging, electroencephalography, and laboratory examinations were performed to evaluate any other causes. The clinical, neuroimaging, and laboratory review in this case suggested that the progressively developed psychotic symptoms that led to chronic deterioration were caused by the GCT. This is the case report in which subacute atypical psychotic symptoms in his thirties could develop from a GCT based on previous basic research findings showing the correlations of psychotic symptoms with GCT although it has the limitation of so early speculation.

Extremely Severe Dysphagia Secondary to Tracheostomy: A Case Report / 대한연하장애학회지

We report an extremely severe case of dysphagia in an elderly patient. Tracheostomy alone was found to be the cause of severe upper esophageal opening dysfunction. An 84-year-old woman was admitted with dyspnea. During hospitalization, she had respiratory failure and underwent a tracheostomy. On day 41 in the hospital, she complained of dysphagia and was a swallowing evaluation was done at the rehabilitation department. We ruled out other etiologies of upper esophageal dysfunction through a brain magnetic resonance imaging (MRI) and endoscopic evaluation. Through follow-up tests, it was found retrospectively that extreme dysphagia could have occurred through the following mechanism: the airway was not protected at the time of the tracheostomy because the movement of the epiglottis did not appear to be normal. This was due to the reduction in laryngeal function affecting the upper esophageal opening after the tracheostomy, and at the same time, the power to push the bolus was weak. After 6 months, at the third test, she had improved enough to ingest a soft diet and fluid with thickeners, so she was able to start an oral diet without decannulation. It is thus important to recognize that tracheostomy alone can cause extremely severe aspiration. If these findings are observed in patients undergoing tracheostomy, it is necessary to check the movements of the epiglottis properly and evaluate whether the condition can be improved by rehabilitation treatment.

Neovascular Glaucoma as the Initial Presentation of Ocular Tuberculosis

Purpose@#To report a case of ocular tuberculosis that first manifested as neovascular glaucoma.Case summary: A 76-year-old male visited our hospital complaining of decreased visual acuity in the left eye. He had undergone tuberculosis treatment 1 year prior, and had been cured. At the time of his visit, decreased visual acuity, increased intraocular pressure, and iris neovascularization were observed in the left eye. He was diagnosed with neovascular glaucoma and was started on treatment to lower the intraocular pressure. At the time of the visit, we also noticed vitreous opacity in both eyes. The patient did not attend his scheduled follow-up visit, but returned 2 months later complaining of decreased visual acuity in both eyes. The vitreous opacity in the retinae of both eyes had become aggravated. Diagnostic vitrectomy was performed on both eyes, and multiple yellowish-white circular lesions were observed throughout the retinae. Systemic abnormalities were suspected, and thus additional tests were performed. Bronchoalveolar lavage fluid analysis revealed recurrence of pulmonary tuberculosis, and tuberculosis treatment was recommenced. Temporary increases in ocular inflammation and deterioration were observed but improved after the addition of systemic steroids. The patient has been under observation without recurrence for about 1 year. @*Conclusions@#Ocular tuberculosis can be expressed in the form of neovascular glaucoma, so ocular tuberculosis should be suspected if there is a history of tuberculosis and abnormal retinal findings.

A Case of Transient Posterior Capsular Opacity After Intravitreal Bevacizumab Injection

Purpose@#We are reporting a case of transient posterior capsular opacity after intravitreal Bevacizumab (Avastin®, Roche Pharma Schweis AG, Zurich, Switzerland) injection in a phakic patient.Case summary: A 34-year-old man visited our clinic with sudden blurred vision in his left eye one day after the intravitreal injection for central serous chorioretinopathy. His visual acuity was 1.0 before the injection and decreased to 0.1 at the presentation. On slit-lamp examination, a snow-flake appearance opacity was noted behind the posterior capsule. No newly appearing lesion was presented on fundus exam, so topical antibiotics and steroid eyedrops were continued. One week after the injection, the visual acuity improved to 1.0 and posterior capsular opacity remained but decreased. Five weeks after the injection, the posterior capsular opacity resolved. Fundus exam revealed improved but persistent subretinal fluid, so he overwent another intravitreal injection. The posterior capsular opacity did not recur for seven months. @*Conclusions@#Iatrogenic lens damage or the turbidity formed by medication can cause a posterior capsular opacity after intravitreal injection. If structural damage is uncertain, close monitoring is needed and ultimately, cataract surgery may be required for chronic crystalline lens opacity.

Comparison of COVID-19-associated multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease shock syndrome: case reports and literature review

Multisystem inflammatory syndrome in children (MIS-C) is a serious post-infectious complication of COVID-19 characterized by hyperinflammation and multi-organ dysfunction including shock. Shock is also seen in a severe form of Kawasaki disease (KD) called KD shock syndrome (KDSS). Here, we present one MIS-C and one KDSS case and compare similarities and differences between them. Both MIS-C (case 1) and KDSS (case 2) showed hyperinflammation, KD-related features, gastrointestinal problems, hypotension, and coagulopathy. The extent of systemic inflammation and organ dysfunction was more severe in KDSS than in MIS-C. Case 1 was diagnosed as MIS-C because SARS-CoV-2 was confirmed, and case 2 was diagnosed as KDSS because no pathogen was identified in microbiological studies. We believe that the most important difference between MIS-C and KDSS was whether SARS-CoV-2 was identified as an infectious trigger. Organ dysfunction is a hallmark of MIS-C and KDSS, but not KD, so MIS-C shares more clinical phenotypes with KDSS than with KD. Comparison of MIS-C and KDSS will be an interesting and important topic in the field of KD-like hyperinflammatory disease research.

Real-World Effectiveness of Nirmatrelvir-Ritonavir and Its Acceptability in High-Risk COVID-19Patients

Background@#Nirmatrelvir-ritonavir is highly effective in preventing severe coronavirus disease 2019 (COVID-19) in high-risk patients with mild-to-moderate severity. However, real-world performance data are limited, and the drug is not so acceptable to the COVID-19 patients at high risk who need it in Korea. @*Methods@#To evaluate the effectiveness of nirmatrelvir-ritonavir, we conducted a propensity score-matched retrospective cohort study on patients with mild-to-moderate COVID-19 at high risk for a severe disease who were hospitalized at four hospitals in South Korea from February 2022 to April 2022. A total of 236 patients in the treatment group (administered nirmatrelvir-ritonavir) and 236 in the matched control group (supportive care only) were analyzed for the primary outcome, i.e., the time to oxygen support-free survival. The secondary outcome was a composite result of disease progression. The reason for not prescribing nirmatrelvir-ritonavir to the indicated patients was also investigated. @*Results@#The treatment group showed significantly longer oxygen support-free survival than the matched control group (adjusted hazard ratio [aHR], 0.07; 95% confidence interval [CI], 0.01–0.31; P < 0.001). Multivariate Cox regression analysis showed that age (aHR, 1.03; 95% CI, 1.00–1.07), National Early Warning Score-2 at admission (aHR, 1.36; 95% CI, 1.08–1.71), nirmatrelvir-ritonavir treatment, female sex (aHR, 0.37; 95% CI, 0.15–0.88), and time from symptom onset to admission (aHR, 0.67; 95% CI, 0.48–0.95) were significantly associated with oxygen therapy. However, none of the factors were related to the composite outcome. In the unmatched control group, 19.9% of 376 patients had documented explanations for nirmatrelvir-ritonavir non-prescription, and 44.0% of these were due to contraindication criteria. In the treatment group, 10.9% of patients discontinued the medication primarily because of adverse events (71.4%), with gastrointestinal symptoms being the most common (50.0%). @*Conclusion@#Nirmatrelvir-ritonavir treatment significantly reduced oxygen therapy requirements in high-risk patients with COVID-19 during the omicron variant surge in South Korea. Physicians are encouraged to consider the active use of nirmatrelvir-ritonavir and to be watchful for gastrointestinal symptoms during medication.

Can We Notice the Suicidal Warning Signs of Adolescents With Different Psychometric Profiles Before Their Death?: Analysis of Teachers’ Reports

Background@#This study aimed to analyze the suicidal warning signs of Korean students with different psychometric profiles based on teacher reports. @*Methods@#This was a retrospective cohort study based on Korean school teachers’ responses to the Student Suicide Report Form. In total, 546 consecutive cases of student suicide were reported from 2017 to 2020. After missing data were excluded, 528 cases were included. The report consisted of demographic factors, the Korean version of the Strengths and Difficulties Questionnaire (SDQ) for teacher reporting, and warning signs of suicide. Frequency analysis, multiple response analysis, the χ2 test, and Latent Class Analysis (LCA) were performed. @*Results@#Based on the scores of the Korean version of the teacher-reported SDQ, the group was divided into nonsymptomatic (n = 411) and symptomatic (n = 117) groups. Based on the LCA results, four latent hierarchical models were selected. The four classes of deceased students showed significant differences in school type (χ2 = 20.410, P < 0.01), physical illness (χ2 = 7.928, P < 0.05), mental illness (χ2 = 94.332, P < 0.001), trigger events (χ2 = 14.817, P < 0.01), self-harm experience (χ2 = 30.618, P < 0.001), suicide attempts (χ2 = 24.072, P < 0.001), depressive symptoms (χ2 = 59.561, P < 0.001), anxiety (χ2 = 58.165, P < 0.001), impulsivity (χ2 = 62.241, P < 0.001), and social problems (χ2 = 64.952, P < 0.001). @*Conclusion@#Notably, many students who committed suicide did not have any psychiatric pathology. The proportion of the group with a prosocial appearance was also high. Therefore, the actual suicide warning signals were similar regardless of students’ difficulties and prosocial behaviors, so it is necessary to include this information in gatekeeper education.

Adolescents’ Experiences of Non-Suicidal Self-Injury: An Interpretative Phenomenological Analysis Study

Purpose@#This qualitative study used interpretative phenomenological analysis and photovoice methods to explore the meaning of non-suicidal self-injury experienced by adolescents. @*Methods@#Participants were adolescents enrolled in middle and high schools in Gyeonggi-do and Jeollabuk-do who were selected through snowball sampling. Six participants had repeatedly engaged in self-injurious behavior for over a year. Data were collected through in-depth interviews and the photovoice method between November 2020 and July 2021. The collected data were analyzed using six steps of interpretative phenomenological analysis. @*Results@#The results yielded 5 main themes and 18 subthemes. The main themes were ‘a silent cry to an indifferent world’, ‘a heartache that one endures with scars’, ‘an inescapable cycle’, ‘filling the space in one’s heart’, and ‘healing the wounds’. The study findings revealed that the self-injurious behavior of adolescents began as a consequence of feeling lost and struggling with conflicts at home and school, which helped them relieve tension and pain. Nonetheless, inflicting self-injury only left signs of regret and remorse, which became a trace that the participants wanted to hide. However, the wounds healed after receiving attention and support from others. They were determined to stop engaging in repeated self-injurious behaviors and made efforts to do so. @*Conclusion@#This study can be used as a basis for the development of educational programs to prevent non-suicidal self-injury in adolescents. Additionally, it can inform nursing interventions that focus on building support systems to help adolescents who attempt self-injury.

The Essential Function of miR-5739 in Embryonic Muscle Development

Background and Objectives@#Embryologically, mesodermal development is closely related to the development of various organs such as muscles, blood vessels, and hearts, which are the main organs that make up the body. However, treatment for mesoderm developmental disorders caused by congenital or acquired factors has so far relied on surgery and drug treatment for symptom relief, and more fundamentally, treatment for mesoderm developmental disorders is needed. @*Methods@#and Results: In our study, microRNA (miRNA), which plays an important role in the mesoderm development process, was identified and the developmental function was evaluated. miRNAs consist of small nucleotides, which act as transcription factors that bind to the 3’ untranslated region and suppressed target gene expression. We constructed the human embryonic stem cell (hESC) knockout cell line and analyzed the function and characteristics of miR-5739, which plays an important role in mesoderm lineage. miR-5739 acts as a transcription factor targeting SMA, Brachyury T, Hand1, which controls muscle proliferation and differentiation, and KDR gene, which regulates vessel formation in vitro. In vivo results suggest a role in regulating muscle proliferation and differentiation. Gene ontology analysis confirmed that the miR-5739 is closely related to genes that regulate muscle and vessel proliferation and differentiation. Importantly, abnormal expression of miR-5739 was detected in somatic cells derived from patients with congenital muscle disease. @*Conclusions@#Our study demonstrate that miR-5739 gene function significantly affects transcriptional circuits that regu-late muscle and vascular differentiation during embryonic development.

Phloretin Ameliorates Succinate-Induced Liver Fibrosis by Regulating Hepatic Stellate Cells

Background@#Hepatic stellate cells (HSCs) are the major cells which play a pivotal role in liver fibrosis. During injury, extracellular stimulators can induce HSCs transdifferentiated into active form. Phloretin showed its ability to protect the liver from injury, so in this research we would like to investigate the effect of phloretin on succinate-induced HSCs activation in vitro and liver fibrosis in vivo study. @*Methods@#In in vitro, succinate was used to induce HSCs activation, and then the effect of phloretin on activated HSCs was examined. In in vivo, succinate was used to generated liver fibrosis in mouse and phloretin co-treated to check its protection on the liver. @*Results@#Phloretin can reduce the increase of fibrogenic markers and inhibits the proliferation, migration, and contraction caused by succinate in in vitro experiments. Moreover, an upregulation of proteins associated with aerobic glycolysis occurred during the activation of HSCs, which was attenuated by phloretin treatment. In in vivo experiments, intraperitoneal injection of phloretin decreased expression of fibrotic and glycolytic markers in the livers of mice with sodium succinate diet-induced liver fibrosis. These results suggest that aerobic glycolysis plays critical role in activation of HSCs and succinate can induce liver fibrosis in mice, whereas phloretin has therapeutic potential for treating hepatic fibrosis. @*Conclusion@#Intraperitoneal injection of phloretin attenuated succinate-induced hepatic fibrosis and alleviates the succinate-induced HSCs activation.

Next-generation sequencing analysis of hepatitis C virus resistance–associated substitutions in direct-acting antiviral failure in South Korea

Background/Aims@#We used next-generation sequencing (NGS) to analyze resistance-associated substitutions (RASs) and retreatment outcomes in patients with chronic hepatitis C virus (HCV) infection who failed direct-acting antiviral agent (DAA) treatment in South Korea. @*Methods@#Using prospectively collected data from the Korean HCV cohort study, we recruited 36 patients who failed DAA treatment in 10 centers between 2007 and 2020; 29 blood samples were available from 24 patients. RASs were analyzed using NGS. @*Results@#RASs were analyzed for 13 patients with genotype 1b, 10 with genotype 2, and one with genotype 3a. The unsuccessful DAA regimens were daclatasvir+asunaprevir (n=11), sofosbuvir+ribavirin (n=9), ledipasvir/sofosbuvir (n=3), and glecaprevir/pibrentasvir (n=1). In the patients with genotype 1b, NS3, NS5A, and NS5B RASs were detected in eight, seven, and seven of 10 patients at baseline and in four, six, and two of six patients after DAA failure, respectively. Among the 10 patients with genotype 2, the only baseline RAS was NS3 Y56F, which was detected in one patient. NS5A F28C was detected after DAA failure in a patient with genotype 2 infection who was erroneously treated with daclatasvir+asunaprevir. After retreatment, 16 patients had a 100% sustained virological response rate. @*Conclusions@#NS3 and NS5A RASs were commonly present at baseline, and there was an increasing trend of NS5A RASs after failed DAA treatment in genotype 1b. However, RASs were rarely present in patients with genotype 2 who were treated with sofosbuvir+ribavirin. Despite baseline or treatment-emergent RASs, retreatment with pan-genotypic DAA was highly successful in Korea, so we encourage active retreatment after unsuccessful DAA treatment.

Communication Experience of Nursing Students: A Simulation using Standardized Patients / 정신간호학회지

Purpose@#The purpose of this research is to assess the communication experiences of nursing students by conducting a simulation using standardized patients and to understand their essential meaning in-depth. @*Methods@#This research was conducted from May to June 2022 and targeted 17 third-year nursing students who were attending K University in Kangwon-do and underwent mental health nursing simulation. In-depth interview was conducted by organizing a focus group, and this the outcomes were analyzed by Colaizzi’s phenomenological method. @*Results@#The communication experiences were derived in four categories, namely, ‘Preoccupation in the situation like it’s real’, ‘Embarrassed by unpredictable communication situation’, ‘Self-reflection on communication’ and ‘The effort to improve communication skills’. @*Conclusion@#Based on the results of this research, there is a need to conduct well-designed scenarios and modules, and to provide pre-training so that standardized patients can provide various communication responses. Moreover, it is necessary to provide opportunities for nursing students to acquire nursing ability on their own.

Co-occurrence of both maternally inherited neurofibromatosis type 1 and Lesch-Nyhan disease in a child with severe neurodevelopmental impairment

Lesch-Nyhan disease (LND) is a rare X-linked recessive inherited purine metabolic disorder that accompanies neurodevelopmental problems. Neurofibromatosis type 1 (NF1) is a relatively common autosomal dominant inherited genetic disorder characterized by tumors in various systems. Some children with NF1 also accompanies neurodevelopmental problems.Here, we describe a 5-year-old boy with a maternally inherited pathogenic variant in NF-1 and hypoxanthine-guanine phosphoribosyltransferase (HPRT ). He was referred for severe neurodevelopmental impairment and hyperuricemia. His mother was diagnosed with NF1 and the patient was also suspected of having NF1 because of cafe au lait macules. He had dystonia, rigidity, cognitive deficit, and speech/language impairment. Serum and urine uric acid concentrations were elevated. He had more severe neurodevelopmental delay than patients with only NF1, so his clinical symptoms could not be fully understood by the disease alone. To find the cause of his neurologic symptoms and hyperuricemia, the patient and his mother underwent a whole-exome sequencing test. As a result, the pathogenic variant c.151C>T (p.Arg51Ter) in HPRT1 was identified as hemizygote in the patient and heterozygote in his mother. The pathogenic variant c.7682C>G (p.Ser2561Ter) in NF-1 was identified as heterozygotes in both of them. Although the clinical symptoms of both diseases were overlapping and complicated, genetic testing was helpful for accurate diagnosis and treatment. Therefore, we suggest to consider preemptive genetic evaluation if there are symptoms not sufficiently explained by known existing diseases. And it is considered valuable to review this rare case to understand the clinical course and possible synergic effects of these diseases.