Inter-observer Reproducibility in the Pathologic Diagnosis of Gastric Intraepithelial Neoplasia and Early Carcinoma in Endoscopic Submucosal Dissection Specimens: A Multi-center Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The diagnostic criteria of gastric intraepithelial neoplasia (IEN) are controversial across the world. We investigated how many discrepancies occur in the pathologic diagnosis of IEN and early gastric carcinoma in endoscopic submucosal dissection (ESD) specimens, and evaluated the reasons of the discordance. MATERIALS AND METHODS: We retrospectively reviewed 1,202 ESD specimens that were originally diagnosed as gastric IEN and early carcinoma at 12 institutions. RESULTS: The final consensus diagnosis of carcinoma were 756 cases, which were originally 692 carcinomas (91.5%), 43 high-grade dysplasias (5.7%), 20 low-grade dysplasias (2.6%), and 1 others (0.1%), respectively. High- and low-grade dysplasia were finally made in 63 and 342 cases, respectively. The diagnostic concordance with the consensus diagnosis was the highest for carcinoma (91.5%), followed by low-grade dysplasia (86.3%), others (63.4%) and high-grade dysplasia (50.8%). The general kappa value was 0.83, indicating excellent concordance. The kappa values of individual institutions ranged from 0.74 to 1 and correlated with the proportion of carcinoma cases. The cases revised to a final diagnosis of carcinoma exhibited both architectural abnormalities and cytologic atypia. The main differential points between low- and high-grade dysplasias were the glandular distribution and glandular shape. Additional features such as the glandular axis, surface maturation, nuclear stratification and nuclear polarity were also important. CONCLUSION: The overall concordance of the diagnosis of gastric IEN and early carcinoma in ESD specimens was excellent. It correlated with the proportion of carcinoma cases, demonstrating that the diagnostic criteria for carcinoma are more reproducible than those for dysplasia.

Influence of Perfectionism and Coping Styles on Burnout in Clinical Nurses / 한국직업건강간호학회지

PURPOSE@#The purpose of this study was to identify the influencing factors on burnout after analyzing the relationship among clinical nurses' various perfectionism and coping styles.@*METHODS@#A descriptive, cross-sectional study was conducted with 200 clinical nurses who had six months or more years of clinical experiences from two general hospitals located in D city. The data were analyzed by t-test, one-way ANOVA, Pearson's correlation coefficients, and stepwise regression analysis using IBM SPSS statistics 23.0 program.@*RESULTS@#The burnout of clinical nurses was positively correlated with socially prescribed perfectionism and negatively correlated with active coping style. Socially prescribed perfectionism was positively correlated with active coping style and passive coping style. Influencing factors on the burnout of clinical nurses were socially prescribed perfectionism (β=.37), satisfied work unit (β=−.64) and neutral satisfaction of work unit (β=−.27), over 40 years of age (β=−.21), and active coping style (β=−.14). The model consisting of these variables explained 42% of variance of burnout in clinical nurses.@*CONCLUSION@#Based on the findings of this study developing intervention programs that consider influencing factors such as perfectionism and coping styles is needed to reduce the level of burnout of clinical nurses.

Influence of Perfectionism and Coping Styles on Burnout in Clinical Nurses / 산업간호학회지

PURPOSE: The purpose of this study was to identify the influencing factors on burnout after analyzing the relationship among clinical nurses' various perfectionism and coping styles. METHODS: A descriptive, cross-sectional study was conducted with 200 clinical nurses who had six months or more years of clinical experiences from two general hospitals located in D city. The data were analyzed by t-test, one-way ANOVA, Pearson's correlation coefficients, and stepwise regression analysis using IBM SPSS statistics 23.0 program. RESULTS: The burnout of clinical nurses was positively correlated with socially prescribed perfectionism and negatively correlated with active coping style. Socially prescribed perfectionism was positively correlated with active coping style and passive coping style. Influencing factors on the burnout of clinical nurses were socially prescribed perfectionism (β=.37), satisfied work unit (β=−.64) and neutral satisfaction of work unit (β=−.27), over 40 years of age (β=−.21), and active coping style (β=−.14). The model consisting of these variables explained 42% of variance of burnout in clinical nurses. CONCLUSION: Based on the findings of this study developing intervention programs that consider influencing factors such as perfectionism and coping styles is needed to reduce the level of burnout of clinical nurses.

Quality of Life after Endoscopic Submucosal Dissection for Early Gastric Cancer: A Prospective Multicenter Cohort Study

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) has been an established treatment for indicated early gastric cancer (EGC) without deterioration of quality of life (QOL) compared with surgical resection. The aim of this study was to evaluate long-term QOL in patients undergoing ESD for EGC. METHODS: Patients scheduled to undergo curative ESD for EGC were prospectively enrolled from 12 institutions between May 2010 and December 2011. Assessments of QOL with Korean versions of the European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaire-core (QLQ-C30) and a gastric cancer-specific questionnaire (STO22) were performed at baseline and at 7 days, 3 months, and 6 months after ESD. RESULTS: A total of 666 subjects were assessed for QLQ-C30 and QLQ-STO22. The mean QLQ-C30 score was 69.5 at baseline, 68.8 at 7 days, 73.1 at 3 months, and 73.2 at 6 months. The global health status on the EORTC QLQ-C30 was significantly improved after 3 and 6 months (p=0.0003 and p<0.0001, respectively). The QLQ-C30 and STO22 scores were not significantly different, or they only slightly deteriorated between before and immediately after ESD, but they were significantly improved after 3 and 6 months (p<0.05). CONCLUSIONS: QOL did not deteriorate immediately after ESD, and it improved more significantly at up to 6 months in patients who underwent curative ESD for EGC without significant complications.

Cytomegalovirus Infection in Pediatric Renal Transplant Recipients: A Single Center Experience

PURPOSE: To investigate the frequency, presentation, management, and outcome of cytomegalovirus (CMV) infection in pediatric patients who underwent renal transplantation. METHODS: We performed a retrospective chart review of 70 patients under the age of 18, who underwent renal transplantation between January 1990 and November 2014. A diagnosis of CMV infection was based on serology, molecular assays, antigenemia assays, and culture. CMV infection was defined as detection of virus and CMV disease was diagnosed when clinical signs and symptoms were present. RESULTS: The number of patients with CMV infection was 18 (25.7% of renal transplant recipients). Twelve were male (66.7%), and the mean±standard deviation (SD) age at infection was 13.3±3.9 years. Median time of infection after renal transplantation was 4 months (range 1.0-31.0 months). Pretransplantation CMV status in the infected group was as follows: donor (D)+/recipient (R)+, 11 (61.1%); D+/R-, 7 (38.9%); D-/R+, 0; and D-/R- 0. Nine patients had CMV disease with fever, leukopenia, thrombocytopenia, or organ involvement such as enteritis, hepatitis, and pneumonitis. The age of disease occurrence was 13.1±3.9 years and the median time to disease onset after renal transplantation was 8 months (range 1.0-31.0). Immunosuppressive agents were reduced or discontinued in 14 patients (77.8%), antiviral agents were used in 11 patients (61.1%), and all patients with CMV infection were controlled. CONCLUSIONS: A quarter of the patients had CMV infection about 4 months after renal transplantation. CMV infection was successfully treated with reduction of immunosuppressants or with antiviral agents.

Cytomegalovirus Infection in Pediatric Renal Transplant Recipients: A Single Center Experience

PURPOSE: To investigate the frequency, presentation, management, and outcome of cytomegalovirus (CMV) infection in pediatric patients who underwent renal transplantation. METHODS: We performed a retrospective chart review of 70 patients under the age of 18, who underwent renal transplantation between January 1990 and November 2014. A diagnosis of CMV infection was based on serology, molecular assays, antigenemia assays, and culture. CMV infection was defined as detection of virus and CMV disease was diagnosed when clinical signs and symptoms were present. RESULTS: The number of patients with CMV infection was 18 (25.7% of renal transplant recipients). Twelve were male (66.7%), and the mean±standard deviation (SD) age at infection was 13.3±3.9 years. Median time of infection after renal transplantation was 4 months (range 1.0-31.0 months). Pretransplantation CMV status in the infected group was as follows: donor (D)+/recipient (R)+, 11 (61.1%); D+/R-, 7 (38.9%); D-/R+, 0; and D-/R- 0. Nine patients had CMV disease with fever, leukopenia, thrombocytopenia, or organ involvement such as enteritis, hepatitis, and pneumonitis. The age of disease occurrence was 13.1±3.9 years and the median time to disease onset after renal transplantation was 8 months (range 1.0-31.0). Immunosuppressive agents were reduced or discontinued in 14 patients (77.8%), antiviral agents were used in 11 patients (61.1%), and all patients with CMV infection were controlled. CONCLUSIONS: A quarter of the patients had CMV infection about 4 months after renal transplantation. CMV infection was successfully treated with reduction of immunosuppressants or with antiviral agents.

Short-Term Outcomes of Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer: A Prospective Multicenter Cohort Study

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) is an effective treatment for early gastric cancer (EGC) that has demonstrated a minimal risk of lymph node metastasis in retrospective studies. We sought to prospectively evaluate the short-term outcomes of ESD treatment in EGCs. METHODS: A prospective multicenter cohort study of neoplasms 3 cm or less in diameter at endoscopic size evaluation was performed in 12 Korean ESD study group-related university hospitals and the National Cancer Center. Resected specimens were evaluated by the central pathologic review board. RESULTS: A patient cohort (n=712) with a total of 737 EGCs was analyzed. The margin-freeen bloc resection rate was 97.3%, and curative resection of 640 lesions (86.8%) was achieved. Lower curative resection rates were associated with lesions 2 to 3 cm in size prior to ESD compared with lesions 2 cm or less in size (78.6% vs 88.1%, respectively, p=0.009). Significant factors associated with noncurative resection were moderately or poorly differentiated histological type, posterior wall tumor location, tumor size larger than 3 cm, ulceration, and submucosal invasion. Delayed bleeding occurred in 49 patients (6.9%), and 12 patients (1.7%) exhibited perforations. CONCLUSIONS: ESD is an effective treatment with a high curative resection rate for EGCs that meets relatively conservative pre-ESD indications. Long-term survival outcomes should be evaluated in follow-up studies.

Observations of Oxygen Administration Effects on Visuospatial Cognitive Performance using Time Course Data Analysis of fMRI

PURPOSE: This study attempted to investigate the effects of supply of highly concentrated (30%) oxygen on human ability of visuospatial cognition using time course data analysis of functional Magnetic Resonance Imaging (fMRI). MATERIALS AND METHODS: To select an item set in the visuospatial performance test, two questionnaires with similar difficulty were developed through group testing. A group test was administered to 263 college students. Two types of questionnaire containing 20 questions were developed to measure the ability of visuospatial cognition. Eight college students (right-handed male, average age of 23.5 yrs) were examined for fMRI study. The experiment consisted of two runs of the visuospatial cognition testing, one with 21% level of oxygen and the other with 30% oxygen level. Each run consisted of 4 blocks, each containing control and visuospatial items. Functional brain images were taken from 3T MRI using the single-shot EPI method. Using the subtraction procedure, activated areas in the brain during visuospatial tasks were col-orcoded by t-score. To investigate the time course data in each activated area from brain images, 4 typical regions (cerebellum, occipital lobe, parietal lobe, and frontal lobe) were selected. RESULTS: The average accuracy was 50.63 +/-8.63 and 62.50 +/-9.64 for 21% and 30% oxygen respectively, and a statistically significant difference was found in the accuracy between the two types of oxygen (p<0.05). There were more activation areas observed at the cerebellum, occipital lobe, parietal lobe and frontal lobe with 30% oxygen administration. The rate of increase in the cerebellum, occipital lobe and parietal lobe was 17% and that of the frontal lobe, 50%. Especially, there were increase of intensity of BOLD signal at the parietal lobe with 30% oxygen administration. The increase rate of the left parietal lobe was 1.4% and that of the right parietal lobe, 1.7%. CONCLUSION: It is concluded that while performing visuospatial tasks, high concentrations of oxygen administration make oxygen administration sufficient, thus making neural network activate more, and the ability to perform visuospatial tasks increase.

Observations of Oxygen Administration Effects on Visuospatial Cognitive Performance using Time Course Data Analysis of fMRI

PURPOSE: This study attempted to investigate the effects of supply of highly concentrated (30%) oxygen on human ability of visuospatial cognition using time course data analysis of functional Magnetic Resonance Imaging (fMRI). MATERIALS AND METHODS: To select an item set in the visuospatial performance test, two questionnaires with similar difficulty were developed through group testing. A group test was administered to 263 college students. Two types of questionnaire containing 20 questions were developed to measure the ability of visuospatial cognition. Eight college students (right-handed male, average age of 23.5 yrs) were examined for fMRI study. The experiment consisted of two runs of the visuospatial cognition testing, one with 21% level of oxygen and the other with 30% oxygen level. Each run consisted of 4 blocks, each containing control and visuospatial items. Functional brain images were taken from 3T MRI using the single-shot EPI method. Using the subtraction procedure, activated areas in the brain during visuospatial tasks were col-orcoded by t-score. To investigate the time course data in each activated area from brain images, 4 typical regions (cerebellum, occipital lobe, parietal lobe, and frontal lobe) were selected. RESULTS: The average accuracy was 50.63 +/-8.63 and 62.50 +/-9.64 for 21% and 30% oxygen respectively, and a statistically significant difference was found in the accuracy between the two types of oxygen (p<0.05). There were more activation areas observed at the cerebellum, occipital lobe, parietal lobe and frontal lobe with 30% oxygen administration. The rate of increase in the cerebellum, occipital lobe and parietal lobe was 17% and that of the frontal lobe, 50%. Especially, there were increase of intensity of BOLD signal at the parietal lobe with 30% oxygen administration. The increase rate of the left parietal lobe was 1.4% and that of the right parietal lobe, 1.7%. CONCLUSION: It is concluded that while performing visuospatial tasks, high concentrations of oxygen administration make oxygen administration sufficient, thus making neural network activate more, and the ability to perform visuospatial tasks increase.