Useful Ultrasound Findings of Pediatric Patients with Equivocal Results of Appendicitis: Analysis Based on a Structured Report Form

Purpose@#To identify the features that can be used for differentiating appendicitis from non-appendicitis in pediatric patients with equivocal ultrasound (US) results. @*Materials and Methods@#A total of 53 pediatric patients (≤ 18 years old) with equivocal results on US examination for suspected appendicitis between November 2012 and October 2017 were included. US evaluation was conducted based on information retrieved from a predefined structured report form. Then, the likelihood of appendicitis was prospectively classified into five categories. The equivocal results were considered as grade 3 (indeterminate) and grade 4 (probably appendicitis). @*Results@#Of the 53 patients, 25 (47.2%) and 28 (52.8%) were classified into grade 3 and 4 groups, respectively. Among the individual US findings, increased vascularity of the appendiceal wall and peri-appendiceal fat infiltration were independent findings associated with the diagnosis of appendicitis (p = 0.005, p = 0.045, respectively) in the multivariate logistic regression analysis and showed the highest diagnostic accuracy (69.8% and 62.3%, respectively). @*Conclusion@#Increased vascularity within the appendiceal wall and peri-appendiceal fat infiltration were significant predictors of appendicitis in patients with equivocal US findings.

Synchronous Cancers of Hepatic Angiosarcoma and Gallbladder Adenocarcinoma, Mimicking Gallbladder Cancer with Hepatic Invasion: a Case Report

Synchronous primary cancers in the liver and gallbladder have been rarely reported.We report a case of synchronous cancers of hepatic angiosarcoma and gallbladder adenocarcinoma, mimicking gallbladder cancer with hepatic invasion. Additionally, the clinical implications, the radiologic features, and the diagnostic difficulties are further discussed.

Analysis of the Participation Reasons and Deterrents on Welfare Facility Dietitians for the Elderly / 대한지역사회영양학회지

OBJECTIVES: This study analyzed the education participation reasons and deterrents of dietitians who work in welfare facilities for the elderly. METHODS: The survey was completed by 144 dietitians working at welfare facilities for the elderly in Korea. The survey was conducted in October, 2018, both on-line and off-line, based on the demographic characteristics, work status on welfare facilities for the elderly, Participation Reasons Scale (PRS) and Deterrents to Participation Scale (DPS-G). The data were analyzed using frequency analysis, descriptive analysis, factor analysis, reliability analysis, regressive analysis using SPSS ver. 25.0. RESULTS: The reason for participation were divided into three factors: ‘Responsibility of professional and self-development (5.76 ± 1.04)’, ‘Job stability and personal benefits (4.98 ± 1.28)’, and ‘Interaction and development of professional competencies (5.85 ± 1.00)’. ‘Interaction and development of professional competencies’ was the highest motivation factor. Also, the deterrents for participation were divided into four factors: ‘Dispositional barrier (2.70 ± 1.29)’, ‘Dissatisfaction of education usability (3.39 ± 1.38)’, ‘Institutional barrier (4.21 ± 1.45)’, and ‘Situational barrier (2.36 ± 1.30)’. ‘Institutional barrier’ showed the highest deterrents factor. In addition, ‘Responsibility of professional and self-development’ and ‘Interaction and development of professional competencies’ were negative attributes for ‘Dispositional barrier’ (p<0.001). CONCLUSIONS: These results provide basic data to promote participation in education and contribute to the improvement of their job ability and education capacity of the food and nutrition management of welfare facilities for the elderly

Analysis of the Participation Reasons and Deterrents on Welfare Facility Dietitians for the Elderly / 대한지역사회영양학회지

OBJECTIVES: This study analyzed the education participation reasons and deterrents of dietitians who work in welfare facilities for the elderly. METHODS: The survey was completed by 144 dietitians working at welfare facilities for the elderly in Korea. The survey was conducted in October, 2018, both on-line and off-line, based on the demographic characteristics, work status on welfare facilities for the elderly, Participation Reasons Scale (PRS) and Deterrents to Participation Scale (DPS-G). The data were analyzed using frequency analysis, descriptive analysis, factor analysis, reliability analysis, regressive analysis using SPSS ver. 25.0. RESULTS: The reason for participation were divided into three factors: ‘Responsibility of professional and self-development (5.76 ± 1.04)’, ‘Job stability and personal benefits (4.98 ± 1.28)’, and ‘Interaction and development of professional competencies (5.85 ± 1.00)’. ‘Interaction and development of professional competencies’ was the highest motivation factor. Also, the deterrents for participation were divided into four factors: ‘Dispositional barrier (2.70 ± 1.29)’, ‘Dissatisfaction of education usability (3.39 ± 1.38)’, ‘Institutional barrier (4.21 ± 1.45)’, and ‘Situational barrier (2.36 ± 1.30)’. ‘Institutional barrier’ showed the highest deterrents factor. In addition, ‘Responsibility of professional and self-development’ and ‘Interaction and development of professional competencies’ were negative attributes for ‘Dispositional barrier’ (p<0.001). CONCLUSIONS: These results provide basic data to promote participation in education and contribute to the improvement of their job ability and education capacity of the food and nutrition management of welfare facilities for the elderly

Spinal Epidural En Plaque Meningioma Misdiagnosed as Lymphoma: A Case Report

Spinal meningiomas in the epidural location are rare, accounting only 2.5% to 3.5% of all spinal meningiomas. The diagnosis of spinal epidural meningiomas, solely based on imaging findings, can be difficult. They are easily mistaken for metastatic tumors or lymphomas, especially, meningiomas of the enplaque type. Misdiagnosis of meningiomas can affect the extent of surgery and patients' outcome; hence, a careful diagnosis is needed. We report a case of pathologically confirmed epidural enplaque meningioma in the cervical spine with neural foraminal extension. Additionally, its clinical implications, radiologic features, and diagnostic difficulties are discussed.

Application of recombinant adenoviruses expressing glycoprotein or nucleoprotein of rabies virus to Korean raccoon dogs

PURPOSE: A new rabies vaccine for animals, including raccoon dogs, in Korea is needed to eradicate rabies infection. In this study, we constructed two recombinant adenoviruses expressing the glycoprotein or nucleoprotein of the rabies virus (RABV). We then investigated the safety and immunogenicity of these strains in raccoon dogs, depending on inoculation route. MATERIALS AND METHODS: Recombinant adenoviruses expressing the glycoprotein (Ad-0910G) or nucleoprotein (Ad-0910N) of rabies were constructed in 293A cells using an adenoviral system. One-year-old raccoon dogs underwent intramuscular (IM) inoculation or oral administration of the recombinant Ad-0910G and Ad-0910N. Clinical symptoms were observed and virus-neutralizing antibodies (VNA) against RABV were measured at 0, 2, 4, and 6 weeks after the immunization. Raccoons were considered positive if VNA titers were > or = 0.1 IU/mL. RESULTS: Raccoon dogs inoculated with the combined Ad-0910G and Ad-0910N virus via the IM route did not exhibit any clinical sign of rabies during the observation period. All raccoon dogs (n = 7) immunized IM had high VNA titers, ranging from 0.17 to 41.6 IU/mL at 2 weeks after inoculation, but 70% (7/10) of raccoon dogs administered viruses via the oral route responded by 6 weeks after administration against RABV. CONCLUSION: Raccoon dogs inoculated with Ad-0910G and Ad-0910N viruses showed no adverse effects. Immunization with the combined Ad-0910G and Ad-0910N strains may play an important role in inducing VNA against RABV in raccoon dogs.

Different Perceptions of Clinical Nutrition Services between Doctors and Dietitians in the Busan-Gyeongnam Area

The purpose of this study was to evaluate the difference in perception of clinical nutrition service (CNS) between doctors and dietitians working in hospitals in Busan and the Gyeongnam area. Research was performed through questionnaires (from November to December 2011) at over 100 beds. 73.3% of dietitians were aware of the Nutrition Support Team (NST), while only 15.6% of doctors were aware of it. Due to heavy work and lack of medical staff, doctors didn't participate in NST, although most of them recognized the necessity of NST. 61.7% of dietitians screened and managed malnourished patients, whereas only 29.8% of doctors did. The main reason dietitians didn't treat malnourished patients was the absence of a treatment system in the hospital. Less than 50% of dietitians participated in the doctor's round to malnourished patients. As for why dietitians didn't participate in doctor's rounds, 71% of doctors chose understaffed dietitians and 38.1% of dietitians chose the doctors' unawareness of the importance of the dietitian in doctor's rounds. For the lower rate of nutrition counseling in provincial regions, compared to the capital region, 46.8% of doctors cited a lack of connection between doctors and clinical dietitians, while 43.3% of dietitians cited the lack of doctors' awareness on the importance of nutrition counseling. Although 87.3% of the doctors and 91.6% of the dietitians answered that CNS is important for treatment, the perception of onsite performance status on CNS was found to be low in both groups. 48.9% of doctors and 50.0% of dietitians regarded dietitians in the hospital as personnel in charge of food services, rather a member of the medical team. To improve the awareness of the importance of the CNS, and the image of clinical dietitians, 31.2% of doctors answered "to introduce a professional dietitian license for each disease" and 26.7% of dietitians answered "to change the system in the hospital". Most subjects found that a separation of clinical nutrition services from the food service part is needed. These results suggest that it is important to narrow the difference in perceptions of clinical nutrition services between doctors and dietitians for an organized clinical nutrition management of patients in hospitals in Busan and the Gyeongnam area.

Vitamin B12 Deficiency Megaloblastic Anemia in a Patient with Acquired Immunodeficiency Syndrome / 감염과화학요법

Anemia is the most common hematologic finding in patients with advanced infections caused by human immunodeficiency virus (HIV) or advanced acquired immunodeficiency syndrome (AIDS). Among many etiologies of HIV-associated anemia, vitamin B12 deficiency plays an important role, mostly due to malabsorption or HIV enteropathy. We experienced a case of megaloblastic anemia caused by vitamin B12 deficiency in a male patient with an AIDS who had no structural gastrointestinal problem. He showed severe anemia, leukopenia, thrombocytopenia and suspicious neurologic manifestations such as aggravation of dementia and gait disturbance. With vitamin B12 and folate treatment, the patient's general condition and hematologic features were improved successfully.

National survey for genetic counseling and demands for professional genetic counselor

PURPOSE: The necessity of professional non-MD genetic counselor has been recently emphasized in a medical field. By conducting a national survey on the demands for generic counseling and professional non-MD generic counselor, we can make a long-term master plan to execute the educational program for professional genetic counselors and indeed promote genetic counseling in Korean health care service in a systemic manner. METHODS: The survey has been conducted from September 3rd to October 4th of 2007 in a way of e-mail, telephone interview, fax, and direct contacts. It's targets were senior researchers and professors in medical and non-medical institutions, policy makers, research institutions or foundations. The survey questions consist of 16 questionnaires. RESULTS: As a result of survey, 102 of 650 people responded. 80% of respondents indicated that genetic counseling is needed as a health care service and 34% among them considered it as "the most needed". In addition, 77% of the respondents showed that, it is necessary to have a professional non-MD genetic counselor with a master degree or higher in the field of medical genetics and among them 29% thought it as "the most necessary". A 77% of respondents considered that the cost of genetic counseling should be covered by health insurance and among them, 29% answered "strongly agreed". A 56% of respondents chose the answer of "They have a plan to hire the professional non-MD genetic counselor" in their institution, and among them 71% selected "within 5 years" in terms of when to hire. Also, they tend to expect the role of the professional non-MD genetic counselor to be not only "genetic counselor" (60%), but also "researcher" (42%), "educator" (18%) and "clinical laboratory coordinator" (19%). CONCLUSION: The 102 of 650 people responded to the survey. Based upon the nationwide survey over the needs on genetic counseling in health care service and demands on the professional non-MD genetic counselor, systematic educational program for the genetic counseling, with reimbursement coverage for counseling service by health insurance should be emphasized in development of a master plan.

Controversial issues in the legal restriction for prenatal genetic testing in Korea

More than 6,000 rare disorders including genetic diseases have been reported. Of them, 1,500 diseases (1,211 for clinical diagnosis and 289 for research only) are technically possible for genetic testing. In Korea, since 2005, only 63 genetic diseases is permitted for prenatal genetic testing by the "Bioethics and Biosafety Law". The article 25 in the law prescribes 63 genetic diseases without clear indication for its selection and inclusion criteria. In EU, USA, and other foreign countries, however, there is no provision in the statute on prenatal genetic testing; it is not restricted by a law. Recently, a woman (Mrs. L, 38y) who is a carrier for Menkes disease made an appeal to a government for an amendment of the "Bioethics and Biosafety Law" prohibiting the prenatal diagnosis of her pregnancy at risk for Menkes disease. Menkes disease (MNK) is an X-linked recessive disorder characterized by neurodegeneration, connective tissue defects and hair abnormalities, and no effective treatment is available yet. The prevalence rate of MNK is one in about 250,000 live births. Menkes syndrome patients fail to absorb copper from the gastrointestinal tract in quantities adequate for meeting nutritional needs. These needs seem particularly acute during the initial 12 month of life, when the velocity of brain growth and motor neurodevelopment. Most of pts. die around 3yrs. of age. Mrs. L had a boy with Menkes disease who died at 2y.o. in 2001. Subsequent pregnancy in 2003, she was able to have prenatal genetic testing for mutation of the Menkes (ATP7A) gene and delivered a healthy baby boy. Now, She is pregnant again and wants to have prenatal diagnosis. however, this time, she was not allowed to have any more because Menkes disease is not included in 63 genetic diseases permitted by the law for prenatal genetic testing, in spite of the fact that she is a Menkes disease carrier and her pregnancy is at risk to have an affected baby. This case shows the practical problem of the legal restriction for prenatal genetic testing in Korea. In this study, we report a arguable case and discuss the controversial issues in the legal restriction for prenatal genetic testing in Korea.