NK Cell-Based Immunotherapies in Cancer

With the development of technologies that can transform immune cells into therapeutic modalities, immunotherapy has remarkably changed the current paradigm of cancer treatment in recent years. NK cells are components of the innate immune system that act as key regulators and exhibit a potent tumor cytolytic function. Unlike T cells, NK cells exhibit tumor cytotoxicity by recognizing non-self, without deliberate immunization or activation. Currently, researchers have developed various approaches to improve the number and anti-tumor function of NK cells. These approaches include the use of cytokines and Abs to stimulate the efficacy of NK cell function, adoptive transfer of autologous or allogeneic ex vivo expanded NK cells, establishment of homogeneous NK cell lines using the NK cells of patients with cancer or healthy donors, derivation of NK cells from induced pluripotent stem cells (iPSCs), and modification of NK cells with cutting-edge genetic engineering technologies to generate chimeric Ag receptor (CAR)-NK cells. Such NK cell-based immunotherapies are currently reported as being promising anti-tumor strategies that have shown enhanced functional specificity in several clinical trials investigating malignant tumors. Here, we summarize the recent advances in NK cell-based cancer immunotherapies that have focused on providing improved function through the use of the latest genetic engineering technologies. We also discuss the different types of NK cells developed for cancer immunotherapy and present the clinical trials being conducted to test their safety and efficacy.

Multilevel Effects of Community Capacity on Active Aging in Community-Dwelling Older Adults in South Korea

Purpose@#This study aimed at identifying the level of active aging in older adults and the influence of the individual and community levels of community capacity on active aging. @*Methods@#A cross-sectional survey was conducted on a stratified sample of 380 older adults living in 35 neighborhoods of five regions in Seoul, the capital of South Korea. The structured questionnaire included the Korean version of instruments that measure active aging and community capacity at the individual level. Secondary data including metropolitan statistical information, a public data portal, and a city plan were used to acquire community-capacity factors at the community level. Data were analyzed with multilevel models. @*Results@#The overall active aging mean score was 3.00 ± 0.55 out of 5; the highest mean score was in the security domain (3.46 ± 0.65) and the lowest one was in the participation domain (2.71 ± 0.66). Individual factors associated with active aging included age, education, income, and community capacity at the individual level. At the community level, two community-capacity factors (senior leisure welfare facilities and cooperative unions) were significantly associated with active aging. In active aging, 6.4% and 4.1% of total variance could be explained by 35 neighborhoods, after considering individual and community level variables, respectively. @*Conclusion@#This study showed that community capacity is important for active aging among older adults. Appropriate strategies that consider both individual and community factors, such as contextual indicators of community capacity, are necessary to improve active aging.

Multilevel Effects of Community Capacity on Active Aging in Community-Dwelling Older Adults in South Korea

Purpose@#This study aimed at identifying the level of active aging in older adults and the influence of the individual and community levels of community capacity on active aging. @*Methods@#A cross-sectional survey was conducted on a stratified sample of 380 older adults living in 35 neighborhoods of five regions in Seoul, the capital of South Korea. The structured questionnaire included the Korean version of instruments that measure active aging and community capacity at the individual level. Secondary data including metropolitan statistical information, a public data portal, and a city plan were used to acquire community-capacity factors at the community level. Data were analyzed with multilevel models. @*Results@#The overall active aging mean score was 3.00 ± 0.55 out of 5; the highest mean score was in the security domain (3.46 ± 0.65) and the lowest one was in the participation domain (2.71 ± 0.66). Individual factors associated with active aging included age, education, income, and community capacity at the individual level. At the community level, two community-capacity factors (senior leisure welfare facilities and cooperative unions) were significantly associated with active aging. In active aging, 6.4% and 4.1% of total variance could be explained by 35 neighborhoods, after considering individual and community level variables, respectively. @*Conclusion@#This study showed that community capacity is important for active aging among older adults. Appropriate strategies that consider both individual and community factors, such as contextual indicators of community capacity, are necessary to improve active aging.

Differences between Perceived Readiness for Interprofessional Learning in Nursing and Other Health-related Students / 한국간호교육학회지

PURPOSE: The purpose of this study was to investigate the level of perceived readiness for interprofessional learning and its differences between nursing and other health-related students. Methods METHODS: A web-based survey was conducted from April 25 to June 30, 2017 in one university in Korea. A total of 325 undergraduate nursing students and other health-related disciplines completed the structured questionnaire consisting of Readiness for Interprofessional Learning Scale and general characteristics. Data were analyzed by descriptive statistics, t-test, ANOVA, and multiple linear regression. RESULTS: The scores of readiness for interprofessional learning in nursing students were significantly higher than those in other health-related students (t=3.50, p=.001). Nursing students had higher collaboration, professional identity, and roles and responsibilities than other health-related students. The class experiences with other major students was a significant factor related to the readiness for interprofessional learning both in nursing (p=.001) and other health-related students (p=.001). CONCLUSION: The findings suggest that nursing educators consider the different level of readiness for interprofessional learning between nursing and other health-related students while integrating interprofessional education into nursing education curricula.

A Novel Immunomodulatory Mechanism Dependent on Acetylcholine Secreted by Human Bone Marrow-derived Mesenchymal Stem Cells

BACKGROUND AND OBJECTIVES: Mesenchymal stem cells (MSCs) are used to treat autoimmune or inflammatory diseases. Our aim was to determine the immunomodulatory mechanisms elicited by MSCs during inflammation. METHODS AND RESULTS: We cocultured MSCs with peripheral blood mononuclear cells for a mixed lymphocyte reaction or stimulated them by phytohemagglutinin. Morphological changes of MSCs and secretion of acetylcholine (ACh) from MSCs were measured. The effects of an ACh antagonist and ACh agonist on lymphocyte proliferation and proinflammatory-cytokine production were determined. The inflammatory milieu created by immune-cell activation caused MSCs to adopt a neuronlike phenotype and induced them to release ACh. Additionally, nicotinic acetylcholine receptors (nAChRs) were upregulated in activated peripheral blood mononuclear cells. We observed that ACh bound to nAChR on activated immune cells and led to the inhibition of lymphocyte proliferation and of proinflammatory-cytokine production. MSC-mediated immunosuppression through ACh activity was reversed by an ACh antagonist called α-bungarotoxin, and lymphocyte proliferation was inhibited by an ACh agonist, ACh chloride. CONCLUSIONS: Our findings point to a novel immunomodulatory mechanism in which ACh secreted by MSCs under inflammatory conditions might modulate immune cells. This study may provide a novel method for the treatment of autoimmune diseases by means of MSCs.

Factors related to Professional Quality of Life among Community Health Practitioners in Korea / 한국직업건강간호학회지

PURPOSE@#The aims of this study were to examine the work, client, and personal environments of community health practitioners, including the level of their professional quality of life (ProQOL), and identify the factors affecting their ProQOL.@*METHODS@#Data were collected using a web-survey questionnaire, which was completed by a sample of 308 community health practitioners currently working in Korea. The questionnaire included items on ProQOL; three dimensions labeled compassion satisfaction, burn out, and secondary traumatic stress; job stress; job satisfaction; sense of community; and general characteristics.@*RESULTS@#The mean scores for the three dimensions were 39.2±6.44 (compassion satisfaction), 31.9±3.59 (burn out), and 26.4±5.05 (secondary traumatic stress). A multiple linear regression revealed that compassion satisfaction varied significantly according to the satisfaction with job choice, sense of community, job stress, and job satisfaction. The factors affecting burn out were sense of community and work load, while the factors affecting secondary traumatic stress were education, job stress, and job satisfaction.@*CONCLUSION@#The findings of this study suggest that comprehensive intervention focusing on improving the sense of community and job satisfaction and reducing job stress is essential to promote community health practitioners' ProQOL.

Factors related to Professional Quality of Life among Community Health Practitioners in Korea / 산업간호학회지

PURPOSE: The aims of this study were to examine the work, client, and personal environments of community health practitioners, including the level of their professional quality of life (ProQOL), and identify the factors affecting their ProQOL. METHODS: Data were collected using a web-survey questionnaire, which was completed by a sample of 308 community health practitioners currently working in Korea. The questionnaire included items on ProQOL; three dimensions labeled compassion satisfaction, burn out, and secondary traumatic stress; job stress; job satisfaction; sense of community; and general characteristics. RESULTS: The mean scores for the three dimensions were 39.2±6.44 (compassion satisfaction), 31.9±3.59 (burn out), and 26.4±5.05 (secondary traumatic stress). A multiple linear regression revealed that compassion satisfaction varied significantly according to the satisfaction with job choice, sense of community, job stress, and job satisfaction. The factors affecting burn out were sense of community and work load, while the factors affecting secondary traumatic stress were education, job stress, and job satisfaction. CONCLUSION: The findings of this study suggest that comprehensive intervention focusing on improving the sense of community and job satisfaction and reducing job stress is essential to promote community health practitioners' ProQOL.

Development and Evaluation of Cardiovascular Disease Prevention Education Materials for Middle-aged Korean-Chinese Female Workers: Applying Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P)

PURPOSE: The purpose of this study was to develop and evaluate the quality (understandability and actionability) of health education materials for Korean-Chinese (KC) female migrant workers, using Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P). METHODS: Educational needs assessment was conducted with 3 focus groups with 20 KC women and a focus group with 4 community stakeholders. The quality of the educational materials was evaluated by 3 experts and a community stakeholder, followed by a survey with 15 KC women using 17 items for understandability and 7 items for actionability by means of a Korean version PEMAT-P. RESULTS: The health educational calendar consists of 12 subjects out of 9 topics related to healthy lifestyles for preventing cardiovascular diseases. The overall mean understandability score was 98.8% and the overall mean actionability was 100%. CONCLUSION: Involvement of KC women and community stakeholders in the development of educational materials was found to be an effective strategy for increasing understandability and actionability of educational materials for KC female migrant workers. This study also demonstrates the PEMAT-P is a useful evaluation tool, emphasizing the actionability of educational materials.

Global Health Competencies for Undergraduate Nursing Students in Korea / 한국간호교육학회지

PURPOSE: The purpose of this study was to identify essential global health competencies for undergraduate nursing students in Korea. METHODS: This study used a mixed methods design including an online survey with a convenient sample of 223 nursing educators, followed by an expert discussion with four nursing educators with expertise in global health. The global health competency was measured using the Global Health Competencies for Nurses in the America, which consists of 30 competencies in 6 domains. Each competency was measured by a 4-point Likert Scale, with at least 80% of 3 or 4 point scores indicating consensus that competency was considered essential for undergraduate nursing students. RESULTS: Nursing educators most strongly agreed the competencies of the Social and Environmental Determinants of Health domain as essential global health competencies for nursing students. A total of 21 items in 5 out of 6 competency domains were initially identified with at least 80% agreement. Finally, the experts decided on 24 global health competencies through the revision and integration of several competencies. CONCLUSION: The findings indicate that nursing educators perceived that nursing students need to be prepared for responding to emerging global health needs. The proposed list of global health competencies can provide guidance to develop a framework for integrating global health into undergraduate nursing curriculums.

The Relationships between Social Determinants of Health and Health-related Quality of Life among the Community-dwelling Elderly

PURPOSE: The purpose of this study was to examine the social determinants of health (SDH) associated with health-related quality of life (HQOL) among the community-dwelling elderly, based on the conceptual framework of the Commission on Social Determinants of Health (CSDH). METHODS: A survey was conducted with 199 elders aged 65 years or older sampled through convenient sampling. Data were collected through face to face interviews by trained interviewers using a structured questionnaire, which included scales of the residential area, social support, sense of community, social network, health behaviors, and HQOL. Data were analyzed by ANOVA and stepwise multivariate regression. RESULTS: Major SDH affecting HQOL included the participants' residential area, sense of community, and health behavior. The HQOL of the elderly residing in the B area with a low rate of basic livelihood security recipients was higher than that of those residing in other areas. CONCLUSION: CSDH framework was useful to determine the factors associated with HQOL among the community-dwelling elderly. In addition to their health behavior, their sense of community was found to be a SDH of HQOL, indicating the need of health promotion programs tailored to the characteristics of residential areas and strategies to enhance involvement in community activities.

Apocrine Hydrocystoma on the Lip / 대한피부과학회지

No abstract available.

A Study on User Satisfaction regarding the Clinical Decision Support System (CDSS) for Medication / 대한의료정보학회지

OBJECTIVES: Many medication errors can occur when ordering and dispensing medicine in hospitals. The clinical decision support system (CDSS) is widely used in an effort to reduce medication errors. This study focused on the evaluation of user satisfaction with the CDSS for medication at a university hospital. Specifically, this study aimed to identify the factors influencing user satisfaction and to examine user requirements in order to further improve user satisfaction and drug safety. METHODS: The study was based on survey data from 218 users (103 doctors, 103 nurses, and 15 pharmacists) at a university hospital that uses the CDSS. In order to identify the factors influencing user satisfaction with the CDSS, a multiple linear regression was performed. In order to compare the satisfaction level among the professional groups, an analysis of variance (ANOVA) was performed. RESULTS: The reliability of information, decision supporting capability, and departmental support were significant factors in influencing user satisfaction. In addition, nurses were the most satisfied group, followed by pharmacists and doctors according to the ANOVA. Areas for further improvement in enhancing drug safety were real time information searching and decision supporting capabilities to prevent adverse drug events (ADE) in a timely manner. CONCLUSIONS: We found that the CDSS users were generally satisfied with the system and that it complements the nationwide drug utilization review (DUR) system in reducing ADE. Further CDSS evaluation in other hospitals is needed to improve user satisfaction and drug safety.

A Case of von Hippel-Lindau Disease Presenting with Pancreatic Neuroendocrine Tumor

Von Hippel-Lindau (VHL) disease is an autosomal dominant disorder that results from a germline mutation of the VHL gene. The affected individuals might develop several benign or malignant tumors such as central nervous system or retinal haemangioblastomas, endolymphatic sac tumors, renal cell carcinomas, pheochromocytomas or pancreatic cysts and neuroendocrine tumors. We report here on a case of a 21 year old female with von Hippel-Lindau disease and she presented with only pancreatic neuroendocrine tumor and no evidence of haemangioblastomas or other visceral complications. Further, direct sequencing of the VHL gene reveals a novel germline frameshift mutation of codon 198 from the deletion of nucleotide 592 (cytosine), leading to truncation of the VHL protein.

A Case of Acute Q Fever with Severe Acute Cholestatic Hepatitis

Minimal hepatic dysfunction can be common in acute Q fever, but severe acute cholestatic hepatitis is rarely reported. We report on a 55-year-old male with acute Q fever and severe acute cholestatic hepatitis. He complained of fever, jaundice, ascites, and restlessness on admission. A liver biopsy revealed the presence of compact fibrin-ring granulomas. Serologic titers for C. burnetii IgM and IgG were 2048:1 and 1024:1, respectively. C. burnetii DNA was detected by a nested polymerase chain reaction on the liver tissue.

Evaluation of CDSS for Drug Prescriptions Based on Success Measures / 대한의료정보학회지

OBJECTIVE: The Clinical Decision Support System (CDSS) for drug prescriptions was developed by integrating the computerized physician order entry (CPOE) system to support doctors and pharmacists in making correct decisions on prescribing drugs in line with the prescription guidelines by the Health Insurance Review Agency (HIRA). The objective of this study was to evaluate the performance of the CDSS with respect to system quality, information quality, and user satisfaction in reducing prescription errors. METHODS: The study was based on survey data from 38 hospitals that were using the CDSS for drug prescriptions. To identify factors influencing the performance of CDSS, multiple linear regression and chi-square analyses were performed. RESULTS: Regression analysis showed that the variables for system quality and information quality significantly influenced the overall system performance. Specifically, ease of understanding the results and terminology assystem quality measures significantly influenced user satisfaction. Furthermore, based on chi-square analysis, two independent variables (ease of understanding results and decision support functions) were statistically significant with respect to all four dependent variables (information satisfaction, system satisfaction, willingness to recommend to other hospitals, and drug safety). CONCLUSION: Based on this study, users should be educated to improve their understanding of the system,and system and information quality should be continuously monitored to improve user satisfaction.

Association of Polymorphisms in Monocyte Chemoattractant Protein-1 Promoter with Diabetic Kidney Failure in Korean Patients with Type 2 Diabetes Mellitus

Monocyte chemoattractant protein-1 (MCP-1) is suggested to be involved in the progression of diabetic nephropathy. We investigated the association of the -2518 A/G polymorphism in the MCP-1 gene with progressive kidney failure in Korean patients with type 2 diabetes mellitus (DM). We investigated -2518 A/G polymorphism of the MCP-1 gene in type 2 DM patients with progressive kidney failure (n=112) compared with matched type 2 DM patients without nephropathy (diabetic control, n=112) and healthy controls (n=230). The overall genotypic distribution of -2518 A/G in the MCP-1 gene was not different in patients with type 2 DM compared to healthy controls. Although the genotype was not significantly different between the patients with kidney failure and the diabetic control (p=0.07), the A allele was more frequent in patients with kidney failure than in DM controls (42.0 vs. 32.1%, p=0.03). The carriage of A allele was significantly associated with kidney failure (68.8 vs. 54.5%, OR 1.84, 95% CI 1.07-3.18). In logistic regression analysis, carriage of A allele retained a significant association with diabetic kidney failure. Our result shows that the -2518 A allele of the MCP-1 gene is associated with kidney failure in Korean patients with type 2 DM.

Evaluation of Therapeutic Effects of Cognitive-Behavioral Therapy in Patients with Panic Disorder using Serial (99m)Tc-ECD Brain Perfusion / 핵의학분자영상

PURPOSE: Although several neuroanatomical models of panic disorder have been proposed, little is known regarding the neurological mechanisms underlying cognitive-behavioral therapy (CBT) in patients with panic disorder. This study was performed to identify the brain structures that show changes of regnioal cerebral blood flow (rCBF) after CBT in patients with panic disorder. MATERIALS AND METHODS: Seven patients who were diagnosed as panic disorder by DSM-IV were treated with CBT for 8 weeks and twelve healthy volunteers joined in this study. Serial (99m)Tc-ECD brain perfusion SPECT images were acquisited and PDSS-SR (Self-Report version of Panic Disorder Severity Scale) and ACQ (Agoraphobic Cognitive Question) scores were measured just before and after CBT in all patients. Data were analyzed using SPM2. RESULTS: Subjective symptoms were improved, and PDSS-SR and ACQ scores were significantly reduced (14.9+/-3.9 vs. 7.0+/-1.8, p<0.05; 30.3+/-8.5 vs. 21.6+/-3.4, p<0.05, respectively) after CBT in panic patients. Before CBT, a significant increase of rCBF was found in the cingulate gylus, thalamus, midbrain, both medial frontal and temporal lobes of the panic patients compared to the normal volunteers. After CBT, we observed a significant rCBF decrease in the left parahippocamus, right insula and cingulate gyrus, both frontal and temporal lobes, and a significant rCBF increase in both the occipital lobes, left insula, both frontal and left parietal lobes. CONCLUSION: These data suggested that CBT is effective for panic disorder and diminish the activity of the brain areas associated with fear in panic disorder.

A Clinical Experience of Cyclosporin A in Severe Atopic Dermatitis of Children / 소아알레르기및호흡기학회지

PURPOSE: Severe atopic dermatitis is a condition that can seriously affect the quality of life. This study was performed to evaluate the efficacy and side effect of cyclosporin A treatment in children. METHODS: Nine children(male 7, female 2) with severe atopic dermatitis resistant to conventional therapy and/or significant suffering and disability. The initial dose of cyclosporin A was 2.1-5.2 mg/kg/day and the duration of treatment was 4-6 weeks. The severity and extent of atopic dermatitis were evaluated with modified criteria of Hanifin and Rajka, at 0, 2, 4 and 6th week and after cessation of cyclosporin, at 10th week. Total clinical score was calculated as the average of both extent and severity score. RESULTS: There are significant improvement in both of the symptom severity and the extent of atopic dermatitis. The mean severity and extent scores were 92% and 88% before treatment and 28% and 34% after 6 weeks' treatment. The overall change of the total clinical score was 59% of decrease. Two patients had to stop the drug after 4 weeks of treatment because of severe abdominal pain, especially at night. After stopping the drug, at the 10th weeks' evaluation, 3 patients showed symptomatic exacervations but 6 patients maintain their improved state only with conventional treatment. CONCLUSION : Despite the side effect, cyclosporin A gave a rapid clinical response to severe refractory atopic dermatitis in children.