Psychosocial Factors Influencing Quality of Life Among Medical Students

Objective@#This study investigated the influence of psychosocial factors on medical students’ quality of life (QOL). @*Methods@#A total of 408 medical students participated in this study. We collected data on participants’ sociodemographic details, symptoms of depression and Internet addiction, self-esteem, social support, and QOL. QOL was assessed using the World Health Organization Quality of Life-Abbreviated form, which has four domains (physical health, psychological health, social relationships, and environment). A stepwise multiple linear regression model was constructed to identify factors’ independent impact on QOL. @*Results@#Higher levels of depression and Internet addiction were associated with lower scores in all domains of QOL, whereas higher levels of self-esteem and social support were associated with higher scores. Being in third-year versus first-year was associated with higher scores in the physical health and environment domains. Living alone or in dormitories, low or middle socioeconomic status, and insufficient or moderate pocket money were associated with lower scores in the environment domain. Additionally, female students displayed significantly lower scores for physical health, psychological health, and environment than male students, but not for social relationships. There were significant differences in certain domains of QOL due to sociodemographic factors. @*Conclusion@#This study demonstrates the psychosocial factors influencing medical students’ QOL. Educational strategies focusing on strengthening self-esteem and social support as well as preventing depression and Internet addiction may contribute to improving medical students’ QOL.

Surgical repair of the supraspinatus: pre- and postoperative architectural changes in the muscle

INTRODUCTION@#Shortening of the tendon and muscle is recognised as a strong predictor of surgical failure of supraspinatus tendon tears. Changes in muscle architecture following repair have not been thoroughly investigated. Hence, we aimed to compare the pre- and postoperative architecture of the supraspinatus.@*METHODS@#We recruited eight participants with full-thickness supraspinatus tears. Images of the supraspinatus were captured preoperatively (pre-op) and postoperatively at one month (post-op1), three months (post-op2) and six months (post-op3) in relaxed and contracted states (0º and 60º glenohumeral abduction). Fibre bundle length (FBL), pennation angle (PA) and muscle thickness were quantified. Self-reported function, and maximal isometric abduction and external rotation strengths were assessed.@*RESULTS@#The mean FBL increased from pre-op to post-op1 (p = 0.001) in the relaxed state and from pre-op to post-op2 (p = 0.002) in the contracted state. Decrease in FBL was observed from post-op2 to post-op3 in the relaxed state. The mean PA decreased from pre-op to post-op1 (p < 0.001) in the relaxed state, but increased from post-op2 to post-op3 in both relaxed (p = 0.006) and contracted (p = 0.004) states. At post-op3, external rotation (p = 0.009) and abduction (p = 0.005) strengths were greater than at post-op2. Overall function increased by 47.67% from pre-op to post-op3.@*CONCLUSION@#Lengthening of the supraspinatus occurs with surgery, altering the length-tension relationship of the muscle, which can compromise muscle function and lead to inferior surgical outcomes. These findings may guide clinicians to optimise loads, velocities and shoulder ranges for effective postoperative rehabilitation.

Severity of Daytime Sleepiness and Parkinsonian-Like Symptoms in Korean Adults Aged 50–64 Years

Background@#and Purpose While excessive daytime sleepiness can predate Parkinson’s disease in late-life, its association with parkinsonian-like (P-L) symptoms in middle age are unknown. Since neurodegeneration can appear decades before a diagnosis of Parkinson’s disease, identifying clinical features associated with this early progression is important. The purpose of this study was to determine the association of daytime sleepiness with P-L symptoms in a population-based sample of middle-aged Korean adults. @*Methods@#During 2013 and 2014, daytime sleepiness and P-L symptoms were assessed in 2,063 males and females aged 50–64 years who were participating in the Korean Genome and Epidemiology Study. The severity of daytime sleepiness was quantified by the score on the Epworth Sleepiness Scale (ESS). Self-reported P-L symptoms included nine motor disorders commonly associated with Parkinson’s disease. Participants with parkinsonism and related conditions are excluded. @*Results@#The prevalence of excessive daytime sleepiness (ESS score >10) was 7.0%. The frequencies of P-L symptoms ranged from 0.5% (for “trouble buttoning buttons”) to 18.4% (for “handwriting smaller than it once was”). After adjustment for covariates and multiple testing, the relative odds of P-L symptoms comparing the 80th and 20th percentiles of ESS scores was 1.6 (p=0.001) for “voice is softer than it once was,” 2.1 (p<0.001) for “balance when walking is poor,” and 1.5 (p=0.002) for “loss of facial expression.” The prevalence of excessive daytime sleepiness increased from 6.3% to 19.8% when the number of symptoms increased from zero to three (p=0.004). @*Conclusions@#In Korean adults aged 50–64 years, daytime sleepiness is significantly associated with P-L symptoms. Whether coexisting daytime sleepiness and P-L symptoms predate extrapyramidal and other impairments in later life warrants further investigation.

Cardiac Toxicities Associated with Immune Checkpoints Inhibitors:Mechanisms, Manifestations and Management

Immune checkpoint inhibitor (ICI) associated cardiovascular adverse events (CVAE) have become more frequent with the growing use of cancer immunotherapy. CVAEs include a wide spectrum of diseases such as myocarditis, pericarditis, heart failure, arrhythmias, coronary artery disease, and hypertension. The induction of cardiovascular side effects by ICI use is hypothesized to occur due to inflammation and immune dysregulation of normal tissue in response to immunotherapy. Management of ICI-associated CVAEs mitigates an overactive immune response by utilizing steroids, immunomodulatory drugs and hemodynamic stabilization. However, few controlled studies on the cardiovascular safety of ICIs exist and treatment of their side effects are mostly from limited case series. Our review seeks to provide the most recent understanding of ICI-associated CVAEs and their management.

Cardiac Toxicities Associated with Immune Checkpoints Inhibitors:Mechanisms, Manifestations and Management

Immune checkpoint inhibitor (ICI) associated cardiovascular adverse events (CVAE) have become more frequent with the growing use of cancer immunotherapy. CVAEs include a wide spectrum of diseases such as myocarditis, pericarditis, heart failure, arrhythmias, coronary artery disease, and hypertension. The induction of cardiovascular side effects by ICI use is hypothesized to occur due to inflammation and immune dysregulation of normal tissue in response to immunotherapy. Management of ICI-associated CVAEs mitigates an overactive immune response by utilizing steroids, immunomodulatory drugs and hemodynamic stabilization. However, few controlled studies on the cardiovascular safety of ICIs exist and treatment of their side effects are mostly from limited case series. Our review seeks to provide the most recent understanding of ICI-associated CVAEs and their management.

Clinical Utility of a Fully Automated Microsatellite Instability Test with Minimal Hands-on Time

BACKGROUND: Microsatellite instability (MSI) analysis is becoming increasingly important in many types of tumor including colorectal cancer (CRC). The commonly used MSI tests are either time-consuming or labor-intensive. A fully automated MSI test, the Idylla MSI assay, has recently been introduced. However, its diagnostic performance has not been extensively validated in clinical CRC samples.METHODS: We evaluated 133 samples whose MSI status had been rigorously validated by standard polymerase chain reaction (PCR), clinical next-generation sequencing (NGS) cancer panel test, or both. We evaluated the diagnostic performance of the Idylla MSI assay in terms of sensitivity, specificity, and positive and negative predictive values, as well as various sample requirements, such as minimum tumor purity and the quality of paraffin blocks.RESULTS: Compared with the gold standard results confirmed through both PCR MSI test and NGS, the Idylla MSI assay showed 99.05% accuracy (104/105), 100% sensitivity (11/11), 98.94% specificity (93/94), 91.67% positive predictive value (11/12), and 100% negative predictive value (93/93). In addition, the Idylla MSI assay did not require macro-dissection in most samples and reliably detected MSI-high in samples with approximately 10% tumor purity. The total turnaround time was about 150 minutes and the hands-on time was less than 2 minutes.CONCLUSIONS: The Idylla MSI assay shows good diagnostic performance that is sufficient for its implementation in the clinic to determine the MSI status of at least the CRC samples. In addition, the fully automated procedure requires only a few slices of formalin-fixed paraffin-embedded tissue and might greatly save time and labor.

CD24⁺ Cell Depletion Permits Effective Enrichment of Thymic iNKT Cells While Preserving Their Subset Composition

Invariant NKT (iNKT) cells are a small subset of thymus-generated T cells that produce cytokines to control both innate and adaptive immunity. Because of their very low frequency in the thymus, in-depth characterization of iNKT cells can be facilitated by their enrichment from total thymocytes. Magnetic-activated cell sorting (MACS) of glycolipid antigen-loaded CD1d-tetramer-binding cells is a commonly used method to enrich iNKT cells. Surprisingly, we found that this procedure also dramatically altered the subset composition of enriched iNKT cells. As such, NKT2 lineage cells that express large amounts of the transcription factor promyelocytic leukemia zinc finger were markedly over-represented, while NKT1 lineage cells expressing the transcription factor T-bet were significantly reduced. To overcome this limitation, here, we tested magnetic-activated depletion of CD24⁺ immature thymocytes as an alternative method to enrich iNKT cells. We found that the overall recovery in iNKT cell numbers did not differ between these 2 methods. However, enrichment by CD24⁺ cell depletion preserved the subset composition of iNKT cells in the thymus, and thus permitted accurate and reproducible analysis of thymic iNKT cells in further detail.

Provocative mesenteric angiography for diagnosis and treatment of occult gastrointestinal hemorrhage

Occult gastrointestinal (GI) hemorrhage can be a great challenge to both patients and physicians, exerting a great toll on patients and the healthcare system. While diagnostic capabilities for diagnosing GI bleeding are improving, particularly with the establishment of computed tomography angiography and capsule endoscopy as routine modalities, patients with intermittent massive GI bleeding continue to pose a diagnostic and management dilemma. In this review, the concept, efficacy, and safety of provocative mesenteric angiography is described. The body of literature suggests that this procedure is safe and effective in this patient population with little to no alternative options.

Radiation safety behavior model for dental hygiene departments of universities in South Korea

Background: Dental hygiene departments in Korean institutions of higher education regularly use radiography systems for educating students. Despite reports indicating that exposure doses from these radiation-generating devices are small, and thus, present low risks for causing physical harm or chromosomal abnormalities, the large numbers of people who participate in oral examinations involving dental radiography raise questions about the optimal methods for managing radiation safety

Materials and Methods: Social cognitive theory incorporating major variables pertaining to radiation safety management derived from the Haddon Matrix was used. This model proposes and refines an approach for enhancing the radiation safety behaviors of both professors and students in Korea's collegiate dental hygiene departments

Results: The results of the study indicate that professors respond most favorably to stated expectations for accomplishing effective radiation safety management; thus model proposes that enhancing safety behaviors among professors depends upon cultivating organizational environments with clear expectations. Students, in contrast, engage in desirable radiation safety management behaviors when they can display self-efficacy; thus, the model proposes that personal education that enhances their practical knowledge for engaging in desired behaviors is most desirable

Conclusion: To enhance the current radiation safety management behaviors of the collegiate dental hygiene departments in Korea, it will be helpful to establish a strategy arising from the model developed here

Dosimetric accuracy of the Acuros XB and Anisotropic analytical algorithm near interface of the different density media for the small fields of a 6- MV flattening-filter-free beam

Background: This study was conducted to assess the accuracy of dose calculation near the air-phantom interface of a heterogeneous phantom for Acuros XB [AXB] and Anisotropic Analytical Algorithm [AAA] algorithm of a 6-MV flattening-filter-free beam, compared with film measurements

Materials and Methods: A phantom included air gap was specially manufactured for this study. In order to evaluate the dose near air gap-phantom interface, Eclipse treatment planning system equipped both AXB and AAA was used for the dose calculations. Measurements in this region were performed with radiochromic film. The central-axis dose [CAD] and off-axis dose [OAD] between calculations and measurements were analyzed for various field sizes and air gaps. The root-mean-square-error [RMSE] was used to evaluate the difference between the calculated and measured OAD. In order to quantify agreement between the calculated and measured dose distributions, the gamma analysis was performed with the 2%/2 mm and 3%/3 mm criteria

Results: For all fields traveling through 1 and 3 cm air gap, the maximum difference in the calculated CAD was -5.3% for AXB and 214.8% for AAA, compared to the measured CAD. For the RMSE between the calculated and measured OAD, the calculated OAD using AXB showed interval in the RMSE [from 4.4 to 12.7] while using AAA indicated broad [from 7.7 to 101.0]. In addition, the gamma passing rates showed that AXB was higher agreement than AAA

Conclusion: This study demonstrated that AXB was more accurate in heterogeneous media near air-phantom interface than AAA when comparing the measured data

Effect of coenzyme Qio on radiation-induced fatigue in rats

Background: Fatigue is a common side effect in cancer patients undergoing radiation therapy [RT]. Radiation-induced fatigue affects the quality of life, but there is no definitive treatment option, in this study, the weight-loaded forced swim test was performed to assess the effect of coenzyme QIO [CoQIO] on radiation-induced fatigue

Materials and Methods: A total of 60 rats were divided randomly and equally into four groups: No swim, No RT, RT + placebo, or RT + CoQIO. The No swim, No RT, and RT + placebo groups received 1 ml of soybean oil daily for 14 days. The RT + CoQIO group received 100 mg/kg of CoQIO in soybean oil at the same times. Both RT groups were irradiated with 10 Gy on the 14th day of treatment. The swim test with sinkers weighing 10% of body weight was performed 24 h later in all animals except the No swim group

Results: The level of blood urea nitrogen [BUN] was significantly lower in the No swim than the other groups. The BUN level of the No RT group was significantly decreased compared with the RT + placebo group, but it did not differ from the RT + CoQIO group. Swimming times to complete exhaustion were significantly longer in the No RT and RT + CoQIO groups compared to the RT + placebo group [99.4, 105.9, and 75.7 s, respectively] [P<0.001]

Conclusion: Supplementation with CoQIO can prevent the decrease in endurance capacity caused by radiation

Induction of Nuclear Enlargement and Senescence by Sirtuin Inhibitors in Glioblastoma Cells

Sirtuin family members with lysine deacetylase activity are known to play an important role in anti-aging and longevity. Cellular senescence is one of the hallmarks of aging, and downregulation of sirtuin is reported to induce premature senescence. In this study, we investigated the effects of small-molecule sirtuin inhibitors on cellular senescence. Various small molecules such as tenovin-1 and EX527 were employed for direct sirtuin activity inhibition. U251, SNB-75, and U87MG glioblastoma cells treated with sirtuin inhibitors exhibited phenotypes with nuclear enlargement. Furthermore, treatment of rat primary astrocytes with tenovin-1 also increased the size of the nucleus. The activity of senescence-associated β-galactosidase, a marker of cellular senescence, was induced by tenovin-1 and EX527 treatment in U87MG glioblastoma cells. Consistent with the senescent phenotype, treatment with tenovin-1 increased p53 expression in U87MG cells. This study demonstrated the senescence-inducing effect of sirtuin inhibitors, which are potentially useful tools for senescence research.

Neurocriminology : A Review on Aggression and Criminal Behaviors Using Brain Imaging

Criminology has been understood within a sociological framework until the emergence of neurocriminology, which describes, understands and predicts criminal behaviors from a neurobiological point of view. Not only using biological factors including genes and hormones to understand criminal behaviors, but also using neuroimaging techniques, the field of neurocriminology aims to delve into both structural and functional differences in the brain of individuals with aggression, antisocial personalities, and even the criminals. Various studies have been conducted based on this idea, however, there still are limitations for the knowledge from these studies to be used in the court. In this review article, we provide an overview of the various research in neurocriminology, and provide insight into the future direction and implication of the field.

Dose distribution evaluation of various dose calculation algorithms in inhomogeneous media

Background: dose calculation algorithms play a very important role in predicting the explicit dose distribution. We evaluated the percent depth dose [PDD], lateral depth dose profile, and surface dose volume histogram in inhomogeneous media using calculation algorithms and inhomogeneity correction methods

Materials and Methods: the homogeneous and inhomogeneous virtual slab phantoms used in this study were manufactured in the radiation treatment planning system to represent the air, lung, and bone density with planned radiation treatment of 6 MV photons, a field size of 10 × 10 cm[2], and a source-to-surface distance of 100 cm

Results: the PDD of air density slab for the Acuros XB [AXB] algorithm was differed by an average of 20% in comparison with other algorithms. Rebuild up occurred in the region below the air density slab [10-10.6 cm] for the AXB algorithm. The lateral dose profiles for the air density slab showed relatively large differences [over 30%] in the field. There were large differences [20.0%-26.1%] at the second homogeneous-inhomogeneous junction [depth of 10 cm] in the field for all calculation methods. The surface dose volume histogram for the pencil beam algorithm showed a response that was approximately 4% lower than that for the AXB algorithm

Conclusion: the dose calculation uncertainties were shown to change at the interface between different densities and in varied densities using the dose calculation methods. In particular, the AXB algorithm showed large differences in and out of the field in inhomogeneous media

Nonmetastatic Castration-Resistant Prostate Cancer

After the introduction of prostate cancer screening with the prostate-specific antigen (PSA) test, we have witnessed a dramatic stage migration. As a result, an increasing number of patients are diagnosed at earlier stages and receive local treatments including surgery or radiation. When these local treatments fail by the definition of increasing PSA levels, patients are usually treated with androgen-deprivation therapy. A fraction of these patients will finally reach a state of castration-resistant prostate cancer (CRPC) even without radiological evidence of metastasis, which is referred to as nonmetastatic CRPC (NM-CRPC). Most men with advanced or metastatic prostate cancer initially respond to various types of androgen ablation, but a considerable portion of them eventually progress to NM-CRPC. Among patients with NM-CPRC, about one-third will develop bone metastasis within 2 years. In these patients, PSA kinetics is the most powerful indicator of progression and is usually used to trigger further imaging studies and enrollment in clinical trials. Although CRPC remains largely driven by the androgen receptor, the benefit of second-line hormonal manipulations, including first-generation antiandrogens, adrenal synthesis inhibitors, and steroids, has not been investigated in men with NM-CRPC. To date, denosumab is the only agent that has been shown to delay the onset of bone metastasis. However, overall survival did not differ. In treating NM-CRPC patients, physicians should recognize the heterogeneity of the disease and acknowledge that the recently approved second-line treatments have been studied only in advanced stages of the disease.

What Is the Evidence to Support the Use of Therapeutic Gardens for the Elderly?

Horticulture therapy employs plants and gardening activities in therapeutic and rehabilitation activities and could be utilized to improve the quality of life of the worldwide aging population, possibly reducing costs for long-term, assisted living and dementia unit residents. Preliminary studies have reported the benefits of horticultural therapy and garden settings in reduction of pain, improvement in attention, lessening of stress, modulation of agitation, lowering of as needed medications, antipsychotics and reduction of falls. This is especially relevant for both the United States and the Republic of Korea since aging is occurring at an unprecedented rate, with Korea experiencing some of the world's greatest increases in elderly populations. In support of the role of nature as a therapeutic modality in geriatrics, most of the existing studies of garden settings have utilized views of nature or indoor plants with sparse studies employing therapeutic gardens and rehabilitation greenhouses. With few controlled clinical trials demonstrating the positive or negative effects of the use of garden settings for the rehabilitation of the aging populations, a more vigorous quantitative analysis of the benefits is long overdue. This literature review presents the data supporting future studies of the effects of natural settings for the long term care and rehabilitation of the elderly having the medical and mental health problems frequently occurring with aging.

Sundown Syndrome in Persons with Dementia: An Update

"Sundowning" in demented individuals, as distinct clinical phenomena, is still open to debate in terms of clear definition, etiology, operationalized parameters, validity of clinical construct, and interventions. In general, sundown syndrome is characterized by the emergence or increment of neuropsychiatric symptoms such as agitation, confusion, anxiety, and aggressiveness in late afternoon, in the evening, or at night. Sundowning is highly prevalent among individuals with dementia. It is thought to be associated with impaired circadian rhythmicity, environmental and social factors, and impaired cognition. Neurophysiologically, it appears to be mediated by degeneration of the suprachiasmatic nucleus of the hypothalamus and decreased production of melatonin. A variety of treatment options have been found to be helpful to ameliorate the neuropsychiatric symptoms associated with this phenomenon: bright light therapy, melatonin, acetylcholinesterase inhibitors, N-methyl-d-aspartate receptor antagonists, antipsychotics, and behavioral modifications. To decrease the morbidity from this specific condition, improve patient's well being, lessen caregiver burden, and delay institutionalization, further attention needs to be given to development of clinically operational definition of sundown syndrome and investigations on etiology, risk factors, and effective treatment options.

Association Analysis of SERPINB5 Polymorphisms with HBV Clearance and HCC Occurrence in a Korean Population

Serpin peptidase inhibitor, Clade B (ovalbumin), Member 5 (SERPINB5), also known as maspin, is a potent tumor suppressor gene. It has correlations with many tumor cells, from pancreas cancer to breast cancer, so it is possible that it may also affect liver cancer. There has also been a report that SERPINB12, a gene placed right next to SERPINB5, is expressed in liver. For this study, 32 polymorphisms were identified in SERPINB5 by direct DNA sequencing, and 11 of them were selected to be tested with a larger scale subjects. The association of the 11 SERPINB5 polymorphisms with Hepatitis B virus (HBV) clearance, hepatocellular carcinoma (HCC) occurrence and the onset age of HCC were analyzed. There were no significant associations found between 11 SERPINB5 polymorphisms and HBV clearance. In the case of HCC occurrence, one of the haplotypes (ht) showed association with HCC occurrence (OR=2.26, p=0.005, P(Cor)=0.05), albeit with a low statistical power (40.8%) and haplotype frequency (0.052). Further study with a bigger sample size will be needed to clearly verify the association between ht5 and HCC occurrence.

Putative Association of ITGB1 Haplotype with the Clearance of HBV Infection

Integrins are transmembrane receptor proteins that mediate cell-cell adhesion and cell-extracellular matrix (ECM) adhesion. The deregulation of cell-ECM adhesion and the abnormal expression of beta1 (beta1) integrins (ITGB1s) are involved in tumor development and metastasis. In the liver, the expression of integrins and ECM proteins can be a cause of hepatocellular carcinoma (HCC) development. We performed direct DNA sequencing of 24 individuals, and identified 23 sequence variants of ITGB1 polymorphisms. Among these 23 variants, 7 common variants were selected based on frequencies and linkage disequilibrium, and then genotyped in a larger-scale group of subjects (n=1,103). The genetic associations of ITGB1 polymorphisms with the clearance of HBV and HCC outcome of HBV patients were analyzed using logistic regression models and Cox relative hazard models. Although there was no significant association observed between the polymorphisms and the HCC outcome of HBV patients, the second most common haplotype (ITGB1 haplotype-2 [C-C-C-C-T-C-T]) was putatively associated with HBV clearance (OR=0.75, p=0.008 and P(corr)=0.05). The minor allele frequency (MAF) of ITGB1 haplotype-2 of the spontaneously recovered (SR) group was significantly higher than that of the chronic carrier group (CC) (freq. = 0.248 vs. 0.199). The information derived from this study could be valuable for understanding the genetic factors involved in the clearance of HBV.

Caregiver management of psychiatric disorders of the elderly in dementia

Dementia caregivers suffer a considerable care burden. They are confronted with a high rate of economic burden, psychological morbidity, social isolation, physical ill-health and financial hardship. Although many researchers have tried to determine the influence of the stressors in dementia caregiving on caregivers, the results remain inconclusive. However, many kinds of psychosocial interventions have been demonstrated to reduce caregivers'psychological symptoms and delay nursing home admission. Caregiver characteristics rather than objective care needs tend to be responsible for a caregiver's psychological symptoms. Future research should focus on individualizing treatment approach and developing partnerships with health professionals as well as disseminating general information about dementia caregiving.