Comparison of work stress, depression, insomnia, and fatigue of emergency department medical staff according to the emergency medical institutions and general characteristics during COVID-19 epidemic

Objective@#The objective of this study was to investigate job stress, depression, insomnia, and fatigue of coronavirus disease 2019 (COVID-19) medical staff and analyze the differences according to their general characteristics. @*Methods@#The study enrolled 98 workers at emergency medical institutions with COVID-19 treatment facilities located in Gangwon Province. An online survey was used to protect personal information. Data were analyzed using the statistical program SPSS version 28. The differences in job stress, depression, insomnia, and fatigue of COVID-19 medical staff were verified by t-test and analysis of variance. @*Results@#Analyzing job stress revealed that the average of the lowest relationship conflict stress for each sub-factor was 2.22, the average stress for job demand was the highest at 3.78, and the average whole job stress was 3.04. Contrarily, the average for depression was 1.69, insomnia 2.96, and fatigue 3.07. No statistically significant differences were observed for job stress, depression, insomnia, and fatigue when considering the type of workplace, gender, and occupation of COVID-19 medical staff. However, statistically significant differences were obtained in some variables including age, family members, working period, COVID-19 confirmed, and COVID-19-related education experience. @*Conclusion@#In this study, differences in job-related stress, depression, insomnia, and fatigue were confirmed considering the general characteristics of COVID-19 medical staff. In particular, the results of this study are significant since the difference in perceived stress in performing COVID-19 tasks was identified through empirical analysis by considering sub-factors of job stress.

Detection of BRAFV600E Mutations in Papillary Thyroid Carcinomas by Peptide Nucleic Acid Clamp Real-Time PCR: A Comparison with Direct Sequencing

BACKGROUND: Papillary thyroid carcinoma (PTC) of the thyroid is the most common endocrine malignancy. High prevalence of an activating point mutation of BRAF gene, BRAFV600E, has been reported in PTC. We assessed the efficiency of peptide nucleic acid clamp real-time polymerase chain reaction (PNAcqPCR) for the detection of BRAFV600E mutation in PTC in comparison with direct sequencing (DS). METHODS: A total of 265 thyroid lesions including 200 PTCs, 5 follicular carcinomas, 60 benign lesions and 10 normal thyroid tissues were tested for BRAFV600E mutation by PNAcqPCR and DS. RESULTS: The sensitivity and accuracy of the PNAcqPCR method were both higher than those of DS for the detection of the BRAFV600E mutation. In clinical samples, 89% of PTCs harbored the BRAFV600E mutation, whereas 5 follicular carcinomas, 50 benign lesions and 10 normal thyroid tissues lacked the mutation. The mutation was associated with aggressive clinical behaviors as extrathyroid invasion (p=0.015), lymph node metastasis (p=0.002) and multiple tumor numbers (p=0.016) with statistical significance. CONCLUSIONS: The PNAcqPCR method is efficiently applicable for the detection of the BRAFV600E mutation in PTCs in a clinical setting.

An Immunohistochemical Study on the Expression of SUMO-2/3 in the Colorectal Carcinoma

OBJECTIVE: The incidence of colorectal carcinomas continues to rise in Korea due to the westernized life style. However, the precise colorectal carcinogenic mechanisms remain to be elucidated. The protein products of oncogenes and cancer suppressor genes play important roles in the carcinogenesis. The effects of the proteins are influenced by post-translational modifications as phosphorylation, acetylation, methylation, and ubiquitination. The aberrant sumoylation plays some roles in carcinogenesis. However, the expression pattern of small ubiquitin-related modifier (SUMO)-2/3 in the colorectal cancer has not been reported. We assessed the expression of SUMO-2/3 and evaluated the expression pattern in colorectal cancer. METHODS: The SUMO-2/3 expression was tested in one normal colon mucosal cell line and 5 colorectal cancer cell lines by Western blot. We collected 322 cases of colorectal cancer operated from January 2000 to December 2010 at Soonchunhyang University Cheonan Hospital. We fabricated the tissue microarray and the expression of SUMO-2/3 was evaluated by immunohistochemistry. The results were analyzed with clinicopathologic parameters. RESULTS: The SUMO-2/3 was not expressed in the normal colon mucosal cell line. However, it was expressed highly in all the 5 colorectal cancer cell lines as the beta-actin. The SUMO-2/3 was expressed in 68.3% of the colorectal cancers and its expression was correlated with the pathological tumor stage stage (odds ratio, 2.89; 95% confidence interval, 1.10 to 7.55; P=0.031). CONCLUSION: The SUMO-2/3 plays some roles in carcinogenesis and progression of the colorectal cancer.

Spindle Cell Epithelioma, a So-called Benign Mixed Tumor of the Vagina: A Case Report

We report a case of spindle cell epithelioma, a so-called benign mixed tumor of the vagina. The patient was a 35-year-old nulliparous woman who presented with a polypoid mass in the posterior wall of the lower vagina just above the hymenal ring. The tumor was relatively well-defined with an expansile margin and composed of stromal-type spindle cells with a myxoid stroma arranged in short fascicles and an irregular cord-like or reticular pattern. A few glandular structures lined by cuboidal cells with squamous metaplasia were also noted. Cellular atypia was not conspicuous and mitosis was not found. We examined this tumor immunohistochemically to identify the histogenesis. The coexpression of epithelial and mesenchymal markers in stromal-type spindle cells suggested a multipotential cell origin for this tumor. The patient has been well with no signs of recurrence during the 12 months after surgery.

Soluble mediators from mesenchymal stem cells suppress T cell proliferation by inducing IL-10

Mesenchymal stem cells (MSCs) can inhibit T cell proliferation; however, the underlying mechanisms are not clear. In this study, we investigated the mechanisms of the immunoregulatory activity of MSCs on T cells. Irradiated MSCs co-cultured with either naive or pre-activated T cells in a mixed lymphocyte reaction (MLR) significantly suppressed T cell proliferation in a dose-dependent manner, irrespective of allogeneic disparity between responders and MSCs. Transwell assays revealed that the suppressive effect was primarily mediated by soluble factors that induced apoptosis. Splenocytes stimulated with alloantigen in the presence of the MSC culture supernatant (CS) produced a significant amount of IL-10, which was attributed to an increase in the number of IL-10 secreting cells, confirmed by an ELISPOT assay. The blockade of IL-10 and IL-10 receptor interaction by anti-IL-10 or anti-IL-10-receptor antibodies abrogated the suppressive capacity of MSC CS, indicating that IL-10 plays a major role in the suppression of T cell proliferation. The addition of 1-methyl-DL-tryptophan (1-MT), an indoleamine 2,3-dioxygenase (IDO) inhibitor, also restored the proliferative capacity of T cells. In conclusion, we demonstrated that soluble mediators from culture supernatant of MSCs could suppress the proliferation of both naive and pre-activated T cells in which IL-10 and IDO play important roles.

Soluble mediators from mesenchymal stem cells suppress T cell proliferation by inducing IL-10

Mesenchymal stem cells (MSCs) can inhibit T cell proliferation; however, the underlying mechanisms are not clear. In this study, we investigated the mechanisms of the immunoregulatory activity of MSCs on T cells. Irradiated MSCs co-cultured with either naive or pre-activated T cells in a mixed lymphocyte reaction (MLR) significantly suppressed T cell proliferation in a dose-dependent manner, irrespective of allogeneic disparity between responders and MSCs. Transwell assays revealed that the suppressive effect was primarily mediated by soluble factors that induced apoptosis. Splenocytes stimulated with alloantigen in the presence of the MSC culture supernatant (CS) produced a significant amount of IL-10, which was attributed to an increase in the number of IL-10 secreting cells, confirmed by an ELISPOT assay. The blockade of IL-10 and IL-10 receptor interaction by anti-IL-10 or anti-IL-10-receptor antibodies abrogated the suppressive capacity of MSC CS, indicating that IL-10 plays a major role in the suppression of T cell proliferation. The addition of 1-methyl-DL-tryptophan (1-MT), an indoleamine 2,3-dioxygenase (IDO) inhibitor, also restored the proliferative capacity of T cells. In conclusion, we demonstrated that soluble mediators from culture supernatant of MSCs could suppress the proliferation of both naive and pre-activated T cells in which IL-10 and IDO play important roles.

A case of cystic change of adenomyosis in adolescent girl complaining acute pelvic pain / 대한산부인과학회지

Cystic adenomyosis is a rare form of adenomyosis of the uterine myometrium that has been described in older adults. This condition has not frequently been reported in the adolescent girl. The adenomyotic cyst was located within the myometrium of a 15-year-old adolescent girl suffering from acute lower abdominal pain, not dysmenorrhea. After laparoscopic operation, patients's symptoms improved. On pathology finding, the cyst diagnosed adenomyotic cyst. We report a case of adenomyotic cyst of the uterus in adolescent girl with a brief review of literatures.

A Case of the Broad Ligamentary Angiomyoma / 대한산부인과학회지

Angiomyoma is a rare, benign, mesenchymal tumor occurring mainly in the female genital tract and higher incidence in the fourth to sixth decades of life. It is originated from smooth muscle cells and contains thick-walled vessels. The most satisfactory treatment is complete excision. We experienced a case of the broad ligamentary angiomyoma that was treated by complete excision with a brief review of literature.

A Case of Tubal Leiomyoma in Pregnancy / 대한산부인과학회지

Tubal leiomyoma during pregnancy is rare. Fewer than 100 cases of leiomyoma of the fallopian tube have been described in the literature. Most of them are asymptomatic. The diagnosis is incidentally if there is a primary tubal lesion such as ectopic pregnancy or during the general gynecologic operation. The tube must be entirely sectioned and completely examined whether there is primary tubal adenocarcinoma, if rare. We experienced a case of tubal leiomyoma in woman at 38+5 weeks gestation with previous primary cesarean section diagnosed after repeat cesarean delivery and bilateral tubal ligation with a brief review of literature.

A Case of Persistent Metastatic Gestational Trophoblastic Disease after Partial Hydatidiform Mole / 대한산부인과학회지

Persistent tumor, usually non-metastatic, develops in approximately 4% of patients with a partial mole, and chemotherapy is required to achieve remission. Following evacuation of hydatidiform mole, careful hCG monitoring is mandatory since it is the most reliable and sensitive method for the early detection of gestational trophoblastic disease. In carefully selected patients in whom the risk of developing gestational trophoblastic disease is significant or when the availability of hCG testing is suboptimal, chemoprophylaxis has been shown to decrease the risk of gestational trophoblastic tumor. We report here a case of patient, 23- year-old woman who experienced unusual course after the evacuation of a partial mole and markedly elevated serum beta-hCG levels. The patient developed persistent metastatic gestational trophoblastic disease and was successfully treated with 3 courses of EMA-CO.

A Case of Hungry Bone Syndrome after Parathyroidectomy in Patient with Tertiary Hyperparathyroidism and Hemodialysis Patient / 대한내분비외과학회지

Hyperparathyroidism is a common finding in patients with chronic renal failure. Among the hyperparathyroidism, tertiary hyperparathyroidism, which is secreting parathyroid hormone autonomously in spite of hypercalcemia. Sometimes it requires surgical intervention due to not only symptomatic hypercalcemia, but also longstanding asymptomatic hypercalcemia. Hungry bone syndrome was known to be developed due to extensive re-mineralization of skeleton after parathyroidectomy. It is characteristic of persistent hypocalcemia, hypophosphatemia and often with tetany. The patient's condition improved without complication after the calcium chloride and calcium carbonate administration. We report a case of hungry bone syndrome developed after parathyroidectomy in patient with tertiary hyperparathyroidism and chronic renal failure.

A Case of Hungry Bone Syndrome after Parathyroidectomy / 대한신장학회잡지

Patients with secondary hyperparathyroidism usually present with a history of underlying disease such as chronic renal failure. Tertiary hyperparathyroidism usually exists in situations of secondary hyperparathyroidism. It occurs when parathyroid hyperplasia becomes so severe that removal of the underlying cause does not eliminate the stimulus for PTH secretion and hypertrophic chief cells become autonomous. Surgical parathyroidectomy sould be considered in patients with uncontrolled hyperparathyroidism. Hungry bone syndrome is known to be developed due to extensive remineralization of skeleton after parathyroidectomy. It is characterized by prolonged symptomatic hypocalcemia, as a complication of the parathyroidectomy for hyperthyroidism. We have experienced a female patient with hypercalcemia, who had been on maintenance hemodialysis for 15 years. She had elevated intact PTH and alkaline phosphatase. We decided parathyroidectomy because of uncontrolled hyperthyroidism despite of medical treatment. A few weeks after the operation she developed a muscle pain and arthralgia, which were found to be due to severe hypocalcaemia. Calcium suppletion led to normalization of the serum calcium level. she was discharged from the hospital in good condition after calcium supplement. We report a case of hungry bone syndrome developed after parathyroidectomy in this patient.

Atypical Hepatic Hemangiomas with Multiple Calcifications Mimicking Hepatic Metastases: Case Report

Although hepatic hemangioma is the most common benign tumor of the liver, it is rarely associated with calcifications. We report on the case of an asymptomatic 58-year-old man in whom multiple hepatic masses containing calcifications were discovered incidentally at ultrasonography. The radiologic features mimicked those of multiple hepatic metastases.

Expression of E-cadherin and Clinical Correlation in Patients with Breast Carcinoma / 한국유방암학회지

PURPOSE: E-cadherin is a Ca (2+)-dependent cell adhesion molecule that plays an important role in normal growth and development via the mediation of homotypic, homophilic cell-cell interactions. Recent studies suggest that E-cadherin may also be important in neoplastic progression, particularly as a suppressor of invasion. METHODS: To evaluate the expression of E-cadherin, according to the histopathological features and the relation between E-cadherin and prognosis in breast carcinoma, immunohistochemical staining, using mouse HECD-1 was performed for 66 cases of breast carcinoma. RESULTS: The breast carcinomas showed loss or marked reduction of E-cadherin expression in 42 (63.6%) of the 66 cases. In a multivariate analysis, E-cadherin expression had no independent prognostic value, while the axillary lymph node status, tumor diameter, and TNM stage were independent prognostic factors. The results indicate that E-cadherin expression was related to several histological features in breast cancer, but had no independent prognostic value over standard prognostic factors. No significant correlation was found between E-cadherin expression and tumor size, stage, nuclear grade, lymph node status, histologic type, or hormonal status. CONCLUSION: The loss or marked reduction of E-cadherin expression in breast carcinomas was not related to the prog nosis of the patients.

A case of Hyperstimulated Corpus luteal cyst torsion in Pregnancy after In vitro Fertilization / 대한산부인과학회잡지

Ovarian torsion is the fifth most common condition in gynecologic surgical emergencies, with an incidence of 2.7% occuring mainly in women of reproductive age. It is an uncommon but well recognized complication of ovarian stimulation, especially when ovarian hyperstimulation syndrome occurs. Patients with ovarian torsion normally present with an acute abdomen, necessitating an exploratory laparotomy, with removal of the organ when necrosis is evident. Ultrasound may suggest the diagnosis of adnexal torsion. If the ovarian tumor is a luteal cyst, it is also standard to administer progesterone after surgical treatment, although how efficient this treatment is in preventing miscarriage is questionable. A documented case of adnexal torsion associated with in vitro fertilization is hyperstimulated enlarged corpus luteal cyst. Emergency left salpingo-oophorectomy was done and have concluded a successful pregnancy after exogenous progesterone support. We report a case of enlarged corpus luteal cyst torsion in early pregnancy with a brief review of literatures.

Clinical Correlation of c-erbB-2, p53, bcl-2, and c-myc Expression in Patients with Breast Cancer

PURPOSE: Breast cancer is a common malignant tumor in Korean women. Various oncogenes have been demonstrated in malignant tumor cells. There were many reports on the relationship between the prognosis and the tumor markers, particularly c-erbB-2, p53, bcl-2, and c-myc. However, this relationship is controversial. The aim of this study was to perform immunohistochemical staining for the c-erbB-2, p53, bcl-2, and c-myc antigenic protein in breast cancer patients, to evaluate the expression rate of each antigen, and to compare the correlations with the patients' prognosis. METHODS: The medical records of 80 patients who were diagnosed with breast cancer and who were treated with a mastectomy between January 1993 and December 1996 at Soonchunhyang University Chunan Hospital were selected according to the condition of the paraffin block fixation. The prognostic factors were investigated. The immunohistochemical expression of c-erbB-2, p53, bcl-2, and c-myc was examined and compared with the survival rate using a Kaplan-Meier estimate and a log rank test. RESULTS: Eighty patients (79 females, 1 male) were included in this study, with a mean (SD) age of 48.2 (10.6) years and follow-up duration of 59.9 (24.9) months. The overall mortality was 41.3 (33/80)% and the mean (SD) survival time was 77 (4) months. The overall 5-year survival rate was 63.3%. Among the study variables, the tumor stage was a significant predictor of survival showing a significantly low survival rate in tumor stage III. The tumor size and lymph node metastasis were significantly associated with the survival rate in patients with breast cancer. CONCLUSION: c-erbB-2, p53, bcl-2, and c-myc might be useful prognostic factors, even though a statistical significance was not achieved.

The Expression of p53 and p21 in Intradermal Nevus, Junctional Nevus and Malignant Melanoma / 대한피부과학회지

BACKGROUND: The function of the p53 protein is known to regulate cell proliferation by inhibiting cells entering S phase, so DNA damaged cell proliferation is inhibited by apoptosis. p21 is a cyclin dependent kinase inhibitor induced by wild type p53, not mutant p53. Thus p21 is thought to mediate the signal of p53 induced by DNA damaged agents to arrest the cell cycle in G1 phase. p53 and p21 are expressed in many malignant tumors, and its role in oncogenesis, tumor progression and prognosis are important. OBJECTIVE: The purpose of this study was to analyze immunohistochemical expression of mutant p53 and p21 protein in melanocytic lesions. METHOD: 11 cases of intradermal nevus, 7 cases of junctional nevus and 6 cases of malignant melanoma were immunohistochemically stained with p53 and p21 monoclonal antibodies. RESULTS: 1. In intradermal nevus, the p53 was negative in 100% and the p21 was negative in 98%. These findings suggest that the composing cells of intradermal nevus is completely mature cell. 2. The positive rates of p53 and p21 in junctional nevus were 43% and 43%, respectively. The positive rates of p53 and p21 in malignant melanoma were 82% and 67%, respectively. CONCLUSION: If the expression of p21 is induced by p53 independent pathway, the cell cycle can be arrested in G1 phase, so the tumor cell proliferation is inhibited. But if the expressed p21 is mutated as p53, it means that the natural function of p21 disappears. More research is necessary about the nature of p21 which is expressed with mutant p53.

Clinical Correlation of c-erbB-2, p53, bcl-2, and c-myc Expression in Patients with Breast Cancer / 한국유방암학회지

PURPOSE: Breast cancer is a common malignant tumor in Korean women. Various oncogenes have been demonstrated in malignant tumor cells. There were many reports on the relationship between the prognosis and the tumor markers, particularly c-erbB-2, p53, bcl-2, and c-myc. However, this relationship is controversial. The aim of this study was to perform immunohistochemical staining for the c-erbB-2, p53, bcl-2, and c-myc antigenic protein in breast cancer patients, to evaluate the expression rate of each antigen, and to compare the correlations with the patients' prognosis. METHODS: The medical records of 80 patients who were diagnosed with breast cancer and who were treated with a mastectomy between January 1993 and December 1996 at Soonchunhyang University Chunan Hospital were selected according to the condition of the paraffin block fixation. The prognostic factors were investigated. The immunohistochemical expression of c-erbB-2, p53, bcl-2, and c-myc was examined and compared with the survival rate using a Kaplan-Meier estimate and a log rank test. RESULTS: Eighty patients (79 females, 1 male) were included in this study, with a mean (SD) age of 48.2 (10.6) years and follow-up duration of 59.9 (24.9) months. The overall mortality was 41.3 (33/80)% and the mean (SD) survival time was 77 (4) months. The overall 5-year survival rate was 63.3%. Among the study variables, the tumor stage was a significant predictor of survival showing a significantly low survival rate in tumor stage III. The tumor size and lymph node metastasis were significantly associated with the survival rate in patients with breast cancer. CONCLUSION: c-erbB-2, p53, bcl-2, and c-myc might be useful prognostic factors, even though a statistical significance was not achieved.

A Case of Left Tubal Squamous Cell Carcinoma / 대한부인종양콜포스코피학회잡지

Neoplasm of the fallopian tube, which account for only a small minority of female genital tract tumors, may have diagnostic difficulties both clinically and pathologically. In most cases, the diagnosis of tubal carcinoma is not suspected preoperatively, and an abnormality of the tube is first appreciated by the gynecologist at the time of operation or by the pathologist on gross or microscopic examination. The predominant cell type of the fallopian tubal carcinoma is known for adenomatous cell type of carcinoma. A case of pure primary squamous cell carcinoma of the Fallopian tube presenting is reported first in Korea.

A case of malignant mixed epithelial tumor on both ovary / 대한산부인과학회잡지

No abstract available.