Usefulness of the odontogenic ameloblast-associated protein and quantitative analysis of periodontal disease-associated bacteria as biomarkers for evaluation of improvement in periodontal status following scaling intervention / 대한구강보건학회지

Objectives@#In this study, we investigated the validity and effectiveness of biomarkers and oral microbiome analysis for evaluation of periodontal status following scaling intervention. @*Methods@#The study included 15 participants who were selected based on inclusion/exclusion criteria. Periodontal indices, including the plaque index, probing depth, modified sulcus bleeding index, and calculus index were measured to evaluate clinical periodontal status and disease progression.Pre- and post-scaling gingival crevicular fluid (GCF) was obtained from 12-20 sites per patient to measure changes in the odontogenic ameloblast-associated protein (ODAM) concentration using an enzyme-linked immunosorbent assay. Additionally, pre- and post-treatment salivary samples were obtained for quantitative analysis of oral microbiome distribution. @*Results@#All clinical parameters showed significant differences in pre- and post-scaling values and significant changes in the ODAM concentration in the GCF in patients with initial and moderate periodontitis. Quantitative analysis performed after scaling intervention revealed changes in eight oral disease-causing bacteria associated with periodontal disease, including Aggregatibacter, Porphyromonas, Tannerella, Treponema, Prevotella, and Fusobacterium. Specifically, Tannerella forsythia and Fusobacterium nucleatum (well-known major periodontal pathogens) numbers were significantly decreased following non-surgical periodontal therapy. However, no significant association was observed between changes in the salivary oral microbiota and ODAM concentration in the GCF, following treatment. @*Conclusions@#Based on the findings of this study, we propose the use of ODAM protein and quantitative analysis of periodontal disease-associated bacteria as objective and quantitative biomarkers for evaluation of improvement in periodontal disease following scaling intervention.

Diagnosis and treatment of dyslipidemia in children and adolescents

Atherosclerotic cardiovascular disease is a major cause of morbidity and mortality worldwide, including in South Korea. Dyslipidemia is an independent risk factor for the development of atherosclerotic cardiovascular diseases. There is strong evidence that atherosclerosis begins early in life and that elevated lipid levels in childhood predict elevated lipid levels into adulthood.Current Concepts: A universal approach for cholesterol screening in all children is recommended. Lipid profiles should be studied for all children aged 9 to 11 years and then for those aged 17 to 21 years, as cholesterol levels may vary after puberty. The non-fasting lipid profile can be as useful in detecting severe genetic dyslipidemias as the fasting lipid profile and thus can be used as a first-line screening in children. The initial treatment for dyslipidemia in a child always begins with a 6-month trial of lifestyle modifications, such as improvements in dietary and physical activity patterns. Statins are as effective in children as in adults and can lower low-density lipoprotein cholesterol levels by up to 50%. Therefore, they are considered first-line therapy for children who meet the criteria for pharmacological therapy.Discussion and Conclusion: Statins and non-statin lipid-lowering agents can lower cholesterol levels with minimal adverse effects in children and adolescents with hypercholesterolemia. However, limited data is currently available on the long-term safety and efficacy of lipid-lowering agents in the pediatric population. Furthermore, non-statin lipid-lowering agents are used far less frequently in children. Therefore, further long-term safety and efficacy studies on lipid-lowering agents in pediatric populations and clinical trials with non-statin lipid-lowering agents are required.

MicroRNA Expression in Plasma of Esophageal Squamous Cell Carcinoma Patients

Background@#Patients with esophageal squamous cell carcinoma (ESCC) have a poor prognosis and there are no effective clinical biomarkers. Recently, stable microRNAs detected in the blood have been suggested as potential biomarkers in various cancers. Therefore, we investigated whether plasma microRNAs could be feasible biomarkers for ESCC. @*Methods@#Peripheral blood samples were obtained from 16 healthy volunteers and 66 ESCC patients before treatment between May 2016 and April 2021. Plasma miR-18b, miR-21, miR-31, and miR-375 expression levels were measured using reverse transcription-quantitative polymerase chain reaction. @*Results@#Compared with those in healthy controls, the expression levels of plasma miR-21 were significantly higher (P = 0.022) and those of plasma miR-31 and miR-375 were significantly lower in ESCC patients (both P < 0.001). Plasma miR-18b expression levels increased in ESCC patients, but the difference was not significant (P = 0.164). The sensitivities and specificities of miR-21, miR-31, and miR-375 for differentiating ESCC patients from healthy controls were 87.5% and 61.9%, 87.5% and 98.4%, and 87.5% and 100%, respectively. There was no difference in expression levels of plasma miR-21, miR-31, and miR-375 according to clinicopathological characteristics of sex, age, tumor size and location, histologic grade, and tumor-node-metastasis stage. @*Conclusion@#Our study demonstrated that plasma miR-21, miR-31, and miR-375 could be potential biomarkers for the diagnosis of ESCC. Particularly, plasma miR-31 and miR-375 showed high sensitivity and specificity for differentiating ESCC patients from healthy controls.

Phubbing as a Millennials’ New Addiction and Relating Factors Among Nursing Students

Objective@#This study investigated phubbing (the act of ignoring one’s companion or companions to pay attention to one’s smartphone) and examined the factors affecting phubbing among nursing students in South Korea. @*Methods@#A cross-sectional survey design was adopted, and a self-reported questionnaire was used. Data were collected from 200 nursing students in two cities. Self-administered questionnaires included demographic data, smartphone addiction, media multitasking motivation, interpersonal competency, and phubbing. @*Results@#Phubbing was positively correlated with smartphone addiction (r=0.41, p<0.001) and media multitasking motivation (r=0.16, p<0.05), and negatively correlated with interpersonal competence (r=-0.51, p<0.001). Factors influencing nursing students’ phubbing were interpersonal competency (β=-0.59, p<0.001), media multitasking motivation (β=0.24, p<0.001), smartphone addiction (β=0.19, p<0.01) and interpersonal relationships (β=0.14, p<0.05). The model including these variables accounted for 43% of variance in phubbing. @*Conclusion@#Nursing students showed a moderate level of phubbing, and interpersonal competency was an important factor for reducing their phubbing of nursing students. Since phubbing occurs frequently among nursing students, educators in nursing are required to develop and implement active interventional measures to help nursing students avoid phubbing and improve their interpersonal relationships by increasing their empathic ability and communication skills.

Clinical Significance of TWIST-Positive Circulating Tumor Cells in Patients with Esophageal Squamous Cell Carcinoma

Background/Aims@#Unlike other gastrointestinal tract cancers, there are relatively few reports on the clinical significance of circulating tumor cells (CTCs) and TWIST, a marker of epithelial-mesenchymal transition, in patients with esophageal squamous cell carcinoma (ESCC). This study aimed to evaluate the clinical significance of TWIST expression in CTCs in patients with ESCC. @*Methods@#Peripheral blood samples for CTC analyses were prospectively obtained from 52 patients with ESCC prior to treatment between September 2017 and September 2019. CTCs were detected using a centrifugal microfluidic system based on a fluid-assisted separation technique, and CTCs positive for TWIST on immunostaining were defined as TWIST (+) CTCs. @*Results@#Of the 52 patients with ESCC, CTCs and TWIST (+) CTCs were detected in 44 patients (84.6%) and 39 patients (75.0%), respectively. The CTC and TWIST (+) CTC counts were significantly higher in patients aged >65 years and those who had a large tumor (>3 cm) thanin those aged ≤65 years and those who had a small tumor (≤3 cm), respectively. There were nodifferences in CTC and TWIST (+) CTC counts according to tumor location, histologic grade, or TNM stage. TWIST (+) CTCs were significantly associated with histologic grade; a proportion of TWIST (+) CTCs ≥0.5 was significantly associated with advanced histologic grade. Other clini-copathologic characteristics such as sex, age, tumor location, tumor size, and TNM stages were not significantly associated with TWIST (+) CTCs. @*Conclusions@#Our study showed that TWIST (+) CTCs were frequently detected in patients with ESCC, and a high proportion of TWIST (+) CTCs was associated with poor differentiation

Changes in Iridocorneal Angle Configuration and Intraocular Pressure during Smartphone Use under Room Light

Purpose@#To investigate changes in intraocular pressure (IOP) and iridocorneal angle (ICA) configuration during smartphone use under room light. @*Methods@#We included healthy adults aged 19-35 years with no ophthalmological abnormalities. All read text on a smartphone for 6 minutes under room light. IOP was measured via rebound tonometry at baseline and at 2, 4, and 6 minutes. ICA images were obtained via anterior segment optical coherence tomography after each IOP measurement. After 6 minutes, participants stopped reading text and rested for 2 minutes. IOP was then measured again. @*Results@#The IOP significantly increased at 2, 4, and 6 minutes of reading compared to baseline (p < 0.001) but recovered to baseline after 2 minutes of rest (p = 1.000). The anterior chamber depth decreased significantly, and the anterior chamber angle width increased after 6 minutes of smartphone reading (both p < 0.05). @*Conclusions@#IOP increased when reading smartphone text under room light but the ICA did not change. Prolonged smartphone reading is inappropriate for a patient at risk of glaucoma or glaucoma progression. Such patients should be cautioned.

Clinical Significance of TWIST-Positive Circulating Tumor Cells in Patients with Esophageal Squamous Cell Carcinoma

Background/Aims@#Unlike other gastrointestinal tract cancers, there are relatively few reports on the clinical significance of circulating tumor cells (CTCs) and TWIST, a marker of epithelial-mesenchymal transition, in patients with esophageal squamous cell carcinoma (ESCC). This study aimed to evaluate the clinical significance of TWIST expression in CTCs in patients with ESCC. @*Methods@#Peripheral blood samples for CTC analyses were prospectively obtained from 52 patients with ESCC prior to treatment between September 2017 and September 2019. CTCs were detected using a centrifugal microfluidic system based on a fluid-assisted separation technique, and CTCs positive for TWIST on immunostaining were defined as TWIST (+) CTCs. @*Results@#Of the 52 patients with ESCC, CTCs and TWIST (+) CTCs were detected in 44 patients (84.6%) and 39 patients (75.0%), respectively. The CTC and TWIST (+) CTC counts were significantly higher in patients aged >65 years and those who had a large tumor (>3 cm) thanin those aged ≤65 years and those who had a small tumor (≤3 cm), respectively. There were nodifferences in CTC and TWIST (+) CTC counts according to tumor location, histologic grade, or TNM stage. TWIST (+) CTCs were significantly associated with histologic grade; a proportion of TWIST (+) CTCs ≥0.5 was significantly associated with advanced histologic grade. Other clini-copathologic characteristics such as sex, age, tumor location, tumor size, and TNM stages were not significantly associated with TWIST (+) CTCs. @*Conclusions@#Our study showed that TWIST (+) CTCs were frequently detected in patients with ESCC, and a high proportion of TWIST (+) CTCs was associated with poor differentiation

Changes in Iridocorneal Angle Configuration and Intraocular Pressure during Smartphone Use under Room Light

Purpose@#To investigate changes in intraocular pressure (IOP) and iridocorneal angle (ICA) configuration during smartphone use under room light. @*Methods@#We included healthy adults aged 19-35 years with no ophthalmological abnormalities. All read text on a smartphone for 6 minutes under room light. IOP was measured via rebound tonometry at baseline and at 2, 4, and 6 minutes. ICA images were obtained via anterior segment optical coherence tomography after each IOP measurement. After 6 minutes, participants stopped reading text and rested for 2 minutes. IOP was then measured again. @*Results@#The IOP significantly increased at 2, 4, and 6 minutes of reading compared to baseline (p < 0.001) but recovered to baseline after 2 minutes of rest (p = 1.000). The anterior chamber depth decreased significantly, and the anterior chamber angle width increased after 6 minutes of smartphone reading (both p < 0.05). @*Conclusions@#IOP increased when reading smartphone text under room light but the ICA did not change. Prolonged smartphone reading is inappropriate for a patient at risk of glaucoma or glaucoma progression. Such patients should be cautioned.

Short-term Changes in Ocular Surface pH after 23-gauge Microincision Vitrectomy Surgery

Purpose@#This study aimed to investigate changes in ocular surface pH after 23-gauge microincision vitrectomy surgery. @*Methods@#This retrospective study included 42 patients who underwent 23-gauge microincision vitrectomy. Best-corrected visual acuity and intraocular pressure were measured. Fundus examination, color fundus photography, and spectral-domain optical coherence tomography were performed. Chemosis was evaluated once a day after surgery, and the ocular surface pH was measured using a microelectrode on the day before surgery and every day up to day 5 after surgery. @*Results@#A total of 42 eyes in 42 patients were examined. The average age was 63.7 years. The indications for surgery included epiretinal membrane in 14 eyes (33.3%), vitreous hemorrhage in 11 eyes (26.2%), macular hole in 11 eyes (26.2%), and rhegmatogenous retinal detachment in six eyes (14.3%). Although the mean ocular surface pH increased from 7.12 ± 0.04 to 7.55 ± 0.04 on the first day after surgery (p < 0.001), it gradually decreased to 7.41 ± 0.03 from the second day postoperatively (p < 0.001). It was subsequently measured as 7.33 ± 0.04 on the third day (p < 0.001) and 7.23 ± 0.03 on the fourth day (p < 0.001) postoperatively. On the fifth postoperative day, the ocular surface pH further decreased to 7.15 ± 0.03 (p = 0.152) and recovered to the preoperative state. A statistically significant correlation was found between the change in ocular surface pH and the chemosis grade (p = 0.001). @*Conclusions@#After 23-gauge microincision vitrectomy surgery, the ocular surface pH shifted temporarily in the alkaline direction within a physiological range correlated with chemosis and intravitreal tamponade usage.

Clinical Manifestations and Computed Tomography Findings of Trapdoor Type Medial Orbital Wall Blowout Fracture

PURPOSE: To report the clinical manifestations and computed tomography (CT) findings of patients with a trapdoor type medial orbital wall blowout fracture.METHODS: From March 2009 to October 2016, the clinical records and computed tomography findings of patients who underwent surgical treatment for a trapdoor type medial orbital wall blowout fracture were retrospectively analyzed.RESULTS: A total of eight patients (six males and two females) were enrolled with a combined mean age of 14.4 years. Clinical manifestations were eyeball movement limitation (abduction and adduction) and ocular motility pain (eight patients, 100%), diplopia (seven patients, 87.5%), and nausea and vomiting (four patients, 50%). On CT, the distance from the orbital apex to the fracture site was an average of 22.0 mm and occurred in the middle position of the entire wall. Two patients had missed rectus completely dislocated into the ethmoid sinus through the fracture gap and six patients had definite involvement in the fracture gap and edema of the medial rectus muscle. The medial rectus muscle cross-sectional area was 47.7 mm² which was edematous compared to the contralateral eye (40.1 mm²). Orbital wall reconstruction was performed an average of 4.1 days after the injury. In all patients with oculocardiac reflex-like nausea and vomiting immediately improved after surgery. Six out of eight patients who had eyeball movement limitations (abduction and adduction) preoperatively showed adduction limitation after surgery. The eyeball movement limitation and diplopia disappeared 11.7 days and 46.7 days after surgery, respectively.CONCLUSIONS: Patients with trapdoor type medial wall blowout fracture showed characteristic computed tomographic findings and clinical manifestations such as eyeball movement limitation, ocular motility pain, diplopia, and oculocardiac reflex. An understanding of clinical findings and quick surgical treatment are therefore required. The type of eyeball movement limitation was abduction and adduction limitation preoperatively and adduction limitation postoperatively.

360° Circumferential Hemorrhagic Lymphangiectasia of the Conjunctivae

PURPOSE: We report a case of hemorrhagic lymphangiectasia of the conjunctiva with a 360° connected circumference, which recovered spontaneously.CASE SUMMARY: A 44-year-old female patient presented with congestion of the right eye 1 day prior to her visit. There was no history of any systemic disease or trauma, but she had experienced relapses of the same episode three times before the visit. There were no accompanying symptoms such as decreased vision or pain. Blood analysis, orbital computed tomography, and angiographic findings showed no remarkable finding. Slit lamp examination showed circumferential lymphatic dilatation extending 360° under the conjunctiva of the eye at a distance of about 6 mm behind the limbus of the right eye, which was accompanied by intralymphatic bleeding. Irregular local lymphatic dilatations were observed on the bulbar conjunctiva at 4 and 8 o'clock of the left eye. The bleeding spontaneously resolved in about 2 weeks, but the translucent enlarged lymphatic vessels were still observed on slit lamp examination and anterior segment optical coherence tomography.CONCLUSIONS: This is the first reported case of hemorrhagic lymphangiectasia involving 360° of the bulbar conjunctiva in Republic of Korea.

A Randomized, Double-Blind, Placebo-Controlled, Multi-Centered Clinical Study to Evaluate the Efficacy and Safety of Artemisia annua L. Extract for Improvement of Liver Function

Non-alcoholic fatty liver disease (NAFLD) has the potential to develop into hepatic steatosis and progress to terminal liver diseases such as cirrhosis and hepatocellular carcinoma. This human clinical study was aimed to demonstrate that SPB-201 (powdered-water extract of Artemisia annua) can improve liver function in subjects with non-alcoholic liver dysfunction at mild to moderate levels. A decrease of 271% in aspartate aminotransferase (AST) level and a significant decrease of 334% in alanine aminotransferase (ALT) level was observed in the test group as compared to the control group at the 4 weeks follow-up. In addition, after 8 weeks, decreases of 199% in AST level and 216% in ALT level were reported in the test group as compared to the control group. These results confirmed that SPB-201 intake significantly enhanced liver function and health. Moreover, the Multidimensional Fatigue Scale score of the test group decreased but that of the control group increased, implicating that SPB-201 also eliminated overall fatigue. No significant adverse events were observed among all subjects during the study. Taken together, our clinical study confirmed the excellent efficacy and safety of SPB-201 in liver function improvement, showing the possibility of SPB-201 as a functional food to restore liver dysfunction and treat liver diseases.

Optic Nerve Sheath Meningocele Diagnosed in Patients with Exophthalmos

Purpose@#To report a rare case of bilateral optic nerve sheath meningocele diagnosed in a patient with exophthalmos.Case summary: A 33-year-old male visited our clinic with bilateral exophthalmos for 6 months. The patient had been diagnosed with hypertension 3 years previously; however, the condition had been poorly controlled. He also had a history of treatment associated with retinal vein occlusion, macular edema, and papilledema 2 years earlier. There was no limitation in his ocular movement. A Hertel exophthalmometry test showed bilateral exophthalmos of 20 mm in both eyes. Visual field tests showed an inferior arcuate visual field defect in the right eye and a superotemporal peripheral field defect in the left eye. In orbital magnetic resonance imagery, cerebrospinal fluid space widening along the optic nerve and flattening of the bilateral posterior pole of the eye were evident. The patient was diagnosed with optic nerve sheath meningocele. @*Conclusions@#Optic nerve sheath meningocele should be considered as a differential diagnosis of exophthalmos patients. Because it is a disease that can affect visual function in a manner similar to that of a visual field defect, rapid diagnosis through imaging study and thorough regular follow-up examinations are essential.

A Randomized, Double-Blind, Placebo-Controlled, Multi-Centered Clinical Study to Evaluate the Efficacy and Safety of Artemisia annua L. Extract for Improvement of Liver Function

Non-alcoholic fatty liver disease (NAFLD) has the potential to develop into hepatic steatosis and progress to terminal liver diseases such as cirrhosis and hepatocellular carcinoma. This human clinical study was aimed to demonstrate that SPB-201 (powdered-water extract of Artemisia annua) can improve liver function in subjects with non-alcoholic liver dysfunction at mild to moderate levels. A decrease of 271% in aspartate aminotransferase (AST) level and a significant decrease of 334% in alanine aminotransferase (ALT) level was observed in the test group as compared to the control group at the 4 weeks follow-up. In addition, after 8 weeks, decreases of 199% in AST level and 216% in ALT level were reported in the test group as compared to the control group. These results confirmed that SPB-201 intake significantly enhanced liver function and health. Moreover, the Multidimensional Fatigue Scale score of the test group decreased but that of the control group increased, implicating that SPB-201 also eliminated overall fatigue. No significant adverse events were observed among all subjects during the study. Taken together, our clinical study confirmed the excellent efficacy and safety of SPB-201 in liver function improvement, showing the possibility of SPB-201 as a functional food to restore liver dysfunction and treat liver diseases.

Optic Nerve Sheath Meningocele Diagnosed in Patients with Exophthalmos

Purpose@#To report a rare case of bilateral optic nerve sheath meningocele diagnosed in a patient with exophthalmos.Case summary: A 33-year-old male visited our clinic with bilateral exophthalmos for 6 months. The patient had been diagnosed with hypertension 3 years previously; however, the condition had been poorly controlled. He also had a history of treatment associated with retinal vein occlusion, macular edema, and papilledema 2 years earlier. There was no limitation in his ocular movement. A Hertel exophthalmometry test showed bilateral exophthalmos of 20 mm in both eyes. Visual field tests showed an inferior arcuate visual field defect in the right eye and a superotemporal peripheral field defect in the left eye. In orbital magnetic resonance imagery, cerebrospinal fluid space widening along the optic nerve and flattening of the bilateral posterior pole of the eye were evident. The patient was diagnosed with optic nerve sheath meningocele. @*Conclusions@#Optic nerve sheath meningocele should be considered as a differential diagnosis of exophthalmos patients. Because it is a disease that can affect visual function in a manner similar to that of a visual field defect, rapid diagnosis through imaging study and thorough regular follow-up examinations are essential.

REvisiting Lipids in REtinal Diseases: A Focused Review on Age-related Macular Degeneration and Diabetic Retinopathy

Dyslipidemia refers to an abnormal amount of lipid in the blood, and the total cholesterol level is defined as the sum of high-density lipoprotein cholesterol, low-density lipoprotein (LDL) cholesterol, and very-LDL cholesterol concentrations. In Korea, the westernization of lifestyle habits in recent years has caused an increase in the incidence of dyslipidemia, which is an important risk factor of cardiovascular disease (CVD). Several studies have been conducted on how dyslipidemia affects not only CVD, but also chorioretinal diseases such as age-related macular degeneration (AMD) and diabetic retinopathy. Recently, a pathological model of AMD was proposed under the assumption that AMD proceeds through a mechanism similar to that of atherosclerotic CVD. However, controversy remains regarding the relationship between chorioretinal diseases and lipid levels in the blood, and the effects of lipid-lowering agents. Herein, we summarize the role of lipids in chorioretinal diseases.In addition, the effects of lipid-lowering agents on the prevention and progression of chorioretinal diseases are presented.

Clinical and microbiological factors associated with early patient mortality from methicillin-resistant Staphylococcus aureus bacteremia

BACKGROUND/AIMS: Methicillin-resistant Staphylococcus aureus bacteremia (MRSAB) is a major bloodstream infection with a high mortality rate. Identification of factors associated with early mortality in MRSAB patients would be useful for predicting prognosis and developing new therapeutic options. METHODS: A prospective cohort of MRSAB patients was examined between August 2008 and June 2011. Early and late mortality was defined as death within 2 and 28 days of blood culture, respectively. The clinical and microbiological characteristics in the early and late mortality and survival groups were compared. Risk factors associated with severe sepsis or septic shock were also investigated. RESULTS: A total of 385 adult MRSAB patients whose S. aureus isolates were available were enrolled; of these patients, 25 patients (6.5%) and 50 (13%) died early and late, respectively. Compared with both the late-mortality group and the survival group, severe sepsis or septic shock was a statistically significant independent risk factor associated with early mortality. Rapidly or ultimately fatal McCabe and Jackson classification (adjusted odds ratio [aOR], 1.94; 95% confidence interval [CI], 1.25 to 3.02) and pneumonia (aOR, 2.04; 95% CI, 1.03 to 4.02) were independently associated with severe sepsis or septic shock. A vancomycin minimum inhibitory concentration (MIC) ≥ 1.5 μg/mL was associated with a reduced incidence of severe sepsis or septic shock (aOR, 0.53; 95% CI, 0.34 to 0.84). CONCLUSIONS: Severity of illness seems to be the most important risk factor associated with early mortality in MRSAB. Although vancomycin MIC was not independently associated with early mortality, reduced vancomycin susceptibility appears to be linked to reduced disease severity.

Clinical Application of Circulating Tumor Cells in Gastric Cancer

Early detection and accurate monitoring of cancer is important for improving clinical outcomes. Endoscopic biopsy and/or surgical resection specimens are the gold standard for diagnosing gastric cancer and are also useful for selecting therapeutic strategies based on the analysis of genomic/immune parameters. However, these approaches cannot be easily performed because of their invasiveness and because these specimens do not always reflect tumor dynamics and drug sensitivities during therapeutic processes, especially chemotherapy. Accordingly, many researchers have tried to develop noninvasive novel biomarkers that can monitor real-time tumor dynamics for early diagnosis, prognostic evaluation, and prediction of recurrence and therapeutic efficacy. Circulating tumor cells (CTCs) are metastatic cells that are released from the primary tumors into the blood stream and comprise a crucial step in hematogenous metastasis. CTCs, as a liquid biopsy, have received a considerable amount of attention from researchers since they are easily accessible in peripheral blood, avoiding the invasiveness associated with traditional biopsy techniques; they can also be used to derive clinical information for monitoring disease status. In this review, with respect to CTCs, we summarize the metastatic cascade, detection methods, clinical applications, and prospects for patients with gastric cancer.

The Effects of Team-based Simulation Education on Problem Solving Process, Communication Ability and Communication Confidence of Nursing Students / 의료커뮤니케이션

The purpose of this study was to identify the effects of simulation education using team-based on problem solving process, communication ability and communication confidence of nursing students. The study used a one group, pre-post test design. The subjects of this study were 88 nursing college students. self-reported questionnaires were collected between March 3 and June 21, 2019. As a result, There was a statistically significant difference in the problem-solving process: 3.37 points beforehand, 3.53 points after death, 3.36 points after communication, 3.54 points after the fact, and communication confidence increased from 6.39 points before to 7.64 points. After team-based simulation training, problem solving process is a communication ability, communicator confidence. The results of this study show that team-based simulation training has been effective in improving problem resolution, communication skills and communication confidence, so it can be used as a basis for future standardized program development.

Using Computed Tomography: Predictive Factors for Recovery Time in Patients with Orbital Fracture with Diplopia

PURPOSE: To identify predictive factors for recovery time in patients with orbital fracture with diplopia through analysis of preoperative and postoperative computed tomography (CT) images and postoperative recovery time. METHODS: We retrospectively analyzed CT findings-preoperative: fracture size, type of fracture, fracture site, extraocular muscle (EOM) swelling, EOM and soft tissue injury, and the amount of soft tissue herniation; post-operative: degree of enophthalmos, and diplopia recovery period in 379 patients who underwent surgical treatment for orbital fracture between March 2006 and December 2015. RESULTS: The average postoperative follow-up period was 556.2 ± 59.5 days, and the mean duration of recovery was 23.9 ± 42.5 (range, 3–186) days. The recovery time of diplopia was significantly increased with the following preoperative CT findings: fracture size (small and medium < large) (p = 0.049), type of fracture (linear < hinge < comminuted, trap-door) (p < 0.01), fracture site (inferior < medial and both) (p < 0.01), EOM and soft tissue injury (prolapse and torsion, muscle entrapment, kinked muscle) (p < 0.01), and the amount of soft tissue herniation (small and medium < large) (p < 0.001). The mechanism of injury, sex, age, and the degree of enophthalmos were not related to the length of the diplopia recovery period. CONCLUSIONS: The length of diplopia recovery could be predicted by CT findings.