A Study of the Relationships between Compassion Fatigue, Compassion Satisfaction, Depression, Anxiety, and Sleep Disorders among Oncology Nurses

PURPOSE: This study was conducted to identify the relationships between various factors, including compassion fatigue, compassion satisfaction, depression, anxiety, and sleep disorders among oncology nurses. METHODS: A convenience sample of 140 oncology nurses from 3 university hospitals completed questionnaires. The collected data were analyzed using t-tests, ANOVA, Pearson's correlation coefficients, and Kruskal-Wallis tests. RESULTS: Compassion fatigue is composed of secondary traumatic stress and burnout. The levels of compassion fatigue showed significant positive correlations with depression, anxiety, and sleep disorder. On the other hand, the levels of compassion satisfaction showed significant negative correlations with compassion fatigue, depression, anxiety, and sleep disorders. The subjects in the at-risk and very distressed group of compassion fatigue and compassion satisfaction risk profile had significantly higher levels of depression, anxiety, and sleep disorders. CONCLUSION: Such efforts will help reduce the level of depression, anxiety, and sleep disorders in oncology nurses at-risk of developing compassion fatigue. It is also necessary to provide organization support for oncology nurses, and to develop an intervention that is designed to mitigate their compassion fatigue and to promote compassion satisfaction.

DNA Methylation Patterns of Ulcer-Healing Genes Associated with the Normal Gastric Mucosa of Gastric Cancers

Recent evidence suggests that gastric mucosal injury induces adaptive changes in DNA methylation. In this study, the methylation status of the key tissue-specific genes in normal gastric mucosa of healthy individuals and cancer patients was evaluated. The methylation-variable sites of 14 genes, including ulcer-healing genes (TFF1, TFF2, CDH1, and PPARG), were chosen from the CpG-island margins or non-island CpGs near the transcription start sites. The healthy individuals as well as the normal gastric mucosa of 23 ulcer, 21 non-invasive cancer, and 53 cancer patients were examined by semiquantitative methylation-specific polymerase chain reaction (PCR) analysis. The ulcer-healing genes were concurrently methylated with other genes depending on the presence or absence of CpG-islands in the normal mucosa of healthy individuals. Both the TFF2 and PPARG genes were frequently undermethylated in ulcer patients. The over- or intermediate-methylated TFF2 and undermethylated PPARG genes was more common in stage-1 cancer patients (71%) than in healthy individuals (10%; odds ratio [OR], 21.9) and non-invasive cancer patients (21%; OR, 8.9). The TFF2-PPARG methylation pattern of cancer patients was stronger in the older-age group (> or =55 yr; OR, 43.6). These results suggest that the combined methylation pattern of ulcer-healing genes serves as a sensitive marker for predicting cancer-prone gastric mucosa.

DNA Methylation and Expression Patterns of Key Tissue-specific Genes in Adult Stem Cells and Stomach Tissues

CpG-island margins and non-island-CpG sites round the transcription start sites of CpG-island-positive and -negative genes are methylated to various degrees in a tissue-specific manner. These methylation-variable CpG sites were analyzed to delineate a relationship between the methylation and transcription of the tissue-specific genes. The level of tissue-specific transcription was estimated by counting the number of the total transcripts in the SAGE (serial analysis of gene expression) database. The methylation status of 12 CpG-island margins and 21 non-island CpG sites near the key tissue-specific genes was examined in pluripotent stromal cells obtained from fat and bone marrow samples as well as in lineage-committed cells from marrow bulk, stomach, colon, breast, and thyroid samples. Of the 33 CpG sites examined, 10 non-island-CpG sites, but none of the CpG-island margins were undermethylated concurrent with tissue-specific expression of their nearby genes. The net methylation of the 33 CpG sites and the net amount of non-island-CpG gene transcripts were high in stomach tissues and low in stromal cells. The present findings suggest that the methylation of the non-island-CpG sites is inversely associated with the expression of the nearby genes, and the concert effect of transitional-CpG methylation is linearly associated with the stomach-specific genes lacking CpG-islands.

Chromosomal Losses are Associated with Hypomethylation of the Gene-Control Regions in the Stomach with a Low Number of Active Genes

Transitional-CpG methylation between unmethylated promoters and nearby methylated retroelements plays a role in the establishment of tissue-specific transcription. This study examined whether chromosomal losses reducing the active genes in cancers can change transitional-CpG methylation and the transcription activity in a cancer-type-dependent manner. The transitional-CpG sites at the CpG-island margins of nine genes and the non-island-CpG sites round the transcription start sites of six genes lacking CpG islands were examined by methylation-specific polymerase chain reaction (PCR) analysis. The number of active genes in normal and cancerous tissues of the stomach, colon, breast, and nasopharynx were analyzed using the public data in silico. The CpG-island margins and non-island CpG sites tended to be hypermethylated and hypomethylated in all cancer types, respectively. The CpG-island margins were hypermethylated and a low number of genes were active in the normal stomach compared with other normal tissues. In gastric cancers, the CpG-island margins and non-island-CpG sites were hypomethylated in association with high-level chromosomal losses, and the number of active genes increased. Colon, breast, and nasopharyngeal cancers showed no significant association between the chromosomal losses and methylation changes. These findings suggest that chromosomal losses in gastric cancers are associated with the hypomethylation of the gene-control regions and the increased number of active genes.

A Study on Pain, Physical Function, Cognitive Function, Depression and Agitation in Elderly Women with Dementia / 성인간호학회지

PURPOSE: The purpose of this study was to determine the relationship between assessed pain, functional status, and emotional status in elderly women with dementia. METHODS: The method was a descriptive correlational design. Subjects were sampled from 75 elderly women with dementia who were resident in nursing home. and their pain, functional status(physical function, cognitive function), emotional status(depression, agitation) were measured. The collected data were analyzed for correlations between pain and functional status and for emotional status using the SPSS 11.0 statistical program. RESULTS: The pain degree of the aged women in dementia were as follows; between 0 and 27 points, average 4.04 points, which was a possible point extent. Looking at the grades in detail items, the wry face expression was shown highest, an average of 0.84 points. The relation with cognitive function was(r=-.259, p<.025) a minus relation. And the relation with physical function was (r=.406, p<.001) a plus one. The relation with depression was (r=.462, p<.001), plus one. And (r=.592, p<.001) a plus relation was found with agitation. CONCLUSION: Pain is associated with impaired functional and emotional status. Major efforts are needed to improve nursing assessment and management of pain in this cognitive impaired population.

Altered Expression of Peritoneal Aquaporin-in Response to Osmotic Stimuli and Glucocorticoid / 대한신장학회잡지

BACKGROUND: To examine the changes of peritoneal aquaporin-1 (AQP-1) expression and peritoneal transport in rats in response to continuous exposure of same osmotic stimuli which was induced by either mannitol or glucose in dialysis solution or glucocorticoids co-reatment. METHODS: Twenty-eight male Sprague-awley rats were divided into three groups:group I (n=10) rats were dialyzed with 5% mannitol solution (0.27 M); group II (n=9) rats were dialyzed with 5% glucose solution (0.28 M): and group III (n=9) rats were dialyzed with 5% glucose solution (0.28 M) accompanied by daily injection of dexamethasone (2 mg/kg, im) for the last 7 days of the 1 month dialysis period. Dialysis exchanges were performed 2 times a day for 1 month with 25 mL per exchange. Immunohistochemistry was performed using a polyclonal anti AQP-1 antibody. The peritoneal membrane (PM) function was assessed by one-hour PET for comparing transport characteristics. PM transport rates were assessed by D/P of urea nitrogen and D/Do of glucose. Water transport of peritoneal membrane was assessed by D/P of sodium at 1 month. RESULTS: The immunolabeling intensity of peritoneal AQP-1 was markedly increased and the most prominent in rats dialyzed with 5% glucose solution accompanied by injection of dexamethasone (group III). Consistent with this, D/P of sodium in rats of group III was significantly decreased (p<0.05), indicating an increased water permeability and ultrafiltration. In contrast, peritoneal AQP-1 labeling intensity was weaker in PD groups dialyzed with mannitol (group I) and glucose (group II) solution having an identical osmolality and was not different between the groups. Rats in group I exhibited significantly lower D/Do of glucose and increased D/P of urea nitrogen, suggesting high PM transport. CONCLUSION: These results indicate that the change of peritoneal AQP-1 expression is not specific to the glucose itself, but rather it could be altered in response to the changes of osmolality per se in PD solution. Moreover, corticosteroid up-egulates peritoneal AQP-expression, which is paralleled by an increased water permeability.

Tracheopathia Osteoplastica Associated with Anthracofibrosis: Case Report

Tracheopathia osteoplastica is a rare benign disorder of the trachea and major bronchi. It is characterized by multiple cartilaginous or osseous submucosal nodules that project into the tracheobronchial lumen. Awareness of the condition is important to avoid unnecessary surgery. We report here on the CT and bronchoscopic findings of tracheopathia osteoplastica associated with anthracofibrosis in a 67-year old woman, and we will then discuss our findings.

A Case of Gastroenteritis Associated with Gastric Trichuriasis

A rare human case of gastroenteritis and eosinophilic ascites associated with gastric trichuriasis is described. The patient was a 32-yr-old woman who was working in a farm near Pohang, Korea. She complained of abdominal pain, diarrhea, and vomiting. Endoscopic examination found focal linear hyperemia on the mucosa of the stomach antrum, and endoscopic biopsy confirmed eosinophilic inflammation of the mucosa and submucosa of the stomach, terminal ileum, and cecum. The biopsy specimen of the stomach included a female Trichuris trichiura which was covered by many inflammatory cells on its surface. Ascites and intestinal wall thickening was found by CT scan, and Douglas pouch centesis aspirated bloody ascites which included many eosinophils. She was medicated with prednisolone and albendazole and cured. She is the first case of eosinophilic inflammation of the gastrointestinal tract and ascites associated with trichuriasis in the stomach.

A Large Malignant Insulinoma: Case Report with Endosonographic, Immunohistochemical and Ultrastructural Features

Malignant insulinoma in the beta cells of the pancreatic islet is rare and usually presented as hypoglycemia. We report a case of large malignant insulinoma in a 53-year-old Korean woman. A presumptive clinical diagnosis was made before surgery, based on the high plasma insulin-to-glucose ratio and a large solitary heterogeneous pancreatic mass by abdominal computed tomography and endosonography. The tumor measured 5.8X4.7X4.5 cm in dimension and showed capsular invasions and metastases in two of four peripancreatic lymph nodes. The tumor cells were strongly immunoreactive to insulin and had a high Ki-67 labeling index (13%) and atypical membranous electron-dense granules, ranging from 120 to 400 nm in diameter, in the cytoplasm on electron microscopy. The patient was treated by distal pancreatectomy with splenectomy and rapidly recovered without neurohypoglycemic symptoms. This case showed not only lymph node metastases, the most reliable parameter for malignancy in pancreatic endocrine tumors, but also other valid diagnostic clues, such as high Ki-67 labeling index, heterogeneous enodosonographic findings, capsular invasions with large tumor and pure atypical secretory granules.

Expression of p27(Kip1) in gastric cancers and precancerous lesions / 대한내과학회지

BACKGROUND: The cyclin-dependent kinase inhibitor p27(Kip1) is a negative regulator of cell cycle progression at G1/S transition. Recently, the expression level of p27(Kip1) was decreased in many cancers such as breast, pituitary gland, colon and stomach. We studied the expression of p27(Kip1) in gastric cancers, precancerous lesions and normal gastric tissues and analysed its correlation to clinicopathologic data including tumor differentiation, tumor depth, nodal and distant metastasis in gastric cancers. METHODS: p27(Kip1) were immunohistochemically stained in the tissue specimens of 62 resected cancers, 110 corresponding adjacent non-neoplastic tissues, 22 gastric adenomas and 10 normal gastric tissues. Adjacent non-neoplastic tissues consisted of 32 chronic gastritis, 29 intestinal metaplasia and 49 transitional mucosa. RESULTS: Gastric cancers showed significantly decreased expression level of p27(Kip1) when compared with non-neoplastic lesions and adenomas. Labeling index of p27(Kip1) were more decreased in chronic gastritis, intestinal metaplasia and transitional mucosa than in normal mucosa. Early gastric cancers showed significantly decreased expression level of p27(Kip1) when compared with advanced gastric cancers. In gastric cancers, p27(Kip1) labeling index was significantly decreased in diffuse type and presence of nodal metastasis however did not show relationship with distant metastasis and tumor depth of advanced gastric cancers. CONCLUSION: We suggest that p27(Kip1) may be decreased in the early stage of gastric carcinogenesis and play an important role in the progression and differentiation of gastric cancers. More further studies are thought to be necessary in order to evaluate its prognostic factor in gastric cancers.

A Case of Pulmonary Trichomoniasis / 대한임상병리학회지

Man is host to three distinct trichomonad species such as Trichomonas vaginalis, T. hominis, and T. tenax. Although reports of trichomonads found outside their natural habitat are rare, sporadic case reports have appeared describing trichomonads in the respiratory tract. The route of infection is unknown, but possible mechanisms include invasion from mouth, oral sex, bronchopleural or pleuroenteral fistula. Pulmonary trichomoniasis is a kind of oppotunistic infection and is usually caused by aspirated T. tenax in male adult patientis with chronic purulent or necrotic pulmonary disease. A 63-year-old male patient with alcoholic liver cirrhosis and chronic bronchiectasis was admitted due to copious sputum, dyspnea, fever and severe weight loss. On the thoracentesis from his right pleural cavity, 1 L of foul-smelling, brownish-yellow exudate was withdrawn and showed a large number of neutrophil, bacteria and numerous flagellated, actively motile organisms with typical appearance of thrichomonads in wet preparation. This patient was expired due to sepsis and insufficiency of multiple organs inspite of chemotherapy with metronidazole, cefuroxime and gentamicin on day 35 of admission. So, we report the first case of pulmonary trichomoniasis diagnosed in wet preparation of pleural fluid in Korea.

Effects of A Systematic Pain Management Method used by a Group of Nurses on Pain Management of Oncology Patients / 성인간호학회지

A review of the literature on cancer pain revealed that many persons with cancer receive inadequate analgesia for pain control, due in part to a lack of knowledge of the control of cancer pain by both physicians and nurses. This study is composed of two parts : one is to train nurses to change their knowledge of and attitude toward the pain management of patients having cancer and to evaluate the effectiveness of this training in comparison with other non-trained group ; the other is to test the applicability of the pain management method knowledge and attitude in the levels of pain of oncology patients. General characteristics of nurses such as age, education, educational experiences of cancer pain management were not different in both groups except the clinical experience. General characteristics of cancer patients and pain-related variables such as pain, sleep, daily activities, treatment modalities, causes of pain were not different in both groups except the educational levels of patients. After an eight-hour educational program given to the experimental nurse group, the knowledge and attitude about assessment of cancer pain, pain medication, and pharmacological knowledge were significantly higher in the experimental group than in the control group, while knowledge about classification of analgesics was not significantly different. The amount of analgesics, measured by the morphine equivalent doses, used in the experimental group was significantly lower than in the control group in the first and the last days. The experimental group used more systematic ways of drug changes from non-narcotic analgesics to narcotic analgesics than the control group. This indicated that the control group used fentanyl patches more commonly than in the control group. Cancer pain scores of both group of patients were measured on an hourly bases for a week in both groups. The patients' pain scores of the first day of measurement in experimental group were not significantly higher than those of control group of patients, while those of the last day were significantly higher than those of the control group. This study supports the need for educational program for the management of cancer pain to the nurses and the doctors.