The Effects of Counseling about Death and Dying on Perceptions, Preparedness, and Anxiety Regarding Death among Family Caregivers Caring for Hospice Patients:A Pilot Study / 한국호스피스완화의료학회지

Purpose@#This pilot study aimed to examine the influence of death counseling on perceptions, preparedness, and anxiety regarding death and dying among family caregivers of hospice patients. @*Methods@#Death counseling developed based on the SPIKES model was provided to 37 family caregivers in a hospice and palliative care unit. Perceptions, preparedness, and anxiety regarding death were assessed with a self-administered structured questionnaire, and participants’ scores before and after counseling were compared using the paired t-test. @*Results@#Significant changes were found in perceptions, preparedness, and anxiety regarding death after counseling. Compared to before counseling, the scores for perceptions of death (t=-4.90, P＜0.001) and preparedness for death and dying (t=-16.23, P＜0.001)improved, while anxiety (t=3.72, P=0.001) decreased after counseling. Some changes were also found in the types of support that family caregivers needed to prepare for the death of their family members in the hospice care unit. @*Conclusion@#The findings demonstrate that death counseling could help family caregivers prepare for the death of their loved ones.Hospice and palliative care providers should play a key role in supporting family caregivers of hospice patients by developing strategies for counseling.

Synergistic Induction of Apoptosis by the Combination of an Axl Inhibitor and Auranofin in Human Breast Cancer Cells

Axl receptor tyrosine kinase has been implicated in cancer progression, invasion, and metastasis in various cancer types. Axl overexpression has been observed in many cancers, and selective inhibitors of Axl, including R428, may be promising therapeutic agents for several human cancers, such as breast, lung, and pancreatic cancers. Here, we examined the cell growth inhibition mediated by R428 and auranofin individually as well as in combination in the human breast cancer cell lines MCF-7 and MDAMB-231 to identify new advanced combination treatments for human breast cancer. Our data showed that combination therapy with R428 and auranofin markedly inhibited cancer cell proliferation. Isobologram analyses of these cells indicated a clear synergism between R428 and auranofin with a combination index value of 0.73. The combination treatment promoted apoptosis as indicated by caspase 3 activation and poly (ADP-ribose) polymerase cleavage. Cancer cell migration was also significantly inhibited by this combination treatment. Moreover, we found that combination therapy significantly increased the expression level of Bax, a mitochondrial proapoptotic factor, but decreased that of the X-linked inhibitor of apoptosis protein. Furthermore, the suppression of cell viability and induction of Bax expression by the combination treatment were recovered by treatment with N-acetylcysteine. In conclusion, our data demonstrated that combined treatment with R428 and auranofin synergistically induced apoptosis in human breast cancer cells and may thus serve as a novel and valuable approach for cancer therapy.

The Influence of Importance and Performance of Nursing Activities, and Professional Self-Concept on Ambulatory Care Nurses’ Job Satisfaction / 간호행정학회지

Purpose@#The purpose of this study was to identify factors influencing job satisfaction among ambulatory care nurses. @*Methods@#Data were collected through a self-evaluation survey of 129 nurses in one tertiary hospital. Data were analyzed using paired t-test, independent t-test, one-way ANOVA, Importance-Performance Analysis, Pearson correlation coefficients, and multiple regression analysis. @*Results@#The mean scores were: for importance, 3.18 out of 4, for performance, 2.24 out of 4, for professional self-concept, 2.92 out of 4, and for job satisfaction 2.77 out of 5. There were statistically significant positive correlations between professional self-concept and job satisfaction (r=.37, p<.001). Stepwise multiple regression analysis showed that satisfaction with professional self-concept, clinical career, and age explained 47.0% of the job satisfaction of ambulatory care nurses (F=37.51, p<.001). Satisfaction with professional self-concept, clinical career, and age were statistically significant predictors of job satisfaction. @*Conclusion@#Findings indicate motivation programs according to clinical career would be useful to improve job satisfaction of ambulatory care nurses. Additionally, continuous education should be provided to strengthen the professional self-concept of nursing professionals in both undergraduate curricula and clinical fields.

G0/G1 Switch 2 Induces Cell Survival and Metastasis through Integrin-Mediated Signal Transduction in Human Invasive Breast Cancer Cells

Human breast cancer cell line, MDA-MB-231, is highly invasive and aggressive, compared to less invasive cell line, MCF-7. To explore the genes that might influence the malignancy of MDA-MB-231, DNA microarray analysis was performed. The results showed that G0/G1 switch 2 (G0S2) was one of the most highly expressed genes among the genes upregulated in MDA-MB-231. Although G0S2 acts as a direct inhibitor of adipose triglyceride lipase, action of G0S2 in cancer progression is not yet understood. To investigate whether G0S2 affects invasiveness of MDA-MB-231 cells, G0S2 expression was inhibited using siRNA, which led to decreased cell proliferation, migration, and invasion of MDA-MB-231 cells. Consequently, G0S2 inhibition inactivated integrin-regulated FAK-Src signaling, which promoted Hippo signaling and inactivated ERK1/2 signaling. In addition, G0S2 downregulation decreased β-catenin expression, while E-cadherin expression was increased. It was demonstrated for the first time that G0S2 mediates the Hippo pathway and induces epithelial to mesenchymal transition (EMT). Taken together, our results suggest that G0S2 is a major factor contributing to cell survival and metastasis of MDA-MB-231 cells.

Appropriate angle and depth in thoracic transforaminal epidural block in Koreans

BACKGROUND: Selective transforaminal epidural block has come to the for as a targetspecific modality in the treatment and diagnosis of spinal pain. Thoracic transforaminal epidural block (TTFEB) has the associated risk of pneumothorax. This article describes a retrospective study conducted using computed tomography (CT) imaging to investigate the TTFEB angle and depth appropriate to minimize the risk of pneumothorax in Koreans. METHODS: The subjects of the present study were 100 randomly selected patients between 50 and 70 years of age found be free of thoracic disease according to chest CT performed in the present hospital. On the chest CT, the superior, middle, and inferior thoracic vertebrae were observed at the T2, T7, and T11 levels, respectively. RESULTS: The average distance and the needle insertion angle from the skin point at which the needle may be inserted without piercing the lung to the intervertebral foramen were 117.8 ± 12.1 mm and 58.1 ± 6.1° at the T2 level, 85.6 ± 10.0 mm and 61.7 ± 4.3° at the T7 level, and 94.3 ± 8.7 mm and 64.4 ± 7.0° at the T11 level, respectively. CONCLUSIONS: The needle insertion at the point further than 40 mm, on the upper, middle thorax, if the needle pass from the inner vertebral body to lamina, it could be safer. However, on the lower thorax, needle could pierce the lung though the needle start from the inner vertebral body. Thus, it can be safer if the needle pass toward the exterior margin of lamina.

Auranofin Suppresses Plasminogen Activator Inhibitor-2 Expression through Annexin A5 Induction in Human Prostate Cancer Cells

Auranofin has been developed as antirheumatic drugs, which is currently under clinical development for the treatment of chronic lymphocytic leukemia. Previous report showed that auranofin induced apoptosis by enhancement of annexin A5 expression in PC-3 cells. To understand the role of annexin A5 in auranofin-mediated apoptosis, we performed microarray data analysis to study annexin A5-controlled gene expression in annexin A5 knockdown PC-3 cells. Of differentially expressed genes, plasminogen activator inhibitor (PAI)-2 was increased by annexin A5 siRNA confirmed by qRT-PCR and western blot. Treatment with auranofin decreased PAI-2 and increased annexin A5 expression as well as promoting apoptosis. Furthermore, auranofin-induced apoptosis was recovered by annexin A5 siRNA but it was promoted by PAI-2 siRNA. Interestingly, knockdown of annexin A5 rescued PAI-2 expression suppressed by auranofin. Taken together, our study suggests that induction of annexin A5 by auranofin may enhance apoptosis through suppression of PAI-2 expression in PC-3 cells.

Induction of Integrin Signaling by Steroid Sulfatase in Human Cervical Cancer Cells

Steroid sulfatase (STS) is an enzyme responsible for the hydrolysis of aryl and alkyl sulfates. STS plays a pivotal role in the regulation of estrogens and androgens that promote the growth of hormone-dependent tumors, such as those of breast or prostate cancer. However, the molecular function of STS in tumor growth is still not clear. To elucidate the role of STS in cancer cell proliferation, we investigated whether STS is able to regulate the integrin signaling pathway. We found that overexpression of STS in HeLa cells increases the protein and mRNA levels of integrin β1 and fibronectin, a ligand of integrin α5β1. Dehydroepiandrosterone (DHEA), one of the main metabolites of STS, also increases mRNA and protein expression of integrin β1 and fibronectin. Further, STS expression and DHEA treatment enhanced phosphorylation of focal adhesion kinase (FAK) at the Tyr 925 residue. Moreover, increased phosphorylation of ERK at Thr 202 and Tyr 204 residues by STS indicates that STS activates the MAPK/ERK pathway. In conclusion, these results suggest that STS expression and DHEA treatment may enhance MAPK/ERK signaling through up-regulation of integrin β1 and activation of FAK.

NGF and HB-EGF: Potential Biomarkers that Reflect the Effects of Fesoterodine in Patients with Overactive Bladder Syndrome

PURPOSE: To determine whether levels of nerve growth factor (NGF) and heparin-binding epidermal growth factor-like growth factor (HB-EGF) can be used to objectively assess overactive bladder syndrome (OAB) treatment outcome and to evaluate the effects of fixed-dose fesoterodine on OAB symptoms. MATERIALS AND METHODS: This study included 124 participants (62 patients with OAB and 62 controls) in Severance Hospital between 2010 and 2012. In patients with OAB, 4 mg fesoterodine was administered once daily. Repeated evaluations of putative biomarker levels, urine creatinine (Cr) levels, and questionnaire responses, including the Overactive Bladder Symptom Score (OABSS) and the Overactive Bladder Questionnaire (OAB q), were performed from baseline to 16 weeks. RESULTS: Urinary levels of NGF/Cr (OAB: 1.13+/-0.9 pg/mg; control: 0.5+/-0.29 pg/mg) and HB-EGF/Cr (OAB: 8.73+/-6.55 pg/mg; control: 4.45+/-2.93 pg/mg) were significantly higher in subjects with OAB than in controls (p<0.001). After 16 weeks of fixed-dose fesoterodine treatment, urinary NGF/Cr levels (baseline: 1.13+/-0.08 pg/mg; 16 weeks: 0.60+/-0.4 pg/mg; p=0.02) and HB-EGF/Cr levels significantly decreased (baseline: 8.73+/-6.55 pg/mg; 16 weeks: 4.72+/-2.69 pg/mg; p=0.03, respectively). Both the OABSS and OAB q scores improved (p<0.001). However, there were no a statistically significant correlations between these urinary markers and symptomatic scores. CONCLUSION: Urinary levels of NGF and HB-EGF may be potential biomarkers for evaluating outcome of OAB treatment. Fixed-dose fesoterodine improved OAB symptoms. Future studies are needed to further examine the significance of urinary NGF and HB-EGF levels as therapeutic markers for OAB.

Changes in Sexual Function and Comparison of Questionnaires Following Surgery for Pelvic Organ Prolapse

PURPOSE: The aim of this study was to evaluate the effect of surgical repair of pelvic organ prolapse on female sexual function and to assess correlations between the two using two current standardized questionnaires. MATERIALS AND METHODS: From October 2009 to September 2010, 143 patients with posterior compartment or combined vaginal prolapse were included. We assessed surgical outcomes according to anatomical change in the vagina and results of the Female Sexual Function Index (FSFI) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function questionnaire (PISQ-12) both pre- and postoperatively. RESULTS: Among the 143 preoperative patients, 99 and 84 patients responded to the PISQ-12 and FSFI, respectively. The mean PISQ-12 score increased after surgery (p<0.001). Specifically, postoperative scores for questions 8 and 12 were higher than their respective preoperative scores (p<0.001). Postoperatively, mean FSFI score changed only slightly (p=0.76), and only the score for the satisfaction domain was improved (p=0.023). In regards to vaginal anatomy, vaginal length was significantly greater postoperatively (6.99+/-0.18 vs. 7.56+/-1.08, p<0.001), and postoperative vaginal caliber was narrowed to a two-finger width. CONCLUSION: In this study, surgery for pelvic organ prolapse was shown to affect female sexual function. Moreover, menopause was associated with a change in postoperative sexual function.

Annexin A5 as a New Potential Biomarker for Cisplatin-Induced Toxicity in Human Kidney Epithelial Cells

Cisplatin is a member of platinum-containing anti-cancer drugs that causes cross-linking of DNA and ultimately cancer cell apoptosis. The therapeutic function of cisplatin on various types of cancers has been widely reported but the side effects have been discovered together and nephrotoxicity has been regarded as major side effect of cisplatin. To select candidates for new sensitive nephrotoxicity biomarker, we performed proteomic analysis using 2-DE/MALDI-TOF-MS followed by cisplatin treatment in human kidney cell line, HK-2 cells, and compared the results to the gene profi le from microarray composed of genes changed in expression by cisplatin from formerly reported article. Annexin A5 has been selected to be the most potential candidate and it has been identifi ed using Western blot, RT-PCR and cell viability assay whether annexin A5 is available to be a sensitive nephrotoxic biomarker. Treatment with cisplatin on HK-2 cells caused the increase of annexin A5 expression in protein and mRNA levels. Overexpression of annexin A5 blocked HK-2 cell proliferation, indicating correlation between annexin A5 and renal cell toxicity. Taken together, these results suggest the possibility of annexin A5 as a new biomarker for cisplatin-mediated nephrotoxicity.

Acute Exacerbation of Interstitial Lung Disease in Newly Diagnosed Probable Dermatomyositis / 대한임상신경생리학회지

No abstract available.

Creutzfeldt-Jakob Disease Mimicking a Stroke as Initial Manifestation

No abstract available.

A Comparison of Efficacy and Safety of Non-steroidal Anti-inflammatory Drugs versus Acetaminophen in the Treatment of Episodic Tension-type Headache: A Meta-analysis of Randomized Placebo-controlled Trial Studies / 가정의학회지

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are widely used in the treatment of tension headache. The objective of this study was to evaluate and compare the efficacy and safety of single doses of acetaminophen and NSAIDs using meta-analysis of randomized placebo-controlled trial studies. METHODS: We searched MEDLINE, EMBASE, CINAHL, Cochrane, KMbase, KoreaMed, RiCH, National Assembly Library, Riss4u, and DBPIA for studies released through 27th July 2010. Two authors independently extracted the data. To assess the risk of bias, the Cochrane Collaborations risk of bias tool was used. Review Manager 5.0 was used for statistics. RESULTS: We identified 6 studies. The relative benefit of the NSAIDs group compared to the acetaminophen group for participants with at least 50% pain relief was 1.18 (95% confidence interval [CI], 0.99 to 1.39; I2 = 85%). We did subgroup analysis based on allocation concealment versus non-allocation concealment, and low-dose NSAIDs versus high-dose NSAIDs. The relative benefit of the low-dose NSAIDs subgroup to the acetaminophen group was 0.98 (95% CI, 0.91 to 1.06; I2 = 0%). However, the heterogeneity of other subgroup analysis was not settled. The relative risk for using rescue medication of the NSAIDs group compared to the acetaminophen group was 0.84 (95% CI, 0.64 to 1.12; I2 = 47%). The relative risk for adverse events was 1.31(95% CI, 0.96 to 1.80; I2 = 0%). CONCLUSION: In this meta-analysis, there was no difference between low-dose NSAIDs and acetaminophen in the efficacy of the treatment for tension type headache. The results suggested that high-dose NSAIDs have more effect but also have more adverse events. The balance of benefit and harm needs to be considered when using high-dose NSAIDs for tension headache.

The Quality of Reporting of Cohort, Case-Control Studies in the Korean Journal of Family Medicine / 가정의학회지

BACKGROUND: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement was developed to improve the reporting of observational studies. We aimed to evaluate the quality of reporting in cohort studies and case-control studies among observational studies published in the Korean Journal of Family Medicine. METHODS: We searched for cohort studies and case-control studies published as original articles in the Journal of the Korean Academy of Family Medicine during the period January 1992 through December 2009. The main outcome measures were the number and proportion of cohort studies and case-control studies that reported each of 22 checklist items of STROBE. RESULTS: We identified a total of 84 articles, of which 46 articles were cohort studies and 38 were case-control studies. Concerning methods, study designs (10%), bias (13%), study size (0%), statistical methods (12-c and 12-e items, 0%; 12-d item, cohort study, 6%) have been poorly reported. Of results, participants (5-6%), descriptive data (14-b item, 5%), and funding (1%) among other information have been poorly reported. CONCLUSION: The degree of adherence the STROBE recommendations was relatively low in cohort studies and case-control studies published in the Korean Journal of Family Medicine. An effort to improve the reporting of observational studies by application and recommendation of the STROBE statement is required.

Rupture of external iliac artery during microscopic lumbar disc surgery: A case report / 대한마취과학회지

Iatrogenic vascular injury during lumbar disc surgery is a rare but serious complication. This paper reports a patient who sustained an injury to the iliac artery while undergoing intervertebral disc surgery at the lumbar region. He suffered from massive bleeding and shock. An urgent laparatomy was performed under cardiopulmonary bypass, and the vascular injuries were repaired successfully. This case shows that a rapid diagnosis and immediate intervention can result in a favorable outcome.

Delayed psoas muscle hematoma formation after spinal anesthesia with the paramedian approach in a hemodialysis patient: A case report

We present a patient who developed a psoas muscle hematoma after spinal anesthesia. He had received hemodialysis with heparin every two days because of end stage renal disease. Under the jack-knife position, he underwent spinal anesthesia and a paramedian approach was used for incision and drainage of an anal abscess. The coagulation tests were normal throughout the surgery. Eleven days after the operation, he complained of sudden onset of right buttock pain and a psoas muscle hematoma was diagnosed by CT. Although heparin is recommended after regional anesthesia, it is a major cause of delayed hematoma. Because of this potential complication, anesthesiologists and clinicians should carefully monitor the usage of anticoagulants after spinal anesthesia, and it is necessary to use active diagnostic tools such as CT for early diagnosis when hematoma formation is suspected in patients receiving anticoagulants.

A Long-Term Treatment Outcome of Abdominal Sacrocolpopexy

PURPOSE: The aim of this study was to evaluate the long-term treatment outcome and major complication rates of abdominal sacrocolpopexy (ASC). MATERIALS AND METHODS: This retrospective study included 57 Korean women who underwent ASC with mesh for symptomatic uterine or vault prolapse and attended follow-up visits for at least 5 years. Forty-seven women with urodynamic stress incontinence concomitantly received a modified Burch colposuspension. The long-term anatomical and functional outcomes and complication rates were assessed. RESULTS: The median follow-up was 66 months (range 60-108). Overall anatomical success rates (no recurrence of any prolapse > or = stage II according to the pelvic organ prolapse-quantification system) were 86.0%. Urinary urgency and voiding dysfunction were significantly improved after surgery, however, recurrent stress urinary incontinence developed in 44.7% (21/47) of cases and half of them developed within 1-3 months post-op. Bowel function (constipation and fecal incontinence) and sexual function (sexual activity and dyspareunia) did not significantly change after surgery. Major complication requiring reoperation or intensive care developed in 12 (21.0%) cases. CONCLUSIONS: ASC provides durable pelvic support, however, it may be ineffective for alleviating pelvic floor dysfunction except for urinary urgency and voiding dysfunction, and it contains major complication risk that cannot be overlooked.

Outcome of mid urethral sling procedures according to age / 대한산부인과학회지

OBJECTIVE: To compare the morbidity and treatment outcomes of mid urethral sling procedures for older women and younger women, and to evaluate whether mid urethral sling procedures can be effectively used in older women. METHODS: This retrospective study included 381 patients who underwent mid urethral sling procedures, tension free vaginal tape (TVT) or transobturator tape (TOT) for urodynamic stress urinary incontinence from March 2000 to June 2006. The patients were divided into two age groups: younger women (30~69 years old) and older women (70~90 years old). Patients were followed up with clinic visits at 1, 3, 6, 12 months, and every year thereafter. RESULTS: 341 (89.7%) were in younger women, 40 (10.5%) in older women. The rates of intra and perioperative complications including hemoglobin difference, urinary retention, UTI, mesh erosion, wound infection were no significant differences between the groups. De novo urgency was more common in older women than younger women (15.9% vs. 30.0%: P0.05) showed no significant differences. CONCLUSION: Our data showed subjective cure rates without any significant increase in intraoperative complications in older women. Postoperative complications of de novo urgency were more common in the older women. Hospital stay and recovery period were short, making TVT and TOT a suitable procedure for all ages.

Differential expression of Matrix Metalloproteinase (MMP)-2, -9 in normal and severe preeclamptic human placentas / 대한산부인과학회지

OBJECTIVE: The aim of the study was to investigate the differential expression of Matrix Metalloproteinase (MMP) -2,-9 in the normal and severe preeclamptic placenta. METHODS: Placentas were obtained from women undergoing cesarean section with normal (n=10) and severe preeclamptic (n=10) pregnancies. Semi-quantitative RT-PCR was done to detect the placental gene expression of MMP-2,-9. Western blot analysis was performed to identify MMP-2,-9 protein expression in each placenta. Immunohistochemical staining were employed to localize MMP-2,-9 in placental tissues. RESULTS: MMP-2,-9 genes were expressed in both normal and severe preeclamptic placenta. There were lower expressions MMP-2,-9 in severe preeclamptic placentas than in normal. MMP-2,-9 proteins were all present in each placental tissue. The expression for MMP-2,-9 was weaker in severe preeclamptic placenta than in normal. MMP-2,-9 were localized only to the trophoblast, and were also weakly positive in severe preeclamptic placenta compared with normal. CONCLUSIONS: MMP-2,-9 expressions were decreased in severe preeclampsia placenta compared to those from normal placenta. This study suggests that decreased expression of MMP-2,-9 may have a role in the development of severe preeclampsia.

Clinical significance of serum carbohydrate antigen 19-9 in ovarian mature cystic teratoma / 대한산부인과학회지

OBJECTIVE: This study is to determine serum carbohydrate antigen (CA) 19-9 levels in ovarian mature cystic teratoma (MCT) as a possible differential diagnostic tool. METHODS: The study group was composed of 201 patients who underwent removal of ovarian MCT and pathologically confirmed at Yonsei University Medical Center from January 2001 to July 2005. All of them were tested for serum CA19-9 levels before operation. Their data was compared with routine gynecologic evaluation group who showed normal serum CA19-9 level. Statistical analysis was carried out with t-test and Pearson correlation by SPSS version 12.0. RESULTS: Serum CA19-9 level was significantly elevated in the patients with ovarian MCT (p=0.011). Serum CA19-9 level and size of MCT showed positive correlation (p=0.009). Moreover, postoperative serum CA19-9 level showed significant decrease, compared to preoperative level (p=0.007). CONCLUSION: Serum CA19-9 can be used as an effective method for differential diagnosis of ovarian MCT, and it is proper to be used as a postoperative follow-up test.