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Sohn BK, Park SM, Park IJ, Hwang JY, Choi JS, Lee JY, Jung HY. The Relationship between Emotional Labor and Job Stress among Hospital Workers. J Korean Med Sci 2018; 33:e246. [PMID: 30250411 PMCID: PMC6146145 DOI: 10.3346/jkms.2018.33.e246] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/20/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND We divided hospital workers into two groups according to whether one was an interpersonal service worker (ISW) or was not (non-ISW). We then explored differences between these groups in job stress and emotional labor type and investigated the mediating factors influencing their relationships. METHODS Our participants included both ISW (n = 353) and non-ISW (n = 71) hospital workers. We administered the Korean Standard Occupational Stress Scale Short Form to measure job stress and the Emotional Labor Scale to indicate both emotional labor type and characteristics. We also administered the Beck Depression Inventory-II to indicate the mediating factors of depressive symptoms, the Beck Anxiety Inventory to indicate the mediating factors of anxiety, and the State Anger Subscale of the State-Trait Anger Expression inventory to indicate the mediating factors of anger. RESULTS The ISW group showed more severe job stress than the non-ISW group over a significantly longer duration, with greater intensity, and with higher level of surface acting. The ISW group showed a significant positive correlation between surface acting and job stress and no significant correlation between deep acting and job stress. Parallel mediation analysis showed that for ISWs surface acting was directly related to increased job stress, indirectly related to depression, and unrelated to anxiety and anger. CONCLUSION The ISW group displayed more surface acting and job stress in its emotional labor than the non-ISW group. In the ISW group, surface acting during emotional labor was positively correlated with job stress. Depression partially mediated their relationship.
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Lim JH, Lee CH, Kim KY, Jung HY, Choi JY, Cho JH, Park SH, Kim YL, Baek MC, Park JB, Kim YH, Chung BH, Lee SH, Kim CD. Novel urinary exosomal biomarkers of acute T cell-mediated rejection in kidney transplant recipients: A cross-sectional study. PLoS One 2018; 13:e0204204. [PMID: 30226858 PMCID: PMC6143249 DOI: 10.1371/journal.pone.0204204] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/05/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Acute rejection is hazardous to graft survival in kidney transplant recipients (KTRs). We aimed to identify novel biomarkers for early diagnosis of acute T cell-mediated rejection (TCMR) in urinary exosomes of KTRs. METHODS Among 458 graft biopsies enrolled in a cross-sectional multicenter study, 22 patients with stable graft function (STA) who had not shown pathologic abnormality and 25 patients who diagnosed biopsy-proven TCMR were analyzed. We performed proteomic analysis using nano-ultra performance liquid chromatography-tandem mass spectrometry (nano-UPLC-MS/MS) to identify candidate biomarkers for early TCMR diagnosis on urinary exosomes. We confirmed the protein levels of each candidate biomarker by western blot analysis. RESULTS A total of 169 urinary exosome proteins were identified by nano-UPLC-MS/MS. Forty-six proteins showed increased expression in STA patients, while 17 proteins were increased in TCMR patients. Among them, we selected five proteins as candidate biomarkers for early diagnosis of TCMR according to significance, degree of quantity variance, and information from the ExoCarta database. We confirmed the proteomic expression levels of five candidate biomarkers by western blot analysis in each patient. Of all candidate biomarkers, tetraspanin-1 and hemopexin were significantly higher in TCMR patients (STA:TCMR ratio = 1:1.8, P = 0.009, and 1:3.5, P = 0.046, respectively). CONCLUSIONS Tetraspanin-1 and hemopexin were detected in KTR urine and could act as potential diagnostic proteins for TCMR.
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Yoon SH, Cho JH, Jung HY, Hwang WM, Yun SR, Choi JY, Park SH, Kim CD, Kim MS, Kim YL. Exceptional mucocutaneous manifestations with amyloid nephropathy: a case report. J Med Case Rep 2018; 12:241. [PMID: 30126443 PMCID: PMC6102914 DOI: 10.1186/s13256-018-1760-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/03/2018] [Indexed: 11/30/2022] Open
Abstract
Background Amyloidosis is a very rare disease that is difficult to diagnose because of the unspecific early clinical manifestations of the disease. Accurate and early diagnosis is extremely important because the effect of treatment is dependent on the extent of disease progression. Sicca syndrome and nail dystrophy are very rare symptoms of amyloidosis. We report here a case of sicca syndrome and nail dystrophy with renal dysfunction in a 52-year-old Korean woman who was diagnosed as having systemic amyloidosis. Case presentation We present the case of a 52-year-old Korean woman complaining of dry mouth and nail dystrophy for 4 months as an initial symptom. A slit lamp examination revealed superficial keratoconjunctival erosion in both eyes. A laboratory test showed anemia, azotemia, and proteinuria. Urine protein electrophoresis showed increased gamma globulin excretion. Serum free light chain of kappa and lambda were increased. Histopathological studies of biopsy specimens of minor salivary glands and kidney revealed deposits of amyloid fibrils. A bone marrow aspiration biopsy showed hypercellular marrow with 5% plasma cells. She was diagnosed as having primary systemic amyloidosis then started on chemotherapy. Conclusion Such atypical mucocutaneous manifestations of amyloidosis can serve as important early diagnostic signs with less invasive biopsy confirmation in patients with systemic amyloidosis.
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Jung HY, Kim SH, Seo MY, Cho SY, Yang Y, Choi JY, Cho JH, Park SH, Kim YL, Kim HK, Huh S, Won DI, Kim CD. Characteristics and Clinical Significance of De Novo Donor-Specific Anti-HLA Antibodies after Kidney Transplantation. J Korean Med Sci 2018; 33:e217. [PMID: 30127706 PMCID: PMC6097072 DOI: 10.3346/jkms.2018.33.e217] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/16/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The association of de novo donor-specific anti-human leukocyte antigens (HLA) antibodies (DSA) and development of antibody-mediated rejection (AMR) in kidney transplant recipients (KTRs) is still undetermined. METHODS We prospectively screened de novo DSA in 167 KTRs during 32 months after kidney transplantation (KT). Timing of DSA detection was at 3, 6, and 12 months post-transplant and annually thereafter and when clinically indicated. DSA levels were determined by Luminex assays and expressed as mean fluorescence intensity (MFI). We evaluated the incidence, characteristics of DSA, and association between DSA and tacrolimus trough levels or AMR. RESULTS De novo DSA developed in 16 KTRs (9.6%) and acute AMR occurred more commonly in KTRs with de novo DSA compared to KTRs without de novo DSA (18.8% vs. 0%, P < 0.001). All de novo DSA were against class II antigens. The mean number of DSA was 1.8 ± 1.2 and the average MFI of DSA was 7,399 ± 5,470. Tacrolimus trough level during the first 0-2 months after KT was an independent predictor of DSA development (hazard ratio, 0.70; 95% confidence interval, 0.50-0.99; P = 0.043). No differences were found in the number of DSA, average MFI of DSA, and tacrolimus levels during the first year between de novo DSA-positive KTRs with AMR and those without AMR. CONCLUSION The results of our study suggest that monitoring of DSA and maintaining proper tacrolimus levels are essential to prevent AMR during the initial period after KT.
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Jung DE, Bhang SY, Lee WH, Yoon HJ, Jung HY, Kim Y. Protective Role of Parenting Attitude on the Behavioral and Neurocognitive Development of the Children from Economically Disadvantaged Families. Psychiatry Investig 2018; 15:584-592. [PMID: 29865783 PMCID: PMC6018147 DOI: 10.30773/pi.2017.12.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 12/25/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Association between home environment and the behavioral and neurocognitive development of children from a community childcare center for low-income families was examined (aged 6 to 12 years, n=155). METHODS The parents performed a questionnaire on home environment (K-HOME-Q) to assess home environment including parenting attitude and the Child Behavior Checklist (K-CBCL). The children performed the Wechsler Intelligence (IQ) Scale, Stroop interference test (Stroop), word fluency test (WF), and design fluency test (DF) to assess their neurocognitive development. RESULTS 'Nurturing of Development' and 'Variety of Language Interaction' scores from the K-HOME-Q, were inversely associated with total behavior problems, externalization, rule-breaking, and aggressive behavior subscales of K-CBCL, and 'Emotional atmosphere' and 'Tolerance toward the child' scores showed inverse associations with the total behavior problems, rule-breaking, aggressive behavior, and withdrawn/depressed subscales. Despite economic hardship, the mean scores of the neurocognitive tests were comparable to the average level of Korean children's normative sample. However, 'Nurturing of Development' and 'Tolerance toward the Child' score of K-HOME-Q were associated with better executive function (IQ, WF, DF). CONCLUSION These results suggest that parental stimulation of development and tolerant parenting attitude may offer protection against the negative effects of suboptimal economic environment on children's behavior and neurocognitive development.
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Jung HY, Jeong KH, Lim JH, Choi JY, Cho JH, Park SH, Kim CD, Kim YL. FP471A BETTER CHOICE FOR QUALITY OF LIFE: HEMODIALYSIS VERSUS PERITONEAL DIALYSIS. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lim AY, Lee SH, Jeon Y, Yoo R, Jung HY. Job-Seeking Stress, Mental Health Problems, and the Role of Perceived Social Support in University Graduates in Korea. J Korean Med Sci 2018; 33:e149. [PMID: 29736162 PMCID: PMC5934522 DOI: 10.3346/jkms.2018.33.e149] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Increases in unemployment and suicide in the young Korean population have recently become major social concerns in the country. The purpose of this study was to examine mental health status in young job seekers and identify sociodemographic factors related to job-seeking stress, depression, and suicidal ideation. We also explored the mediating effect of depression on the relationship between job-seeking stress and suicidal ideation and examined whether social support moderated this effect. METHODS In total, 124 university graduates completed the Job-Seeking Stress Scale, Beck Depression Inventory-II, Beck Scale for Suicide Ideation, and Multidimensional Scale of Perceived Social Support. Descriptive statistics were calculated for participants' general characteristics, and t-tests or analyses of variance, correlation analysis, simple mediation analysis, and mediated moderation analysis were performed. RESULTS Of the 124 participants, 39.5% and 15.3% exhibited clinical levels of depression and suicidal ideation, respectively. Sociodemographic factors (i.e., sex, academic major, educational expenses loan, and willingness to accept irregular employment) were associated with job-seeking stress, depression, and suicidal ideation. Women and graduates who were willing to accept irregular employment exhibited high levels of job-seeking stress, depression, and suicidal ideation. Job-seeking stress affected suicidal ideation via depression, and perceived social support moderated the effect of job-seeking stress on depression and the effect of depression on suicidal ideation. CONCLUSION The results suggest that depression management and interventions are urgently required for young job seekers, and social support should be provided to assist them both emotionally and economically.
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Sohn BK, Oh YK, Choi JS, Song J, Lim A, Lee JP, An JN, Choi HJ, Hwang JY, Jung HY, Lee JY, Lim CS. Effectiveness of group cognitive behavioral therapy with mindfulness in end-stage renal disease hemodialysis patients. Kidney Res Clin Pract 2018; 37:77-84. [PMID: 29629280 PMCID: PMC5875579 DOI: 10.23876/j.krcp.2018.37.1.77] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 02/09/2018] [Accepted: 02/20/2018] [Indexed: 11/22/2022] Open
Abstract
Background Many patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) experience depression. Depression influences patient quality of life (QOL), dialysis compliance, and medical comorbidity. We developed and applied a group cognitive behavioral therapy (CBT) program including mindfulness meditation for ESRD patients undergoing HD, and measured changes in QOL, mood, anxiety, perceived stress, and biochemical markers. Methods We conducted group CBT over a 12-week period with seven ESRD patients undergoing HD and suffering from depression. QOL, mood, anxiety, and perceived stress were measured at baseline and at weeks 8 and 12 using the World Health Organization Quality of Life scale, abbreviated version (WHOQOL-BREF), the Beck Depression Inventory II (BDI-II), the Hamilton Rating Scale for Depression (HAM-D), the Beck Anxiety Inventory (BAI), and the Perceived Stress Scale (PSS). Biochemical markers were measured at baseline and after 12 weeks. The Temperament and Character Inventory was performed to assess patient characteristics before starting group CBT. Results The seven patients showed significant improvement in QOL, mood, anxiety, and perceived stress after 12 weeks of group CBT. WHOQOL-BREF and the self-rating scales, BDI-II and BAI, showed continuous improvement across the 12-week period. HAM-D scores showed significant improvement by week 8; PSS showed significant improvement after week 8. Serum creatinine levels also improved significantly following the 12 week period. Conclusion In this pilot study, a CBT program which included mindfulness meditation enhanced overall mental health and biochemical marker levels in ESRD patients undergoing HD.
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Cho JH, Jang HM, Jung HY, Choi JY, Park SH, Kim CD, Yang CW, Jin DC, Kim YL. A Real-world Cost-effectiveness Analysis of Sevelamer Versus Calcium Acetate in Korean Dialysis Patients. Clin Ther 2018; 40:123-134. [DOI: 10.1016/j.clinthera.2017.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 02/09/2017] [Accepted: 02/11/2017] [Indexed: 11/28/2022]
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Jung HY, Seong SJ, Choi JY, Cho JH, Park SH, Kim CD, Yoon YR, Kim HK, Huh S, Yoon SH, Lee JS, Kim YL. The efficacy and stability of an information and communication technology-based centralized monitoring system of adherence to immunosuppressive medication in kidney transplant recipients: study protocol for a randomized controlled trial. Trials 2017; 18:480. [PMID: 29037222 PMCID: PMC5644178 DOI: 10.1186/s13063-017-2221-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/29/2017] [Indexed: 12/25/2022] Open
Abstract
Background Immunosuppression non-adherence in kidney transplant recipients (KTRs) not only increases the risk of medical intervention due to acute rejection and graft loss but burdens the socioeconomic system in the form of increased healthcare costs. An aggressive preemptive effort by healthcare professionals, geared to ensure adherence to immunosuppressants in KTRs, is significant and imperative. Methods/design This study was designed as a prospective, open-label, multicenter, randomized controlled study aimed at evaluating the efficacy and stability of an information and communication technology (ICT)-based centralized monitoring system in boosting medication adherence in KTRs. One hundred fourteen KTRs registered throughout the year 2017 to 2018 are randomized into either the ICT-based centralized home monitoring system or to ambulatory follow-up. The planned follow-up duration is 6 months. The ICT-based centralized home monitoring system described consists of a smart pill box equipped with personal identification system, a home monitoring system, an electronic Case Report Form (eCRF) system, and a comprehensive clinical trial management system (CTMS). It alerts both patients and medical staff with texts and pill box alarms if there is a dosage/dosing time error or a missed dose. Medication adherence and transplant outcomes for the follow-up period are compared between the two groups, while patient satisfaction as well as the stability and cost-effectiveness of the ICT-based monitoring system are to be evaluated. Discussion This on-going study is expected to determine if consistent use of the ICT-based centralized monitoring system described could maximize mediation adherence and subsequently enhance transplant outcomes in KTRs. Further, it would lay the foundation for successful implementation of this ICT-based monitoring system for effective management of medication adherence in KTRs. Trials registration ClinicalTrials.gov, Identifier: NCT03136588. Registered on 20 April 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2221-z) contains supplementary material, which is available to authorized users.
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Lee JE, Lim JH, Jang HM, Kim YS, Kang SW, Yang CW, Kim NH, Kwon E, Kim HJ, Park JM, Jung HY, Choi JY, Park SH, Kim CD, Cho JH, Kim YL. Low serum phosphate as an independent predictor of increased infection-related mortality in dialysis patients: A prospective multicenter cohort study. PLoS One 2017; 12:e0185853. [PMID: 28973026 PMCID: PMC5626510 DOI: 10.1371/journal.pone.0185853] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 09/20/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The role of mineral metabolism in mortality among dialysis patients has received increased attention, but some aspects remain unclear. The aim of the present study was to investigate the prognostic value of serum calcium and phosphate levels for all-cause mortality and cause-specific mortality in dialysis patients. METHODS Patients on hemodialysis and peritoneal dialysis were enrolled from a multicenter prospective cohort study in Korea (NCT00931970). The patients were divided into low, normal, and high groups according to their baseline serum calcium or phosphate levels. Cox proportional analysis and a proportional hazards model for the subdistribution of a competing risk were used to calculate hazard ratios (HRs) for the association of serum calcium and phosphate levels with all-cause and cause-specific mortality. Time-dependent values of calcium and phosphate were also evaluated to assess the effect of longitudinal change in mineral metabolism parameters on mortality types. RESULTS A total of 3,226 dialysis patients were followed up for a mean of 19.8 ± 8.2 months. Infection was the most common cause of death. Low serum phosphate was significantly associated with all-cause and infection-related death using time-dependent values (HR, 1.43 [95% confidence interval (CI), 1.06-1.93], P = 0.02, and HR, 1.66 [95% CI, 1.02-2.70], P = 0.04, respectively). Low serum phosphate was associated with significantly higher infection-related mortality, especially in patients older than 65 years or on dialysis more than one year or with serum albumin lower than 3.9 g/dL (HR, 2.06 [95% CI, 1.13-3.75], P = 0.02, HR, 2.19 [95% CI, 1.20-4.01], P = 0.01, and HR, 1.77 [95% CI, 1.00-3.13], P = 0.05, respectively). Multinomial logistic regression analysis results suggested that low serum albumin, creatinine, and body mass index correlated with low serum phosphate. CONCLUSIONS Low serum phosphate in dialysis patients was an independent risk factor for infection-related death, especially in elderly patients. Persistently low serum phosphate might be a nutritional biomarker to predict increased susceptibility to infection and in turn worse outcomes in dialysis patients.
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Han BS, Kim KS, Kim YJ, Van Minh N, Jung HY, Sohn MJ, Kim Won G. Nurr1-Activating Daphnane Diterpenes from Daphne genkwa and its Neuroprotective Effect in an Animal Model of Parkinson's Disease. Am J Transl Res 2017. [DOI: 10.1055/s-0037-1608460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Park YJ, Kim SU, Lee KH, Lee JH, Kwon E, Jung HY, Choi JY, Cho JH, Park SH, Kim YL, Kim HK, Huh S, Kim CD. Vitamin D deficiency is associated with increased risk of bacterial infections after kidney transplantation. Korean J Intern Med 2017; 32:505-513. [PMID: 27017390 PMCID: PMC5432788 DOI: 10.3904/kjim.2015.214] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 08/22/2015] [Accepted: 09/09/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND/AIMS There may be an association between vitamin D levels and allograft outcomes in kidney transplant recipients (KTRs). However, few studies have been conducted to determine the association between vitamin D levels and post-transplant infections. This study investigated the impact of vitamin D deficiency on the risk of infection after kidney transplantation. METHODS We measured 25-hydroxyvitamin D (25(OH)D) levels prior to kidney transplantation. Vitamin D deficiency was defined as a serum 25(OH)D level < 20 ng/mL. We examined the incidence of various post-transplant infections during follow-up period. We used Cox proportional hazards regression analysis to determine factors associated with increased risk of post-transplant infections during the follow-up period. RESULTS A total of 164 KTRs were followed up for a mean of 24.8 ± 10.7 months. Among them, 135 patients (82.3%) had vitamin D deficiency. Patients with vitamin D deficiency had a significantly higher incidence of urinary tract infection (p = 0.027) and any bacterial infection (p = 0.010) compared to those without vitamin D deficiency. Vitamin D deficiency was not significantly associated with incidence of viral or fungal infections. Cox proportional hazards regression analysis revealed that vitamin D deficiency (hazard ratio, 11.07; 95% confidence interval, 1.46 to 84.03; p = 0.020) was independent risk factor for post-transplant bacterial infections. CONCLUSIONS Pre-transplant vitamin D deficiency was a significant risk factor for bacterial infections after kidney transplantation. Further studies are needed on possible benefits of vitamin D supplementation for preventing post-transplant bacterial infection.
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Sohn BK, Hwang JY, Park SM, Choi JS, Lee JY, Lee JY, Jung HY. Developing a Virtual Reality-Based Vocational Rehabilitation Training Program for Patients with Schizophrenia. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2017; 19:686-691. [PMID: 27831757 DOI: 10.1089/cyber.2016.0215] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Maintaining employment is difficult for patients with schizophrenia because of deterioration of psychosocial and cognitive functions. Such patients usually require vocational rehabilitation training, which is both demanding and costly. In this study, we developed a virtual reality-based vocational rehabilitation training program (VR-VRTP) for such patients and evaluated its feasibility as an alternative to traditional rehabilitation programs. We developed the VR-VRTP to include various situations commonly encountered in two types of occupations: convenience store employee and supermarket clerk. We developed practical situations, as well as a system for providing feedback, to ensure patients would not lose interest during training. Nine participants each performed the VR-VRTP repeatedly per week for a total of 8 weeks. At baseline and after training, all participants were evaluated using the following clinical and neuropsychological tests: Manchester Scale, Clinical Global Impression, Personal and Social Performance Scale (PSP), Hamilton Depression Rating Scale, Zung Depression Rating Scale, Beck Anxiety Inventory, Wisconsin Card Sorting Test, Stroop Test, Rey-Osterrieth Complex Figure Test (RCFT), and Auditory Verbal Learning Test (AVLT). After training, patient scores improved on the PSP, general symptoms on the Manchester Scale, AVLT, and delayed recall on the RCFT. The Manchester positive symptom score showed a trend of improvement. No significant changes were observed for other measures. The VR-VRTP may improve general psychosocial function and memory, potentially influencing real-world vocational performance. These findings provide preliminary evidence regarding the utility of the VR-VRTP in patients with schizophrenia.
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Jung DH, Hwang S, Song GW, Ahn CS, Moon DB, Ha TY, Kim KH, Park GC, Kim BS, Park IJ, Lim SB, Kim JC, Yoo MW, Byeon JS, Jung HY, Lee GH, Myung SJ, Choe J, Choi JY, Park HW, Lee SG. Survival Benefit of Early Cancer Detection Through Regular Endoscopic Screening for De Novo Gastric and Colorectal Cancers in Korean Liver Transplant Recipients. Transplant Proc 2016; 48:145-51. [PMID: 26915860 DOI: 10.1016/j.transproceed.2015.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 12/10/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND De novo malignancy is not uncommon after liver transplantation (LT). Gastric cancer is one of the most common malignancies in both the Korean general population and LT recipients, and colorectal cancer prevalence is gradually increasing. METHODS Among 3690 adult recipients who underwent LT from January 1999 and December 2013, the screening patterns and prognosis of 26 cases of gastric cancer and 22 cases of colorectal cancer were analyzed. RESULTS For gastric cancer, the mean patient age was 54.6 ± 6.2 years at LT and 59.5 ± 6.7 years at cancer diagnosis, with a post-transplant interval of 60.2 ± 29.8 months. Patients were divided into regular (n = 18) and non-regular (n = 8) screening groups, with early cancer found in 14 and 0 patients; their 2-year survival rates after cancer diagnosis were 93.1% and 33.3% (P = .006), respectively. Endoscopic resection was successfully performed in 8 patients, all in the regular screening group. For colorectal cancer, the mean patient age was 53.3 ± 6.1 years at LT and 58.1 ± 6.7 years at cancer diagnosis, with a post-transplant interval of 54.3 ± 38.0 months. Patients were divided into regular (n = 19) and non-regular (n = 3) screening groups, with early cancer found in 12 and 0 patients; their 2-year survival rates after cancer diagnosis of 92.3% and 33.3% (P = .003), respectively. Endoscopic resection was successfully performed in 6 patients, all in the regular screening group. CONCLUSIONS LT recipients are strongly advised to undergo regular screening studies for various de novo malignancies, especially cancers common in the general population. Regular endoscopic screening contributes to the timely detection of gastric and colorectal cancers, improving post-treatment survival outcomes.
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Cho JH, Ryu HM, Oh EJ, Yook JM, Ahn JS, Jung HY, Choi JY, Park SH, Kim YL, Kwak IS, Kim CD. Alpha1-Antitrypsin Attenuates Renal Fibrosis by Inhibiting TGF-β1-Induced Epithelial Mesenchymal Transition. PLoS One 2016; 11:e0162186. [PMID: 27607429 PMCID: PMC5015906 DOI: 10.1371/journal.pone.0162186] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/18/2016] [Indexed: 01/12/2023] Open
Abstract
Alpha1-antitrypsin (AAT) exerts its anti-inflammatory effect through regulating the activity of serine proteinases. This study evaluated the inhibitory effects of AAT against the transforming growth factor (TGF)-β1 induced epithelial-to-mesenchymal transition (EMT) in unilateral ureter obstruction (UUO) mice and Madin-Darby canine kidney (MDCK) cells. C57BL/6 mice with induced UUO were injected intraperitoneally with AAT (80 mg/Kg) or vehicle for 7 days. MDCK cells were treated with TGF-β1 (2 ng/mL) for 48 hours to induce EMT, and co-treated with AAT (10 mg/mL) to inhibit the EMT. Masson’s trichrome and Sirius red staining was used to estimate the extent of renal fibrosis in UUO mice. The expression of alpha-smooth muscle actin (α-SMA), vimentin, fibronectin, collagen I, and E-cadherin in MDCK cells and kidney tissue were evaluated. Masson’s and Sirius red staining revealed that the area of renal fibrosis was significantly smaller in AAT treated UUO group compared with that of UUO and vehicle treated UUO groups. AAT treatment attenuated upregulation of Smad2/3 phosphorylation in UUO mouse model. Co-treatment of MDCK cells with TGF-β1 and AAT significantly attenuated the changes in the expression of α-SMA, vimentin, fibronectin, collagen I, and E-cadherin. AAT also decreased the phosphorylated Smad3 expression and the phosphorylated Smad3/Smad3 ratio in MDCK cells. AAT treatment inhibited EMT induced by TGF-β1 in MDCK cells and attenuated renal fibrosis in the UUO mouse model. The results of this work suggest that AAT could inhibit the process of EMT through the suppression of TGF-β/Smad3 signaling.
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Jung HY, Lee JH, Park YJ, Kim SU, Lee KH, Choi JY, Park SH, Kim CD, Kim YL, Cho JH. Duration of anuria predicts recovery of renal function after acute kidney injury requiring continuous renal replacement therapy. Korean J Intern Med 2016; 31:930-7. [PMID: 26867084 PMCID: PMC5016271 DOI: 10.3904/kjim.2014.290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 06/30/2015] [Accepted: 07/04/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Little is known regarding the incidence rate of and factors associated with developing chronic kidney disease after continuous renal replacement therapy (CRRT) in acute kidney injury (AKI) patients. We investigated renal outcomes and the factors associated with incomplete renal recovery in AKI patients who received CRRT. METHODS Between January 2011 and November 2013, 408 patients received CRRT in our intensive care unit. Of them, patients who had normal renal function before AKI and were discharged without maintenance renal replacement therapy (RRT) were included in this study. We examined the incidence of incomplete renal recovery with an estimated glomerular filtration rate < 60 mL/min/1.73 m(2) and factors that increased the risk of incomplete renal recovery after AKI. RESULTS In total, 56 AKI patients were discharged without further RRT and were followed for a mean of 8 months. Incomplete recovery of renal function was observed in 20 of the patients (35.7%). Multivariate analysis revealed old age and long duration of anuria as independent risk factors for incomplete renal recovery (odds ratio [OR], 1.231; 95% confidence interval [CI], 1.041 to 1.457; p = 0.015 and OR, 1.064; 95% CI, 1.001 to 1.131; p = 0.047, respectively). In a receiver operating characteristic curve analysis, a cut-off anuria duration of 24 hours could predict incomplete renal recovery after AKI with a sensitivity of 85.0% and a specificity of 66.7%. CONCLUSIONS The renal outcome of severe AKI requiring CRRT was poor even in patients without further RRT. Long-term monitoring of renal function is needed, especially in severe AKI patients who are old and have a long duration of anuria.
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Lee J, Choi JY, Kwon YK, Lee D, Jung HY, Ryu HM, Cho JH, Ryu DH, Kim YL, Hwang GS. Changes in serum metabolites with the stage of chronic kidney disease: Comparison of diabetes and non-diabetes. Clin Chim Acta 2016; 459:123-131. [DOI: 10.1016/j.cca.2016.05.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 05/02/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
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Jung HY, Kim JW, Lee S, Yoo SH, Jeon JH, Kim TW, Park JS, Jeong SY, Oh SJ, Kim EJ, Shin MS. A Study of Core Humanistic Competency for Developing Humanism Education for Medical Students. J Korean Med Sci 2016; 31:829-35. [PMID: 27247489 PMCID: PMC4853659 DOI: 10.3346/jkms.2016.31.6.829] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 03/23/2016] [Indexed: 11/20/2022] Open
Abstract
The authors conducted a survey on essential humanistic competency that medical students should have, and on teaching methods that will effectively develop such attributes. The participants consisted of 154 medical school professors, 589 medical students at Seoul National University College of Medicine, 228 parents, and 161 medical school and university hospital staff. They answered nine questions that the authors created. According to the results, all groups chose "morality and a sense of ethics," a "sense of accountability," "communication skills," and "empathic ability" were selected as essential qualities. According to the evaluation on the extent to which students possess each quality, participants believed students had a high "sense of accountability" and "morality," whereas they thought students had low "empathic ability," "communicate," or "collaborate with others". In terms of effective teaching methods, all sub-groups preferred extracurricular activities including small group activities, debates, and volunteer services. With regard to the speculated effect of humanism education and the awareness of the need for colleges to offer it, all sub-groups had a positive response. However the professors and students expressed a relatively passive stance on introducing humanism education as a credited course. Most participants responded that they preferred a grading method based on their rate of participation, not a relative evaluation. In order to reap more comprehensive and lasting effects of humanism education courses in medical school, it is necessary to conduct faculty training, and continuously strive to develop new teaching methods.
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Jung HY, Jang HM, Kim YW, Cho S, Kim HY, Kim SH, Bang K, Kim HW, Lee SY, Jo SK, Lee J, Choi JY, Cho JH, Park SH, Kim CD, Kim YL. Depressive Symptoms, Patient Satisfaction, and Quality of Life Over Time in Automated and Continuous Ambulatory Peritoneal Dialysis Patients: A Prospective Multicenter Propensity-Matched Study. Medicine (Baltimore) 2016; 95:e3795. [PMID: 27227956 PMCID: PMC4902380 DOI: 10.1097/md.0000000000003795] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Health-related quality of life (HRQOL) is an important clinical outcome for dialysis patients. However, relative superiority in HRQOL between automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) are not clearly known. We compared HRQOL over time between APD and CAPD patients and evaluated factors associated with HRQOL.All 260 incident patients initiating APD or CAPD at multiple centers throughout Korea were prospectively enrolled in this study between October 2010 and February 2013. HRQOL, depressive symptoms, and renal treatment satisfaction were assessed 1 and 12 months after the start of dialysis by the Kidney Disease Quality of Life Short Form 36 (KDQOL-36), the Beck Depression Inventory (BDI), and the Renal Treatment Satisfaction Questionnaire (RTSQ), respectively.Of 196 patients who completed all questionnaires and did not change the peritoneal dialysis (PD) modality during the 1-year follow-up period, 160 were matched. APD patients showed better baseline HRQOL than CAPD patients for the symptoms, patient satisfaction, pain, and social function domains. There were no differences in HRQOL between the 2 groups at 12 months, and CAPD patients had significantly greater improvements in symptoms (P = 0.02), the mental composite summary (P = 0.03), and health status domains (P = 0.03) than APD patients. There were similar improvements in depressive symptoms (P = 0.01) and patient satisfaction with treatment (P = 0.01) in CAPD and APD patients. Interestingly, depressive symptoms, not PD modality, was the most influential and consistent factor for HRQOL. Despite the spontaneous improvement of depressive symptoms, considerable PD patients still had depressive symptoms at the 1-year appointment.APD has no advantage over CAPD for HRQOL. Considering the substantial negative effect of depressive symptoms on HRQOL, it is important to evaluate PD patients for depression and to treat those with depression to improve their HRQOL.
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Kim DH, Yoon HB, Yoo DM, Lee SM, Jung HY, Kim SJ, Shin JS, Lee S, Yim JJ. Etiquette for medical students' email communication with faculty members: a single-institution study. BMC MEDICAL EDUCATION 2016; 16:129. [PMID: 27121179 PMCID: PMC4848876 DOI: 10.1186/s12909-016-0628-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 04/06/2016] [Indexed: 05/23/2023]
Abstract
BACKGROUND Email is widely used as a means of communication between faculty members and students in medical education because of its practical and educational advantages. However, because of the distinctive nature of medical education, students' inappropriate email etiquette may adversely affect their learning as well as faculty members' perception of them. Little data on medical students' competency in professional email writing is available; therefore, this study explored the strengths and weaknesses of medical students' email etiquette and factors that contribute to professional email writing. METHODS A total of 210 emails from four faculty members at Seoul National University College of Medicine were collected. An evaluation criteria and a scoring rubric were developed based on the various email-writing guidelines. The rubric comprised 10 items, including nine items for evaluation related to the email components and one item for the assessment of global impression of politeness. Three evaluators independently assessed all emails according to the criteria. RESULTS Students were identified as being 61.0% male and 52.8% were in the undergraduate-entry program. The sum of each component score was 62.21 out of 100 and the mean value for global impression was 2.6 out of 4. The results demonstrated that students' email etiquettes remained low-to-mediocre for most criteria, except for readability and honorifics. Three criteria, salutation (r=0.668), closing (r=0.653), and sign-off (r=0.646), showed a strong positive correlation with the global impression of politeness. Whether a student entered a graduate-entry program or an undergraduate-entry program significantly contributed to professional email writing after other variables were controlled. CONCLUSIONS Although students in the graduate-entry program demonstrated a relatively superior level of email etiquette, the majority of medical students did not write emails professionally. Educating all medical students in email etiquette may well contribute to the improvement of student-faculty relationships as well as their email writing.
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Ham JY, Jung HY, Choi JY, Park SH, Kim YL, Kim HK, Huh S, Kim CD, Won DIL, Song KE, Cho JH. Usefulness of mycophenolic acid monitoring with PETINIA for prediction of adverse events in kidney transplant recipients. Scandinavian Journal of Clinical and Laboratory Investigation 2016; 76:296-303. [DOI: 10.3109/00365513.2016.1149879] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Lee HJ, Oh MH, Lee JH, Cho HD, Jang SH, Jung HY, Kim KJ. Abstract P5-04-20: TLE1 protein expression in HER2-positive and triple-negative breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-04-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose
Transducin-like enhancer protein 1 (TLE1) is a member of the Groucho (Gro)/TLE family of transcriptional co-repressors that regulate the transcriptional activity of a wide range of genes. TLE1 has been shown to be a specific and diagnostically useful immunohistochemical marker for synovial sarcoma. However, there have been few reports of the status of TLE1 in breast cancers. The purpose of this study was to clarify the nuclear expression of TLE1 in 511 Korean breast cancers by immunohistochemistry (IHC) and to correlate the findings to clinicopathologic variables including prognostic significance.
Methods
IHC was performed on tissue microarrays (TMAs) in 511 cases of breast cancer. Associations between the TLE1 expression and the clinicopathologic characteristics were retrospectively analyzed. Progression-free survival and disease-specific survival was assessed by the Kaplan–Meier method and Cox regression model.
Results
Of 511 cases of breast cancer, high expression of the TLE1 was detected in 63 (12.3%) cases. TLE1-high expression was strongly associated with HER2-positive breast cancer phenotype (p < 0.001) and triple-negative breast cancer phenotype (p < 0.001). Furthermore, high TLE1was significantly associated with high histologic grade (p < 0.001), node-negative (p =0.011), estrogen receptor negativity (p < 0.001), progesterone receptor negativity (p < 0.001), CK5/6 positivity (p < 0.001), epidermal growth factor receptor positivity (p < 0.001), high ki-67 proliferative index (p < 0.001) and high p53 expression (p < 0.001). Survival analysis demonstrated no significant association between TLE1 expression and disease progression and cancer-related death (p =0.112 and p =0.068, respectively).
Conclusion
Our results show that high TLE1expression is significantly associated with HER2-positive and triple-negative breast cancer. TLE1 may represent a potential therapeutic target for this aggressive disease, which warrants further investigation.
Citation Format: Lee HJ, Oh M-H, Lee J-H, Cho HD, Jang S-H, Jung HY, Kim K-J. TLE1 protein expression in HER2-positive and triple-negative breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-04-20.
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Lee JH, Park SH, Lim JH, Park YJ, Kim SU, Lee KH, Kim KH, Park SC, Jung HY, Kwon O, Choi JY, Cho JH, Kim CD, Kim YL. Impact of dialysis modality on technique survival in end-stage renal disease patients. Korean J Intern Med 2016; 31:106-15. [PMID: 26767864 PMCID: PMC4712414 DOI: 10.3904/kjim.2016.31.1.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/12/2014] [Accepted: 08/19/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND/AIMS This study analyzed the risk factors for technique survival in dialysis patients and compared technique survival rates between hemodialysis (HD) and peritoneal dialysis (PD) in a prospective cohort of Korean patients. METHODS A total of 1,042 patients undergoing dialysis from September 2008 to June 2011 were analyzed. The dialysis modality was defined as that used 90 days after commencing dialysis. Technique survival was compared between the two dialysis modalities, and the predictive risk factors were evaluated. RESULTS The dialysis modality was an independent risk factor predictive of technique survival. PD had a higher risk for technique failure than HD (hazard ratio [HR], 10.8; 95% confidence interval [CI], 1.9 to 62.0; p = 0.008) during a median follow-up of 11.0 months. In the PD group, a high body mass index (BMI) was an independent risk factor for technique failure (HR, 1.3; 95% CI, 1.0 to 1.8; p = 0.036). Peritonitis was the most common cause of PD technique failure. The difference in technique survival between PD and HD was more prominent in diabetic patients with a good nutritional status and in non-diabetic patients with a poor nutritional status. CONCLUSIONS In a prospective cohort of Korean patients with end-stage renal disease, PD was associated with a higher risk of technique failure than HD. Diabetic patients with a good nutritional status and non-diabetic patients with a poor nutritional status, as well as patients with a higher BMI, had an inferior technique survival rate with PD compared to HD.
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Choi JY, Kang YJ, Jang HM, Jung HY, Cho JH, Park SH, Kim YL, Kim CD. Nafamostat Mesilate as an Anticoagulant During Continuous Renal Replacement Therapy in Patients With High Bleeding Risk: A Randomized Clinical Trial. Medicine (Baltimore) 2015; 94:e2392. [PMID: 26717390 PMCID: PMC5291631 DOI: 10.1097/md.0000000000002392] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Nafamostat mesilate (NM), a synthetic serine protease inhibitor, has been used increasingly as an anticoagulant during continuous renal replacement therapy (CRRT). However, there, are limited data from randomized studies on NM use in patients with a bleeding tendency. This prospective study evaluated the efficacy and safety of NM use during CRRT in patients with acute kidney injury (AKI) patients at high risk of bleeding.Patients with AKI at high risk of bleeding were randomized into the NM and no anticoagulant (NA) groups. The primary outcome was the treatment efficacy represented by the filter lifespan. Several parameters, including safety and patient survival rates at 30 and 90 days, were analyzed as secondary outcomes.Fifty-five patients were included in this study (NM group = 31, NA group = 24). The baseline characteristics did not significantly differ between the groups. The mean filter lifespan was significantly longer in the NM group than in the NA group (31.7 ± 24.1 versus 19.5 ± 14.9 hours; P = 0.035). The most common cause of filter failure was filter clotting, which was significantly more frequent in the NA group than in the NM group (59.6% versus 37.7%, P = 0.024). The Cox proportional hazards model showed a 42.2% longer filter lifespan in the NM group compared with the NA group (hazard ratio, 0.578; 95% confidence interval, 0.362-0.923; P = 0.022). There were no significant differences in the frequencies of transfusions and major bleeding between the groups. Patient survival rates at 30 and 90 days after CRRT initiation were comparable between the groups.Nafamostat mesilate is a safe and effective anticoagulant for CRRT and allows sufficient filter survival without increasing the risk of bleeding in critically ill patients with AKI and bleeding tendencies.
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