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This study is a non-equivalence control groups pre- and post-similar experimental design study to find out an efficient practical education method by comparing the blood transfusion nursing practice education method applied with virtual reality and the blood transfusion nursing practice education method applying the traditional arm model. The subjects of this study were 53 students who were 3rd year nursing students at a university in G city and had no clinical practice experience. The test subjects were divided into experimental groups 1 & 2 and the control group, the mixed practice (VR + traditional arm model) was applied to the experimental group 1, the VR practice was applied to the experimental group 2, and the traditional arm model practice was applied to the control group. Data were analyzed by frequency and percentage, mean and standard deviation, chi-square test, and Kruskal Wallis using the SPSS Version 22.0 statistical program. As a result of the study, there were significant differences in performance confidence, performance ability, and learning immersion between students who received practical training that mixed virtual reality and traditional arm model(experiment group 1), students who only received virtual reality practice education(experiment group 2).

Purpose We investigated and compared the factors influencing parents' promotion of healthy behavior in young children according to their family cohesion level during the COVID-19 pandemic in South Korea. Design and methods This was a cross-sectional study involving 432 parents of young children (ages 1–6) in six South Korean cities (320 and 112 from the high and low family cohesion groups, respectively). We collected data using self-report questionnaires on parents' health promotion behavior, stress, risk perception due to COVID-19, positive psychological capital, and family cohesion, and analyzed it using stepwise multiple regressions with the SPSS program. Results The factors influencing parents' health promotion behavior differed across the family cohesion groups. For the high group, family cohesion, positive psychological capital, gender, and stress significantly affected parents' health promotion behavior (adjusted R2 = 0.22, p

To evaluate the prognostic role of volume of parapharyngeal fat pad (VThis retrospective cohort study was conducted in 50 patients with moderate to severe obstructive sleep apnea syndrome who underwent polysomnography (preoperative and postoperative 6 months) and preoperative facial computed tomography with multilevel sleep surgery between May 2010 and February 2019. All patients had failed or refused positive airway pressure treatment.Of the 50 patients with moderate to severe obstructive sleep apnea syndrome who underwent multilevel sleep surgery, 46 were male (92.0%) with mean ± standard deviation age of 41.2 ± 12.5 years. On the preoperative polysomnography, mean ± standard deviation of apnea-hypopnea index and CT90 (cumulative percentage of time spent at oxygen saturation less than 90%) were 43.4 ± 19.3 events/h and 5.6 ± 9.6%, respectively. The average VVKim BK, Park SI, Hong SD, Jung YG, Kim HY. Volume of parapharyngeal fat pad in obstructive sleep apnea syndrome: prognostic role for multilevel sleep surgery.

Positive airway pressure (PAP) is considered a standard treatment for Obstructive sleep apnea (OSA), but there are compliance issues. As compliance to PAP tends to decrease with time, it is necessary to consider reasons affecting compliance at each period. Therefore, this study aimed to define factors affecting short-term and long-term compliance in PAP.One hundred eighty-seven OSA patients who started PAP treatment between July 2018 to March 2020 were included. Acceptance and compliance rates were monitored. Demographics, Polysomnography (PSG) profiles, cephalometric data, and physical examination results were analyzed to identify factors predictive of PAP compliance at short-term (3 months) and long-term (12 months) periods.The acceptance rate of PAP was 92.5%. Compliance at 3-months and 12-months was 79.1% and 51.3%, respectively. Higher apnea-hypopnea index (AHI) (OR 1.018,In PAP use, indicators of OSA severity such as AHI affect short-term compliance. On the other hand, MPH and subjective symptoms such as nasal obstruction and awakening can affect long-term compliance.

Although reconstruction techniques after endoscopic skull base surgery have been improved, there are difficulties in reconstructing the skull base with a nasoseptal flap (NSF), especially in the case of high-flow cerebrospinal fluid (CSF) leak. The aim of this study was to analyze risk factors for the development of postoperative CSF leaks in terms of less experienced surgeon practices. Retrospective review of medical records was performed for 125 patients who underwent endoscopic skull base surgery for intradural pathology with intraoperative high-flow CSF leakage between Oct 2012 and Apr 2017. Basic demographic data were collected, including body mass index (BMI), tumor pathology, comorbidities, and outcomes. To assess the learning curve effect, patients were divided into early cohort (n = 30) and late cohort (n = 95) groups. Overall postoperative CSF leakage was 10.4% (13/125) in this series. There were no significant risk factors for postoperative CSF leakage among the demographic data including BMI, comorbidities, or radiation history. Postoperative CSF leakage was most prevalent in the transclival approach than in other approaches, but the difference was not statistically significant (20.8%, p = 0.351). When dividing the results by timetable, the patients who underwent skull base reconstruction in the early cohort experienced more postoperative CSF leakage (23.3%, 7 cases out of 30) than in the late cohort (6.3%, 6 cases out of 95, p = 0.014). The learning curve was steeper in the early cohort (30 early cases 23.3%, 31–60 10%, 61–90 6.7%, 91–125 2.9%). To improve the success rate of endoscopic skull base reconstruction, surgeons have to keep the basic technical details in mind to reduce the learning curve.

BACKGROUND Parotidectomy is the treatment of choice in many parotid tumors. Due to the extensive nature of the procedure, unfavorable complications such as gustatory sweating, surgical site depression are common. Various techniques using fascia, muscle or AlloDerm have been developed but debate still remains regarding its availability and affordability. We applied a newly developed acellular dermal matrix (Insuregraf) to the parotidectomy field to act as a physical barrier and to provide adequate filling effect for prevention of functional and aesthetic complications. METHODS From March 2010 to March 2017, 30 patients with parotid tumors underwent superficial parotidectomy. Twenty patients underwent only superficial parotidectomy. Ten patients had Insuregraf applied to the surgical site after superficial parotidectomy. We evaluated the incidence of Frey's syndrome, surgical site depression, and patient satisfaction rate in both groups. RESULTS The incidence of Frey's syndrome was lower in the Insuregraf group (0 vs. 2). Surgical site depression was also lower in the Insuregraf group (2 vs. 20). Satisfaction score for facial contour in Insuregraf group was 9.2 out of 10, which was comparable to 6.2 out of 10 in the control group. CONCLUSION Application of Insuregraf after superficial parotidectomy is an effective surgical procedure to prevent complications such as Frey's syndrome and surgical site depression. This technique is affordable and safe with no immune reactions. Above all this surgical method should be considered as an option for patients who are concerned about the contour of the face after surgery.

IntroductionThe prevalence of dementia among the elderly population in South Korea was 9.94% in 2017, and the number of people living with dementia is estimated to increase up to one million by 2024. Considering that approximately 55%–85% of people with dementia are taken care of by family members in South Korea, the phenomenon of resilience for family caregivers with patients with dementia should be understood within a Korean cultural context. The purpose of this paper is to describe the protocol of a scoping review addressing the resilience of family caregivers for Koreans with dementia.Methods and analysisArksey and O'Malley’s scoping review framework and Joanna Briggs Institute’s manual for scoping reviews will guide the review methods. Multiple databases, including Ovid-MEDLINE, Ovid-EMBASE, PsycINFO, Cumulative Index for Nursing and Allied Health Literature and Korean databases will be identified using controlled vocabulary and text words. Two review authors will independently screen and select studies based on predefined eligible criteria. The extracted data will undergo descriptive analysis of the contextual data and a quantitative analysis using the appropriate descriptive statistics.Ethics and disseminationBecause the scoping review methodology consists of reviewing and collecting data from the published literature, this study does not require ethics approval. This scoping review will serve to highlight existing gaps within the literature to guide further research and to develop future strategies to measure and improve the resilience of family caregivers for patients with dementia in South Korea.

Purpose: Salivary gland cancer (SGC) in the oral cavity is not common and has been less studied in comparison with oral squamous cell carcinoma (SCC). This study aimed to identify the clinical characteristics and outcomes of SGC in the oral cavity compared with oral SCC.Methods: The medical charts of the patients with SGC (N = 68) arising from minor salivary glands and SCC (N = 750) in the oral cavity between 1995 and 2017 were reviewed retrospectively. The clinical and pathological factors and treatment outcomes were compared to identify clinical differences between oral SGC and SCC in total cases and in tumor size and subsite (propensity score)-matched pairs (N = 68 in each group). In addition, pattern of local invasion was pathologically assessed in a subset of SGC and SCC tumors.Results: Patients with SGC in the oral cavity showed >90% survival at 5 years. Most common pathologies of SGC were mucoepidermoid carcinoma (39.7%) and adenoid cystic carcinoma (35.3%), where high-grade tumors (including adenoid cystic carcinomas having solid components, grade 2 or 3) represented only 36.8%. Compared with oral SCC, surgery for SGC had narrow surgical safety margin. However, local control was very successful in SGC even with

Background Skin engraftment of intraoral defects is known to be inconsistent due to mobility of the oral structure, uneven wounds, and accumulation of saliva under the skin graft. To improve the success rate of oral skin graft, we proposed a novel and simple dressing technique for intraoral skin graft to control saliva accumulation, in comparison with the conventional bolster dressing. Methods We retrospectively reviewed 31 patients reconstructed with skin graft in their intraoral defect. The patients were divided into two groups; conventional bolster group (n = 21) and modified bolster group (n = 10). In the modified bolster group, a polyvinyl alcohol sponge was designed to fit the skin graft and a suction drain was inserted with tagging suture to apply continuous suction. We analyzed the success rate, the size of the skin grafts and clinical variables of each method. Results The overall success rate of oral skin graft was not different between the two groups (90.0 and 90.5%). However, partial necrosis in the engrafted skin was observed frequently in the control group (57.1% versus 20.0%). The relative engrafted area was significantly higher in the modified bolster group (55.0 ± 11.6% versus 23.0 ± 18.7%, p = 0.015). The duration of bolster dressing and the time to start an oral diet were shorter in the modified bolster group. Conclusions Our modified method could be easily applied for removing saliva accumulation under a skin graft and for enhancing skin engraftment of an oral cavity wound. Electronic supplementary material The online version of this article (10.1186/s40463-018-0314-7) contains supplementary material, which is available to authorized users.

다지표 잠재성장모형(LGM)은 여러 관측변수에 의해 측정되는 요인의 시간에 따른 변화 궤적을 2차 요인모형을 이용하여 분석하는 모형이다. 다지표 LGM은 여러 가지 장점에도 불구하고 요인척도법에 따라 모형 적합도와 모수 추정값이 달라지는 문제를 가지고 있다. 본 연구는 다지표 LGM에서 요인동일성의 수준과 요인척도의 설정 방식에 따라 요인 평균의 의미가 어떻게 달라지는지를 규명하고, 요인척도의 설정이 다지표 LGM의 모형 적합도와 모수 추정 값에 어떻게 영향을 미치는지를 확인하였다. 먼저 종단 요인분석 모형에서 요인동일성 제약과 요인척도법에 따라 요인 평균이 어떻게 정의되는지와 모형 적합도가 어떻게 달라지는지 논의하였다. 또한 절편의 합을 0으로 제약하는 설정이 요인 평균을 어떻게 정의하는지 밝히고, 이러한 제약이 약한 요인동일성을 가정한 다지표 LGM의 성장 요인 평균에 대해 일관적인 분석 결과와 해석을 제공한다는 것을 제시하였다. 이어서 패널 자료를 이용한 실제 자료의 분석을 통해 이와 같은 다지표 LGM의 특징을 예시하였다. 끝으로 평균공분산구조 모형의 분석에서 요인동일성과 요인척도 설정의 중요성과 다지표 LGM에서 강한 요인동일성 모형을 사용하는 것의 중요성에 대해 논의하였다.

Objective The purpose of the study was to evaluate audiologic findings according to mucopolysaccharidosis (MPS) subtypes and to estimate hearing changes as the disease progressed, as well as the therapeutic effect of enzyme replacement therapy on the hearing apparatus. Methods A total of 124 patients who were diagnosed with MPS between September 1994 and December 2016 were retrospectively analyzed. Play audiometry or pure-tone audiometry was performed for hearing assessment, and auditory brainstem response was conducted in patients with poor compliance. Results In total 124 patients were identified, ranging in age at diagnosis from 0 to 33 years. Fourteen of the patients had been diagnosed with type I, while 91 had type II, 2 had type III, 14 had type IV, and 3 had type VI. Mean bone conduction and air conduction for the better ear were 26.13±16.95 dB and 34.77 ± 20.00 dB in all patients, and 34.20±7.64 dB and 40.70±9.67 dB in patients with MPS II. The average auditory brainstem response threshold was 68.96 ±21.93 dB nHL. The most common type of hearing loss was pure sensorineural hearing loss in all subtypes, and the degree of hearing loss was variable mostly within the mild to severe range. The increase in the hearing threshold was also significantly correlated with the disease duration. However, the change in hearing level was not correlated with the duration of enzyme replacement therapy. Conclusions Hearing impairment in MPS patients is common and is aggravated as the disease progresses. Thus, adequate intervention and hearing rehabilitation might play an important role in managing hearing disabilities in MPS patients.

Combinations of various treatment modalities were shown to be more effective than monotherapy when treating hypertrophic scars and keloids. This study was conducted to assess the effectiveness of combination therapy with non-ablative fractional laser and intralesional steroid injection. From May 2015 to June 2017, a total of 38 patients with hypertrophic scars or keloids were evaluated. The control group of 21 patients received steroid injection alone, and 17 patients (the combined group) received 1550-nm erbium-glass fractional laser treatment and steroid injection simultaneously. The mean number of treatment sessions was statistically fewer in the combined group than in the control group (6.95 vs 5.47, P = .042). There was a significant difference in the patient's scale in the combined group (14.62 vs 22.82, P = .005); however, the observer's scale was not significantly different (17.92 vs 20.55, P = .549). The recurrence rate was 38.1% (8/21) in the control group and 35.3% (6/17) in the combined groups and showed no significant difference (P = .859). However, the mean remission period was statistically longer in the combined group (3.00 months vs 4.17 months, P = .042). Combination therapy with non-ablative fractional laser and intralesional steroid injection showed better results for the treatment of hypertrophic scars and keloids with fewer treatment sessions, better patient satisfaction, and longer remission periods.

To compare clinical and functional outcomes of different reconstructive options for a hypopharyngeal defect after head and neck cancer surgery.We retrospectively analyzed 127 cases who had undergone hypopharyngeal reconstruction, as either pedicled (25 cases), fasciocutaneous free flap (FCFF) (41 cases) or visceral flap (61 cases).Overall incidence of flap compromise was 10.2% (13 cases), and there were no statistically significant factors associated with flap compromise. Fistula or stenosis occurred in 36.2% (46 patients) and 23.6% (30 patients), respectively. Salvage surgery increased the risk of fistula formation (OR 2.93, 95% CI 1.32-6.52, p 0.01), whereas FCFF showed a protective effect for stenosis, compared to pedicled flap (OR 0.09, 95% CI 0.01-0.47, p 0.01).Outcomes of hypopharynx reconstruction can be successful if different flap options are used appropriately according to the type of defect and previous treatment history of the patient.

Background. Various materials are available for the reconstruction of bone defects in cases of medial wall blowout fracture. This study was conducted to assess the efficacy of the combination of a resorbable meshed plate and cancellous bone allograft. Methods. From March 2014 to March 2017, a total of 111 patients were evaluated. Sixty-three patients received reconstruction surgery with porous polyethylene plates (control group) and the other forty-eight patients underwent operation with a resorbable meshed plate plus allogenic cancellous bone (combined group). The results were assessed by exophthalmometric measurements, width, and volume discrepancies as compared with the unaffected orbit, and operation time. Results. The difference in exophthalmometric measurements between the affected and unaffected orbits were 0.94 ± 0.70 mm in the control group and 1.05 ± 0.73 mm in the combined group without statistical significance (p=0.425). In the analysis of computed tomography images, the width discrepancy was 1.55 ± 0.86 mm and 1.08 ± 0.69 mm, respectively (p=0.003); however, the volume discrepancy demonstrated no statistically significant difference (2.58 ± 1.40 cm3 versus 2.20 ± 1.80 cm3; p=0.209). Operation time was significantly shorter in the combined group as compared with the control group (43.0 ± 7.0 versus 38.3 ± 7.0 minutes; p=0.001). Conclusion. The combination material composed of resorbable meshed plate and cancellous bone allograft made reconstruction surgery of medial wall blowout fracture easier and quicker to perform with long-lasting results.

Objectives In parotid gland cancer (PGC), it is not clear whether facial weakness always reflects tumor invasion of the facial nerve (FN) requiring nerve resection. The aims of this study were to evaluate oncological and functional outcomes in patients with PGC and pre-treatment facial weakness, and to analyze local tumor invasion of the FN. Materials and methods The clinical outcomes of patients (n = 45) with PGC and pretreatment facial weakness were retrospectively analyzed. Patients had undergone 1 of 4 types of treatments: complete tumor resection, FN sacrifice with or without FN reconstruction, tumor resection with FN preservation and primary non-surgical treatments. Pathologic specimens in patients with nerve resection patients (n = 26) were reviewed to identify FN invasion by the tumor. Results Patients with PGC and facial weakness had poor clinical outcomes (44.0%, 3Y progression-free survival), and 86.7% of tumors were high-grade. In these subjects, regional or distant metastasis was an independent prognostic factor for survival. Recovery from facial weakness was suboptimal in patients with FN graft. In cases with nerve resection, 26.9% had intra-neural tumor invasion, 42.3% had perineural invasion, and 30.8% had no neural invasion in the FN. Conclusion Facial weakness did not always indicate tumor invasion of the FN in PGC. Thus, the decision regarding FN resection can reasonably be further based on intraoperative findings. In cases with incomplete facial weakness and safe separation of the FN from the tumor, FN preservation offers the best functional outcomes, without compromising oncological outcomes.

Purpose: The purposes of this study were to investigate daycare teachers’ knowledge, anxiety and management of childhood fever and to identify factors affecting their management of childhood fever. Methods: A descriptive correlation study was conducted. Participants were 109 daycare center teachers from G metropolitan city. A self-administered questionnaire was used for data collection. Results: The mean percent of correct answers for knowledge about childhood fever was 42.9%. Levels of anxiety related to children’s fever were high among day care teachers in this study. Many daycare center teachers used management practices which were not recommended for childhood fever management. There was a statistically significant difference in participants’ knowledge about childhood fever by marital status and having a child. Moreover, there were statistically significant positive correlation between daycare center teachers’ knowledge and management and negative correlation between daycare center teachers’ anxiety and management of childhood fever. Knowledge and anxiety related to childhood fever accounted for 15.2% of variance for fever management. Conclusion: Results: show that day care teachers’ knowledge and anxiety related to fever are important factors in predicting their fever management. Development and evaluation of educational interventions to improve daycare teachers’ childhood fever management are recommended.

Background Ginsenoside Rg3 and arginine–fructose (Arg-Fru) are known as the hypotensive compounds of Panax ginseng ; however, their efficacy on antihypertension has not been reported yet to our best knowledge. Thus, hypotensive components-enriched fraction of red ginseng (HCEF-RG) was prepared from fine root concentrate (FR) and their antihypertensive effects were investigated in spontaneously hypertensive rats (SHR). Methods Male SHRs were divided into six groups: control (Wistar Kyoto, SHR); FR 500; FR 1,000; HCEF-RG 500; and HCEF-RG 1,000; samples (mg/kg body weight) were orally administered every day for 8 wk. Blood pressure was monitored at 1 wk, 2 wk, 3 wk, 4 wk, 6 wk, and 8 wk by tail cuff method. At 8 wk after samples administration, mice were killed for the measurement of renin activity (RA), angiotensin-I converting enzyme inhibition, angiotensin II, and nitric oxide (NO) levels in plasma. Results HCEF-RG with four-fold more Rg3 and 24-fold more Arg-Fru contents was successfully prepared from reacted mixtures of FR and persimmon vinegar (12 times against FR, v/v) at 80°C for 18 h. Both FR 1,000 and HCEF-RG 1,000 showed lowered systolic blood pressure than SHR control group and HCEF-RG 1,000 group exhibited a significant decrease in diastolic blood pressure. RA was significantly lowered in all treated groups, while angiotensin II did not affect by FR and HCEF-RG treatment. However, angiotensin-I converting enzyme inhibition and NO in FR 1,000 and HCEF-RG 1,000 were significantly increased compared with SHR control group. Conclusion HCEF-RG is more effective and useful for alleviating hypertension than FR, implying the health benefit of Rg3 and Arg-Fru.

Objectives Unplanned reoperation causes physical and psychological stress in patients and it costs more in terms of medical, economic and social resource. The purpose of the study was to evaluate the incidence, risk factors and clinical significance of unplanned reoperation (any unscheduled surgery within 30 days from the initial surgery) in patients who had undergone head and neck cancer (HNC) surgery. Materials and methods A total of 574 consecutive patients who had received surgery for HNC with or without flap reconstruction from 2010 to 2015 were analyzed. Clinical and biochemical characteristics, cause of unplanned reoperation, cancer subsites, and previous treatment history were compared between unplanned reoperation group (n = 60) and control group (n = 514). Multivariable analyses were performed to identify risk factors for unplanned reoperation. Clinical significance was evaluated by multivariable survival analyses using Cox proportional hazard model. Results Overall rate of unplanned reoperation was 10.5%. Flap complication (40.0%) was the most common cause, followed by infection (16.7%), necrosis (11.7%), and bleeding (8.3%). Higher N (N2) classification, long operation time and previous treatment before surgery were identified as risk factors for unplanned reoperation. Based on multivariable survival analyses, recurrence-free survival was significantly decreased in unplanned reoperation group (Hazard ratio = 1.85, 95% confidence interval [1.23–2.80]), but not overall survival. Conclusion Unplanned reoperation significantly decreased recurrence-free survival in patients with HNC surgery. Thus, careful surgical/ perioperative management is needed to reduce unplanned reoperation in HNC patients with advanced nodal disease, long operation time or previous treatment history.

Background Although magnetocardiography (MCG) has been proposed as a non-invasive technique with high accuracy for functional diagnosis of myocardial injury, the validation of MCG against fractional flow reserve FFR in diagnosing coronary artery disease (CAD) has not yet been established. The goal of the study was to determine the diagnostic accuracy of MCG versus invasively determined FFR in patients with suspected or known CAD. Methods Forty seven patients with suspected CAD (35 men; mean age 69 years) who underwent coronary angiography and FFR measurement were enrolled. FFR ≤ 0.8 was considered to indicate significant myocardial ischemia. The change of ST-segment fluctuation score from rest to stress was calculated from the MCG. In addition, two blinded cardiologists assessed MCG images that were visualized by post-processing method, bull's-eye mapping. Results The best cut-off value of the percent change of ST-segment fluctuation score was -39.0% with sensitivity of 86.7% and specificity of 73.9%. Sensitivity, specificity, diagnostic accuracy, and the area under the receiver-operator characteristics curve of bull's-eye mapping for the detection of significant CAD were 90.5%, 92.3%, 91.5%, and 0.914 on a patient basis and 90.0%, 93.8%, 92.3%, and 0.919 by coronary territory, respectively. Conclusions MCG accurately detects functionally significant CAD as defined by using FFR, provides an assessment of ischemic status in agreement with the change of ST-segment fluctuation score, and accurately localizes the ischemic territory in bull's eye mapping. Therefore, MCG may provide an incremental value for prediction of myocardial ischemia non-invasively and safely in clinical practice with fast examination time.