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Evaluation of Malignancy Risk of Ampullary Tumors Detected by Endoscopy Using 2-[18F]FDG PET/CT

  • Pei-Ju Chuang;Hsiu-Po Wang;Yu-Wen Tien;Wei-Shan Chin;Min-Shu Hsieh;Chieh-Chang Chen;Tzu-Chan Hong;Chi-Lun Ko;Yen-Wen Wu;Mei-Fang Cheng
    • Korean Journal of Radiology
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    • v.25 no.3
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    • pp.243-256
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    • 2024
  • Objective: We aimed to investigate whether 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (2-[18F]FDG PET/CT) can aid in evaluating the risk of malignancy in ampullary tumors detected by endoscopy. Materials and Methods: This single-center retrospective cohort study analyzed 155 patients (79 male, 76 female; mean age, 65.7 ± 12.7 years) receiving 2-[18F]FDG PET/CT for endoscopy-detected ampullary tumors 5-87 days (median, 7 days) after the diagnostic endoscopy between June 2007 and December 2020. The final diagnosis was made based on histopathological findings. The PET imaging parameters were compared with clinical data and endoscopic features. A model to predict the risk of malignancy, based on PET, endoscopy, and clinical findings, was generated and validated using multivariable logistic regression analysis and an additional bootstrapping method. The final model was compared with standard endoscopy for the diagnosis of ampullary cancer using the DeLong test. Results: The mean tumor size was 17.1 ± 7.7 mm. Sixty-four (41.3%) tumors were benign, and 91 (58.7%) were malignant. Univariable analysis found that ampullary neoplasms with a blood-pool corrected peak standardized uptake value in earlyphase scan (SUVe) ≥ 1.7 were more likely to be malignant (odds ratio [OR], 16.06; 95% confidence interval [CI], 7.13-36.18; P < 0.001). Multivariable analysis identified the presence of jaundice (adjusted OR [aOR], 4.89; 95% CI, 1.80-13.33; P = 0.002), malignant traits in endoscopy (aOR, 6.80; 95% CI, 2.41-19.20; P < 0.001), SUVe ≥ 1.7 in PET (aOR, 5.43; 95% CI, 2.00-14.72; P < 0.001), and PET-detected nodal disease (aOR, 5.03; 95% CI, 1.16-21.86; P = 0.041) as independent predictors of malignancy. The model combining these four factors predicted ampullary cancers better than endoscopic diagnosis alone (area under the curve [AUC] and 95% CI: 0.925 [0.874-0.956] vs. 0.815 [0.732-0.873], P < 0.001). The model demonstrated an AUC of 0.921 (95% CI, 0.816-0.967) in candidates for endoscopic papillectomy. Conclusion: Adding 2-[18F]FDG PET/CT to endoscopy can improve the diagnosis of ampullary cancer and may help refine therapeutic decision-making, particularly when contemplating endoscopic papillectomy.

Psychological benefits of bench-step aerobics program in overweight or obese adult women: its effects on anger, exercise self-efficacy, exercise-related affect, and body image (과체중 및 비만 성인 여성 대상 스텝운동 프로그램의 심리적 효과: 분노, 운동관련 자기 효능감, 운동관련 정서 및 신체상에 미치는 효과)

  • Lee, Mi-Ra;Kim, Wan-Soo
    • Korean Journal of Health Education and Promotion
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    • v.24 no.5
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    • pp.119-135
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    • 2007
  • Objectives: The efficacy, feasibility, and safety of bench-step aerobics (BSA) program in overweight or obese Korean adult women have been implied. However, there has been almost no evidence for its psychological benefits. As such, the purpose of this study was to investigate the psychological benefits of BSA program in overweight or obese (body mass index ${\geq}\;23\;kg/m^2$) Korean adult women. Method: Anger, exercise self-efficacy, exercise-related affect, and body image of overweight or obese women who participated in a 12-week BSA program (n=15) were compared with those of their counterparts in the control group (n=13). Subjects were selected among public health center visitors and those recruited by putting an advertisement in local newspapers and the public health center homepage. Data from the exercise and control groups were collected before and after the 12-week BSA program (from August to November in 2006) at the public health centers. The exercise program consisted of 45 to 60 min moderate-intensity (40/50 to 50/60% of their hear rate reserve) BSA performed for 3 days a week. Results: After the BSA program, body image of the subjects in the exercise group was significantly improved and there was a significant difference between the exercise and control groups. Anger, exercise self-efficacy, and exercise-related affect were improved after the BSA program but the changes did not reach the level of statistical significance and there were no significant differences between the exercise and control groups. Conclusions: In conclusion, BSA appears to significantly enhance body image in overweight or obese Korean adult women but its effects on anger, exercise self-efficacy, and exercise-related affect do not appear to be statistically significant. Further studies involving different subjects, particularly whose levels of anger are high or whose levels of exercise-related affect are low to exclude the influence of the ceiling or floor effect, are warranted in a randomized controlled design.

Rationalizing Strategies for Children's Activity Spaces and Facilities (어린이 활동공간 및 놀이시설 제도 합리화 방안)

  • Park, Mi-Ok;Koo, Bon-Hak
    • Journal of the Korean Institute of Landscape Architecture
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    • v.40 no.4
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    • pp.36-50
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    • 2012
  • This study was carried out to find contradiction factors on laws for children's activity spaces and facilities and to suggest the rational options to control and manage those spaces and facilities by environmental and landscape planning methods. The results of this study are as follows: 1. The major laws related to the environmental safety for children's activity spaces are "Environmental Health Act (ERA)" for managing the environmental safety of children's activity spaces; "Safety Supervision Law of Children's Play Facilities(SSLCPF)" for the inspection and management for safety of children's play facilities; "Quality Management and Industrial Products Safety Management Law(QMIPSML)" for managing safety certification on children's play equipments. 2. The interior space such as "living room" by the Children's Welfare Law(CWL), "Children Park" by the Act on Urban Parks and Green Spaces(AUPGS), "classroom" on private educational institutes by the Act on Establishment and Operation Private Lesson and Training(AEOPLT) and "nursing room" of child care center smaller than $430m^2$ are needed to be managed as an activity space. 3. In order to reduce industrial burden in the production, establishment, construction, and operation and to minimize unwilling extra burden in the administration effort due to legally double regulate, it is necessary to mitigate the inspections on the equipment certificate from QMIPSML and overlapped or different factors and standards must be unified. With this study, the landscape domain could he enlarged from producing, import of play equipment and establishment, construction and operation of play facilities for a comprehensive range of activity spaces, and the landscape industry such as engineering industry, academic research, management, etc.

Education Need of the Visit ing Health Service Workers in Gwangju and Jeollanam-do Public Health Facilities (일부 공공보건기관 방문보건요원의 교육요구도 조사)

  • Kim, Young-Lak;Kim, Shin-Woel;Chung, Eun-Kyung;Choi, Jin-Su
    • Journal of agricultural medicine and community health
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    • v.27 no.1
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    • pp.51-64
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    • 2002
  • This study was aimed to provide the basic data for the development of effective educational program by reflecting the opinions of the visiting health service workers. The subjects were 144 visiting health service workers in Gwangju and Jeollanam-do area who responded the mail questionnaire. The data were collected from June to July, 2001 using questionnaire composed of the education need, knowledge by subjective appraisal, and experience of education. The major findings of this study were as follows: 1. The number of respondents who received at least one education within recent three years were 43(29.9%) at the central level, 57(39.6%) at the provincial level and 53(36.8%) at the district level. The satisfaction with education was higher at the central level than at the provincial and district level. 2. Knowledges by subjective appraisal on the 'chronic degenerative diseases management' and 'health promotion' was relatively high. while that of 'rehabilitation' was low. 3. The knowledge by subjective appraisal of visiting health service was related with experience of education and license status. The knowledge was higher in registered nurses than in nurse aids. The curricula related to increased level of knowledge of visting health service workers were 'elderly health care', 'rehabilitation' and 'psychiatric-mental health nursing' educations at the central level 'continuing education for the community health practioners' and 'psychiatric-mental health education' at the provincial level and 'elderly health care', 'rehabilitation' 'psychiatric-mental health' and 'acute diseases control' educations at the district level. 4. The respondents preferred elderly health management as the contents of education, officer group education as the method of education, province(30.4%) as the main body of education, exercise and practice as the form of education, 2-3 times per year as the frequency of education, and 3-5days as the period of education. The findings of this study could suggest that future education program should be planned to increae the knowledge level of visiting health service workers by reflecting their educational need.

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Analysis of Coexistence Rates of Attention Deficit/Hyperactivity Disorder Symptoms in Patients with Depression (우울감을 주소로 내원한 환자들에서 주의력 결핍/과잉행동장애 증상의 공존율 분석)

  • Jeong, Mi Young;Park, Seo Young;Kim, Jung Ho;Im, Woo Young;Lee, Yeon Jung
    • Korean Journal of Psychosomatic Medicine
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    • v.27 no.2
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    • pp.147-154
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    • 2019
  • Objectives : Cognitive dysfunction, including inattention, is often observed in patients with depression. Inattentive symptoms in patients with depression is similar to those among attention deficit/hyperactivity disorder (ADHD) patients. It is important to diagnose the two diseases accurately, because the treatment varies depending on the cause of inattention. This study aimed to investigate the coexistence rate of ADHD and the correlation between ADHD symptoms and depression in patients with depression. Methods : Participants in this study were 158 outpatients presenting with depression, who visited the psychiatric department from March 2015 to July 2018. Participants divided into a depression and a non-depression group according to the Korean version of the Center for Epidemiological Studies-Depression Scale (CES-D) score and were administered the following : a sociodemographic variables form (age, sex, academic background, occupation), the self-reporting test for adult ADHD (Adult Attention Deficit/Hyperactivity Disorder self-report scale-V 1.1; ASRS V1.1), and the Korean version of the Connors adult ADHD rating scale (K-CAARS). Descriptive statistical analysis, crossover analysis, t-tests, and Pearson's correlation coefficient were conducted on the data. Results : The coexistence rate of adult ADHD symptom was as high as 36.7% in patients with depression (p<0.001). In K-CAARS, the depression group (Inattention=1.80, Hyperactivity=1.92, Impulsivity=1.56, Self-concept=2.06) showed higher average scores on ADHD symptoms than the non-depressive group (Inattention=1.28, Hyperactivity=1.25, Impulsivity=1.09, Self-concept=1.42, p<0.001). Conclusions : This study confirmed that ADHD symptoms coexist in the depression group. When evaluating the symptoms of patients who complain of depression, it is suggested that they should be accurately diagnosed and appropriately treated with interest to the coexistence of ADHD symptoms and the possibility for ADHD diagnosis.

The Effects of Smoking Cessation Coaching Program based on Motivation Stage to Stop Smoking of Patients at a Public Hospital (금연동기단계에 따른 코칭프로그램이 환자 금연에 미치는 영향)

  • Kwak, Mi-Young;Hwang, Eun Jeong
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.17 no.4
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    • pp.188-198
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    • 2016
  • This study examined the effects of a smoking cessation coaching program based on the motivation stage applying the Transtheoretical Model to stop the smoking of patients in terms of the amount of smoking, nicotine dependence, CO level, and urine cotinine. The study design was a multi-repeat multiple repeat intermittent time series study with one-group, a pre-post design. The participants were 47 smoking patients (44 males and 3 females), who were treated at a public hospital in N city. The participants were 4 (8.51%) subjects in the action stage and 43 subjects (91.49%) in the preparation stage of the motivation stage. The coaching program intervention was conducted at the first day, second week, and 6th week. The smoking cessation maintenance of the subjects was checked at the 12th week. A chi-square test and t-test were used to analyze the data. The subjects in the action stage were kept under the condition of no smoking and nicotine dependence. After the program of subjects in the preparation stage, the amount of smoking, nicotine dependence, and CO level were significantly lower compared to the pre-test (p<.001). The findings suggest that the coaching program based on the motivation stage was effective in improving the smoking cessation for patients who smoke. On the other hand, the patients in the smoking cessation program may require much more financial assistance than those of healthy people. A greater workforce and budget will be needed for patients to stop smoking.

A Survey on the Consumer Attitude Toward Health Food in Korea (II) -Consumer Perception on Health Foods- (건강식품에 대한 소비자 인식 연구 (II) -건강식품에 관한 소비자 의식구조-)

  • Lee, Eun-Joo;Ro, Seung-Ok;Lee, Cherl-Ho
    • Journal of the Korean Society of Food Culture
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    • v.11 no.4
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    • pp.487-495
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    • 1996
  • The consumer perception on health and food habit, the experience of health food use and the discrimination between health food and drug of Korean consumer were surveyed by using a questionnaire containing 20 items in order to obtain the basic data for the assessment of the benefit and risk of health foods in Korea. A total of 1,000 people over 20 years of age living in Seoul and the vicinities were interviewed and asked to fill out the questionnaire during the period from the October 1995 to the February 1996. Among the 882 answers collected 23 was incomplete data, and 859 answers were used for the statistical analysis by using SAS program. The survey revealed a strong interest of the consumer on health food by showing that more than a half of the subjects (58.8%) had the experience of actual use of health food, and 68.2% believed the effectiveness. What the consumer expect most from health food was to have beneficial effect to maintain overall health condition (59.8%), and the most negative aspect of health food was the overstatement on the effectiveness by the producers (52.1%). The most important source of information for the purchase of health food was the suggestion of friends and relatives (30.6%). Among the health foods registered and regulated by the food law, royal jelly (22.7%), squalene (16.0%), refined fish oil (15.1%), lactic acid bacteria (10.6%) and aloe (8.8%) were relatively well aware. Although 84% of the subjects perceived that health food is different from drug or traditional medicine, the largest percentage of the subject selected ginseng as the most well known type of health food (22.7%) as well as the most well known drug (or traditional medicine) (41.7%). Ginseng was also chosen as the most frequently used health food (17.0%), and vitamin tablets the third (13.0%). The vague definition of health food and unambiguous discrimination of it from medicine by the consumers were problematic for the correct use and reasonable purchasing behavior. The clear definition and proper regulation on the manufacture and distribution of health food, more strict control of labelling and advertisement, and a wide consumer education on health food were recommended.

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A Survey on the Consumer Attitude Toward Health Food in Korea (I) -Consumer Perception on Health and Food Habit- (건강식품에 대한 소비자 인식 연구 (I) -건강과 식습관에 관한 소비자 의식구조-)

  • Lee, Eun-Joo;Ro, Seung-Ok;Lee, Cherl-Ho
    • Journal of the Korean Society of Food Culture
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    • v.11 no.4
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    • pp.475-485
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    • 1996
  • The consumer perception on health and food habit, the experience of health food use and the discrimination between health food and drug of Korean consumer were surveyed by using a questionnaire containing 15 items in order to obtain the basic data for the assessment of the benefit and risk of health foods in Korea. A total of 1,000 people over 20 years of age living in Seoul and the vicinities were interviewed and asked to fill out the questionnaire during the period from the October 1995 to the February 1996. Among the 882 answers collected, 23 was incomplete data, and 859 answers were used for the statistical analysis by using SAS program. The perception of Korean consumer on health and food habit indicated that food habit was considered the most important factor for the maintenance of health, as appeared in 39.8% of the subjects, among which 93.9 % believed that food habit could cause disease, and 97.1% believed that disease could be cured by changing food habit. The most worried disease was cancer (30.6%), degenerative diseases (14.1%), diseases by accident (12.6%) and obesity (10.0%). The disease which likely to be caused by food habit was diabetes (35.6%), obesity (22.4%), high blood pressure (12.8%), constipation (12.7%) and cancer (7.9%). The disease which was believed to be cured by changing food habit was diabetes (40.1%), obesity (25.9%), constipation (16.5%), high blood pressure (7.4%) and cancer (3.3%). It appeared that the people had a perception that food habit was highly related with diabetes and obesity, but less with cancer which was mostly worried.

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Palliative Care Practitioners' Perception toward Pediatric Palliative Care in the Republic of Korea (소아완화의료에 대한 호스피스 완화의료 전문기관 종사자의 인식)

  • Moon, Yi Ji;Shin, Hee Young;Kim, Min Sun;Song, In Gyu;Kim, Cho Hee;Yu, Juyoun;Park, Hye Yoon
    • Journal of Hospice and Palliative Care
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    • v.22 no.1
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    • pp.39-47
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    • 2019
  • Purpose: This study was performed to investigate the current status of pediatric palliative care provision and how it is perceived by the palliative care experts. Methods: A descriptive study was conducted with 61 hospice institutions. From September through October 2017, a questionnaire was completed by experts from the participating institutions. Data were analyzed using SPSS 21.0. Results: Among 61 institutions, palliative care is currently provided for pediatric cancer patients by 11 institutions (18.0%), all of which are concentrated in Seoul, Incheon and Gyeonggi and Gyengsang provinces; 85.2% of all do not plan to provide specialized pediatric palliative care in the future. According to the experts, the main barriers in providing pediatric palliative care were the insufficient number of trained specialists regardless of the delivery type. Experts said that it was appropriate to intervene when children were diagnosed with cancer that was less likely to be cured (33.7%) and to move to palliative care institutions when their conditions worsened (38.2%); and it was necessary to establish a specialized pediatric palliative care system, independent from the existing institutions for adult patients (73.8%). Conclusion: It is necessary to develop an education program to establish a nationwide pediatric palliative care centers. Pediatric palliative care intervention should be provided upon diagnosis rather than at the point of death. Patients should be transferred to palliative care institutions after intervention by their existing pediatric palliative care team at the hospital is started.

The effect of Type 2 diabetes management using a smartphone-based blood glucose management training program (모바일 자가혈당관리 교육프로그램을 이용한 2형 당뇨병 관리 효과 분석)

  • Lee, Jung-Hwa;Jung, Jin-Hee;Sim, Kang-Hee;Choi, Hee-Sun;Lee, Jeong-Rim;Kang, Yang-Gyo;Song, Bok-Rye
    • Journal of Industrial Convergence
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    • v.20 no.9
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    • pp.59-70
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    • 2022
  • Background: Diabetes education is an important factor in blood glucose control. Reinforced education is necessary for effective diabetes education. However, it is difficult to provide reinforced diabetes education within Korea's medical environment. Therefore, we want to analyze the effect of continuous diabetes education using mobile health care that can effectively provide repeated education without having to face the patient. Methods: This study is a multicenter, randomized, controlled, pre-post design study conducted to analyze the effect of a continuous diabetes education method. A total of 109 people were registered at five hospitals in south Korea, and they were randomly assigned to the app group (34 people) who received real-time coaching and repetitive training, the logbook group (37 people) who received face-to-face training after writing a blood glucose logbook, and the general group (38 people) who received a one-time diabetes education. The study was conducted for a total of 24 weeks. Twenty-one patients withdrew their consent and failed to perform an HbA1c. A final 88 patients were analyzed. The difference in HbA1c, Self-management behavior, and Quality of life before and after education was analyzed. Results: The study involved 51 (58%) male subjects, mean age was 55.8 years and mean duration of diabetes was 7.6 years. After 24 weeks of intervention, there was no significant difference in self-care behavior and quality of life between the three groups, but the HbA1c of the app group significantly decreased after education compared to the logbook group and the general group (F=4.62, p=.013). Conclusion: It can be seen through the app group that receiving real-time education is more effective in improving blood glucose management and continuous diabetes education is important.