Assessment of Risk Factors for Postoperative Delirium in Older Adults Who Underwent Spinal Surgery and Identifying Associated Biomarkers Using Exosomal Protein

Purpose@#With an increase in the aging population, the number of patients with degenerative spinal diseases undergoing surgery has risen, as has the incidence of postoperative delirium. This study aimed to investigate the risk factors affecting postoperative delirium in older adults who had undergone spine surgery and to identify the associated biomarkers. @*Methods@#This study is a prospective study. Data of 100 patients aged ≥ 70 years who underwent spinal surgery were analyzed. Demographic data, medical history, clinical characteristics, cognitive function, depression symptoms, functional status, frailty, and nutritional status were investigated to identify the risk factors for delirium. The Confusion Assessment Method, Delirium Rating Scale-R-98, and Nursing Delirium Scale were also used for diagnosing deliri-um. To discover the biomarkers, urine extracellular vesicles (EVs) were analyzed for tau, ubiquitin carboxy-terminal hydrolase L1 (UCH-L1),neurofilament light, and glial fibrillary acidic protein using digital immunoassay technology. @*Results@#Nine patients were excluded, and data obtained from the remaining 91 were analyzed. Among them, 18 (19.8%) developed delirium. Differences were observed between partici-pants with and without delirium in the contexts of a history of mental disorder and use of benzodiazepines (p = .005 and p = .026, respectively). Tau and UCH-L1—concentrations of urine EVs—were comparatively higher in participants with severe delirium than that in partici-pants without delirium (p = .002 and p = .001, respectively). @*Conclusion@#These findings can assist clinicians in accurately identifying the risk factors before surgery, classifying high-risk patients, and predicting and detecting delirium in older patients. Moreover, urine EV analysis revealed that postoperative delirium following spinal surgery is most likely associated with brain damage.

Exosomal Protein Profiles as Novel Biomarkers in Weight Gain After Kidney Transplantation: A Pilot Study

Purpose@#Weight gain after kidney transplantation is a critical factor that can lead to poor outcomes with cardiovascular complications. Many studies have been conducted to identify predictive markers of future weight changes at the time of transplant. Recently, circulating exosomes and its contents including miRNAs and proteins have attracted attention as potential biomarkers. In this pilot study, we investigated exosomal proteins and weight change after kidney transplant. @*Methods@#Recipients (n=10) were classified into two groups; weight gainers (n=5, 9.7±4.4kg) and weight losers (n=5, -6.4±1.8kg) based on their weight changes at 12-months posttransplant. Based on the exosomal protein profiles obtained by the LC-MS/MS, differentially expressed proteins were identified between the groups. @*Results@#Concentration and the mean size of exosomes significantly increased at 12-months compared to the baseline (p=.009) in the total group. Eleven exosomal proteins were found at the baseline as differentially expressed between the two groups. In the weight gain group, complement proteins including HV169, C3, C4B, and C4A, were significantly upregulated. @*Conclusion@#Our pilot study suggests that exosomal complementary proteins are associated with weight gain after kidney transplantation. Further studies are needed to clarify the role of these exosomal proteins in the underlying mechanisms of weight changes in kidney transplant recipients.

Pro-inflammatory Cytokine Levels and Cancer-related Fatigue in Breast Cancer Survivors: Effects of an Exercise Adherence Program / 한국유방암학회지

Purpose@#This study aimed to determine the effect of an exercise intervention on subjective cancer-related fatigue (CRF) and pro-inflammatory cytokine levels in breast cancer survivors (BCS). @*Methods@#BCS with greater than moderate CRF (≥ 4) were recruited and randomly assigned to experimental or control groups. The experimental group participated in a 12-week exercise adherence program (Better Life after Cancer - Energy, Strength, and Support; BLESS). Interleukin (IL)-6 and tumor necrosis factor-α (TNF-α) levels were determined at 3 time points (M1: baseline, M2: post-intervention, and M4: 6 months after intervention). Subjective fatigue was measured using the Korean version of the revised Piper Fatigue Scale. @*Results@#In this analysis of participants with physiological fatigue measures available (19 experimental, 21 control), there were no statistically significant differences in IL-6 (F = 1.157, p = 0.341), TNF-α levels (F = 0.878, p = 0.436), and level of fatigue (F = 2.067, p = 0.118) between the 2 groups at baseline. Fatigue in the experimental group showed statistically significant improvement compared to the control only at M2 (p = 0.022). There was no significant relationship between subjective and physiological fatigue at the 3 measurement points. @*Conclusion@#The BLESS intervention improved CRF in BCS immediately at post-intervention, and this study presents clinical feasibility for the management of CRF in BCS in the early survivorship phase who are already experiencing fatigue.

Knowledge and Anxiety Related to Hereditary Ovarian Cancer in Serous Ovarian Cancer Patients / 여성건강간호학회지

PURPOSE: The awareness of hereditary breast and ovarian cancer (HBOC) and BRCA testing is increasing in Korea. Compared to the sizable research on HBOC knowledge among breast cancer women, studies in the ovarian cancer population are limited. This paper aimed to investigate the level of knowledge of hereditary ovarian cancer and anxiety in women diagnosed with serous ovarian cancer in Korea and determine differences in the knowledge and anxiety according to whether genetic testing was undertaken and whether BRCA1 or BRCA2 mutations were present.METHODS: Using a descriptive research design, a cross-sectional survey was conducted on 100 women diagnosed with serous ovarian cancer at N hospital in Gyeonggi-do, Korea, from July to November 2018. The collected data were analyzed by descriptive statistics, independent t-tests, one-way analysis of variance, and Pearson's correlation coefficient using the SPSS 21.0 program.RESULTS: The hereditary ovarian cancer-related knowledge score was mid-level (mean score 8.90±3.29 out of a total of 17), as was the state anxiety level was mid-level (mean score 47.96±3.26 out of possible score range of 20–80). Genetic knowledge of hereditary ovarian cancer was associated with age, education, occupation, genetic counseling, and BRCA mutations. There were no statistically significant factors related to anxiety and there were no statistically significant correlations between knowledge level and anxiety.CONCLUSION: More comprehensive education on gene-related cancer is needed for ovarian cancer patients, especially for items with low knowledge scores. A genetic counseling protocol should be developed to allow more patients to alleviate their anxiety through genetic counseling.

Current Status of Biological Nursing Science Education for Clinical Nurses in General Hospital

PURPOSE: The purpose of this study was to investigate the extent and the nature of biological nursing science education for clinical nurses in general hospital. METHODS: Five advanced general hospitals located in Seoul and Gyeonggi province were conveniently sampled. Contents of education for nurses conducted by the hospital nursing department from January 1 to December 31 of 2015 were collected. Contents of education included biological nursing science and the scope of inclusion and time of assignment were analyzed. RESULTS: A total of 271 cases of nursing education data were collected and 223 cases were analyzed after excluding 48 cases whose contents were not confirmed. Biological nursing science was included in the contents of education for 117 cases (52.5%), but not for 106 cases (47.5%). Regarding the frequency of the biological nursing science education contents, ‘pathophysiology’was the most frequently included (n=286), followed by ‘structure and function of the human body’ (n=191), ‘mechanisms and effects of drugs’ (n=114) and ‘clinical microbiology’ (n=43). CONCLUSION: Results of this study confirmed that the education for clinical nurses included a lot of biological nursing science related contents. These results can be used as basis for the development of curriculum and training course for nurses.

Factors Affecting Body Image and Sexual Life for the Colorectal Cancer Patients with Stoma

PURPOSE: The purpose of this study was to describe factors affecting body image and sexual life for colorectal cancer patients with stoma. METHODS: A cross-sectional descriptive correlational study was applied to 102 ostomates from June to November in 2015 using self-report questionnaires: the Body image scale (BIS), and the Derogatis interview for sexual functioning self report (DISF-SR). RESULTS: The influencing factors for body image were ‘need for preoperative sexual education and sexual counseling’ (β=−.29, p=.003), and clinical stage II of colorectal cancer (β=−.26, p=.006). The influencing factor for sexual life was educational level (college education or higher) (β=.21, p=.02). CONCLUSION: The results of this study showed that colorectal cancer patients with stoma had a negative body image. The sexual counseling and education for ostomates should be approached by considering gender characteristics.

High-fat Intake is Associated with Alteration of Peripheral Circadian Clock Gene Expression

PURPOSE: Recent studies demonstrated disruption of the circadian clock gene is associated with the development of obesity and metabolic syndrome. Obesity is often caused by the high calorie intake, In addition, the chronic stress tends to contribute to the increased risk for obesity. To evaluate the molecular mechanisms, we examined the expression of circadian clock genes in high fat diet-induced mice models with the chronic stress. METHODS: C57BL/6J mice were fed with a 45% or 60% high fat diet for 8 weeks. Daily immobilization stress was applied to mice fed with a 45% high fat for 16 weeks. We compared body weight, food consumption, hormone levels and metabolic variables in blood. mRNA expression levels of metabolic and circadian clock genes in both fat and liver were determined by quantitative RT-PCR. RESULTS: The higher fat content induced more severe hyperglycemia, hyperlipidemia and hyperinsulinemia, and these results correlated with their relevant gene expressions in fat and liver tissues. Chronic stress had only minimal effects on metabolic variables, but it altered the expression patterns of metabolic and circadian clock genes. These results suggest that the fat metabolism regulates the function of the circadian clock genes in peripheral tissues, and stress hormones may contribute to its regulation.

Quality of Sleep and Heart Rate Variability by Physical Activity in High School Students

PURPOSE: This study was done to investigate quality of sleep and heart rate variability by the physical activity in high school students. METHODS: A survey that measures physical activity and quality of sleep was distributed to 118 students at Y High School. Heart rate variability was obtained using the LXC3203 heart rate monitor. The data of 105 students were analyzed using descriptive statistics, t-test, x2-test, and ANOVA with Scheffe test. RESULTS: Boys and students with part-time jobs had significantly higher physical activity. The quality of sleep was significantly high when the students were non-smokers, felt healthy, happy, less stressed, and satisfied with their school lives. Mean heart rate was significantly higher among girls, and standard deviation from normal to normal R-R intervals were high in boys. Physical activity had no significant relationships with quality of sleep and heart rate variability. CONCLUSIONS: Physical activity should be encouraged for high school students, especially for girls. An experimental study with different intensity and time of physical activity is recommended to examine the relationships with quality of sleep and heart rate variability in the future.

Factors Affecting Symptom Experiences of Breast Cancer Patients: Based on the Theory of Unpleasant Symptoms

PURPOSE: The purpose of this study was to identify the factors affecting symptom experiences of breast cancer patients. METHODS: A cross-sectional descriptive study was conducted with based on the Unpleasant symptom Theory. Sixty breast cancer patients were recruited. We measured their symptom experiences, physiologic factors (immune system function and specific perceived symptoms), psychological factors (depression and anxiety), and situational factors (family support). After obtaining permission from the IRB, data were collected from self-report questionnaires and electronic medical records from a single cancer center. Descriptive statistics, t-test, one-way ANOVA, correlations and multiple regressions were used to analyze the data. RESULTS: The most frequent and severe symptoms were fatigue (4.47+/-2.99), numbness or tingling (3.67+/-3.08) and sadness (3.45+/-3.64). Symptom experiences were significantly positively correlated with psychological factors (r=.603, p<.01) and physical symptoms (r=.384, p<.01). Symptom experiences and situational factors (r=.302, p<.05) were had a significantly negative correlation. The factor that had the most impact on symptom experiences were psychological factors, followed by perceived physical symptoms. The regression model explained 44.8% of the variances. CONCLUSION: Based on the results of this study, the physiological, psychological and situational factors should be considered for caring breast cancer patients.