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Purpose@#This study aimed to develop a motivational interviewing pulmonary rehabilitation program based on self-determination theory to maintain pulmonary rehabilitation-related health behaviors in patients with chronic obstructive pulmonary disease. The program was developed by reviewing the literature on pulmonary rehabilitation guidelines, drawing on the self-determinism theory to establish its contents, recruiting experts to test its validity, and conducting a preliminary survey. @*Methods@#A quasi-experimental design was used to confirm the effect of the program. The participants were outpatients diagnosed with chronic obstructive pulmonary disease at three general hospitals in Busan. There were 33 subjects: 15 in the experimental group and 18 in the control group. The experimental group performed a motivational interviewing pulmonary rehabilitation program which comprised 11 sessions delivered over 10 weeks. The outcomes were measured using basic psychological needs, dyspnea, 6-minute walking distance, and functional status. Intervention effects were analyzed using repeated-measures ANOVA. @*Results@#The analysis revealed significant differences between the experimental and control groups in competence among the subdomains of basic psychological needs, dyspnea during exercise, and functional status. @*Conclusion@#The developed program affects physical conditions and can be applied as an effective clinical nursing intervention to continuously improve the pulmonary rehabilitation behavior of patients with chronic obstructive pulmonary disease.
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Background@#The implementation of an effective suicide prevention program requires the identification and monitoring of subpopulations with elevated risks for suicide in consideration of demographic characteristics, to facilitate the development of tailored countermeasures for tackling the risk factors of suicide. We examined the annual trends in emergency department (ED) visits for suicide attempts (SAs) or self-harm and investigated the sex- and age-specific characteristics of individuals who visited the ED for SA and self-harm. @*Methods@#Data on ED visits for SAs or self-harm in Korea from 2016 to 2020 were extracted from the National Emergency Department Information System and assessed. We evaluated the age-standardized incidence rate of ED visits for SAs or self-harm, and hospital mortality among individuals who visited the ED for SAs or self-harm. In addition, the characteristics of the individuals were compared according to sex and age. @*Results@#We identified 145,963 ED visits for SAs or self-harm (0.42% of the total ED visits) during the study period. The rate of ED visits increased in the youngest age group (19–29 years old), and was more prominent among women (increased by an annual average of 22.5%), despite the coronavirus disease pandemic. The middle-aged group (45–64 years old) had a higher rate of mortality than other age groups, and the highest proportion of individuals on Medical Aid. @*Conclusion@#It is necessary to plan age- and gender-specific suicide prevention programs that focus on improving the limited public mental health resources for the vulnerable populations.
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Purpose@#This study investigated recent trends in the topics of women's health research in the United States (US), Canada, Japan, and the European Union where various research projects related to women and gender have been conducted. @*Methods@#To explore recent international women's health research, we selected research projects conducted between 2012 and 2022 from the US National Institute of Health, Canada's Research Information System, Japan's Health, Labor and Welfare Science Research Performance Database, and the European Union's CORDIS website. We categorized the identified research into three main areas; common or serious diseases and conditions affecting women, diseases, and conditions specific to women, and factors influencing women's health. @*Results@#The focus of health research expanded beyond traditional views of women, gender, and gender differences. Projects addressed the health needs of vulnerable groups, including refugees, migrants, incarcerated women, trans individuals, and pregnant women with autism. They also explored the connections between gender and racial differences in women's health. This inclusive approach considered the gaps and intersections within women's health. @*Conclusion@#Future women's health research in Korea will need to consider the intersectionality of gender, aging, and immigration. Environment-based approach in the research of drug addiction, mental health, nursing, and care would be important.
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Background@#With the epidemiological transition, sociodemographic changes and differential lifetime experiences of women, women’s health research improves knowledge of diverse health issues and the impact of policies. To explore the initiatives of women’s health research in Korea, the present study examined the trends and topics of research on women’s health funded by the government. @*Methods@#We searched all research projects on women’s health funded by the government between 2012 and 2020 in Korea using the National Science & Technology Information Service database. We reviewed all the titles and abstract of the projects and examined the research trends by year. Content analysis was performed using both deductive and inductive approaches. Text network analysis and visualization by topic were conducted for keywords with a minimum of 10 occurrences in the title and abstract. @*Results@#Total number and funding amount of research projects on women’s health in 2020 increased by 2.4 and 2.2 times over 2012 levels, respectively. The Ministry of Health and Welfare and the Ministry of Food and Drug Safety funded 20.9% of all projects. The majority of the topics (59.8%) addressed breast and gynecological cancers. Those on sexual and reproductive health accounted for 16.7%, with steep growth in the number (6.1 times) and funding (11.1 times) over 2012 levels. The topic analysis presented a more complex keyword network in 2020 than in 2012; however, the keywords frequently used in 2020 were similar to those of 2012. @*Conclusion@#Women’s health research projects have been growing in number and funding, with limited diversity in topics. Diversifying the topics and focusing on issues beyond the breast and pregnancy would be needed to reflect the complete life course of women.Institutionalization of diverse communication channels with various interest groups for women’s health would be needed to better understand women’s health needs from a public health perspective.
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Purpose@#: This study aimed to identify the factors affecting the quality of life of lung transplant patients.Method : The participants were patients who received lung transplants at a general hospital in City Y. Data were collected through structured questionnaires from June 2023 to August 2023. General characteristics, lung transplantation-related characteristics, quality of life, functional disability, treatment compliance, social support, anxiety, and depression—were measured. For data analysis, hierarchical multiple regression was performed using SPSS/WIN 29.0. @*Results@#: In the final model, quality of life was associated with income, self-help group attendance, functional disability, social support, treatment compliance, and anxiety and depression. Together, they explained 61.2% of the total variance in the results. @*Conclusion@#: Our findings suggest that improving lung transplant patients’ quality of life requires active intervention in stress management to perform treatment instructions well, a social support system that can help them financially, and encouraging and participating in social activities as patients.
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Purpose@#: This descriptive survey aims to identify the prevalence of factors associated with sarcopenia among hemodialysis patients. @*Methods@#: The study subjects were 137 patients with chronic kidney failure undergoing hemodialysis in three artificial kidney centers in B and Y cities. Data were collected from August 1 to September 30, 2020, using the SARC-F (Strength, Assistant walking, Rising from a chair, Climbing stairs, Falls) questionnaire, Mini Nutritional Assessment-Short Form (MNA-SF), International Physical Activity Questionnaire (IPAQ-SF), Bioelectrical Impedance Analysis (BIA), and a grip dynamometer. The collected data were analyzed using t-tests, crossover analysis, and logistic regression using the IBM SPSS 23 program. @*Results@#: The prevalence of sarcopenia among hemodialysis patients, determined using the SARC-F questionnaire, was 16.1%. The associated factors of sarcopenia among hemodialysis patients were found to be gender (OR=6.44, p =.002), age (OR=1.07, p =.015), nutritional status (OR=10.37, p =.027), and albumin level (OR=0.10, p =.014). These findings are supported by an explanatory power of 46.3% (p =.597). @*Conclusion@#: The identified risk factors for sarcopenia in hemodialysis patients were; sex, age, nutritional status, and albumin level. The findings of this study can serve as clinical evidence for the development of an intervention program for preventing and managing sarcopenia in patients undergoing hemodialysis.
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Background@#The appropriate use of personal protective equipment (PPE) can significantly reduce the risk of infection associated with caring for patients. This study aimed to investigate the knowledge, awareness, and behaviors related to the PPE usage among frontline nurses in a nationally designated coronavirus disease 2019 (COVID-19) hospital during the COVID-19 pandemic. @*Materials and Methods@#The study was performed in two phases: (1) a questionnaire survey to assess the knowledge, awareness, and behaviors related to PPE use, and (2) in-depth personal interviews to elaborate the survey findings. The questionnaires were distributed to all 121 registered nurses in three isolation wards and an intensive care unit which dedicated for patients with COVID-19 and 102 nurses completed survey (84.3% response rate). In-depth interviews were conducted with a total of 7 nurses. @*Results@#Among the survey participant, 100% stated that they knew how to protect themselves while providing nursing care and 93.1% stated that they knew the recommended PPE by task. Most survey participant mainly wore gloves, face shield, N95 or equivalent respirator, and a long-sleeved gown, but one-third of the participants sometimes used coveralls instead of long-sleeved gown. In-depth interviews, the importance of timely updated and specific guidelines for selecting the appropriate type of PPE was highlighted. The adequate supply of PPE, convenience at work, and the role of responsible leadership mainly determined behaviors related to the PPE. @*Conclusion@#As new information on COVID-19 continues to emerge, the up-to-date and specific PPE guideline with evidence should be prepared. The spread of accurate information, the role of accountable leadership, and the active communication under positive organizational culture are important for the proper use of PPE.
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Background@#Based on that the key function of health technology is improving the quality of healthcare services, our study purports to explore the process of medical device development in detail and to discuss its policy implications. @*Methods@#A total of 12 in-depth interviews were conducted with four groups of industry, hospital, academia, and civil society. All of the interviewees except those from civil society were involved in the new medical device development between 2009 and 2018. We performed a text network analysis and content analysis of the interview data. @*Results@#The frequency and the degree centrality rankings suggested a close association between the utilization issue and the technology development. Similarly, the results of the content analysis showed that the appropriate intervention in the utilization of technology has a direct impact on the progress of development. Under the continuous industrial effort to boost profits by developing new technology, service providers and citizens should be knowledgeable of and make good use of the new technology for the provision of better services. @*Conclusion@#As the development itself would not guarantee the improvement of service quality and better health outcomes, health technology policies should take a more comprehensive view to serve the unmet needs and even to facilitate the technology development.
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Purpose@#: This study investigated the occurrence of postoperative ileus and its related factors in patients after spinal surgery. @*Methods@#: After a retrospective review of data from patients who underwent spinal surgery at a single hospital located in Busan from 2012 through 2016, a total of 253 patients were included. The subjects were divided into non-ileus and ileus groups. We compared patient-, surgery-, and postoperative hematologicalrelated factors. @*Results@#: A total of 41 (16.2%) out of 253 patients experienced postoperative ileus. Data analysis revealed significant differences between the two groups in mean age (68.44 vs 60.50 years), occupation (9.8 vs 28.8%), cardiovascular comorbidity (63.4 vs 37.7%), approach of surgery (supine/prone: 29.3/70.7 vs 12.7/87.3%), duration of anesthesia (5.86 vs 4.43 hours), narcotic use (75.6 vs 56.6%), postoperative serum hemoglobin level (3 days: 10.81 vs 11.41 g/dL), postoperative serum protein (immediately/3 days: 5.30/5.43 vs 5.62/5.68 g/dL), postoperative albumin level (3 days: 3.17 vs 3.40 g/dL), postoperative C-reactive protein level (3 days: 11.44 vs 8.36 mg/dL), postoperative bed stabilization period (3.32 vs 2.50 days), and onset of bowel movement (2.59 vs 1.94 days). In multivariate logistic regression, age and time of anesthesia were independent risk factors of postoperative ileus. @*Conclusion@#: To detect ileus after spinal surgery early, nurse education is needed with intensive screening on advanced age, surgery-related factors, and postoperative hematological indices.
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Purpose@#: This study examined the effects of an integrated management program on physical function, cognitive function, and depression in patients with subacute stroke. @*Methods@#: A nonequivalent control group design was adopted. The participants were assigned to either the experimental group (n=20) or control group (n=23). The experimental group received an 8-week integrated management program and standard rehabilitation service (i.e., physical therapy and occupational therapy), while the control group received the standard rehabilitation service only. Physical function was measured as gait speed and balance ability using the Berg Balance Scale (BBS). Cognitive function was measured with neuro-behavioral cognitive status examination (NCSE), and depression was measured using the Beck Depression Inventory-II (BDI-II). Repeated measure ANOVA was used to determine changes in physical function, cognitive function, and depression over 8-weeks. @*Results@#: The interaction between group and time was significant, indicating that the experimental group showed improvement in gait speed, balance ability, cognitive function (linguistic ability, linguistic memory, reasoning), and a decrease in depression compared to the control group. @*Conclusion@#: These results indicate that the integrated management program developed herein was beneficial in restoring physical function, cognitive function, and depression in subacute stroke patients.
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Objectives@#Cancer diagnoses have a tremendous impact on individuals and communities, drawing intense public concern. The objective of the current research was to examine news coverage and content related to cancer-related issues in Korean newspapers. @*Methods@#Primarily using the database system of the Korea Press Foundation, we conducted a content analysis of 2806 articles from 9 Korean daily newspapers during a recent 3-year period from 2015 to 2017. Thematic categories, the types of articles, attitudes and tone, and the number of sources in each article were coded and classified. @*Results@#Many news articles dealt with a diverse range of themes related to cancer, including general healthcare information, the latest research and development, specific medical institutions and personnel, and technology and products, which jointly accounted for 74.8% of all articles. Those thematic categories differed markedly in terms of article type, tone, and the number of cited sources. News articles provided extensive information about healthcare resources, and many articles seemed to contain advertising content. However, the content related to complex social issues such as National Health Insurance did not include enough information for the reader to contextualize the issues properly or present the issues systematically. @*Conclusions@#It can be assumed that the media exert differential influence on individuals through news coverage. Within the present reporting framework, the availability and usefulness of information are likely to depend solely on individuals’ capabilities, such as financial and health literacy; this dependency has a negative impact on knowledge gaps and health inequities.
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Purpose@#It is important to understand the differences between men and women when it comes to attitudes and risk perception toward disease. This study aimed to explore the fear of cancer from the standpoint of themselves and the opposite sex by cancer type. @*Materials and Methods@#A cross-sectional survey with a representative sample was conducted. @*Results@#The least and the most feared cancers in men were thyroid cancer and lung cancer, respectively. When men assumed the perspective of women, the least and the most feared cancer were thyroid cancer and stomach cancer, respectively. The least and the most feared cancers in women were thyroid cancer and stomach cancer, respectively. When women assumed the perspective of men, the least and the most feared cancer were prostate cancer and lung cancer, respectively. When both men and women assume the perspective of the opposite sex, the fear of sex-specific cancer was relatively low compared to the actual responses of both men and women. The top six of the most feared side effects of cancer treatment were pain, psychological problems, general weakness, digestive dysfunction, fatigue, and appearance change. These were the same between men and women. @*Conclusion@#Health care providers and caregivers in the family should provide care with more attention to the differences in thoughts about cancer between men and women. Health care providers should provide care with more attention to the differences in these problems between men and women.
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PURPOSE: As the recent term of “financial toxicity” implies, cancer causes a treatment-related financial harm. Financial Aid Program for Cancer Patient (FAPCP) is a government’s financial support for low-income patients in the Republic of Korea. This study aimed to describe FAPCP applicants’ condition and to investigate factors influencing financial burden, which would provide the basis for implementing a strategy for FAPCP administration. MATERIALS AND METHODS: The telephone survey results from 2,700 FAPCP participants were analyzed, including demographic, socioeconomic, and disease characteristics and experiences associated with financial burden and the actions or measures to cope with them. RESULTS: Overall, 87.6% experienced financial burden more than moderate degree, 39.2% got financial help/a loan, 17.8% disposed of their property, and 10.2% changed or stopped treatment owing to medical costs. Monthly household income was connected to financial burden, and the highest income group was associated with the lowest financial burden (odds ratio [OR], 0.21; 95% confidence interval [CI], 0.11 to 0.38) and the lowest rate of changing/stopping care (OR, 0.23; 95% CI, 0.05 to 1.00). Parents of childhood cancer patients got financial help/a loan (OR, 2.24; 95% CI, 1.03 to 4.88) and disposed of their property (OR, 3.18; 95% CI, 1.40 to 7.22) more frequently, and Medical Aids applicants showed the highest rate of changing/stopping care (OR, 3.01; 95% CI, 1.89 to 4.78). CONCLUSION: FAPCP targets low income groups; however, financial burden and the consequent actions taken still exist disproportionately, depending on the income of the applicants. FAPCP should focus on more vulnerable groups including Medical Aid applicants and parents of childhood cancer patients, by increasing funds and expanding their support coverage.
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Humans , Family Characteristics , Financial Management , Financial Support , Health Care Costs , Parents , Public Assistance , Republic of Korea , TelephoneABSTRACT
BACKGROUND: To better understand cancer-related health behaviors, it is critical to know how general populations with different socioeconomic and demographic backgrounds perceive cancer. The current paper explored differences in general attitudes and beliefs towards cancer among Koreans. METHODS: A cross-sectional national survey was conducted for 1,000 Korean participants who were not cancer patients and did not have immediate family members with cancer via proportional quota random sampling. General attitudes and beliefs about cancer were measured by face-to-face interview using the awareness and beliefs about cancer (ABC) measure. RESULTS: Most respondents (84.8%–88.5%) had optimistic attitudes towards cancer. However, 35.6% to 87.7% agreed with negative cancer beliefs across all age groups simultaneously. Socioeconomic disparity of positive cancer beliefs was not evident. Unexpectedly, the highest income group agreed more strongly with the negatively framed statements that cancer treatment is worse than the cancer itself (odds ratio [OR], 2.68; 95% confidence interval [CI], 1.31–5.53), that they would not want to know if they have cancer (OR, 1.61; 95% CI, 0.94–2.75), and that a cancer diagnosis is a death sentence (OR, 2.32; 95% CI, 1.34–4.01), than the lowest income group. CONCLUSION: The present results imply a complicated context of cancer beliefs in Korea, unlike those shown in the studies of western populations. While the contradictory attitudes toward cancer can be attributable to the dual nature of information processing, social environment might have played a role. The association between socioeconomic status and negative attitudes toward cancer may vary depending on the diversity of the contexts.
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Humans , Electronic Data Processing , Diagnosis , Health Behavior , Korea , Social Class , Social Environment , Surveys and QuestionnairesABSTRACT
BACKGROUND/AIMS: Recent studies have suggested an important role of adipokines in the development of insulin resistance and diabetes mellitus. The clinical relevance of adipokines on long-term outcomes in patients with diabetes and chronic kidney disease is uncertain. The purpose of this study was to identify a predictable factor in patients with long-term diabetic complications. METHODS: A total of 161 diabetic individuals were followed-up from 2002 to 2013. Circulating plasma levels of adiponectin, glypican-4, irisin, visfatin, and visit-to-visit glucose variability were measured in diabetic patients. Associations among adipokines and variable metabolic parameters and microvascular, and macrovascular complications were evaluated. RESULTS: Plasma adiponectin and glypican-4 levels were significantly increased in patients with renal insufficiency. These adipokines were negatively associated with estimated glomerular filtration rate and positively associated with urinary albumin excretion. The relative risk of renal progression to dialysis increased independently with increasing level of adiponectin. Glypican-4 and visfatin were not predictive of any microvascular or macrovascular complications. Glucose variability increased the risk of diabetic nephropathy and cerebrovascular complications. CONCLUSIONS: Adiponectin and glypican-4 were associated with renal function and might be able to predict renal progression. Glucose variability was a predictable factor for diabetic nephropathy and cerebrovascular complications.
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Humans , Adipokines , Adiponectin , Diabetes Complications , Diabetes Mellitus , Diabetic Nephropathies , Dialysis , Glomerular Filtration Rate , Glucose , Glypicans , Insulin Resistance , Nicotinamide Phosphoribosyltransferase , Plasma , Renal Insufficiency , Renal Insufficiency, ChronicABSTRACT
The traditional boundaries between public and private sectors has been blurred, and questions raised regarding how publicness could be conceptualized. The empirical study on the concept of publicness can reveal greatly diversified views on publicness, and help to reduce confusion over publicness. For the content analysis, 750 news articles of 8 national Korean newspapers were retrieved from the Korea Integrated News Database System. The articles were coded by the inductive category for the topic of the paragraph, the concept related to publicness, and the overall tone toward publicness. Publicness was addressed in a number of different issues, and diverse and specific statuses or actions were associated with the realization of publicness. The most frequent concept was “government,” which represented the main agent of healthcare provision and the owner of institutions for “the vulnerable.” Issues of industrialization of healthcare/healthcare industry and reform of the national healthcare system mentioned publicness in a normative sense, which laid stress on “not-for-profit” service and the right of “universal access” to service for publicness. Articles of health/disease information or global health regarded “the population/public” as the main targets or beneficiaries of healthcare services. Occasionally, publicness was not related to specific concepts, being used unclearly or as a routine. The fulfillment of the specific actions or status may lead to the enhancement of publicness. However, publicness itself could not be reduced to the specific concepts suggested. The use of publicness in healthcare delivered only its normative sense without substantive meaning.
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Delivery of Health Care , Global Health , Korea , Periodical , Private SectorABSTRACT
BACKGROUND: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has standardized the reporting of thyroid cytology specimens. The objective of the current study was to evaluate the nationwide usage of TBSRTC and assess the malignancy rates in each category of TBSRTC in Korea. METHODS: Questionnaire surveys were used for data collection on the fine needle aspiration (FNA) of thyroid nodules at 74 institutes in 2012. The incidences and follow-up malignancy rates of each category diagnosed from January to December, 2011, in each institute were also collected and analyzed. RESULTS: Sixty out of 74 institutes answering the surveys reported the results of thyroid FNA in accordance with TBSRTC. The average malignancy rates for resected cases in 15 institutes were as follows: nondiagnostic, 45.6%; benign, 16.5%; atypical of undetermined significance, 68.8%; suspicious for follicular neoplasm (SFN), 30.2%; suspicious for malignancy, 97.5%; malignancy, 99.7%. CONCLUSIONS: More than 80% of Korean institutes were using TBSRTC as of 2012. All malignancy rates other than the SFN and malignancy categories were higher than those reported by other countries. Therefore, the guidelines for treating patients with thyroid nodules in Korea should be revisited based on the malignancy rates reported in this study.
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Humans , Academies and Institutes , Biopsy, Fine-Needle , Data Collection , Follow-Up Studies , Incidence , Korea , Thyroid Gland , Thyroid NoduleABSTRACT
The concentration of adenosine in the normal kidney increases markedly during renal hypoxia, ischemia, and inflammation. A recent study reported that an A3 adenosine receptor (A3AR) antagonist attenuated the progression of renal fibrosis. The adriamycin (ADX)-induced nephropathy model induces podocyte injury, which results in severe proteinuria and progressive glomerulosclerosis. In this study, we investigated the preventive effect of a highly selective A3AR antagonist (LJ1888) in ADX-induced nephropathy. Three groups of six-week-old Balb/c mice were treated with ADX (11 mg/kg) for four weeks and LJ1888 (10 mg/kg) for two weeks as following: 1) control; 2) ADX; and 3) ADX + LJ1888. ADX treatment decreased body weight without a change in water and food intake, but this was ameliorated by LJ1888 treatment. Interestingly, LJ1888 lowered plasma creatinine level, proteinuria, and albuminuria, which had increased during ADX treatment. Furthermore, LJ1888 inhibited urinary nephrin excretion as a podocyte injury marker, and urine 8-isoprostane and kidney lipid peroxide concentration, which are markers of oxidative stress, increased after injection of ADX. ADX also induced the activation of proinflammatory and profibrotic molecules such as TGF-β1, MCP-1, PAI-1, type IV collagen, NF-κB, NOX4, TLR4, TNFα, IL-1β, and IFN-γ, but they were remarkably suppressed after LJ1888 treatment. In conclusion, our results suggest that LJ1888 has a renoprotective effect in ADX-induced nephropathy, which might be associated with podocyte injury through oxidative stress. Therefore, LJ1888, a selective A3AR antagonist, could be considered as a potential therapeutic agent in renal glomerular diseases which include podocyte injury and proteinuria.
Subject(s)
Animals , Mice , Adenosine , Albuminuria , Hypoxia , Body Weight , Collagen Type IV , Creatinine , Doxorubicin , Eating , Fibrosis , Inflammation , Ischemia , Kidney , Oxidative Stress , Plasma , Plasminogen Activator Inhibitor 1 , Podocytes , Proteinuria , Receptors, Purinergic P1 , WaterABSTRACT
PURPOSE: In this single repeated measures study, an examination was done on the effects of dialysate flow rate on dialysis adequacy and fatigue in patients receiving hemodialysis. METHODS: This study was a prospective single center study in which repeated measures analysis of variance were used to compare Kt/V urea (Kt/V) and urea reduction ratio (URR) as dialysis adequacy measures and level of fatigue at different dialysate flow rates: twice as fast as the participant’s own blood flow, 500 mL/min, and 700 mL/min. Thirty-seven hemodialysis patients received all three dialysate flow rates using counterbalancing. RESULTS: The Kt/V (M±SD) was 1.40±0.25 at twice the blood flow rate, 1.41±0.23 at 500 mL/min, and 1.46±0.24 at 700 mL/min. The URR (M±SD) was 68.20±5.90 at twice the blood flow rate, 68.67±5.22 at 500 mL/min, and 70.11±5.13 at 700 mL/min. When dialysate flow rate was increased from twice the blood flow rate to 700 mL/min and from 500 mL/min to 700 mL/min, Kt/V and URR showed relative gains. There was no difference in fatigue according to dialysate flow rate. CONCLUSION: Increasing the dialysate flow rate to 700 mL/min is associated with a significant nicrease in dialysis adequacy. Hemodialysis with a dialysate flow rate of 700 mL/min should be considered in selected patients not achieving adequacy despite extended treatment times and optimized blood flow rate.