The Effects of a Death Preparation Education Program on Death Anxiety, Death Attitudes, and Attitudes toward End-of-Life Care among Nurses in Convalescent Hospitals / 한국호스피스완화의료학회지

Purpose@#The purpose of this study was to examine the effects of a death preparation education program for nurses working in convalescent hospitals on death anxiety, death attitudes, and attitudes toward end-of-life care. @*Methods@#This was a quasi-experimental study with a non-equivalent control group, pre-test and post-test design. Among 53 participants, 26 were assigned to the non-equivalent experimental group and 27 to the control group. The program was performed in the formats of lectures, video-watching, group discussions, and sharing, and consisted of 10 sessions held twice a week, for 5 weeks (90minutes per session). Data were analyzed using descriptive statistics, the t-test, and the chisquare test in SPSS version 21.0. @*Results@#Significant differences between the experimental and control groups were observed in death anxiety (t=7.62, P＜0.001), death attitudes (t=-7.58, P＜0.001), and attitudes to end-of-life care (t=-10.30, P＜0.001). @*Conclusion@#It was confirmed that the death preparation education program reduced death anxiety and had a positive effect on death attitudes and attitudes toward end-of-life care. Based on the results of this study, it is expected that specialized and systematic education that can increase the implementation and stability of death preparation education in various fields, including nursing, will have a positive effect on both hospice patients and members of society more broadly.

Janus kinase inhibitors for the treatment of rheumatoid arthritis

Rheumatoid arthritis is a chronic inflammatory destructive disorder that affects the joints, muscles, and tendons accompanying various extra-articular manifestations. Traditional disease-modifying anti-rheumatic drugs (DMARDs) represent the basic treatment for rheumatoid arthritis. Over the last 20 years, biologic DMARDs (tumor necrosis factor inhibitors, interleukin-1 inhibitors, interleukin-6 inhibitors, T cell inhibitors, and B cell inhibitors) have been widely used as a novel class of DMARDs that have efficacy and efficiency. Discovery of the underlying pathogenesis of autoimmune disease enables us to develop new target therapies such as a Janus kinase (JAK) inhibitor. Activated JAK is known to activate signal transducers as well as activators of transcription (STAT) signaling. A JAK inhibitor is a type of medication that functions by inhibiting the JAK-STAT signaling pathway. In addition, it is easy to take a JAK inhibitor orally. In Korea, several JAK inhibitors have been approved. This review describes the types of JAK inhibitors, recommended doses, side effects, and updated European Alliance of Associations for Rheumatology guidelines. Clinicians should more often consider JAK inhibitors in the treatment of refractory rheumatoid arthritis in current rheumatology clinics

The Effects of a Death Preparation Education Program on Death Anxiety, Death Attitudes, and Attitudes toward End-of-Life Care among Nurses in Convalescent Hospitals / 한국호스피스완화의료학회지

Purpose@#The purpose of this study was to examine the effects of a death preparation education program for nurses working in convalescent hospitals on death anxiety, death attitudes, and attitudes toward end-of-life care. @*Methods@#This was a quasi-experimental study with a non-equivalent control group, pre-test and post-test design. Among 53 participants, 26 were assigned to the non-equivalent experimental group and 27 to the control group. The program was performed in the formats of lectures, video-watching, group discussions, and sharing, and consisted of 10 sessions held twice a week, for 5 weeks (90minutes per session). Data were analyzed using descriptive statistics, the t-test, and the chisquare test in SPSS version 21.0. @*Results@#Significant differences between the experimental and control groups were observed in death anxiety (t=7.62, P＜0.001), death attitudes (t=-7.58, P＜0.001), and attitudes to end-of-life care (t=-10.30, P＜0.001). @*Conclusion@#It was confirmed that the death preparation education program reduced death anxiety and had a positive effect on death attitudes and attitudes toward end-of-life care. Based on the results of this study, it is expected that specialized and systematic education that can increase the implementation and stability of death preparation education in various fields, including nursing, will have a positive effect on both hospice patients and members of society more broadly.

Analysis of the Types and Affecting Factors of Older People’s Health-related Quality of Life, Using Latent Class Analysis

Purpose@#This study aims to identify the types of health-related quality of life (QoL) based on the EuroQoL 5 Dimensions among community older people and predict the factors affecting these types. @*Methods@#This study used data from the 2016 Korea Health Panel Survey, whose participants included 3,848 older people. The data were analyzed using the software jamovi 1.2.17 and Mplus 8.2 for latent class analysis. @*Results@#The subgroups of the older people’s health-related QoL were identified as three latent classes: General stable type (43.9%), pain-related low type (35.0%), and general low type (21.1%). The types and characteristics of health-related QoL among the latent classes differed. Comparing the difference between the general low type and general stable type, the subjects showed higher probability of belonging to the general stable type when they were men, younger, higher education level, employment, better subjective health, lower BMI and stress level, and no suicidal ideation. A comparison between the general low type and the pain-related low type showed that the subjects were more likely to be classified as the pain-related low type when they were younger, higher education, employment, and better subjective health. @*Conclusion@#The results showed a significant heterogeneity in the types of health-related QoL among community older people, and the predictors for each type were not the same. These findings present basic data for cultivating nursing interventions that enhance health-related QoL.

Potential Oncogenic Role of the Papillary Renal Cell Carcinoma Gene in Non-Small Cell Lung Cancers

PURPOSE: Papillary renal cell carcinoma (PRCC) gene, which located in 1q23.1, is recurrently amplified in non-small cell lung cancer (NSCLC). However, it is unknown whether PRCC is overexpressed in primary NSCLCs and whether PRCC overexpression contributes to lung tumorigenesis. In this study, we aimed to identify the profiles of PRCC expression in Korean NSCLC patients and to elucidate the role of PRCC overexpression on lung tumorigenesis. MATERIALS AND METHODS: We performed immunohistochemistry analysis with a tissue array containing 161 primary NSCLCs. Small interfering RNA targeting PRCC (siPRCC) was transfected into two lung cancer cell lines (NCI-H358 and A549), after which tumor growth, migration, and invasion were observed. Expressions of cell proliferation-, cell cycle-, and metastasis-related molecules were examined by Western blot analysis. We also explored the in vivo effect of PRCC silencing. RESULTS: PRCC overexpression was recurrently observed in NSCLCs (95/161, 59%). After siPRCC treatment, tumor cell proliferation, colony formation, and anchorage independent growth were significantly reduced (p < 0.001 for all three effects). Migration and invasiveness were also significantly repressed (p < 0.001 for both effects). Reflecting cell proliferation, cell cycle, and metastasis, the expressions of Ki67, cyclin D1, AKT-1, pAKT, NF-kB p65, vimentin and CXCL-12 were found to be downregulated. Through mouse xenograft analysis, we confirmed that PRCC silencing significantly repressed a xenograft tumor mass in vivo (p < 0.001). CONCLUSION: The present data provide evidence that PRCC overexpression is involved in the tumorigenesis and progression of lung cancer.

Oral Administration of Silk Peptide Enhances the Maturation and Cytolytic Activity of Natural Killer Cells

Silk peptide, the hydrolysate of silk protein derived from cocoons, has been employed as a biomedical material and is believed to be safe for human use. Silk peptide display various bioactivities, including anti-inflammatory, immune-regulatory, anti-tumor, anti-viral, and anti-bacterial. Although earlier investigations demonstrated that silk peptide stimulates macrophages and the production of pro-inflammatory cytokines, its effect on natural killer (NK) cell function has not yet been explored. In this study, we initially confirmed that silk peptide enhances NK cell activity in vitro and ex vivo. To assess the modulatory activity of silk peptide on NK cells, mice were fed various amounts of a silk peptide-supplemented diet for 2 months and the effects on immune stimulation, including NK cell activation, were evaluated. Oral administration of silk peptide significantly enhanced the proliferation of mitogen- or IL-2-stimulated splenocytes. In addition, oral silk peptide treatment enhanced the frequency and degree of maturation of NK cells in splenocytes. The same treatment also significantly enhanced the target cell cytolytic activity of NK cells, which was determined by cell surface CD107a expression and intracellular interferon-γ expression. Finally, oral administration of silk peptide stimulated T helper 1-type cytokine expression from splenic lymphocytes. Collectively, our results suggest that silk peptide potentiates NK cell activity in vivo and could be used as a compound for immune-modulating anti-tumor treatment.

Oral administration of red ginseng powder fermented with probiotic alleviates the severity of dextran-sulfate sodium-induced colitis in a mouse model / 中国天然药物

Red ginseng is a well-known alternative medicine with anti-inflammatory activity. It exerts pharmacological effects through the transformation of saponin into metabolites by intestinal microbiota. Given that intestinal microflora vary among individuals, the pharmacological effects of red ginseng likely vary among individuals. In order to produce homogeneously effective red ginseng, we prepared probiotic-fermented red ginseng and evaluated its activity using a dextran sulfate sodium (DSS)-induced colitis model in mice. Initial analysis of intestinal damage indicated that the administration of probiotic-fermented red ginseng significantly decreased the severity of colitis, compared with the control and the activity was higher than that induced by oral administration of ginseng powder or probiotics only. Subsequent analysis of the levels of serum IL-6 and TNF-α, inflammatory biomarkers that are increased at the initiation stage of colitis, were significantly decreased in probiotic-fermented red ginseng-treated groups in comparison to the control group. The levels of inflammatory cytokines and mRNAs for inflammatory factors in colorectal tissues were also significantly decreased in probiotic-fermented red ginseng-treated groups. Collectively, oral administration of probiotic-fermented red ginseng reduced the severity of colitis in a mouse model, suggesting that it can be used as a uniformly effective red ginseng product.

In vitro Stimulation of NK Cells and Lymphocytes Using an Extract Prepared from Mycelial Culture of Ophiocordyceps sinensis

Ophiocordyceps sinensis is a natural fungus that has been valued as a health food and used in traditional Chinese medicine for centuries. The fungus is parasitic and colonizes insect larva. Naturally occurring O. sinensis thrives at high altitude in cold and grassy alpine meadows on the Himalayan mountain ranges. Wild Ophiocordyceps is becoming increasingly rare in its natural habitat, and its price limits its use in clinical practice. Therefore, the development of a standardized alternative is a great focus of research to allow the use of Ophiocordyceps as a medicine. To develop an alternative for wild Ophiocordyceps, a refined standardized extract, CBG-CS-2, was produced by artificial fermentation and extraction of the mycelial strain Paecilomyces hepiali CBG-CS-1, which originated from wild O. sinensis. In this study, we analyzed the in vitro immune-modulating effect of CBG-CS-2 on natural killer cells and B and T lymphocytes. CBG-CS-2 stimulated splenocyte proliferation and enhanced Th1-type cytokine expression in the mouse splenocytes. Importantly, in vitro CBG-CS-2 treatment enhanced the killing activity of the NK-92MI natural killer cell line. These results indicate that the mycelial culture extract prepared from Ophiocordyceps exhibits immune-modulating activity, as was observed in vivo and this suggests its possible use in the treatment of diseases caused by abnormal immune function.

Asymptomatic Common Iliac Artery Stenosis as a Cause of Renal Allograft Dysfunction and Uncontrolled Hypertension / 대한이식학회지

Occlusive disease of the iliac segment, proximal to the transplant artery (prox-TRAS), in kidney transplant recipients is a rare complication. Prox-TRAS, located in the common iliac artery, is extremely rare in these patients. Herein, we present an interesting case of a common iliac artery stenosis that manifested as decreased allograft function and uncontrolled blood pressure without other typical clinical symptoms. The patient was successfully treated with percutaneous luminal angioplasty and stent insertion.

Multiple Cavitary Pulmonary Nodules Caused by Mycobacterium intracellulare / 가정의학회지

Nontuberculous mycobacteria (NTM) have been increasingly recognized as an important cause of chronic pulmonary infections. The Mycobacterium avium complex (MAC), which is composed of two species, Mycobacterium avium and Mycobacterium intracelluare, is the most commonly encountered pathogen associated with NTM lung disease. MAC pulmonary infection typically presents in a fibrocavitary form or a nodular bronchiectatic form. However, there have been atypical presentations of MAC pulmonary infections, including solitary pulmonary nodules (SPN). There have been several previous reports of SPN due to MAC infection in the United States, Japan, and Korea. In 2009, Sekine and colleagues reported a case of MAC pulmonary infection presenting with multiple nodules. To date, however, there have been no cases of NTM lung infection with multiple cavitary pulmonary nodules, and neither a fibrotic change nor nodular bronchiectasis. The present case showed a multiple cavitating nodular lung infection due to MAC, which is very rare and different from the typical presentation of MAC pulmonary infections. We also showed that percutaneous transthoracic needle aspiration can be a useful diagnostic tool to evaluate a case of multiple cavitary nodules.

The Effects of Posttraumatic Growth and Meaning in Life on Health Promotion Behavior in Cancer Patients

PURPOSE: The purpose of this study was to identify the influence of posttraumatic growth and meaning in life on health promotion behavior in cancer patients. METHODS: The participants were 124 cancer patients who were treated at a general hospital in Pusan. Data were collected for posttraumatic growth, meaning in life, and health promotion behavior. The data were analyzed using descriptive statistics, t-tests, ANOVA, Pearson correlation coefficients and stepwise multiple regression with SPSS 21.0. RESULTS: The mean scores were health promotion behavior 2.72+/-0.47, posttraumatic growth 3.38+/-0.89, and meaning in life 3.29+/-0.59. The scores of health promotion behavior were significantly different by gender, perceived economic status, and economic difficulties due to diagnosis. Health promotion behavior had a significant correlation with posttraumatic growth and meaning in life. In multiple regression analysis, meaning in life and posttraumatic growth accounted for 26.0% of health promotion behavior. CONCLUSION: Posttraumatic growth and meaning in life were important factors that could be used to improve the health promotion behavior of cancer patients.

A Facility Design Model for 1300 Capacity School Foodservice with Adjacency and Bubble Diagrams / 대한지역사회영양학회지

This study aimed to suggest a 1300 scale of a middle school foodservice facility floor plan which was compliant to the principle of HACCP, as well as ensuring food and work safety, and the flow of personnel and food materials. which consisted of 46 nutrition teachers and 6 experts, responded with a questionnaire on the relationship of functional area and space. Using their opinions, key principles for the design of the facility were single direction movement of food materials, customers and workers; minimization of the cross-contamination through the separation of functional space; and securement of customer-focused efficiency; staff-centered convenience and efficiency; and work and food safety. After the completion of an adjacency diagram, bubble diagram and program statement, the functional areas of a 1300 scale middle school food-service facility were allocated as follows: 9.9 m2 for the receiving area, 56.1 m2 for the pre-preparation area, 10.5 m2 for the food storage area, 6.0 m2 for the supplies storage area, 97.8 m2 for the cooking area, 33.6 m2 for the service area, 52.5 m2 for dish washing area, cafeteria 410.5 m2, 4.5 m2 for the front room, for a total of 725.8 m2. Expert groups have pointed to limitations within this model as there are no windows in the office for the influx of fresh outside air and a need for the straight line installation of steam-jacket and frying kettles on the sides of windows. This study can be useful as the guidelines for estimating the investment cost of the facility and placing the placement of functional areas and equipment in the renovation of the facility. It can be also useful data for a methodology of foodservice facility design.

Assessment of Left Atrial Function and Remodeling in Patients With Atrial Fibrillation by Performing Strain Echocardiography: A Prospective Study to Assess the Influence of Renin-Angiotensin System Inhibitors on Atrial Fibrillation

BACKGROUND AND OBJECTIVES: Renin-angiotensin system (RAS) inhibitors are likely to reduce the development of atrial fibrillation (AF) by preventing atrial fibrosis. We attempted to assess the relevance of strain echocardiography for quantitative assessment of the left atrial (LA) status in AF, its modification by RAS inhibitors and changes of biochemical markers during cardiac remodeling in AF. SUBJECTS AND METHODS: Strain echocardiography is performed 2 times (baseline and 12 month) in 60 patients with AF (RAS inhibitors-used group: 30, non-used group: 30). In an apical 4-chamber view, the regional analysis consisted of placing the region of interest cursor at the basal segments of the septal and lateral wall of LA. Mean peak systolic and early diastolic strain/rate are measured with LA end-systolic antero-posterior, longitudinal and transverse dimensions. RESULTS: Six patients of RAS inhibitors-used group (group A, 20%) and three patients of non-used group (group B, 10%) were converted to normal sinus rhythm during the study. LA size, E wave velocity, E/E', strain parameters showed no significant differences between groups at the baseline. There were no significant differences in LA size and E wave velocity between groups at the 12 months, however, peak systolic strain/rate were significantly higher in group A (36.71+/-13.63% and 2.98+/-0.59s(-1), p<0.05, respectively) than group B (27.21+/-10.49% and 2.21+/-0.47s(-1)). In addition, peak early diastolic strain/rate were significantly higher in group A (-1.89+/-3.30% and -2.32 +/-0.77s-1 p<0.05, respectively) than group B (-0.83+/-2.79% and -1.77+/-0.25s(-1)). There were no significant differences in C-reactive protein (CRP) and B-type natriuretic peptide (BNP) at the baseline, but BNP were significantly reduced in group A (822.9+/-798.3 pg/mL, p<0.05) than group B (1481.9+/-209.97 pg/mL) at the 12-month follow-up. CONCLUSION: The increased values of atrial peak systolic and diastolic strain/rate after treatment with RAS inhibitors revealed that passive stretching and shortening of LA wall might improve in some patients with AF even before LA size change possibly because of reduced atrial fibrosis and increased compliance. Our results indicated that strain echocardiography provides clinically useful information of LA function and remodeling and treatment with RAS inhibitors appears to preserve LA reservoir function in AF patients without visible LA structural change.