A Rare Case of Juvenile Gangrenous Vasculitis of the Scrotum in Korea

Juvenile gangrenous vasculitis is characterized by the abrupt onset of scrotal ulcerations in young males, preceded by fever and pharyngeal symptoms. The etiology of this disease is poorly understood. The course is benign and self-limiting within a few weeks with no relapse. Because of its rare incidence, physicians often confuse it with Fournier’s gangrene, which progresses rapidly to severe systemic symptoms requiring urgent surgical intervention. Herein, we report a rare case of juvenile gangrenous vasculitis of the scrotum and emphasize the importance of awareness of this diagnosis to avoid unnecessary invasive surgical intervention. A 17-year-old boy presented with painful and tender, diffuse erythema and swelling with a necrotic lesion on the scrotum for three days. Preceding the cutaneous manifestations, he had a fever and sore throat. Physical examination showed an about 2 cmsized well-demarcated necrotic lesion on the anterior scrotum. Laboratory findings revealed neutrophilic leukocytosis with an elevated C-reactive protein and erythrocyte sedimentation rate. On scrotal ultrasonography, only edematous skin thickening and an increase in vascularity were observed. Histopathological examination showed epidermal necrosis and dermal neutrophilic infiltration. Empirical antibiotic treatment with ampicillin/sulbactam and clindamycin was administered and a prompt clinical resolution was observed.

Glossopharyngeal Neuralgia Caused by Nerve Compression and Traction by Tortuous Vertebral and Posterior Inferior Cerebellar Arteries

Glossopharyngeal neuralgia is a condition characterized by lancinating pain in the tongue, soft palate, and pharynx. This condition can be caused by the combination of traction and compression of the glossopharyngeal nerve by tortuous vertebral and posterior inferior cerebellar arteries, which tug down and exert pressure on the nerve. Medical treatments including carbamazepine and gabapentin have been found to effectively manage glossopharyngeal neuralgia, even in cases with overt compression and traction of the nerve.

Two Cases of Perinuclear Anti-neutrophil Cytoplastic Antibodies Associated Hypertrophic Pachymeningitis Presented with Visual Loss

Pachymeningitis is an inflammatory process mainly involving the dura mater and is possibly associated with infectious, neoplastic, or autoimmune disease. However, in most cases, the etiology remains unknown. Clinical manifestations of pachymeningitis can vary, ranging from headache, cranial neuropathy, cerebellar dysfunction, to seizure. Here we report two cases of perinuclear anti-neutrophil cytoplasmic antibodies associated with pachymeningitis, in both the visual loss attributed to optic neuropathy was the primary sign.

Keyword Network Analysis and Topic Modeling of News Articles Related to Artificial Intelligence and Nursing

Purpose@#The purpose of this study was to identify the main keywords, network properties, and main topics of news articles related to artificial intelligence technology in the field of nursing. @*Methods@#After collecting artificial intelligence-and nursing-related news articles published between January 1, 1991, and July 24, 2022, keywords were extracted via preprocessing. A total of 3,267 articles were searched, and 2,996 were used for the final analysis. Text network analysis and topic modeling were performed using NetMiner 4.4. @*Results@#As a result of analyzing the frequency of appearance, the keywords used most frequently were education, medical robot, telecom, dementia, and the older adults living alone. Keyword network analysis revealed the following results: a density of 0.002, an average degree of 8.79, and an average distance of 2.43; the central keywords identified were ’education,’ ‘medical robot,’ and ‘fourth industry.’ Five topics were derived from news articles related to artificial intelligence and nursing: ‘Artificial intelligence nursing research and development in the health and medical field,’ ‘Education using artificial intelligence for children and youth care,’ ‘Nursing robot for older adults care,’ ‘Community care policy and artificial intelligence,’ and ‘Smart care technology in an aging society.’ @*Conclusion@#The use of artificial intelligence may be helpful among the local community, older adult, children, and adolescents. In particular, health management using artificial intelligence is indispensable now that we are facing a super-aging society. In the future, studies on nursing intervention and development of nursing programs using artificial intelligence should be conducted.

Impact of Role Conflict, Nursing Organizational Culture, and Nurse-Physician Collaboration on Job Embeddedness of Intensive Care Unit Nurses / 중환자간호학회지

Purpose@#: The purpose of this study is to identify the factors affecting the degree of job embeddedness by examining role conflict among intensive care unit nurses, the nursing organizational culture, nurse-physician collaboration, degree of job embeddedness, to understand the relationship between these variables.Method : Participants are 148 nurses from two hospitals in the intensive care unit. Collected data are analyzed using independent t-tests, ANOVA, Scheffé test, Pearson correlations, and multiple regressions using the SPSS 25.0 program. @*Results@#: The factors that significantly influenced the participants’ job embeddedness are role conflict (β=-.19, p =.015), innovation-oriented culture (β=.26, p =.003), and nurse-physician collaboration (β=.24, p =.002). The total explanatory power of these factors for job embeddedness is 44.5% (F=15.06, p =.001). @*Conclusion@#: This study identifies role conflict among intensive care unit nurses, innovation-oriented culture, and nurse-physician collaboration as important factors affecting job embeddedness.

Comparison of Th1 and Th17 Inflammatory Cytokine Profiles Between Chronic Plaque and Acute Guttate Psoriasis

Background@#The phenotypic heterogeneity of psoriasis is suspected to reflect differences in its pathogenesis, but not yet completely elucidated. Studies of the Th1 and Th17 cytokines associated with different phenotypes of psoriasis have yielded inconsistent results. @*Objective@#To investigate the tissue expression levels of Th1 and Th17 cytokines among patients with chronic plaque psoriasis, acute guttate psoriasis, and healthy control. @*Methods@#A total of 20 patients with psoriasis (10 with chronic plaque type and 10 with acute guttate type) and 5 healthy controls were enrolled. The tissue mRNA and protein levels of following cytokines were measured: interleukin (IL)-12, IL-2, interferon (IFN)-γ, IL-23, IL-17A, and IL-22. @*Results@#The tissue mRNA levels of IL-12, IFN-γ, IL-23, IL-17A, IL-22 and the protein levels of IL-12, IL-2, IFN-γ, IL-17A, IL-22 were significantly increased in the psoriasis patients compared with the healthy controls. In comparisons of the subtypes, the tissue mRNA level of IFN-γ was increased in acute guttate psoriasis, whereas the protein levels of IL-12 and IL-17A were significantly increased in chronic plaque psoriasis. The cytokine ratios of IL-17A/IL-2 and IL-22/IL-2 were significantly higher in chronic plaque psoriasis than in acute guttate psoriasis. @*Conclusion@#We confirmed that the tissue levels of Th1 and Th17 cytokines were increased in psoriasis patients compared with healthy controls. The increased IFN-γ mRNA level in acute guttate psoriasis and increased IL-12 and IL-17A protein levels in chronic plaque psoriasis suggest that an imbalance between Th1 and Th17 cytokines may play a role in the phenotypic transition of psoriasis.

Enriching CCL3 in the Tumor Microenvironment Facilitates T cell Responses and Improves the Efficacy of Anti-PD-1 Therapy

Chemokines are key factors that influence the migration and maintenance of relevant immune cells into an infected tissue or a tumor microenvironment. Therefore, it is believed that the controlled administration of chemokines in the tumor microenvironment may be an effective immunotherapy against cancer. Previous studies have shown that CCL3, also known as macrophage inflammatory protein 1-alpha, facilitates the recruitment of dendritic cells (DCs) for the presentation of tumor Ags and promotes T cell activation. Here, we investigated the role of CCL3 in regulating the tumor microenvironment using a syngeneic mouse tumor model. We observed that MC38 tumors overexpressing CCL3 (CCL3-OE) showed rapid regression compared with the wild type MC38 tumors. Additionally, these CCL3-OE tumors showed an increase in the proliferative and functional tumor-infiltrating T cells. Furthermore, PD-1 immune checkpoint blockade accelerated tumor regression in the CCL3-OE tumor microenvironment. Next, we generated a modified CCL3 protein for pre-clinical use by fusing recombinant CCL3 (rCCL3) with a non-cytolytic hybrid Fc (HyFc).Administering a controlled dose of rCCL3-HyFc via subcutaneous injections near tumors was effective in tumor regression and improved survival along with activated myeloid cells and augmented T cell responses. Furthermore, combination therapy of rCCL3-HyFc with PD-1 blockade exhibited prominent effect to tumor regression. Collectively, our findings demonstrate that appropriate concentrations of CCL3 in the tumor microenvironment would be an effective adjuvant to promote anti-tumor immune responses, and suggest that administering a long-lasting form of CCL3 in combination with PD-1 blockers can have clinical applications in cancer immunotherapy.

Neuroleptic Malignant Syndrome Applied with Targeted Temperature Management

Neuroleptic malignant syndrome (NMS) is a life-threatening neurologic emergency associated with the use of dopamine receptor-antagonist properties or the rapid withdrawal of dopaminergic medications. NMS is characterized by refractory hyperpyrexia, altered mental state, dysautonomia, and rigor. If hyperpyrexia persists, it can result in multiorgan failure. Herein, we report a case of NMS occurring after metoclopramide administration in a patient with pontine hemorrhage, which was successfully treated with targeted temperature management using a surface cooling device.

To What Depth Is a Congenital Melanocytic Nevus Affected by 84 Pigment Laser Treatments? / 대한피부과학회지

Total excision is the treatment of choice of congenital melanocytic nevus. However, it is often infeasible, laser therapy is being explored as a useful therapeutic approach. A 26-year-old woman presented with a solitary, skin-colored plaque surrounded by whitish patches on her right calf. She was diagnosed with a congenital melanocytic nevus and underwent 84 laser treatment sessions using a 1,064 nm Nd:YAG laser over 7 years. Histopathological examination of the whitish plaque revealed small foci of nevus cells that penetrated the tissue to a depth that was 12-fold higher than the epidermal depth (1,260 μm). No report in the literature describes histopathological findings of a congenital melanocytic nevus treated with 84 sessions of laser therapy. This case report highlights the depth of penetration of pigment laser to treat a congenital melanocytic nevus. Our findings will serve as useful clinical guidelines to perform laser treatment for congenital melanocytic nevi.

Enriching CCL3 in the Tumor Microenvironment Facilitates T cell Responses and Improves the Efficacy of Anti-PD-1 Therapy

Chemokines are key factors that influence the migration and maintenance of relevant immune cells into an infected tissue or a tumor microenvironment. Therefore, it is believed that the controlled administration of chemokines in the tumor microenvironment may be an effective immunotherapy against cancer. Previous studies have shown that CCL3, also known as macrophage inflammatory protein 1-alpha, facilitates the recruitment of dendritic cells (DCs) for the presentation of tumor Ags and promotes T cell activation. Here, we investigated the role of CCL3 in regulating the tumor microenvironment using a syngeneic mouse tumor model. We observed that MC38 tumors overexpressing CCL3 (CCL3-OE) showed rapid regression compared with the wild type MC38 tumors. Additionally, these CCL3-OE tumors showed an increase in the proliferative and functional tumor-infiltrating T cells. Furthermore, PD-1 immune checkpoint blockade accelerated tumor regression in the CCL3-OE tumor microenvironment. Next, we generated a modified CCL3 protein for pre-clinical use by fusing recombinant CCL3 (rCCL3) with a non-cytolytic hybrid Fc (HyFc).Administering a controlled dose of rCCL3-HyFc via subcutaneous injections near tumors was effective in tumor regression and improved survival along with activated myeloid cells and augmented T cell responses. Furthermore, combination therapy of rCCL3-HyFc with PD-1 blockade exhibited prominent effect to tumor regression. Collectively, our findings demonstrate that appropriate concentrations of CCL3 in the tumor microenvironment would be an effective adjuvant to promote anti-tumor immune responses, and suggest that administering a long-lasting form of CCL3 in combination with PD-1 blockers can have clinical applications in cancer immunotherapy.

Neuroleptic Malignant Syndrome Applied with Targeted Temperature Management

Neuroleptic malignant syndrome (NMS) is a life-threatening neurologic emergency associated with the use of dopamine receptor-antagonist properties or the rapid withdrawal of dopaminergic medications. NMS is characterized by refractory hyperpyrexia, altered mental state, dysautonomia, and rigor. If hyperpyrexia persists, it can result in multiorgan failure. Herein, we report a case of NMS occurring after metoclopramide administration in a patient with pontine hemorrhage, which was successfully treated with targeted temperature management using a surface cooling device.

Effects of Awareness of Patient Safety Culture, Emotional Labor and Job Stress on Patient Safety Nursing Activities by Comprehensive Nursing Care Medical Service Ward Nurses / 중환자간호학회지

Purpose@#: This study aimed to examine the effects of the awareness of patient safety culture, emotional labor, and job stress on patient safety nursing activities by comprehensive nursing care medical service ward nurses. @*Methods@#: The participants were 112 nurses from the comprehensive nursing care service wards from six hospitals. Data were collected using structured questionnaires and analyzed using a t-test, ANOVA, Scheffé test, Pearson correlation coefficients, and multiple regression analysis using SPSS version 20.0. @*Results@#: The factors that significantly influenced patient safety nursing activities in the comprehensive nursing care medical service ward nurses included job stress (β=-0.18, p<.032) and awareness of patient safety culture (β=0.54, p<.001). The explanatory power of these factors was 31.0% (F=13.43, p<.001). @*Conclusion@#: This study showed that the factors that influenced patient safety management activities of comprehensive nursing care medical service ward nurses included job stress and awareness of patient safety culture.

A Structural Equation Model of Clinical Nurses’ End-of-life Care Performance / 중환자간호학회지

Purpose@#: Based on Quint’s theory and the relevant literature, this study constructed a structural equation model for explaining and predicting end-of-life care performance in clinical nurses. @*Methods@#: A self-administered questionnaire was used to collect data from 265 nurses between September 1 and September 30, 2016. The data were analyzed using SPSS ver. 21 and AMOS ver. 21. @*Results@#: The goodness of fit of the modified model was found to be relatively satisfactory (χ2=114.82, Nomed χ2(χ2/df)=2.44, SRMR=.06, GFI=.94, AGFI=.89, CFI=.95, TLI=.91, RMSEA=.07). End-of-life care performance was affected by the attitudes toward nursing care of the dying, working unit, and death anxiety. The attitudes toward such care had the highest effect on end-of-life care performance. @*Conclusion@#: The results suggest that end-of-life care performance is directly and indirectly affected by attitudes toward nursing care of the dying, participation in end-of-life care education, working unit, death perception, and death anxiety. To improve clinical nurses’ end-of-life care performance, effective programs to promote death anxiety and attitudes toward nursing care of the dying need to be developed. In addition, hospital nursing organizations should attempt to produce concrete measures for death anxiety and terminal care attitudes in clinical nurses.

To What Depth Is a Congenital Melanocytic Nevus Affected by 84 Pigment Laser Treatments? / 대한피부과학회지

Total excision is the treatment of choice of congenital melanocytic nevus. However, it is often infeasible, laser therapy is being explored as a useful therapeutic approach. A 26-year-old woman presented with a solitary, skin-colored plaque surrounded by whitish patches on her right calf. She was diagnosed with a congenital melanocytic nevus and underwent 84 laser treatment sessions using a 1,064 nm Nd:YAG laser over 7 years. Histopathological examination of the whitish plaque revealed small foci of nevus cells that penetrated the tissue to a depth that was 12-fold higher than the epidermal depth (1,260 μm). No report in the literature describes histopathological findings of a congenital melanocytic nevus treated with 84 sessions of laser therapy. This case report highlights the depth of penetration of pigment laser to treat a congenital melanocytic nevus. Our findings will serve as useful clinical guidelines to perform laser treatment for congenital melanocytic nevi.

The Risk Factors Related to Early Readmission to the Intensive Care Unit / 중환자간호학회지

PURPOSE: The purpose of this study was to identify status and characteristics of patients who have been readmitted to ICU, and to analyze risk factors associated with the readmission to ICU within 48hours.METHODS: Data were collected from patient's electronic medical reports from one hospital in B city. Participants were 2,937 patients aged 18 years old or older admitted to the ICU. Data were analyzed using odd ratios (ORs) from multivariate logistic regressions.RESULTS: 2.2% of the 2,937 patients were early readmitted to ICU. Risk factors for early readmission to ICU were existence of respiratory disease, use of mechanical ventilator, and duration of hospitalization (longer).CONCLUSION: The assessment on the respiratory system of the patient who will be discharged from the ICU was identified as an important nursing activity. Therefore, the respiratory system management and education should be actively conducted. In addition, early ICU readmission may be prevented and decreased if a link was built to share the information on patient condition between the ICU and general wards.

The Effects of Chest Physiotherapy on Applied to Patients Mechanicalventilated: In Patients with Acute Lung Injury / 중환자간호학회지

PURPOSE: The purpose of this study was to examine the effects of two single chest physiotherapies mechanically ventilated patients with acute lung injury.METHOD: Participants were 30 ICU patients depending entirely on ventilators without self-respiration. Each patients received two single chest physiotherapiesvibration palm cup percussion at hour intervals. Data were analyzed one-way ANOVA and Wilcoxon signed-rank test. Statistical significance was accepted at a p value less than .05.RESULTS: ibration therapy, dynamic compliance and statics compliance demonstrated a significant increase immediately and remained increased until 30 minutes after chest physiotherapy. palm cum percussion therapy saturation showed a significant increase immediately chest physiotherapyut there were no significant differences in tidal volume, dynamic compliance and statics compliance.CONCLUSION: In this study, we analyzed the effects of oscillation method and palm cup percussion method separately for each type of chest physiotherapy. Nursing interventions that actively utilize vibration methods should be provided to patients with respiratory diseases.

Resilience as a Moderator and Mediator of the Relationship between and Emotional Labor and Job Satisfaction among Nurses working in ICUs / 중환자간호학회지

PURPOSE: The purpose of this study was to identify the moderating and mediating effects of resilience in the relationship between emotional labor and job satisfaction among nurses working in intensive care units (ICUs).METHOD: The participants were 144 ICU nurses from three university hospitals. Data were collected using structured questionnaires and analyzed by t-test, ANOVA, Scheffé test, Pearson correlation coefficients, and multiple regression analysis, using SPSS 25.0. The mediating effect of resilience in the relationship between emotional labor and job satisfaction was analyzed by multiple regression analysis according to Baron and Kenny's procedure.RESULTS: Statistically significant negative correlations were found between emotional labor and resilience (r=−.21, p<.014) and between emotional labor and job satisfaction (r=−.34, p<.001). A significant positive correlation was found between resilience and job satisfaction (r=.31 p<.001). A partial mediating effect by resilience was found between emotional labor and job satisfaction (Z=−2.11, p =.034), but no moderating effect was found.CONCLUSION: To improve the job satisfaction of ICU nurses, evaluation of their emotional labor, resilience, and interventions are necessary to alleviate emotional labor and improve resilience.

Biocompatibility of n-butyl-2-cyanoacrylate (Histoacryl) in cervical structures of rats: prospective in vivo study

PURPOSE: We investigated the biocompatibility of n-butyl-2-cyanoacrylate (NBCA) in the cervical deep tissues of rats to assess its biocompatibility. METHODS: A total of 30 Sprague-Dawley rats were injected with NBCA. After 30, 90, 180, and 360 days, cubes of tissue (1 cm × 1 cm × 1 cm) surrounding the NBCA and normal tissue from the other side of the neck were excised from each rat. The adhesion of NBCA to adjacent structures was examined histologically. Cells were counted per high-power field (HPF), and fibrosis was graded with the measurement of fibrotic thickening. RESULTS: All animals displayed normal behavior without any symptoms of distress throughout the study. There was no recognizable inflammatory reaction, foreign body reaction, or fibrosis in the 30 control samples. The analyses of experimental samples showed significantly decreased inflammatory cell counts over time (lymphoplasma cell count decreased from 100 (range, 70–100) to 30 (range, 30–50) per HPF, P = 0.010; neutrophil count decreased from 2 (range, 2–30) to 0 (range, 0–2) per HPF, P = 0.017). However, there was no significant difference in the number of multinuclear giant cells throughout the study period (a decrease from 22 [range, 16–34] to 16 [range, 12–22] per HPF, P = 0.287). The level of fibrosis was Common Toxicity Criteria ver. 4.0 Grade 1 without further thickening (P = 0.600). However, maturation of fibrosis progressed gradually. CONCLUSION: NBCA was biologically tolerable in the cervical deep tissues of rats. However, precautions are needed with respect to preventing a sustained foreign body reaction and fibrosis.

Association between Genetic Variations of MERTK and Chronic Obstructive Pulmonary Disease in Koreans

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a debilitating lung disease. To date, a large number of clinical studies have been conducted to investigate the association between genetic variations and COPD. However, little is known regarding the genetic susceptibility of Koreans to this disease. MER receptor tyrosine kinase (MERTK) plays important roles in the inhibition of inflammation and in the clearance of apoptotic cells. Here, we investigated the association between genetic variations in MERTK and the development of COPD in Koreans. METHODS: We conducted genetic analysis of MERTK using genomic DNA samples from 87 patients with COPD and 88 healthy controls and compared the frequency of each variation or haplotype between the patient and control groups. Subsequently, the effect of each variation was evaluated using in vitro assays. RESULTS: Ten variations were identified in this study, four of them for the first time. In addition, we found that the frequency of each variation or haplotype was comparable between the patient and control groups. However, we observed that the frequency for the wild-type haplotype was higher in the control group, compared to that in the group of patients with COPD, in the subgroup analysis of current smokers, although the difference was not statistically significant (P = 0.080). In in vitro assays, we observed that none of the variations affected the activity of the promoter or the expression of MERTK. CONCLUSION: Our findings indicate that the susceptibility to COPD is not related to the genetic variations or haplotypes of MERTK in Koreans.

Efficacy of Albis for the Prevention of Gastric Mucosal Injury Concomitant with the Use of Low-Dose Aspirin: A Prospective, Randomized, Placebo-Controlled Study

BACKGROUND/AIMS: Long-term use of aspirin can be a risk factor of peptic ulcer diseases. The aim of this study was to evaluate the efficacy of Albis (Daewoong Pharmaceutical Co., Ltd.) for the prevention of gastric mucosal injury caused by aspirin. METHODS: Aspirin users were enrolled and randomized into the Albis or placebo group. Screening and follow-up endoscopy were performed for modified Lanza scores (MLSs). Primary outcome was measured by the incidence rate of peptic ulcer, and secondary outcomes were measured by the incidence rate of gastritis, improvement in MLS and subjective symptoms. RESULTS: In total, 81 aspirin users were randomized, 43 in the Albis group and 38 in the placebo group. There was no incidence of peptic ulcer in both groups. The incidence of gastritis was significantly higher in the placebo group (44.4% vs. 10.0%, p=0.003); however, the scores of mucosal edema, hyperemia and hemorrhage were not statistically different between the two groups (p>0.05). The frequency of subjective symptoms were more improved in the Albis group than in the placebo group (p=0.023). CONCLUSIONS: The incidence of gastritis was lower in the group that received low-dose aspirin and Albis. The development of peptic ulcer due to long-term use of aspirin might be prevented with concomitant use of Albis.