Cut-Off Values of the Post-Intensive Care Syndrome Questionnaire for the Screening of Unplanned Hospital Readmission within One Year

Purpose@#This study aimed to assign weights for subscales and items of the Post-Intensive Care Syndrome questionnaire and suggest optimal cut-off values for screening unplanned hospital readmissions of critical care survivors. @*Methods@#Seventeen experts participated in an analytic hierarchy process for weight assignment. Participants for cut-off analysis were 240 survivors who had been admitted to intensive care units for more than 48 hours in three cities in Korea. We assessed participants using the 18-item Post-Intensive Care Syndrome questionnaire, generated receiver operating characteristic curves, and analysed cut-off values for unplanned readmission based on sensitivity, specificity, and positive likelihood ratios. @*Results@#Cognitive, physical, and mental subscale weights were 1.13, 0.95, and 0.92, respectively.Incidence of unplanned readmission was 25.4%. Optimal cut-off values were 23.00 for raw scores and 23.73 for weighted scores (total score 54.00), with an area of under the curve (AUC) of .933 and .929, respectively. There was no significant difference in accuracy for original and weighted scores. @*Conclusion@#The optimal cut-off value accuracy is excellent for screening of unplanned readmissions. We recommend that nurses use the Post-Intensive Care Syndrome Questionnaire to screen for readmission risk or evaluating relevant interventions for critical care survivors.

Cut-Off Values of the Post-Intensive Care Syndrome Questionnaire for the Screening of Unplanned Hospital Readmission within One Year

Purpose@#This study aimed to assign weights for subscales and items of the Post-Intensive Care Syndrome questionnaire and suggest optimal cut-off values for screening unplanned hospital readmissions of critical care survivors. @*Methods@#Seventeen experts participated in an analytic hierarchy process for weight assignment. Participants for cut-off analysis were 240 survivors who had been admitted to intensive care units for more than 48 hours in three cities in Korea. We assessed participants using the 18-item Post-Intensive Care Syndrome questionnaire, generated receiver operating characteristic curves, and analysed cut-off values for unplanned readmission based on sensitivity, specificity, and positive likelihood ratios. @*Results@#Cognitive, physical, and mental subscale weights were 1.13, 0.95, and 0.92, respectively.Incidence of unplanned readmission was 25.4%. Optimal cut-off values were 23.00 for raw scores and 23.73 for weighted scores (total score 54.00), with an area of under the curve (AUC) of .933 and .929, respectively. There was no significant difference in accuracy for original and weighted scores. @*Conclusion@#The optimal cut-off value accuracy is excellent for screening of unplanned readmissions. We recommend that nurses use the Post-Intensive Care Syndrome Questionnaire to screen for readmission risk or evaluating relevant interventions for critical care survivors.

Delayed contralateral traumatic carotid cavernous fistula after craniomaxillofacial fractures

A carotid-cavernous sinus fistula is a rare condition in which an abnormal communication exists between the internal or external carotid artery and the cavernous sinus. It typically occurs within a few weeks after craniomaxillofacial trauma. In most cases, the carotid-cavernous sinus fistula occurs on the same side as the craniomaxillofacial fracture. We report a case of delayed carotidcavernous sinus fistula that developed symptoms 7 months after the craniomaxillofacial fracture. The fistula developed on the side opposite to that of the craniomaxillofacial fracture. Based on our experience with this case, we recommend a long follow-up period of 7–8 months after the occurrence of a craniomaxillofacial fracture. We also recommend that the follow-up should include consideration of the side contralateral to the injury.

Instruments to Assess Physical Impairments in Post-Intensive Care Syndrome: A Systematic Review / 중환자간호학회지

PURPOSE: The purpose of this study was to systematically review the instruments utilized to assess physical impairment in post-intensive care syndrome (PICS) of intensive care unit (ICU) survivors.METHOD: Online databases searched were MEDLINE, Cochrane, CINAHL, and Embase. Studies that met the following criteria were included: 1) the study population exclusively had experience with ICU admission; 2) the study assessed pulmonary, neuromuscular, and physical functions; and 3) the study was published in English language journals after 2007.RESULTS: A total of 56 instruments (2 pulmonary, 25 neuromuscular, 29 physical function) from 94 studies were reviewed. They were classified into self-report, observation, and measurement according to the type of assessment. No instrument measured all 3 areas of physical impairment. Five instruments were originally developed for the ICU patients. The most frequently applied instruments were the Medical Research Council and the 36-item Short Form Survey (physical component summary), which were used in 23 studies each. Only 13.8% of reviewed studies reported the reliability or validity of the instruments.CONCLUSION: Our results suggest that the appropriateness of instruments assessing physical impairment in PICS cannot be guaranteed. Despite the multidimensional concept of physical disabilities, most studies measured only one area, and studies that reported psychometric properties were limited. Accordingly, we propose to develop a unique and multifaceted instrument for ICU survivors.

Threats to Identity: A Grounded Theory Approach on Student Nurses' Experience of Incivility during Clinical Placement

PURPOSE@#This qualitative study aimed to explore the experience of incivility among nursing students.@*METHODS@#Sixteen nursing students who had experienced incivility during their clinical placement were invited for one-on-one interviews until the point of theoretical saturation. The grounded theory approach of Corbin and Strauss was adopted to analyze transcribed interview contents.@*RESULTS@#Incivility occurred in the context of a hierarchical organizational culture, due to nursing students' position as outsiders, non-systematic clinical education, and poor nursing work environment. The experience of incivility was identified as “being mistreated as a marginal person,” and nursing students responded to this phenomenon in the following three steps: reality shock, passive action, and submissive acceptance. This process caused students to lose self-esteem and undergo role conflict. Furthermore, nursing students' experience of incivility could eventually lead to workplace bullying in nurses.@*CONCLUSION@#The results of this study suggest that nursing students' experience of incivility can be a process that threatens their identity. It is necessary to develop educational programs and provide appropriate counseling services so that nursing students can actively cope with the incivility. In addition, institutional plans are needed to ensure safe and supportive clinical learning environments.

Development and Validation of a Measurement to Assess Person-centered Critical Care Nursing

PURPOSE: The purpose of this study was to develop a scale to measure person-centered critical care nursing and verify its reliability and validity. METHODS: A total of 38 preliminary items on person-centered critical care nursing were selected using content validity analysis of and expert opinion on 72 candidate items derived through literature review and qualitative interviews. We conducted a questionnaire survey with 477 nurses who worked in intensive care units. The collected data were analyzed using exploratory factor analysis (EFA) and confirmative factor analysis (CFA) with SPSS and AMOS 24.0 program. RESULTS: EFA was performed with principal axis factor analysis and Varimax rotation. The 15 items in 4 factors that accounted for 50.8% of the total variance were identified by deleting the items that were not meet the condition that the commonality should be .30 or more and the factor loading over .40. We named the factors as compassion, individuality, respect, and comfort, respectively. The correlation coefficient between this scale and the Caring Perception Scale was r=.57 (p < .001), which determined concurrent validity. The item-total correlation values ranged from .39 to .63, and the internal consistency for the scale was Cronbach's α=.84. CONCLUSION: The reliability and validity of the 15 item person-centered critical care nursing scale were verified. It is expected that the use of this scale would expand person-centered care in critical care nursing.

Threats to Identity: A Grounded Theory Approach on Student Nurses' Experience of Incivility during Clinical Placement

PURPOSE: This qualitative study aimed to explore the experience of incivility among nursing students. METHODS: Sixteen nursing students who had experienced incivility during their clinical placement were invited for one-on-one interviews until the point of theoretical saturation. The grounded theory approach of Corbin and Strauss was adopted to analyze transcribed interview contents. RESULTS: Incivility occurred in the context of a hierarchical organizational culture, due to nursing students' position as outsiders, non-systematic clinical education, and poor nursing work environment. The experience of incivility was identified as “being mistreated as a marginal person,” and nursing students responded to this phenomenon in the following three steps: reality shock, passive action, and submissive acceptance. This process caused students to lose self-esteem and undergo role conflict. Furthermore, nursing students' experience of incivility could eventually lead to workplace bullying in nurses. CONCLUSION: The results of this study suggest that nursing students' experience of incivility can be a process that threatens their identity. It is necessary to develop educational programs and provide appropriate counseling services so that nursing students can actively cope with the incivility. In addition, institutional plans are needed to ensure safe and supportive clinical learning environments.

Post-Intensive Care Syndrome Experience among Critical Care Survivors: A Meta-synthesis of Qualitative Research / 중환자간호학회지

PURPOSE: The purpose of this study was to integrate the results of qualitative studies to understand critical care survivors' experience of the post-intensive care syndrome (PICS).METHODS: This was a meta-synthesis of primary studies that used qualitative methods. We reviewed 26 qualitative studies on PICS selected from 8 international and Korean databases and from a manual search. Thomas and Harden's 3 stages (free coding, development of descriptive themes, generation of analytical themes) for thematic synthesis were utilized to analyze the collected qualitative data.RESULTS: Four descriptive themes emerged from the thematic synthesis: weak physical conditions, psycho-emotional changes, the painful-memory of intensive care units, and social vulnerability. The analytical theme for the current study was “unfamiliarity with the vulnerable self.” Critical care survivors had to confront entirely different “selves” after discharge from intensive care units. They had become physically weak, psychologically unstable, and the critical memories continued to create distress. These changes increased their social vulnerability by making them dependent on others, causing family conflicts, and changing interpersonal relationships.CONCLUSIONS: Finding from this qualitative synthesis and other related literature highlight the severity of PICS and the importance of rehabilitative intervention for critical care survivors.

Liposarcoma in the Axilla Developed from a Longstanding Lipoma

No abstract available.

Nitric Oxide-Induced Apoptosis of Human Dental Pulp Cells Is Mediated by the Mitochondria-Dependent Pathway

Nitric oxide (NO) is recognized as a mediator and regulator of inflammatory responses. NO is produced by nitric oxide synthase (NOS), and NOS is abundantly expressed in the human dental pulp cells (HDPCs). NO produced by NOS can be cytotoxic at higher concentrations to HDPCs. However, the mechanism by which this cytotoxic pathway is activated in cells exposed to NO is not known. The purpose of this study was to elucidate the NO-induced cytotoxic mechanism in HDPCs. Sodium nitroprusside (SNP), a NO donor, reduced the viability of HDPCs in a dose- and time-dependent manner. We investigated the in vitro effects of nitric oxide on apoptosis of cultured HDPCs. Cells showed typical apoptotic morphology after exposure to SNP. Besides, the number of Annexin V positive cells was increased among the SNP-treated HDPCs. SNP enhanced the production of reactive oxygen species (ROS), and N-acetylcysteine (NAC) ameliorated the decrement of cell viability induced by SNP. However, a soluble guanylate cyclase inhibitor (ODQ) did not inhibited the decrement of cell viability induced by SNP. SNP increased cytochrome c release from the mitochondria to the cytosol and the ratio of Bax/Bcl-2 expression levels. Moreover, SNP-treated HDPCs elevated activities of caspase-3 and caspase-9. While pretreatment with inhibitors of caspase (z-VAD-fmk, z-DEVD-fmk) reversed the NO-induced apoptosis of HDPCs. From these results, it can be suggested that NO induces apoptosis of HDPCs through the mitochondria-dependent pathway mediated by ROS and Bcl-2 family, but not by the cyclic GMP pathway.

Clinical Experience of Stewart-Treves Syndrome in the Lower Leg

No abstract available.

Involvement of Bcl-2 Family and Caspases Cascade in Sodium Fluoride-Induced Apoptosis of Human Gingival Fibroblasts

Sodium fluoride (NaF) has been shown to be cytotoxic and elicit inflammatory response in human. However, the cellular mechanisms underlying NaF-induced cytotoxicity in periodontal tissues have not yet been elucidated. This study is aimed to investigate the mechanisms of NaF-induced apoptosis in human gingival fibroblast (HGF). NaF decreased the cell viability of HGF in a dose- and time-dependent manner. NaF gave rise to apoptotic morphological changes including cell shrinkage, chromatin condensation, and DNA fragmentation. However, NaF did not affect the production of ROS. In addition, NaF augumented cytochrome c release from mitochondria into the cytosol, and enhanced caspase -9 and -3 activities., cleavage (85 kDa fragments) of poly (ADP-ribose) polymerase (PARP) and upregulation of voltage-dependent anion channel (VDAC) 1. These results demonstrated that NaF-induced apoptosis in HGF may be mediated with mitochondria. Furthermore, NaF elevated caspase-8 activity and upregulated Fas-ligand (Fas-L), suggesting involvement of death receptor mediated pathway in NaF-induced apoptosis. Expression of Bcl-2, an anti-apoptotic Bcl-2 family, was downregulated, whereas expression of Bax, a pro-apoptotic Bcl-2 family, was not affected in NaF-treated HGF. These results suggest that NaF induces apoptosis in HGF through both mitochondria- and death receptor-mediated pathway mediated by Bcl-2 family.

Involvement of Caspases and Bcl-2 Family in Nitric Oxide-Induced Apoptosis of Rat PC12 Cells

This study was aimed to investigate the nitric oxide (NO)-induced cytotoxic mechanism in PC12 cells. Sodium nitroprusside (SNP), an NO donor, decreased the viability of PC12 cells in dose- and time-dependent manners. SNP enhanced the production of reactive oxygen species (ROS), and gave rise to apoptotic morphological changes including cell shrinkage, chromatin condensation, and DNA fragmentation. Expression of Bax was not affected, whereas Bcl-2 was downregulated in SNP-treated PC12 cells. SNP augmented the release of cytochrome c from mitochondria into cytosol and enhanced caspase -8, -9, and -3 activities. SNP upregulated both Fas and Fas-L, which are known to be components of death receptor assembly. These results suggest that NO induces apoptosis of PC12 cells through both mitochondria- and death receptor-mediated pathways mediated by ROS and Bcl-2 family.

Inhibition of Hypoxia-induced Apoptosis in PC12 Cells by Estradiol

Neuronal apoptotic events, which result in cell death, are occurred in hypoxic/ischemic conditions. Estradiol is a female sex hormone with steroid structure known to provide neuroprotection through multiple mechanisms in the central nervous system. This study was aimed to investigate the signal transduction pathway of CoCl2-induced neuronal cell death and the inhibitory effects of estradiol. Administration of CoCl2 decreased cell viability in both a dose- and time-dependent manner in PC12 cells. CoCl2-induced cell death produced genomic DNA fragmentation and morphologic changes such as cell shrinkage and condensed nuclei. It was found that CoCl2-treated cells increased the reactive oxygen species (ROS) as well as caspase-8, -9 and -3 activities. However, pretreatment with estradiol before exposure to CoCl2 prevented the reduction in cell viability reduction and attenuated DNA fragmentation and morphologic changes caused by CoCl2. Furthermore, the CoCl2-induced increases of ROS levels and caspases activities were attenuated by estradiol. Gene expression analysis revealed that estradiol blocked the underexpression of the Bcl-2 and ameliorated the increase in the release of cytochrome c from mitochondria into cytoplasm and Fas-ligand (Fas-L) upregulated by CoCl2. These results suggest that CoCl2 induce apoptosis in PC12 cells through both mitochondria- and death receptor-mediated cell death pathway. Estradiol was found to have a neuroprotective effect against CoCl2-induced apoptosis through the inhibition of ROS production and by modulating apoptotic effectors associated with the mitochondria- and death-dependent pathway in PC12 cells.

Inhibition of Nitric Oxide-induced Neuronal Apoptosis in PC12 Cells by Epigallocatechin Gallate

In the central nervous system, nitric oxide (NO) is associated with many pathological diseases such as brain ischemia, neurodegeneration and inflammation. The epigallocatechin gallate (EGCG), a major compound of green tea, is recognized as protective substance against neuronal diseases. This study is aimed to investigate the effect of EGCG on NO-induced cell death in PC12 cells. Administration of sodium nitroprusside (SNP), a NO donor, decreased cell viability in a dose- and time-dependent manner and induced genomic DNA fragmentation with cell shrinkage and chromatin condensation. EGCG diminished the decrement of cell viability and the formation of apoptotic morphologenic changes as well as DNA fragmentation by SNP. EGCG played as an antioxidant that attenuated the production of reactive oxygen species (ROS) by SNP. The cells treated with SNP showed downregulation of Bcl-2, but upregulation of Bax. EGCG ameliorated the altered expression of Bcl-2 and Bax by SNP. The release of cytochrome c from mitochondria into cytosol and expression of voltage -dependent anion channel (VDAC) 1, a cytochrome c releasing channel in mitochondria, were increased in SNP-treated cells, whereas were attenuated by EGCG. The enhancement of caspase-9, preceding mitochondria-dependent pathway, caspase-8 and death receptor-dependent pathway, as well as caspase-3 activities were suppressed by EGCG. SNP upragulated Fas and Fas-L, which are death receptor assembly, whereas EGCG ameliorated the expression of Fas enhanced by SNP. These results demonstrated that EGCG has a protective effect against SNP-induced apoptosis in PC12 cells, through scavenging ROS and regulating the mitocondria- and death receptor-mediated signal pathway. The present study suggest that EGCG might be a natural neuroprotective substance.

Nitric Oxide (NO) Inhibites the Neuronal Activities in the Rat Nucleus Tractus Solitarius

Nitric oxide (NO) system has been implicated in a wide range of physiological functions in the nervous system. However, the roleof NO in regulating the neural activity in the gustatory zone of nucleus tractus solitarius (NTS) has not been established. The present study was aimed to investigate the role of NO in the gustatory NTS neurons. Sprague-Dawley rats, weighing about 50 g, were used. Whole cell patch recording and immunohistochemistry were done to determine the electrophysiological characteristics of the rostral gustatory nucleus of the tractus solitarius and distribution of NO synthases (NOS). Neuronal NOS (nNOS) immunoreactivity was strongly detected along the solitary tract extending from rostral to caudal medulla. Resting membrane potentials of NTS neurons were -49.2+/-2 mV and action potential amplitudes were 68.5+/-2 mV with a mean duration measured at half amplitude of 1.7+/-0.3 ms. Input resistance, determined from the response to a 150 ms, -100 pA hyperpolarizing current pulse, was 385+/-15 MOmega. Superfusion of SNAP or SNP, NO donors, produced either hyperpolarization (68%), depolarization (5%), or no effect (27%). The hyperpolarization was mostly accompanied by a decrease in input resistance. The hyperpolarization caused by SNAP or SNP increased the time to initiate the first action potential, and decreased the number of action potentials elicited by current injection. SNP or SNAP also markedly decreased the number of firing neural discharges of the spontaneous NTS neural activity under zero current. Superfusion of L-NAME, a NOS inhibitor, slightly depolarized the membrane potential and increased the firing rate of NTS neurons induced by current injection. ODQ, a soluble guanylate cyclase inhibitor, ameliorated the SNAP-induced changes in membrane potential, input resistance and firing rates. 8-Br-cGMP, a non-degradable cell-permeable cGMP, hyperpolarized the membrane potential and decreased the number of action potentials. It is suggested that NO in the gustatory NTS has an inhibitory role on the neural activity of NTS through activating soluble guanylate cyclase.

Nociceptive and Trigeminal Cardiovascular Reflex Mechanisms after Noxious Intrapulpal Stimulation of the Rat Incisors / 대한해부학회지

Expression of c-Fos, an immediate early gene, has accepted to be a marker of functional activity in neurons. This study was aimed to investigate the dental pain pathway and the affection of dental pain on other brain regions such as the cardiovascular regulation center using c-Fos immunohistochemistry. Expression of c-Fos in Sprague Dawley rats weighting 300 ~350 gm was examined 1.5 hr after dental pain elicited by intrapulpal injecton of 2 M KCl into upper and lower incisor pulps exposed by bone cutter. c-Fos positive neurons were demonstrated in the trigeminal nucleus caudalis and the ventroposterior medial nucleus of thalamus known to be a sharp pathway. Dental pain enhanced mean arterial pressure and heart rate. In addition, c-Fos expression was induced in the rostral ventrolateral nucleus of medulla oblongata, nucleus tractus solitarius, paraventricular nucleus and supraoptic nucleus of hypothalamus, central presser areas of systemic blood pressure. These results suggest that trigeminal nucleus caudalis and ventroposterior medial nucleus of thalamus plays vital roles in the transmission of dental pain besides, dental pain affected the central cardiovescular regulation centers, resulting to the elevation of systemic blood pressure.

Distribution of Aquaporins (Water Channels) in the Rat Salivary Glands / 대한해부학회지

The salivary glands produce 1.5 l of fluid per day. As in other organs, the general paradigm in the salivary glands is that water movement occurs secondary to osmotic driving forces created by active salt transport. Therefore, high water permeability in salivary glands is expected to need a variety of aquaporin (AQP), a water channel. Although four AQPs have been known to reside in salivary glands, the precise location and roles of AQPs have been not well examined. This study is aimed to investigate the distribution of AQPs in 3 major salivary glands and their changes after cholinergic stimulation using immunohistochemical study in Sprague Dawley rats weighing 300 g under pentobarbital sodium anesthesia. AQP1 was localized in the endothelial cells of all salivary capillary vessels and the myoepithelial cells. AQP4 was demonstrated in the epithelium of the excretory ductal cells of all salivary glands. AQP5 and 8 were abundantly present in the basolateral membrane and apical membranes of the serous acini including intercellular secretory canaliculi, whereas AQP5 was weakly present in mucous acini. In addition, AQP5 was found in the epithelium of the intercalated and striated ducts. Upon stimulation of carbachol (10 micro gram/kg, I.P). AQP5 and 8 tended to translocate from basolateral membrane to the apical membrane, appearing as clusters of dots. These results suggest that AQP5 and 8 are the candidate molecules responsible for the water movement in salivary acinar cells.

Cauda Equina Syndrome Following Epidural Anesthesia: A case report / 대한마취과학회지

Severe neurologic complication after epidural anesthesia is very rare. We experinced a case of cauda equina syndrome following epidural anesthesia with 2% lidocaine 20 ml, alkalinized with sodium bicarbonate and 1: 200,000 epinephrine added in female patient underwent abdominal hysterectomy. She complained hypoesthesia of buttock, perineum, left leg and weakness of left leg. She also suffered from urinary retension and defecation difficulty and abdominal discomfort 2 days after epidural block. In MRI taken 4 days after block, spinal stenosis (L4-5) and mild disc bulging (L3-4) were noted. She was treated with medication, bladder training and physical therapy and recovered slowly but gradually, finally discharged 2 months after block with mild weakeness of left leg. We suggest the causative factors are the temporary neural compression due to spinal stenosis and the spinal cord ischemia due to vascular spasm because of added epinephrine.