Effects of ASPAN's Evidence-based Clinical Practice Guidelines for Promotion of Hypothermia of Patients with Total Knee Replacement Arthroplasty

PURPOSE: In this study an examination was done of the effects of the American Society of PeriAnesthesia Nurses (ASPAN) Evidence-Based Clinical Practice Guidelines on body temperature, shivering, thermal discomfort, and time to achieve normothermia in patients undergoing total knee replacement arthroplasty (TKRA) under spinal anesthesia. METHODS: This study was an experimental study with a randomized controlled trial design. Participants (n=60) were patients who underwent TKRA between December 2011 and March 2012. Experimental group (n=30) received active and passive warming measures as described in the ASPAN's guidelines. Control group (n=30) received traditional care. Body temperature, shivering, thermal discomfort, time to achieve normothermia were measured in both groups at 30 minute intervals. RESULTS: Experimental group had slightly higher body temperature compared to control group (p=.002). Thermal discomfort was higher in the experimental group before surgery but higher in the control group after surgery (p=.034). It decreased after surgery (p=.041) in both groups. Time to achieve normothermia was shorter in the experimental group (p=.010). CONCLUSION: ASPAN's guidelines provide guidance on measuring patient body temperature at regular intervals and on individualized and differentiated hypothermia management which can be very useful in nursing care, particularly in protecting patient safety and improving quality of nursing.

The Effects of Pre-operative Visual Information and Parental Presence Intervention on Anxiety, Delirium, and Pain of Post-Operative Pediatric Patients in PACU

PURPOSE: The purpose of this study was to test whether pre-operative visual information and parental presence had positive effects on anxiety, delirium, and pain in pediatric patients who awoke from general anesthesia in a post-surgical stage. METHODS: This study used a non equivalent control-group post test design (n=76). Independent variables were provision of pre-operative visual information and parental presence for post-surgical pediatric patients in PACU (post anesthesia care unit). Dependent variables were anxiety, delirium, and pain in the pediatric patients measured three times at 10 minute intervals after extubation in the PACU. Measurements included Numerical Rating Scale for assessing state anxiety, Pediatric Anesthesia Emergence Delirium Scale by Sikich & Lerman (2004) for delirium, and Objective Pain Scale by Broadman, Rice & Hannallah (1988) for pain. RESULTS: Experimental group showed significantly decreased state anxiety at time points-10, 20, and 30 minutes after extubation. Delirium was significantly lower at 10 minutes and 30 minutes after extubation in the experimental group. Pain was significantly lower at 10 minutes after extubation in the experimental group. CONCLUSION: The results of this study suggest that this intervention can be a safe pre-operative nursing intervention for post-surgical pediatric patients at PACU.

Apoptotic Effect of Combination Treatment with a Proteasome Inhibitor, Lactacystin, and a Histone Deacetylase Inhibitor, Trichostatin A, on MCF-7 Cells / 대한해부학회지

Although much information has been accumulated about the synergistic interaction of proteasome inhibitors and HDAC inhibitors to induce apoptosis in a certain type of cells, much less is known currently about the underlying mechanism. This study was undertaken to explore the combination effect of a histone deacetylase inhibitor, TSA, and a proteasome inhibitor, lactacystin, on the induction of apoptosis. Pretreatment of TSA and subsequent treatment of lactacystin showed the strong antitumor activity and nuclear condensation. Western blot assay showed that combination treatment of TSA and lactacystin increased Bax/Bcl-2 ratio and decreased level of XIAP. Activation of caspase-7 and cleavage of PARP were demonstrated after the combination treatment. In combination treatment group, cell cycle arrest was induced at G2/M phase and abolished increase in proteasome activity. This study is elucidating the mechanims whereby targeting apoptotic machineries may help in directing therapeutic strategies.

Simultaneous Detection of Adenovirus types 3, 7 and 11 by a Multiplex PCR from Cell Cultured Clinical Specimens of Hospitalized Patients

Adenovirus (AD) is classified into A, B, C, D, E and F subgenera on the basis of neutralization, hemagglutination and DNA homology tests. Six AD subgenera have 51 serotypes. We selected AD types 3, 7, and 11 since they are known to frequently cause respiratory disease, gastrointestinal disease and meningitis, which often require hospitalization of the patients. The purpose of this study was to detect and to evaluate the correlation of AD types 3, 7 and 11 and the diseases. The detection method, used for AD types 3, 7 and 11, was a multiplex polymerase chain reaction (PCR) with HEp-2 cell cultured with clinical samples. The result was as follows: AD 3 (22/62, 35.5%), AD 7 (27/62, 43.5%), and AD 11 (50/62, 80.6%) were detected by the multiplex PCR in 62 clinical samples. AD 3 detection rate in cerebrospinal fluid was relatively higher than in other specimens but its statistical significance was low (p=0.07). AD 11 was detected (50/62, 80.6%) with the highest frequency and appeared to significantly be associated with gastroenteritis, respiratory disease, and meningitis in hospitalized children, and arthritis in adult patients. AD 3, AD 7 and AD 11 types were detected singly in 21/62 (33.9%), doubly in 15/62 (24.2%), and triply in 16/62 (25.8%). The multiplex PCR method using Hep2 cell culture with clinical specimens could detect AD types 3, 7, and 11 in children with meningitis, respiratory infection, or gastroenteritis, and in adults with cancer and arthritis.

Haemophilus influenzae and Human Herpes Virus-6 Detection by EIA and PCR in CSF from Young Hospitalized Children with Aseptic Meningitis

There are various microbial agents which causing meningitis in children. It is well known that Haemophilus influenzae (HI) are the most frequent bacterial agents. In Korea, it is hard to find studies detecting HI in cerebrospinal fluid (CSF) from pediatric patients with aseptic meningitis by PCR. It has been also reported that human herpes virus-6 (HHV-6) causes meningitis, meningoencephalitis, neuroinvasion and persistent infection of the central nervous system in children. In this study we also detected HHV-6 in the same CSF by EIA and PCR. We used 85 CSF specimens from 85 aseptic meningitis patients (mean age 6.6 years) taken from the Department of pediatrics at Ewha Womans University MokDong Hospital from June 2001 to August 2002. Detection rate of HI by EIA method was 12.9% (11/85) and by PCR was 16.5% (14/85). Detection rate of HHV-6 by EIA and by PCR was 18.8% (16/85) and 21.2% (18/85), respectively. Co-detection rate of HI and HHV-6 was 7.1% (6/85) by EIA and 12.9% (11/85) by PCR. In conclusion, by PCR in combination with EIA, HI infection could be proved in the aseptic meningitis CSF from which no bacterium was cultivated.