Participation and Influencing Factors in the Decision-Making of Life-Sustaining Treatment:A Focus on Deceased Patients with Hematologic Neoplasms / 한국호스피스완화의료학회지

Purpose@#This study aimed to investigate the involvement of patients who died from hematologic neoplasms in the decision-making process surrounding the withdrawal of lifesustaining treatment (LST). @*Methods@#A total of 255 patients diagnosed with hematologic neoplasms who ultimately died following decisions related to LST during their end-of-life period at a university hospital were included in the study. Data were retrospectively obtained from electronic medical records and analyzed utilizing the chi-square test, independent t-test, and logistic regression. @*Results@#In total, 42.0% of patients participated in the decision-making process regarding LST for their hematologic neoplasms, while 58.0% of decisions were made with family involvement. Among these patients, 65.1% died in general wards and 34.9% in intensive care units (ICUs) as a result of decisions such as the suspension of LST. The period from the LST decision to death was longer when the decision was made by the patient (average, 27.15 days) than when it was made by the family (average, 7.48 days). Most decisions were made by doctors and family members in the ICU, where only 20.6% of patients exercised their right to make decisions regarding LST, a rate considerably lower than 79.4% observed in general wards. Decisions to withhold or withdraw LST were more commonly made by patients themselves than by their families. @*Conclusion@#The key to discussing the decision to suspend hospice care and LST is respecting the patient’ s self-determination. If a patient is lucid prior to admission to the ICU, considerations about suspending LST should involve the patient input.

Nurses’ Intentions for COVID-19 Vaccination in South Korea in 2022 / 기본간호학회지

Purpose@#This study was to identify nurses’ intentions for COVID-19 vaccination in 2022. @*Methods@#A questionnaire survey was conducted among 222 nurses in Korea. The collected data were analyzed using the independent t-test, one-way analysis of variance, the Wilcoxon rank sum test, Pearson’s correlation coefficients, and multiple regression analysis. @*Results@#The score for intention to be vaccinated against COVID-19 in 2022 was 2.70 points on a 5-point scale, significantly lower than in 2020 (3.02 points on a 5-point scale). The average score for knowledge related to COVID-19 was 7.22 out of 10 points. Positive correlations were found between the intention for COVID-19 vaccination in 2022 and preventive health behavior, as well as between nurses’ intentions for COVID-19 vaccination in 2022 and 2020. The factors affecting nurses’ intentions for COVID-19 vaccination in 2022 were preventive health behavior (β=.11, p=.045) and nurses’ intentions for COVID-19 vaccination in 2020 (β=.65, p<.001). This model showed a significant explanatory power of approximately 45% (F=36.88, p<.001) for the COVID-19 vaccination intention in 2022. @*Conclusion@#This result points to the importance of managing nurses’ preventive health behaviors to promote COVID-19 vaccination uptake. Nurses’ vaccination intentions are an important issue for the safety of both nurses and patients. A safe vaccination environment and national policy should be prepared to reduce nurses' hesitations about COVID-19 vaccination.

Improving Patients’ Perception of the Quality of Nursing Services and Nurses’ Perception of Nursing Rounds through Purposeful and Timely Nursing Rounds / 간호행정학회지

Purpose@#This descriptive study aimed to identify the effects of purposeful and timely nursing rounds on patients' perception of the quality of nursing services and nurses' perception of nursing rounds. @*Methods@#Intentional nursing rounds were conducted by communicating patients’ questions on pain, position, pump, potty, and possessions. A total of 144 nurses and 149 patients participated, and data were collected using self-report questionnaires. The independent t-test, x 2 test, and Wilcoxon’s rank-sum test were used to analyze the data with SPSS version 24.0. @*Results@#Although intentional nursing rounds improved the nurses’ perception of nursing rounds, there was no significant difference. The nurses’ benefit had the lowest score (3.36), and the benefit of communication with patients had the highest score (3.79).Intentional nursing rounds significantly improved the patients’ perception of the quality of nursing services in the intervention group. Among the factors of empathy (Z=4.98, p<.001) related to the quality of nursing services as perceived by the patient, assurance (Z=5.50, p<.001), reliability (Z=4.43, p<.001), and responsiveness (Z=5.02, p<.001) significantly increased. @*Conclusion@#Intentional nursing rounds positively affected patients’ perception of the quality of nursing service. It is important to improve intentional nursing rounds to enhance nurses’ perceptions of them.

Correlation between the actual sleep time 24 hours prior to an examination and the time to achieve chloral hydrate sedation in pediatric patients in South Korea: a prospective cohort study

Purpose@#This study investigated correlations between the actual sleep time 24 hours prior to an examination and the time to achieve chloral hydrate sedation in pediatric patients. @*Methods@#With parental consent, 84 children who were placed under moderate or deep sedation with chloral hydrate for examinations from November 19, 2020 to July 9, 2022 were recruited. @*Results@#Patients' average age was 19.9 months. Pediatric neurology patients and those who underwent electroencephalography took significantly longer to achieve sedation with chloral hydrate. There was a negative correlation between the time to achieve sedation and actual sleep time within 24 hours prior to the examination. Positive correlations were found between the actual sleep time 24 hours prior to the examination and the second dose per weight, as well as between the sedation recovery time and awake hours before the examination. @*Conclusion@#Sleep restriction is not an effective adjuvant therapy for chloral hydrate sedation in children, and sedation effects vary according to pediatric patients' characteristics. Therefore, it would be possible to reduce the unnecessary efforts of caregivers who restrict children's sleep for examinations. It is more important to educate parents about safe sedation than about sleep restriction.

Depth of double-lumen endobronchial tube: a comparison between real practice and clinical recommendations using height-based formulae

The depth of double-lumen endobronchial tube (DLT) is reportedly known tobe directly proportional to height and several height-based recommendations have beensuggested. This retrospective study was designed to find out the difference between calculated depths using height-based formulae and realistic depths in clinical practice of DLTplacement by analyzing pooled data from patients intubated with left-sided DLT.Methods: The electronic medical records of adults, intubated with DLT from February 2018to December 2020, were reviewed. Data retrieved included age, sex, height, weight, andsize and depth of DLT. The finally documented DLT depth (depth final, DF) was comparedwith the calculated depths, and the relationship between height and DF was also evaluated.A questionnaire on endobronchial intubation method was sent to anesthesiologists.Results: A total of 503 out of 575 electronic records of consecutive patients were analyzed.Although the relationship between height and DF was shown to have significant correlation(Spearman’s rho = 0.63, P < 0.001), DF was shown to be significantly greater than calculated depths (P < 0.001). Despite 57.1% of anesthesiologists have knowledge of clinical recommendations to anticipate size and depth of DLT, no one routinely utilizes those recommendations.Conclusions: Anesthesiologists tend to place DLTs in a deeper position than expected whendepths are calculated using height-based recommendations. Although such discrepanciesmay not be clinically meaningful, efforts are needed to standardize the methods of endobronchial intubation to prevent potential complications associated with malposition.

Analysis of ROX Index, ROX-HR Index, and SpO 2 /FIO 2 Ratio in Patients Who Received HighFlow Nasal Cannula Oxygen Therapy in Pediatric Intensive Care Unit

Purpose@#This study aimed to evaluate the use of the respiratory rate oxygenation (ROX) index, ROX-heart rate (ROX-HR) index, and saturation of percutaneous oxygen/fraction of inspired oxygen ratio (SF ratio) to predict weaning from high-flow nasal cannula (HFNC) in patients with respiratory distress in a pediatric intensive care unit. @*Methods@#A total of 107 children admitted to the pediatric intensive care unit were enrolled in the study between January 1, 2017, and December 31, 2021. Data on clinical and personal information, ROX index, ROX-HR index, and SF ratio were collected from nursing records. The data were analyzed using an independent t-test, χ2 test, Mann–Whitney U test, and area under the curve (AUC). @*Results@#Seventy-five (70.1%) patients were successfully weaned from HFNC, while 32 (29.9%) failed. Considering specificity and sensitivity, the optimal cut off points for predicting treatment success and failure of HFNC oxygen therapy were 6.88 and 10.16 (ROX index), 5.23 and 8.61 (ROX-HR index), and 198.75 and 353.15 (SF ratio), respectively. The measurement of time showed that the most significant AUC was 1 hour before HFNC interruption. @*Conclusion@#The ROX index, ROX-HR index, and SF ratio appear to be promising tools for the early prediction of treatment success or failure in patients initiated on HFNC for acute hypoxemic respiratory failure. Nurses caring for critically ill pediatric patients should closely observe and periodically check their breathing patterns. It is important to continuously monitor three indexes to ensure that ventilation assistance therapy is started at the right time.

Current concepts of craniofacial fibrous dysplasia: pathophysiology and treatment

Fibrous dysplasia is an uncommon genetic disorder in which bone is replaced by immature bone and fibrous tissue, manifesting as slowgrowing lesions. Sporadic post-zygotic activating mutations in GNAS gene result in dysregulated GαS-protein signaling and elevation of cyclic adenosine monophosphate in affected tissues. This condition has a broad clinical spectrum, ranging from insignificant solitary lesions to severe disease. The craniofacial area is the most common site of fibrous dysplasia, and nine out of 10 patients with fibrous dysplasia affecting the craniofacial bones present before the age of 5. Surgery is the mainstay of treatment, but the technique varies according to the location and severity of the lesion and associated symptoms. The timing and indications of surgery should be carefully chosen with multidisciplinary consultations and a patient-specific approach.

Factors Affecting Intensive Care Unit Nurses’ Care Burden of Patients with Hematologic Neoplasm

Purpose@#This study was a descriptive study to identify the factors affecting nurses' care burden of patients with hematologic neoplasm (PHN) in the intensive care unit (ICU). @*Methods@#A total of 139 ICU nurses were enrolled and data were collected using self-report questionnaires about compassion satisfaction, compassion fatigue, nursing work performance, and the care burden of PHN. Data were analyzed using the independent t-test and one–way analysis of variance, Pearson's correlation coefficient, and hierarchical regression analysis. @*Results@#The average of nurses’ care burden of PHN was 35.75 points in the ICU. Analyzing the correlations among the main variables showed that the care burden of PHN showed a negative correlation with compassion satisfaction and nursing work performance, and a positive correlation with compassion fatigue. We noted that the compassion satisfaction showed a negative correlation with burnout and a positive correlation with nursing work performance. The factor affecting the care burden of PHN was burnout (β=.30, p=.019), and showed a significant explanatory power of 16.0% (F=7.37, p<.001) @*Conclusion@#Efforts such as policies and nurse support programs are needed to reduce burnout, a factor that affects care burden of PHN in intensive care nurses.

Association between anesthetic method and postpartum hemorrhage in Korea based on National Health Insurance Service data

Postpartum hemorrhage (PPH) is a major cause of maternal mortality and the risk factors for PPH differ among studies. In this large-scale study, we investigated whether the anesthetic method used was associated with PPH after cesarean section. Methods: We extracted data on cesarean sections performed between January 2008 and June 2013 from the National Health Insurance Service database. The anesthetic methods were categorized into general, spinal and epidural anesthesia. To compare the likelihood of PPH among deliveries using different anesthetic methods, crude and adjusted odds ratios (ORs) and 95% confidence intervals were calculated using logistic regression analysis. Results: Data from 330,324 cesarean sections were analyzed, and 21,636 cases of PPH were identified. Univariate analysis showed that general and epidural anesthesia increased the risk of PPH compared to spinal anesthesia. The OR for PPH was highest for morbidly adherent placenta, followed by placenta previa, placental abruption, and hypertension. When other clinical covariates were controlled for, general and epidural anesthesia still remained significant risk factors for PPH compared to spinal anesthesia. Conclusions: This study showed that general and epidural anesthesia elevated the risk of PPH compared to spinal anesthesia during cesarean section. Since we could not consider the potential bias of group differences in indications, more in-depth clinical trials are needed to validate our findings. Obstetric factors such as placental abnormalities had high odds ratios and thus are more important than the choice of anesthetic method, which should be based on the patient’s clinical condition and institutional resources.

Assessment of Perioperative Atelectasis Using Lung Ultrasonography in Patients Undergoing Pneumoperitoneum Surgery in the Trendelenburg Position: Aspects of Differences according to Ventilatory Mode

Background@#During robotic gynecologic pneumoperitoneum surgery in the Trendelenburg position, aeration loss leads to perioperative atelectasis. Recently developed ventilator mode pressure-controlled ventilation volume-guaranteed (PCV-VG) mode could provide adequate ventilation with lower inspiratory pressure compared to volume-controlled ventilation (VCV); we hypothesized that PCV-VG mode may be beneficial in reducing perioperative atelectasis via low tidal volume (VT ) of 6 mL/kg ventilation during robotic gynecologic pneumoperitoneum surgery in the Trendelenburg position. We applied lung ultrasound score (LUS) for detecting perioperative atelectasis. We aimed to compare perioperative atelectasis between VCV and PCV-VG with a low VT of 6 mL/kg during pneumoperitoneum surgery in the Trendelenburg position using LUS. @*Methods@#Patients scheduled for robotic gynecologic surgery were randomly allocated to the VCV (n = 41) or PCV-VG group (n = 41). LUS, ventilatory, and hemodynamic parameters were evaluated at T1 (before induction), T2 (10 minutes after induction in the supine position), T3 (10 minutes after desufflation of CO2 in the supine position), and T4 (30 minutes after emergence from anesthesia in the recovery room). @*Results@#Eighty patients (40 with PCV-VG and 40 with VCV) were included. Demographic data showed no significant differences between the groups. The total LUS has changed from baseline to T4, 0.63 (95% confidence interval [CI], 0.32, 0.94) to 1.77 (95% CI, 1.42, 2.21) in the VCV group and 0.86 (95% CI, 0.56, 1.16) to 1.43 (95% CI, 1.08, 1.78) in the PCV-VG group (P = 0.170). In both groups, total LUS increased significantly compared to the baseline values. @*Conclusion@#Using a low VT of 6 mL/kg during pneumoperitoneum surgery in the Trendelenburg position, our study showed no evidence that PCV-VG ventilation was superior to VCV in terms of perioperative atelectasis.

Compare Value Congruence of Nurse-Patient Assignment with Work Performance in Neonatal Intensive Care Unit / 간호행정학회지

Purpose@#This study aimed to compare the value congruence of nurse-patient assignment (NPA) with work performance in the neonatal intensive care unit (NICU). @*Methods@#Data were collected with 30-items on factors that affect NPA and 17-items on work performance. Two questionnaire surveys each were conducted with 79 nurses from the NICU. The difference between expectations and actual experience on NPA were analyzed, and the effects of NPA on work performance and overtimes were investigated. The collected data were analyzed with a paired t-test, analysis of variance, and Pearson’s correlation coefficients using the SPSS software version 20.0. @*Results@#The NPA criteria were surveyed with 30 items, with 13 patient-related, and 17 nurse-related. The validity of the tool was S-CVI .95 and the reliability (Cronbach’s ⍺) was .942. There were significant differences based on age (F=3.69, p=.029) and caring for patients on an artificial ventilator (t=2.55, p=.013). The higher the patient-related actual assignment score, the higher the nurse-related actual assignment score (r=.68, p<.001) and work performance (r=.48, p<.001). As the nurse-related actual assignment score increased, work performance also increased significantly (r=.36, p=.001). @*Conclusion@#It was confirmed that the value congruence of NPA is positively correlated with work performance.

Differences in perceived parental stress between parents with very low birth weight infants and nurses in neonatal intensive care units, South Korea

Purpose@#This descriptive study compared the perceived parental stress levels between parents with very low birth weight infants (VLBWIs) and nurses in the neonatal intensive care unit (NICU). @*Methods@#In total, 83 parents of VLBWIs and 78 NICU nurses were enrolled. Data were collected with the Parental Stress Scale (PSS) and analyzed using the t-test and analysis of variance in SAS version 9.4. @*Results@#The average PSS score was 3.31 among parents and 3.45 among nurses. The stress score was significantly higher among nurses with children (t=2.46, p=.016) and senior nurses (t=2.12, p=.037). There was a significant difference in the stress score according to parents' education (t=3.29, p=.002) and occupation (F=3.14, p=.049) in the sights and sounds subscale. Mothers had significantly higher stress scores than fathers in the parental role alterations subscale (t=2.32, p=.023). Parental stress scores were higher than those perceived by nurses in the infant's appearance and behaviors subscale for breathing patterns (t=2.95, p=.004), followed by jerky/ restless behavior (t=2.70, p=.008). @*Conclusion@#Nurses should provide explanations to parents of VLBWIs in order to reduce parental stress about the appearances and behavior of VLBWIs. This is more important than aspect of the NICU environment and education about parental roles.

Evaluating the accuracy (trueness and precision) of interim crowns manufactured using digital light processing according to post-curing time: An in vitro study

PURPOSE@#This study aimed to compare the accuracy (trueness and precision) of interim crowns fabricated using DLP (digital light processing) according to postcuring time. MATERIALS AND METHODS: A virtual stone study die of the upper right first molar was created using a dental laboratory scanner. After designing interim crowns on the virtual study die and saving them as Standard Triangulated Language files, 30 interim crowns were fabricated using a DLP-type 3D printer. Additively manufactured interim crowns were post-cured using three different time conditions-10-minute post-curing interim crown (10-MPCI), 20-minute postcuring interim crown (20-MPCI), and 30-minute post-curing interim crown (30-MPCI) (n = 10 per group). The scan data of the external and intaglio surfaces were overlapped with reference crown data, and trueness was measured using the best-fit alignment method. In the external and intaglio surface groups (n = 45 per group), precision was measured using a combination formula exclusive to scan data (10 C2). Significant differences in accuracy (trueness and precision) data were analyzed using the Kruskal-Wallis H test, and post hoc analysis was performed using the Mann-Whitney U test with Bonferroni correction (α=.05). @*RESULTS@#In the 10-MPCI, 20-MPCI, and 30-MPCI groups, there was a statistically significant difference in the accuracy of the external and intaglio surfaces (P <.05). On the external and intaglio surfaces, the root mean square (RMS) values of trueness and precision were the lowest in the 10-MPCI group. @*CONCLUSION@#Interim crowns with 10-minute post-curing showed high accuracy.

Long-term Outcomes of Clopidogrel Monotherapy versus Prolonged Dual Antiplatelet Therapy beyond 12 Months after Percutaneous Coronary Intervention in High-risk Patients

Background@#There are no data on comparison between clopidogrel monotherapy and prolonged dual antiplatelet therapy (DAPT) in patients at high-risk undergoing percutaneous coronary intervention (PCI). @*Methods@#Of 2,082 consecutive patients undergoing PCI using second-generation drugeluting stent (DES), we studied 637 patients at high-risk either angiographically or clinically who received clopidogrel longer than 24 months and were event-free at 12 months after index PCI. Patients were divided into 2 groups: the clopidogrel monotherapy group and the prolonged DAPT group. The primary outcome was a composite of all-cause death, non-fatal myocardial infarction (MI), definite or probable stent thrombosis, or stroke between 12 months and 36 months after the index PCI. @*Results@#In propensity score-matched population (246 pairs), the cumulative rate of primary outcome was 4.5% in the clopidogrel monotherapy group and 4.9% in the prolonged DAPT group (hazard ratio, 1.21; 95% confidence interval, 0.54–2.75; P = 0.643). There was no significant difference in all-cause death, MI, stent thrombosis, stroke between the clopidogrel monotherapy group and the prolonged DAPT group. @*Conclusion@#Compared with prolonged DAPT, clopidogrel monotherapy showed similar long-term outcomes in patients at high-risk after second-generation DES implantation.

Long-term Outcomes of Clopidogrel Monotherapy versus Prolonged Dual Antiplatelet Therapy beyond 12 Months after Percutaneous Coronary Intervention in High-risk Patients

Background@#There are no data on comparison between clopidogrel monotherapy and prolonged dual antiplatelet therapy (DAPT) in patients at high-risk undergoing percutaneous coronary intervention (PCI). @*Methods@#Of 2,082 consecutive patients undergoing PCI using second-generation drugeluting stent (DES), we studied 637 patients at high-risk either angiographically or clinically who received clopidogrel longer than 24 months and were event-free at 12 months after index PCI. Patients were divided into 2 groups: the clopidogrel monotherapy group and the prolonged DAPT group. The primary outcome was a composite of all-cause death, non-fatal myocardial infarction (MI), definite or probable stent thrombosis, or stroke between 12 months and 36 months after the index PCI. @*Results@#In propensity score-matched population (246 pairs), the cumulative rate of primary outcome was 4.5% in the clopidogrel monotherapy group and 4.9% in the prolonged DAPT group (hazard ratio, 1.21; 95% confidence interval, 0.54–2.75; P = 0.643). There was no significant difference in all-cause death, MI, stent thrombosis, stroke between the clopidogrel monotherapy group and the prolonged DAPT group. @*Conclusion@#Compared with prolonged DAPT, clopidogrel monotherapy showed similar long-term outcomes in patients at high-risk after second-generation DES implantation.

Evaluating the accuracy (trueness and precision) of interim crowns manufactured using digital light processing according to post-curing time: An in vitro study

PURPOSE@#This study aimed to compare the accuracy (trueness and precision) of interim crowns fabricated using DLP (digital light processing) according to postcuring time. MATERIALS AND METHODS: A virtual stone study die of the upper right first molar was created using a dental laboratory scanner. After designing interim crowns on the virtual study die and saving them as Standard Triangulated Language files, 30 interim crowns were fabricated using a DLP-type 3D printer. Additively manufactured interim crowns were post-cured using three different time conditions-10-minute post-curing interim crown (10-MPCI), 20-minute postcuring interim crown (20-MPCI), and 30-minute post-curing interim crown (30-MPCI) (n = 10 per group). The scan data of the external and intaglio surfaces were overlapped with reference crown data, and trueness was measured using the best-fit alignment method. In the external and intaglio surface groups (n = 45 per group), precision was measured using a combination formula exclusive to scan data (10 C2). Significant differences in accuracy (trueness and precision) data were analyzed using the Kruskal-Wallis H test, and post hoc analysis was performed using the Mann-Whitney U test with Bonferroni correction (α=.05). @*RESULTS@#In the 10-MPCI, 20-MPCI, and 30-MPCI groups, there was a statistically significant difference in the accuracy of the external and intaglio surfaces (P <.05). On the external and intaglio surfaces, the root mean square (RMS) values of trueness and precision were the lowest in the 10-MPCI group. @*CONCLUSION@#Interim crowns with 10-minute post-curing showed high accuracy.

Evaluation of the effect of abutment preparation angles on the repeatability and reproducibility using a blue light model scanner

. The purpose of the study is to evaluate the repeatability and reproducibility of the abutment angle using a blue light scanner. MATERIALS AND METHODS. 0°, 6°, and 10° wax cast abutment dies were fabricated. Each of the silicone impression was produced using the replicable silicone. Each study die was constructed from the prepared replicable stone used for scans. 3-dimensional data was obtained after scanning the prepared study dies for the repeatability by using the blue light scanner. The prepared 3-dimensional data could have the best fit alignment using 3-dimensional software. For reproducibility, each abutment was used as the first reference study die, and then it was scanned five times per each. 3-dimensional software was used to perform the best fit alignment. The data obtained were analyzed using a nonparametric Kruskal-Wallis H test (α=.05), post hoc Mann-Whitney U test, and Bonferroni correction (α=.017). RESULTS. The repeatability of 0°, 6°, and 10°abutments was 3.9, 4.4 and 4.7 μm, respectively. Among them, the 0° abutment had the best value while the 10° abutment showed the worst value. There was a statistically significant difference (P.05).CONCLUSION. In repeatability, the 0° abutment showed a positive result. In reproducibility, the 10° abutment achieved a positive result.

Anesthetic Management during Electroconvulsive Therapy / 이화의대지

Some patients with depression require electroconvulsive therapy performed undergeneral anesthesia. This requires rapid loss of consciousness, with minimal interferencefrom seizure activity, appropriate muscle relaxation status, prevention of hyperdynamicresponses to the electrical stimulus, and proper recovery of spontaneous ventilationand consciousness. The authors report the first case of electroconvulsive therapy performedwith the patient under general anesthesia at the Ewha Womans UniversityMedical Center, Korea.

Cathelicidin-related Antimicrobial Peptide Contributes to Host Immune Responses Against Pulmonary Infection with Acinetobacter baumannii in Mice

Acinetobacter baumannii is known for its multidrug antibiotic resistance. New approaches to treating drug-resistant bacterial infections are urgently required. Cathelicidin-related antimicrobial peptide (CRAMP) is a murine antimicrobial peptide that exerts diverse immune functions, including both direct bacterial cell killing and immunomodulatory effects. In this study, we sought to identify the role of CRAMP in the host immune response to multidrug-resistant Acinetobacter baumannii. Wild-type (WT) and CRAMP knockout mice were infected intranasally with the bacteria. CRAMP−/− mice exhibited increased bacterial colony-forming units (CFUs) in bronchoalveolar lavage (BAL) fluid after A. baumannii infection compared to WT mice. The loss of CRAMP expression resulted in a significant decrease in the recruitment of immune cells, primarily neutrophils. The levels of IL-6 and CXCL1 were lower, whereas the levels of IL-10 were significantly higher in the BAL fluid of CRAMP−/− mice compared to WT mice 1 day after infection. In an in vitro assay using thioglycollate-induced peritoneal neutrophils, the ability of bacterial phagocytosis and killing was impaired in CRAMP−/− neutrophils compared to the WT cells. CRAMP was also essential for the production of cytokines and chemokines in response to A. baumannii in neutrophils. In addition, the A. baumannii-induced inhibitor of κB-α degradation and phosphorylation of p38 MAPK were impaired in CRAMP−/− neutrophils, whereas ERK and JNK phosphorylation was upregulated. Our results indicate that CRAMP plays an important role in the host defense against pulmonary infection with A. baumannii by promoting the antibacterial activity of neutrophils and regulating the innate immune responses.

Analysis of Characteristics of Peripheral Arterial Ischemia in Premature Babies and Effects of Nitroglycerin Patch Application

Purpose@#The aim of this retrospective study was to analyze the characteristics of peripheral arterial ischemia and tissue necrosis in premature babies, as well as the effects of nitroglycerin. @*Methods@#In total, 513 newborns were enrolled who were admitted to the neonatal intensive care unit with a gestational age of 34 weeks or younger. Data were collected on general personal and clinical information, peripheral arterial ischemia, and nitroglycerin patch application in the premature infants. The collected data were analyzed using the x2 test, t-test, Mann-Whitney U test, logistic regression. @*Results@#Thirty-six (7.0%) infants had peripheral arterial ischemia, while 477 (93.0%) infants did not. Lower gestational age (x2=35.97, p<.001), lower birth weight (x2=29.40, p<.001), lower blood pressure (x2=23.10, p<.001), and insertion of an umbilical artery catheter (p<.001) were significantly associated with the occurrence of peripheral arterial ischemia. Among the preterm infants in whom nitroglycerin patches were applied, 30 (83.3%) premature infants without necrosis improved without complications, 4 (11.1%) showed hypotension, and 2 (5.6%) showed skin damage. @*Conclusion@#Based on a review of our experiences with nitroglycerin patches, we recommend closely observing skin color and using nitroglycerin patches on the skin to help improve flow in premature infants with peripheral arterial ischemia.