Psychological factors associated with exercise self-efficacy in the recipients of an implantable cardioverter defibrillator.

BACKGROUND: Insufficient exercise affects the health of patients who have implantable cardioverter defibrillators (ICD). The purpose of this study was to investigate the correlations between exercise self-efficacy (ESE) and its associated psychological factors in ICD recipients. METHODS: This cross-sectional study included individuals who had undergone ICD implantation at the cardiology department of a medical centre in Taiwan. A face-to-face survey was conducted. The survey questionnaire included questions regarding the participants' demographics, perceived health (PH), ICD shock-related anxiety (ICD-SRA), self-care self-efficacy (SSE), perceived exercise benefit (PE-benefit), perceived exercise barrier (PE-barrier), and ESE. Data were analysed using SPSS 20.0 Software. Stepwise multiple regression analyses were also performed to evaluate the predictive effects of the aforementioned factors on ESE. RESULTS: A total of 52 ICD recipients were enrolled. ESE was negatively correlated with ICD-SRA (r = -0.511; p < 0.01) and PE-barrier (r = -0.563; p < 0.01), but positively correlated with SSE (r = 0.339; p < 0.05) and PE-benefit (r = 0.464; p < 0.01). The stepwise multiple regression analysis revealed that PE-barrier, PE-benefit, and ICD-SRA effectively predicted ESE in the participants. CONCLUSIONS: ESE may be improved by overcoming PE-barrier, ICD-SRA and enhancing PE-benefit. Consequently, improving ESE may enhance the health benefits of exercise.

Structural and biological insights into Klebsiella pneumoniae surface polysaccharide degradation by a bacteriophage K1 lyase: implications for clinical use.

BACKGROUND: K1 capsular polysaccharide (CPS)-associated Klebsiella pneumoniae is the primary cause of pyogenic liver abscesses (PLA) in Asia. Patients with PLA often have serious complications, ultimately leading to a mortality of ~ 5%. This K1 CPS has been reported as a promising target for development of glycoconjugate vaccines against K. pneumoniae infection. The pyruvylation and O-acetylation modifications on the K1 CPS are essential to the immune response induced by the CPS. To date, however, obtaining the fragments of K1 CPS that contain the pyruvylation and O-acetylation for generating glycoconjugate vaccines still remains a challenge. METHODS: We analyzed the digested CPS products with NMR spectroscopy and mass spectrometry to reveal a bacteriophage-derived polysaccharide depolymerase specific to K1 CPS. The biochemical and biophysical properties of the enzyme were characterized and its crystal structures containing bound CPS products were determined. We also performed site-directed mutagenesis, enzyme kinetic analysis, phage absorption and infectivity studies, and treatment of the K. pneumoniae-infected mice with the wild-type and mutant enzymes. RESULTS: We found a bacteriophage-derived polysaccharide lyase that depolymerizes the K1 CPS into fragments of 1-3 repeating trisaccharide units with the retention of the pyruvylation and O-acetylation, and thus the important antigenic determinants of intact K1 CPS. We also determined the 1.46-Å-resolution, product-bound crystal structure of the enzyme, revealing two distinct carbohydrate-binding sites in a trimeric ß-helix architecture, which provide the first direct evidence for a second, non-catalytic, carbohydrate-binding site in bacteriophage-derived polysaccharide depolymerases. We demonstrate the tight interaction between the pyruvate moiety of K1 CPS and the enzyme in this second carbohydrate-binding site to be crucial to CPS depolymerization of the enzyme as well as phage absorption and infectivity. We also demonstrate that the enzyme is capable of protecting mice from K1 K. pneumoniae infection, even against a high challenge dose. CONCLUSIONS: Our results provide insights into how the enzyme recognizes and depolymerizes the K1 CPS, and demonstrate the potential use of the protein not only as a therapeutic agent against K. pneumoniae, but also as a tool to prepare structurally-defined oligosaccharides for the generation of glycoconjugate vaccines against infections caused by this organism.

[The Adaptation to an Implantable Cardioverter Defibrillator in a Survivor of Sudden Death Due to Fatal Arrhythmia].

The purpose of this article was to explore the adaptation to an implantable cardioverter defibrillator (ICD) of a survivor of sudden death due to fatal arrhythmia. Owing to medical urgency, the case patient, a woman, did not have sufficient time to get prepared mentally. Therefore, the case had difficulty coping and ultimately rejected the ICD device. During the period of hospital care (November 10th to 19th, 2015), in-depth interview and clinical observation were used to obtain information from the case. The interview was transcribed and analyzed by repeated reading. The analysis found the following major post-ICD-implantation-associated health problems: confusion about the necessity of ICD, changes in body image due to ICD device implantation, and maladaptation in post-ICD daily life. In addition to providing ICD-related information and to strengthening her support system, we explored with the case the meanings of the ICD device in order to resolve her confusion. In addition, we recognized her perception regarding the ICD device without judgement and discussed the impact on her body of having the ICD. Concurrently, we encouraged the case to re-examine her self-value and life goals. In addition, we reconstructed the picture of the appearance of wound and made her realized the merit of the ICD. In terms of broader application, we hope that patients may learn to understand the worth and meanings of the ICD device and to restore positive attitudes with regard to body image. Furthermore, these interventions help encourage patients to re-examine their self-worth and goals and to internalize the ICD device, thereby minimizing the psychological impact of implantation. Ultimately, this case adapted well to the ICD device. Finally, we hope to share this experience as a reference for improving quality of care. These results may specifically help sudden death survivors to adapt to ICD implantation.