HeartMate 3 Implantation via Only Left Thoracotomy: A Case Report.

Median sternotomy is a standard surgical technique used for left ventricular assist device (LVAD) implantation. However, if sternotomy has a prohibitive surgical risk, LVAD implantation can be performed through only left thoracotomy. We managed a patient with endstage heart failure who had recently undergone coronary artery bypass grafting (CABG) elsewhere. The patient also had a deep sternal wound infection and bacteremia. Because of refractory cardiogenic shock, we performed extracorporeal membrane oxygenation (ECMO). After multiple mediastinal washouts and omental flap placement, ECMO was converted to extracorporeal LVAD (from the left ventricular apex to the descending aorta) through a left thoracotomy. The extracorporeal LVAD was maintained for 18 days and replaced by the HeartMate 3 LVAD. The patient was discharged in good condition 115 days after CABG.

Impact of Interatrial Septal Reconstruction on Atrial Tachyarrhythmia after Surgical Resection of Myxoma.

Background: Complete surgical excision is the only curative treatment for primary cardiac tumors. For wide excision, interatrial septal reconstruction (ISR) is commonly performed. We hypothesized that ISR may increase the risk of postoperative atrial tachyarrhythmia (AT) after surgical resection of cardiac myxoma. Methods: After excluding patients with a history of cardiac surgery and concomitant procedures unrelated to tumor resection and those with AT or permanent pacemakers, we finally enrolled 272 adult patients who underwent benign cardiac tumor surgery from 1995 to 2021 at our institution. They were divided into the ISR (n=184) and non-ISR (n=88) groups. The primary outcome was postoperative new-onset AT. Results: The study cohort predominantly consisted of women (66.2%), with a mean age of 57.2±13.6 years. The incidence of postoperative new-onset AT was 15.4%. No 30-day mortality or recurrence was observed. The cardiopulmonary bypass time and aortic cross-clamping time were significantly longer in the ISR group than in the non-ISR group (p<0.001). The median duration of hospital stay of all patients was 6.0 days (interquartile range, 5.0-7.0 days), and no significant difference was observed between the 2 groups (p=0.329). ISR was not an independent predictor of new-onset AT (p=0.248). Male sex and hypertension were found to be independent predictors of new-onset AT. Conclusion: ISR was not a significant predictor of postoperative new-onset AT. ISR might be a feasible and safe procedure for surgical resection of cardiac myxoma and should be considered if needed.

Concept analysis of adolescent use of social media for emotional well-being.

AIM: The aim of the study is to conduct a concept analysis of adolescents' emotional well-being resulting from healthy social media use. BACKGROUND: Adolescents are the group that uses mobile social media the most. They connect to others and achieve life satisfaction via social media. Here, we consider both the positive and negative aspects of social media use and recognize the need for clear guidance on proper social media use among adolescents. DESIGN: This study utilized an eight-step method of concept analysis. DATA SOURCES: A systematic literature search of PubMed, CINAHL and PsycInfo was conducted, and 10 articles were selected. REVIEW METHODS: We defined attributes, model cases, antecedents, consequences and referents. RESULTS: The attributes of adolescent emotional well-being on social media are (a) relationships with others, (b) internet-based communication and (c) being happy and maintaining emotional health. Adolescents use social media to feel safe, seek information and connect to others. Adolescents reported having better relationships and positive affect as a result of social media use. CONCLUSION: This concept analysis will help health-care providers understand how adolescent emotional well-being is attained through social media. Additionally, this study will provide the basis of behavioural theories and future interventions that guide adolescent use of social media.

Control of a nosocomial measles outbreak among previously vaccinated adults in a population with high vaccine coverage: Korea, 2019.

We describe a measles outbreak among previously vaccinated healthcare workers (HCWs) and inpatients and the control measures implemented at a tertiary care hospital in 2019. Case-patients were laboratory-confirmed measles with throat swabs tested by quantitative polymerase chain reactions (PCR), during April-May 2019. Medical histories and documented immunization records were obtained. We compared attack rates (ARs) among HCWs by occupational subgroup and age and examined the outbreak-associated costs. The index case was not ascertained. Among 26 measles case-patients (22 HCWs, four inpatients) aged 18-28 years, 25 had previously received measles-mumps-rubella (MMR) vaccine (12/26, 46% (two doses); 13/26, 50% (one dose)), and 16 (62%) had positive results of measles IgG prior to measles diagnosis. ARs were higher among HCWs aged < 30 years (1.88%), especially in the subgroup under 25 years of age (2.22%). Control measures included work restrictions for seronegative HCWs (218/2320, 9.4%) in immunity verification, administration of the MMR vaccine (207 HCWs) or intravenous immunoglobulin (2 HCWs and 11 inpatients), enhanced health surveillance of HCWs, and mandatory assessment of patients with measles-like symptoms at the infectious diseases screening units. The hospital spent 90,417,132 Korean won (US $79,733) in response to the outbreak. Measles outbreaks can occur in healthcare settings despite high population immunity, highlighting the importance of stronger vaccination policies, particularly among young HCWs. Moreover, an effective outbreak response comprising immunization activities and enhanced surveillance of HCWs and patients to rapidly detect measles-like symptoms at a prodromal phase is essential to control nosocomial measles outbreaks.

[Validity and Reliability of a Korean Version of Yale Food Addiction Scale for Children (YFAS-C)].

PURPOSE: This study evaluated the psychometric properties of the Korean version of Yale Food Addiction Scale for Children (YFAS-C). METHODS: Participants were 419 young adolescent students (11~15 years old). The content validity of the expert group was calculated as the content validity index (CVI) after the translation and reverse translation process of the 25 items of the YFAS-C. The multitrait-multimethod matrix (MTMM) method was used to verify the construct validity; the generalized linear model (GLM) was used to evaluate the concurrent and incremental validity. Reliability was calculated as Kuder-Richardson-20 (KR-20) and Spearman-Brown coefficients. RESULTS: The CVI of the 25 items was greater than the item-level CVI .80 and the scale-level CVI .90. The Korean version of YFAS-C had verified convergent validity in emotional eating and external eating and discriminant validity in restrained eating. In addition, it had verified concurrent validity in emotional eating and external eating. Finally the incremental validity of the Korean version of YFAS-C was statistically significant on BMI. Reliability was KR-20 α=.69 and the Spearman-Brown coefficient was .64. CONCLUSION: The Korean version of YFAS-C is a valid and reliable scale for measuring the severity of food addiction; it can be a useful scale for preventing obesity by predicting food addiction early.

[Difficulties in Caring for Psychiatric Patient as Experienced by Non-Psychiatric Nurses].

PURPOSE: The purpose of this study was to identify non-psychiatric nurses' difficulties in caring for patients with mental illness. METHODS: Data were collected from eighteen general medical-surgical nurses working at a university hospital in Seoul, Korea. This study involved two focus group discussions and three in-depth individual interviews. All interviews were recorded and transcribed as they were spoken, and data were analyzed using qualitative content analysis. RESULTS: General medical-surgical nurses experienced difficulties in 3 categories, 9 subcategories, 27 codes. The three categories were 'nurse' related factors, 'patient' related factors, 'resource' related factors. The nine categories were 'unpreparedness', 'nursing barriers due to stigma', 'undervaluing and avoidance of psychiatric nursing', 'eroding into the trap of a vicious cycle', 'facing unapproachable patients', 'dealing with unhelpful family members', 'burdening already overburdened staff', 'obstructive environment', and 'isolation of staff with heavy responsibilities'. CONCLUSION: The results of this study indicate the need to develop psychiatric mental health education programs for non-psychiatric nurses. Education about psychiatric mental health and support from institutions for non-psychiatric nurses can reduce their negative attitude toward psychiatric patients and difficulties in caring for psychiatric patients.

Expression of Yes-associated protein 1 and its clinical significance in ovarian serous cystadenocarcinoma.

Yes-associated protein 1 (YAP1) is a key transcriptional regulator in the Hippo signaling pathway that plays a critical role in the development and progression of several types of malignancies, including ovarian cancer. Herein, we investigated the expression of YAP1 and its clinical significance in a large population of patients with ovarian serous cystadenocarcinoma (OSC), which is the most common form of epithelial ovarian neoplasm, using the TCGA database. Surprisingly, cross-cancer mRNA expression and alterations in YAP1 were higher in OSC than in those of other types of cancers in the TCGA database. YAP1 mRNA expression was significantly higher in OSC compared with normal ovarian samples, and was higher in stages III and IV, than stages I and II. The level of YAP1 protein, which is mainly localized to the nucleus, was also higher in stage IV as compared with stages I, II and III. However, the protein level of pYAP1, which is inactive and is localized to the cytoplasm, was not significantly different between stages. The ratio of pYAP/YAP, which shows higher activity at a low ratio, was lower in stage III than in stages I and II. High YAP and low pYAP levels were significantly correlated with a poor prognosis in patients with OSC. The mRNA and protein expression of YAP1 were significantly increased in the proliferative subtype as compared to the differentiated, immunoreactive and mesenchymal subtypes. According to bioinformatics analysis, YAP1 is most highly correlated with the cell cycle. TGF-ß signaling and WNT signaling were significantly increased in the high YAP1 group according to gene set enrichment analysis. Taken together, our results suggest that not only high YAP1 expression but also its subcellular distribution may be associated with poor overall survival in patients with OSC.

[Comparison of boys' and girls' families for actor and partner effect of stress, depression and parent-adolescent communication on middle school students' suicidal ideation: triadic data analysis].

PURPOSE: This study was done to compare families of boys or of girls for actor and partner effect of stress, depression and parent-adolescent communication as perceived by mother, father and adolescent on adolescents' suicidal ideation. METHODS: Participants were 183 families (104 boys' families, 79 girls' families) who met eligibility criteria. All measures were self-administered. Data were analyzed using SPSS 18.0 and AMOS 18.0 program. RESULTS: In boys' families, boys' depression and communication with father showed actor effect on boys' suicidal ideation. Boys' stress showed indirect effect on boys' suicidal ideation through communication with father and boys' depression. Mothers' depression showed indirect partner effect on boys' suicidal ideation through boys' depression. In families of girls, girls' depression and stress showed actor effects on girls' suicidal ideation. Girls' communication with mother showed indirect effects through girls' depression. Also girls' stress showed indirect effect through girls' depression. Stress in mothers and/or fathers showed partner effect on girls' suicidal ideation. CONCLUSION: To intervene in adolescents' suicidal ideation and promote adolescents' mental health, programs should be developed differently according to gender and based on parent's psychological states.

Effect of dietary supplementation with omega-3 fatty acid and gamma-linolenic acid on acne vulgaris: a randomised, double-blind, controlled trial.

This study was undertaken to evaluate the clinical efficacy, safety, and histological changes induced by dietary omega-3 fatty acid and γ-linoleic acid in acne vulgaris. A 10-week, randomised, controlled parallel dietary intervention study was performed in 45 participants with mild to moderate acne, which were allocated to either an omega-3 fatty acid group (2,000 mg of eicosapentaenoic acid and docosahexaenoic acid), a γ-linoleic acid group (borage oil containing 400 mg γ-linoleic acid), or a control group. After 10 weeks of omega-3 fatty acid or γ-linoleic acid supplementation, inflammatory and non-inflammatory acne lesions decreased significantly. Patient subjective assessment of improvement showed a similar result. Heamatoxylin & eosin staining of acne lesions demonstrated reductions in inflammation and immunohistochemical staining intensity for interleukin-8. No severe adverse effect was reported. This study shows for the first time that omega-3 fatty acid and γ-linoleic acid could be used as adjuvant treatments for acne patients.

Clinicopathological characteristics of synchronous and metachronous gastric neoplasms after endoscopic submucosal dissection.

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) has become accepted as a minimally invasive treatment for gastric neoplasms. However, the development of synchronous or metachronous gastric lesions after endoscopic resection has become a major problem. We investigated the characteristics of multiple gastric neoplasms in patients with early gastric cancer (EGC) or gastric adenoma after ESD. METHODS: In total, 512 patients with EGC or gastric adenoma who had undergone ESD between January 2008 and December 2011 participated in this study. The incidence of and factors associated with synchronous and metachronous gastric tumors were investigated in this retrospective study. RESULTS: In total, 66 patients (12.9%) had synchronous lesions, and 13 patients (2.5%) had metachronous lesions. Older (> 65 years) subjects had an increased risk of multiple gastric neoplasms (p = 0.012). About two-thirds of the multiple lesions were similar in macroscopic and histological type to the primary lesions. The median interval from the initial lesions to the diagnosis of metachronous lesions was 31 months. The annual incidence rate of metachronous lesions was approximately 3%. CONCLUSIONS: We recommend careful follow-up in patients of advanced age (> 65 years) after initial ESD because multiple lesions could be detected in the remnant stomach. Annual surveillance might aid in the detection of metachronous lesions. Large-scale, multicenter, and longer prospective studies of appropriate surveillance programs are needed.

Distal appendiceal dilatation in equivocal appendicitis may be a useful sign for prediction of normal appendix.

Despite many efforts to reduce unnecessary appendectomy for appendicitis, the negative appendectomy rate remains relatively high. Here, we investigated predisposing factors for normal appendix by analyzing the surgical outcomes for patients with equivocal appendicitis. Over a 3-year period, 1516 patients underwent treatment for appendicitis and 148 (10%) were prospectively diagnosed with equivocal appendicitis. We defined equivocal appendicitis as a right lower quadrant pain with tenderness and an apppendiceal diameter of 6 to 9 mm without appendicolith or severe adjacent inflammation as radiological findings. We investigated normal appendix rates in relation to clinical and radiological features. Of the 148 patients, 48 (32%) had a normal appendix and 100 had appendicitis. A higher normal appendix rate was found for low white blood cell count than for leukocytosis (41% vs 23%, odds ratio (OR) = 2.48), and laparoscopic treatment was then open (42% vs 21%, OR = 2.58). Distal appendiceal dilatation, as determined by radiological imaging, was associated with a higher normal appendix rate than whole dilatation (60% vs 27%, OR = 3.96). Low white blood cell count, laparoscopic treatment, and distal appendiceal dilatation were significant predisposing factors for normal appendix after surgery. Radiologically determined distal dilatation of the appendix may be a useful sign for predicting normal appendix.