Ultrasonographic examination of the safe zone for medial needle approach towards the median-innervated flexor digitorum profundus muscle: Effect of changes in position of the forearm.

The flexor digitorum profundus (FDP) is a forearm flexor muscle. Certain cases require the needle to be inserted accurately and safely into the deep, lateral portion of the FDP, which is innervated by the anterior interosseous nerve. In this study, we compared 2 techniques for approaching the median-innervated FDP (MFDP) medially, each according to the position of the forearm, supinated or pronated. The forearms of healthy volunteers without any musculoskeletal problems of the upper extremities were examined. Using high-resolution ultrasonography, the medial aspects of the forearms were scanned with elbows flexed at 90°. Using the images obtained, several parameters for distance and angle were measured in 2 different positions: forearm-supinated and forearm-pronated. Thirty-seven forearms from the volunteers were subject to examination. The angle α, which is the valid angle of insertion when approaching with the needle towards the deeply located MFDP, slightly increased from 22.89° to 23.41° when the forearm was pronated from the supinated position; however, this increase was not statistically significant. In contrast, the angle ß, which is the safe angle of insertion when approaching with the needle towards the MFDP without contacting the ulnar nerve, was significantly increased from 41.40° to 46.80° upon forearm pronation. Because the safe angle of insertion of the needle medially into the MFDP increases with forearm pronation, the forearm-pronated position is recommended, instead of the forearm-supinated position, when inserting a needle into the MFDP in the medial aspect of the forearm.

Perception of precocious puberty among school-aged children in South Korea with the experience of treatment for precocious puberty: a Q methodological approach.

PURPOSE: This study aimed to investigate the perceptions of precocious puberty and elucidate the distinct characteristics of each type of perception related to precocious puberty among school-aged children who had undergone treatment for the condition. METHODS: This study applied the Q methodology to identify and classify the perceptions of precocious puberty among school-aged children who had undergone treatment for the condition. The analysis involved 34 questions from the Q sample and data from 35 individuals in the P sample, using the PC-QUANL Program for analysis. RESULTS: The perceptions of precocious puberty among school-aged children who had undergone precocious puberty treatment were classified into the following four types: "shyness - passive self-management," "resentment - suppression," "anxiety - fear," and "adaptation - acceptance." CONCLUSION: This study investigated the experiences and perceptions of children who have undergone treatment for precocious puberty. Through the identification of four types of perceptions, we can see that there is a need to develop an intervention program for nursing that is tailored to the specific type of precocious puberty.

Health Behavior, Emotional Intelligence, and Stress of Elementary School Students in Korea.

BACKGROUND: We aimed to provide the baseline data of nursing intervention for promoting the health promotion and promotion of growth and development for elementary students. METHODS: By subjecting the 887 elementary students from 20 elementary schools located in the northern area of Gyeonggi-do Province, South Korea, data were gathered from April 10-May 30, 2017. The SPSS was used for analysis of data. RESULTS: Some elements of emotional intelligence were found to differ depending on the gender and family type of lower-grade children, and depending on gender, sleep time, family type, and physical activity experience of higher-grade children. Some factors of stress were found to have differences according to sleeping time of the lower grades, and according to gender, sleeping time, family type, and whether they have experience in physical activity of higher-graders. CONCLUSION: It is possible to improve emotional intelligence and solve the stress of elementary students. This study will be the baseline data on developing the Health Promotion Education Arbitration Program for elementary students.

Effects of nonylphenols on embryonic development and metamorphosis of Xenopus laevis: FETAX and amphibian metamorphosis toxicity test (OECD TG231).

Nonylphenols (NPs) are a group of endocrine-disrupting surfactants that mimic estrogen. To determine the developmental toxicity and thyroid-disrupting effect of NPs, the effects of exposure to nonylphenol (NP), 4-nonylphenol (4-NP), and nonylphenol ethoxylate (NP-12) were examined according to the frog embryo teratogenesis assay-Xenopus (FETAX) and Organization for Economic Co-operation and Development test guidelines 231 (TG231). In FETAX, the LC50 values of NP, 4-NP, and NP-12 were 59.14 mg/L, 10.13 mg/L, and 14.60 mg/L, respectively. At 10.0 mg/L, NP, 4-NP, and NP-12 significantly decreased the total length of tadpoles, and NP and 4-NP increased gut malformation and bent tails. In surviving tadpoles, the EC50 values for malformation of NP, 4-NP, and NP-12 were 4.66, 6.51, and 13.08 mg/L, respectively. The teratogenic indices of NP, 4-NP, and NP-12 were 12.69, 1.56, and 1.08, respectively, suggesting the teratogenic potential of NP and 4-NP. In a range-finder assay for TG231, the 96-h LC50 values of NP, 4-NP, and NP-12 were 2.0, 2.0, and 10.57 mg/L, respectively. When NF stage 51 larvae were exposed for 21 days, larval growth was inhibited by NP, 4-NP, and NP-12 at 0.67, 0.07, and 0.37 mg/L, respectively. 4-NP at 0.07 mg/L accelerated the developmental stage and significantly increased hind limb length, while 0.67 mg/L 4-NP delayed the developmental stage and decreased hind limb length, suggesting a bimodal effect of 4-NP on metamorphosis. NP and NP-12 at test concentrations did not alter the larval stage, but NP-12 at 0.37 mg/L significantly decreased total length and tail length, suggesting growth inhibition in larvae. The total colloid area of thyroid follicles was significantly increased by 0.07 mg/L 4-NP but not by NP and NP-12, suggesting that 4-NP may interfere with thyroid function. Together, the developmental toxicity of NPs was in the following order: 4-NP, NP-12, and NP. 4-NP may alter metamorphosis driven by thyroid hormones in X. laevis.

Effects of citrate ester plasticizers and bis (2-ethylhexyl) phthalate in the OECD 28-day repeated-dose toxicity test (OECD TG 407).

Citrate esters are considered functional alternatives to phthalate plasticizers, but their toxicity remains poorly understood. The toxicity of citrate esters, including triethyl 2-acetylcitrate (ATEC) and trihexyl O-acetylcitrate (ATHC), were examined together with that of bis (2-ethylhexyl) phthalate (DEHP) using the Organization for Economic Co-operation and Development Test Guideline 407 (OECD TG407). Following 28-day oral administration, no significant differences in body weight or the weight of the brain, pituitary, heart, epididymis, seminal vesicles, or coagulating gland were found between the vehicle control and DEHP, ATEC or ATHC groups. In the 400 mg/kg day DEHP group, liver, adrenal, thymus, spleen, kidney, testis, and prostate weights were significantly increased. In the 400 mg/kg day ATHC group, kidney, adrenal, thymus, testis and prostate weights were significantly increased. In the 400 mg/kg day ATEC group, kidney, adrenal and testis weights were significantly increased. Hepatocyte size was significantly increased in the 400 mg/kg day DEHP group, suggestive of hepatotoxicity, but was not increased in the ATEC or ATHC groups. There were no significant differences in white blood cell, red blood cell or platelet counts, hemoglobin concentrations, hematocrit, mean corpuscular volume, fasting glucose, insulin, or testosterone concentrations between the vehicle control and DEHP, ATEC and ATHC groups. In the ATHC 400 mg/kg day group, T3 was decreased while T4 was increased, suggestive of disruption of thyroid function. The results of the OECD TG407 subacute repeated dosing toxicity test indicate ATEC is less toxic compared to ATHC or DEHP and could be recommended as an alternative to phthalate plasticizers.

Types of Parenting of Fathers during Early Childhood: A Q Methodological Approach.

PURPOSE: The purpose of this study was to examine types of parenting among fathers. The characteristics of parenting each type in early childhood were identified by systematically analyzing and classifying father's perceptions of parenting using the Q-methodology, which places importance on the perspective of the performer. METHODS: The Q-method, which is effective for measuring individual subjectivity was used. The subjects in this study were 50 fathers with young children (2~36 months). RESULTS: Four parenting types were identified analyzing the subjective perceptions of fathers with young children about parenting. One type was centered on character development. Another was centered on social development. A third was centered on physical health and development. The fourth was centered on building values. CONCLUSION: Parenting education programs should be developed based on type-specific characteristics and further research should investigate the effects of father's parenting type.

Effects of pre-education combined with a simulation for caring for children with croup on senior nursing students.

Educational outcomes, such as knowledge, confidence in performance, ability in nursing practice, and satisfaction with learning methods in caring for children with croup, were compared between groups of students that received education through simulation combined with pre-education, simulation only, and pre-education only. In this quasi-experimental design, the educational intervention for the experimental group was the pre-education modality. Data from a convenience sample of 127 senior nursing students were drawn from three nursing schools in South Korea. There were significant differences in the mean scores of knowledge, confidence in performance, satisfaction with the learning method, and ability in nursing practice between the three groups. Pre-education with simulation significantly enhanced students' knowledge, confidence in performance, ability in nursing practice, and satisfaction with learning methods compared with pre-education or simulation alone. Simulation strategies should focus more on enhancing nursing students' learning outcomes.

[Development of a Measurement Instrument for Parenting Behavior of Primary Caregivers in Early Childhood].

PURPOSE: The purpose of this study was to develop an instrument to measure the parenting behavior of primary caregivers of children in early childhood. METHODS: An instrument was developed according to Devellis's instrument development process. The participants in this study who completed the main survey were 370 mothers and grandmothers. The survey was conducted from June 1 to July 30, 2014, and collected data were analyzed using item analysis, half-split reliability and Cronbach's alpha coefficient, exploratory and confirmatory factor analysis, convergent validity. RESULTS: The factor structure of the instrument showed the cumulative variance as 55.7% in the factor analysis. As a result of a confirmatory factor analysis, a four-factor structure was found to be appropriate, and the construct validity and convergent validity of the instrument were thereby confirmed. The finalized parenting behavior instrument consisted of 26 items and four independent factors: affectionate, laissez-faire, educational and impulsive. A five-point Likert scale was employed, and a higher score in a particular factor showed that most of the behaviors belonged to the factor. CONCLUSION: The instrument developed in this study was found to be reliable and valid, and can be used to develop parent-child relationship building.

[Types of child rearing behavior of parents during early childhood: Q-methodological approach].

PURPOSE: The purpose of this study was to identify the awareness of child rearing among parents of children in early childhood and to provide fundamental data for parent education programs according to child rearing type. METHODS: Q-methodology which provides a method of analyzing the subjectivity of each item was used. Forty Q items which were derived from a literature review and interviews with nurturing mothers were classified into a normal distribution using a 9-point scale. Collected data were analyzed using the QUANAL PC Program. RESULTS: Four types of parents' child rearing were identified. Type I was named 'affection-respect type', type II, 'concern-rule compliant type', type III, 'solicitude-model type', and type IV, 'geniality-encouragement type'. CONCLUSION: For proper growth and development during early childhood, parents should have rational information and awareness of their child rearing type. Results of this study can be used as essential data to develop child rearing education programs according to parents' child rearing attitude.

Pre-treatment of porcine pulmonary xenograft with desmopressin: a novel strategy to attenuate platelet activation and systemic intravascular coagulation in an ex-vivo model of swine-to-human pulmonary xenotransplantation.

BACKGROUND: Von Willebrand factor (vWF) has been proposed as a major contributor to the development of coagulopathy in pulmonary xenotransplantation. Pretreatment of donor swine with 1-deamino-8-d-arginine vasopressin (DDAVP), an analog of vasopressin, can reduce the content of vWF in pulmonary xenografts. Here, we investigate the effects of DDAVP pre-treatment in an ex-vivo perfusion model of pulmonary xenotransplantation. METHODS: We set up and performed the ex-vivo perfusion using porcine pulmonary accessory lobes and fresh human whole blood (n = 12). Half of the donor swine were given 3 mug/kg DDAVP intravenously for 3 days before ex-vivo perfusion (DDAVP group) and half of them were left untreated (control group). The porcine lung was perfused with fresh blood for 1 h and changes in the following parameters were monitored: pulmonary arterial pressure, pulmonary vascular resistance, blood cell counts, fibrinogen, antithrombin, platelet factor 4, D-dimer, C3a, C4d, and xenoreactive IgM. The release of Galalpha1-3Gal xenoantigen (alphaGal) from porcine lung which had been perfused and retained for 30 min with human blood was assessed by enzyme-linked immunosorbent assay using alphaGal-binding lectin. RESULTS: Both DDAVP and control groups showed typical findings of immediate pulmonary dysfunction: an increase of pulmonary vascular resistance and sequestration of leukocytes and platelets after ex-vivo perfusion. However, in the DDAVP group, the increase of platelet factor 4, C3a, and C4d after perfusion was attenuated compared to that in the control group. The release of alphaGal after blood retention was significantly lower in the DDAVP group than that of the control group. CONCLUSION: Pre-infusion of DDAVP to the donor swine was beneficial in attenuating platelet activation as well as complement/coagulation activation. These effects of DDAVP are likely to relate to the reduction of porcine vWF content in the xenograft. Therefore, the modulation of vWF secretion in donor lungs could be an additional therapeutic way to reduce systemic coagulopathy in pulmonary xenotransplantation.

Molecular changes of epidermal growth factor receptor (EGFR) and KRAS and their impact on the clinical outcomes in surgically resected adenocarcinoma of the lung.

Recent studies have reported that clinical response to epidermal growth factor receptor (EGFR) inhibitors is associated with somatic changes of EGFR in the advanced stage of lung cancer. However, there is no clear data demonstrating whether such molecular changes of EGFR per se can affect the clinical outcome of early stage cancer after surgical resection. DNA mutations of EGFR and KRAS were investigated in 71 adenocarcinoma patients who received surgical resection. Fluorescence in situ hybridization (FISH) of EGFR gene amplification was performed in 48 samples. We detected EGFR mutations in 25 patients (35.2%). EGFR mutation was more frequently found in cases with BAC features (13/22 (59.1%):13/49 (26.5%); p=0.008) and in non-smokers (19/41 (46.3%):7/30 (23.3%); p=0.047). However, the EGFR mutation was not associated with age, gender, or clinical stage. The amplification of EGFR copy was frequently observed in the female gender (12/29 (41.4%):3/19 (15.8%); p=0.061) and in the advanced stage (> or =Stage IIIA, 9/19 (47.4%):6/29 (20.7%); p=0.051). KRAS mutations were present in five patients (7.0%) and none of them showed EGFR mutation. KRAS mutations (p=0.000), male gender (p=0.001), absence of BAC feature (p=0.003), advanced stage (p=0.039), and smoking history (p=0.030) were poor prognostic factors for overall survival, whereas EGFR mutation (p=0.184) and amplification (p=0.756) were not. The presence of EGFR mutation was not a prognostic factor of the clinical outcome of early lung cancer after surgical resection. This result provides an important message for the protocol design of future trials of EGFR inhibitors in early lung cancer. As the KRAS mutation was a poor prognostic factor and it presents reciprocally with EGFR mutation, KRAS mutation should be investigated in such trials. DNA mutations of EGFR and KRAS were investigated in 71 adenocarcinoma patients who received surgical resection. Whereas KRAS mutation was a poor prognostic factor, EGFR mutation was not, and its presence per se did not affect the clinical outcome of early lung cancer after surgical resection.

Deep gray matter perfusion in multiple sclerosis: dynamic susceptibility contrast perfusion magnetic resonance imaging at 3 T.

OBJECTIVES: To assess the presence of perfusion abnormalities in the deep gray matter of patients with relapsing-remitting and primary progressive multiple sclerosis (MS) in comparison with healthy controls and to investigate the impact of perfusion impairment on clinical disability and fatigue. DESIGN: Survey. SETTING: Research-oriented hospital. Patients Twenty-two patients with MS and 11 age- and sex-matched healthy volunteers. Intervention Absolute cerebral blood flow, cerebral blood volume, and mean transit time were measured in the thalamus, putamen, and caudate nuclei. MAIN OUTCOME MEASURES: Decrease of cerebral blood flow in the deep gray matter of patients with MS and correlation between perfusion impairment and the severity of fatigue. RESULTS: The cerebral blood flow value averaged over the thalamus, putamen, and caudate nuclei was significantly lower in patients with primary progressive MS (P<.001) and in patients with relapsing-remitting MS (P = .01) compared with controls, and there was a trend for patients with primary progressive MS to have lower average cerebral blood flow than patients with relapsing-remitting MS (P = .06). With respect to cerebral blood volume, there was a significant difference between patients with primary progressive MS and controls (P<.001) and between the 2 groups of patients (P = .03) but not between patients with relapsing-remitting MS and controls (P>.30). The fatigue score was significantly correlated with cerebral blood flow (r = 0.4; P<.001) and cerebral blood volume (r = 0.5; P = .004). CONCLUSION: The decrease of tissue perfusion in the deep gray matter of patients with MS is associated with the severity of fatigue.

Prognostic implication of aberrant promoter hypermethylation of CpG islands in adenocarcinoma of the lung.

OBJECTIVES: DNA hypermethylation in promoter regions has been studied for various types of cancer. However, there is no clear evidence that shows whether methylation status can predict long-term survival in patients with lung cancer. METHODS: We collected tissues from 72 patients with lung adenocarcinomas. The cancer and normal lung tissues were tested for DNA hypermethylation by using methylation-specific polymerase chain reaction. The genes investigated were p16INK4alpha(p16), retinoic acid receptor beta-promoter (RARbetaP2), death-associated protein kinase (DAPK), O6-methylguanine-DNA-methyltransferase (MGMT), and glutathione-S-transferase P1 (GSTP1). The status of the DNA methylation was analyzed, and we focused on long-term outcomes, as well as other clinical variables. RESULTS: DNA hypermethylation was observed in 83% for p16, 63% for RARbetaP2, 32% for DAPK, 17% for MGMT, and 46% for GSTP1 from the cancer tissue. From normal lung tissue, the results of methylation were positive in 75% for p16, 24% for RARbetaP2, 10% for DAPK, 6% for MGMT, and 33% for GSTP1. During the mean follow-up period of 18 +/- 11 months (1-40 months), 25 (35%) patients experienced recurrence, and 13 died. In multivariable analysis, old age (>60 years, P = .007), male sex (P = .004), unmethylation of DAPK from cancer tissue (P = .045), and hypermethylation of RARbetaP2 from normal tissue (P = .000) were risk factors for poor survival. Pathologic stage (P = .023), unmethylation of DAPK from normal tissue (P = .043), and hypermethylation of RARbetaP2 from normal tissue (P = .030) were risk factors for disease-free survival. CONCLUSIONS: DNA methylation status of CpG islands seems to be a useful predictor of long-term outcome for adenocarcinoma of the lung. However, because the predictive power is still low, further studies, including those with multiple genes, are necessary to increase its usefulness in the clinical setting.

The essential role of p21 in radiation-induced cell cycle arrest of vascular smooth muscle cell.

The biologic mechanisms for the success and failure of intravascular radiation therapy after angioplasty have not been well studied. We investigated the molecular mechanism of radiation-induced cell cycle arrest in vascular smooth muscle cell (VSMC) and examined whether p21 knock-out is a cause of radiation failure. Using different dosages of gamma radiation, we evaluated the effect of radiation on VSMC apoptosis and cell cycle progression, and its action mechanism. Irradiation significantly retarded the growth of cultured VSMC, which was not due to induction of apoptosis but mainly due to cell cycle arrest. Radiation showed remarkable cell cycle arrest at G1 and G2 phase (G0/G1:S:G2/M phases = 61%:34%:5% with 0 Gy versus 61%:9%:30% with 16 Gy, 12 h after radiation). In immunoblot analysis and kinase assay, radiation increased the expression of p21 and decreased the expression and activity of CDK2 and 1. In contrast, radiation did not affect the expression and activity of CDK4 and 6, nor the expression of p27 and p16. When p21 was knocked out, cell cycle of VSMC was not arrested by radiation, leading to increased proliferation. These finding provide the evidence that radiation inhibits VSMC proliferation through cell cycle arrest by enhancing p21 expression and suppressing CDK1 and 2. This observation supports the key role of p21 in radiation-induced cell cycle arrest and the degree of p21 expression may be the possible mechanism of radiation failure and delayed restenosis.

Differential effects of homocysteine on porcine endothelial and vascular smooth muscle cells.

High concentrations of homocysteine damage endothelial cells and lower concentrations increase vascular smooth muscle cell (VSMC) growth. This study investigated the effects of various concentrations of homocysteine on endothelial cells (VECs) and VSMCs in terms of cell survival, proliferation, and function. VECs and VSMCs from porcine thoracic aorta were studied. These cells were exposed to homocysteine in concentrations of 20 microM, 400 microM, and 1 mM every 8 h for 24 h, and its effect on cell survival, proliferation, and function were studied using methylthiazoletetrazolium assay, [3H]-thymidine incorporation test, and 6-keto-prostaglandin F1alpha enzyme-linked immunosorbent assay for VECs, and platelet-derived growth factor (PDGF) enzyme-linked immunosorbent assay for VSMCs, respectively. In VECs, 20 microM of homocysteine reduced the viable cell count to 95 +/- 31%, 400 microM reduced it to 89 +/- 35%, 1,000 microM reduced it to *58 +/- 29% (control = 100 +/- 30%, n = 18, *p < 0.05). In VSMCs, 20 microM of homocysteine slightly increased the viable cell count to 106 +/- 30%, but there was no statistical significance; 400 microM of homocysteine reduced the viable cell count to *74 +/- 29%, 1,000 microM to *50 +/- 24% (control = 100 +/- 28%, n = 18, *p < 0.05). In VECs, 20 microM of homocysteine reduced [3H]-thymidine uptake by 98 +/- 14%, 400 microM reduced it by *82 +/- 17%, 1,000 microM reduced it by *66 +/- 17% (control = 100 +/- 12, n = 6, *p < 0.05), respectively. But in VSMCs, 20 microM of homocysteine significantly increased [3H]-thymidine uptake (*131 +/- 16%), and thereafter, homocysteine decreased VSMCs [3H]-thymidine uptake, 400 microM by *24 +/- 7%, 1,000 microM by *29 +/- 10% (control = 100 +/- 16, n = 6, *p < 0.05), respectively. Homocysteine decreased VEC prostacyclin secretion in a dose-dependent manner, 20 microM by 105 +/- 0.65 pg/100 microl, 400 microM by *100 +/- 2.37 pg/100 microl, 1,000 microM by *93 +/- 2.54 pg/100 microl (control = 107 +/- 1.26 pg/100 microl, n = 6, *p = 0.007). In VSMCs, 20 microM of homocysteine slightly increased PDGF secretion by 62.2 +/- 20.7 pg/100 microl, but there was little statistical significance (p = 0.13); 400 microM of homocysteine reduced PDGF secretion by *28.9 +/- 10.7 pg/100 microl, and 1,000 microM reduced it by *21.3 +/- 4.7 pg/100 microl (control = 54.5 +/- 9.3 pg/100 microl, n = 6, *p < 0.05). High concentrations of homocysteine damaged both VECs and VSMCs with respect to cell survival, proliferation, and function. By increasing exposure to homocysteine, it was shown that physiologic high concentrations of homocysteine enhanced VSMC proliferation.