[Impact of novel P2Y12 receptor inhibitors on platelet reactivity in acute coronary syndrome patients undergoing percutaneous coronary intervention].

OBJECTIVE: To investigate the impact of novel P2Y(12) receptor inhibitors including prasugrel or ticagrelor on platelet reactivity in patients with acute coronary syndrome (ACS) receiving percutaneous coronary intervention (PCI), and provide clinical data for novel oral P2Y(12) receptor inhibitors use among Chinese patients. METHODS: Between October 2011 to February 2014, 174 consecutive patients (135 males; (67.8±11.8) years old) with ACS undergoing PCI in Kiang Wu Hospital, Macau were prospectively enrolled in this study. Oral aspirin and one P2Y(12) receptor inhibitor were administered for 5 days or above after PCI, patients were divided into clopidogrel, prasugrel and ticagrelor groups in accordance with the agent administered. Platelet reactivity of the patients was detected by VerifyNow P2Y(12) reaction unit (PRU); and the high on-treatment platelet reactivity (HPR) and non-HPR were defined as PRU≥208 and PRU<208 respectively. Patients with HPR during clopidogrel therapy were switched either to prasugrel or ticagrelor, or continued the same treatment; and then the platelet reactivity was monitored again. RESULTS: There were 113 clopidogrel cases (64.9%), 20 prasugrel cases (11.5%) and 41 ticagrelor cases (23.6%). Fifty-seven cases (32.8%) were defined as HPR post P2Y(12) receptor inhibitor use, in which 55 cases (55/113, 48.7%) were treated with clopidogrel. The degree of inhibition of platelet reactivity was significantly different in patients on clopidogrel, prasugrel and ticagrelor therapy, percent inhibition assayed by the VerifyNow P2Y(12) system was 28.2%±23.5%, 61.4%±26.7% and 81.3%±19.8% respectively (P<0.05). Different degree of platelet reactivity was achieved by the 3 P2Y(12) receptor inhibitors at multiple time points. The among-group differences in platelet reactivity became apparent at the early treatment stage (P<0.05). Platelet aggregation decreased significantly in patients switched from clopidogrel to prasugrel or ticagrelor (P<0.05). CONCLUSION: Novel oral P2Y(12) receptor inhibitors are more effective in inhibiting platelet reactivity in ACS patients, and our results show that novel oral P2Y(12) receptor inhibitors provide a new option for ACS patients with HPR post clopidogrel or high-risk features of ischemic complications, including stent thrombosis and post-PCI ischemic events.

Effects of individual reminiscence therapy for older women living alone.

BACKGROUND: The loss of cognitive function and memory interrupts the independent activities of daily living of older women, and it eventually causes role loss, increased dependence, declining self-esteem and low quality of life. AIM: To examine the effects of the individual reminiscence therapy on memory self-efficacy, memory practice, Mini Mental State Examination and quality of life for older Korean women living alone. METHODS: A quasi-experimental pre-test-post-test control group design was employed. Seventy-eight older women aged 65 and older who were living alone in Seoul and Gyeong-gi-do, Korea, was recruited through convenient sampling. Individual reminiscence therapy was applied for 1 h/week in the experimental group (40 subjects) for 4 weeks. A study questionnaire was designed to measure general characteristics, memory self-efficacy, memory practice (immediate, delayed), Mini Mental State Examination (MMSE) and quality of life. RESULTS: There were significant differences in the effects of individual reminiscence therapy on memory self-efficacy, memory practice (immediate, delayed), and quality of life between experimental and control group. CONCLUSION: Individual reminiscence therapy was an effective intervention for improving memory self-efficacy, memory practice (immediate, delayed), cognitive function and quality of life of older Korean women living alone. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Individual reminiscence therapy can be utilized as a nursing intervention for improving memory, cognition and quality of life of older women in the nursing practice. Health policy needs to give attention to health issues of older women living alone. Individual reminiscence therapy can be utilized as a nursing intervention for improving memory, cognition and the quality of life of older women. Health policy needs to give attention to health issues of older women living alone.

Depression, self-esteem and anger expression patterns of Korean nursing students.

BACKGROUND: According to previous studies, nursing students' anger expression patterns, depression and self-esteem significantly affected the physical and mental well-being of patients. It is of utmost importance that the relationship among them is thoroughly investigated in this study. AIM: The purpose of this study was to examine the degrees of anger expression patterns, depression and self-esteem of Korean nursing students and to examine the correlations among them. METHODS: This was a descriptive cross-sectional study. The subjects consisted of 320 Korean nursing students at colleges in S and G city, Korea. The measurements were based on the Korean standard STAXI (State-Trait Anger Expression Inventory), SCL-90-R (Symptom Checklist-90-Revision) and SLCS-R (Self-Liking/Self-Competence Scale-Revised Version). RESULTS: In the analysis of the degrees of variances, the subjects showed lower anger repression, anger expression, control of anger and depression. The degree of self-esteem revealed a higher than the median value. There were significant correlations among anger expression patterns (anger repression, anger expression and anger control), depression and self-esteem. LIMITATIONS: The study limitations were the degree of representativeness of the setting and sample, and its generalizability. CONCLUSION: Based on the findings of this study, interventions are needed for Korean nursing students in order to promote anger management and improved self-esteem. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The development of an anger control programme for nursing students should focus on lowering depression and enhancing self-esteem. One of the policy issues focused on providing anger management programmes for lowering depression and enhancing self-esteem. This study will enable nursing students to recognize the importance of controlling their anger, enhancing their self-esteem, establishing positive emotions and improving their overall well-being as future professional nurses.

A comparison of the factors influencing life satisfaction between Korean older people living with family and living alone.

BACKGROUND: As the global population of older people continuously increases, many countries are beginning to experience health problems associated with older age. These countries may be interested in knowing and understanding the health problems experienced by the older Korean population, which is projected to age the most rapidly. AIM: This study aimed to compare and examine the factors that influence the life satisfaction between older people living with their family and those living alone. METHODS: A cross-sectional survey was conducted. The participants comprised a total 300 older Koreans (150 living with their family, 150 living alone) aged 65 years or over who met the eligibility criteria. All measures were self-administered. Data were analysed using the SAS statistical software program version 6.12 (SAS Institute Inc., Cary, NC). RESULTS: The older people living with their family were better than the older people living alone in perceived health status, self-esteem, depression and life satisfaction. Perceived health status, self-esteem, depression, age and monthly allowance were found to be the factors related to the life satisfaction of older people living with their family and those living alone. The factors that were found to have the greatest influence on the life satisfaction of older people living with their family and those living alone were depression and perceived health, respectively. CONCLUSIONS: This study may help healthcare providers to understand the factors that can influence the life satisfaction among older people living with their family and living alone in Korea.

A comparison of the health and related quality of life between middle-aged Korean and Chinese women.

BACKGROUND: The proportion of middle-aged people in one's total life cycle has increased. Health providers are required to promote and manage their health, and improve the quality of their life, especially middle-aged women. As international interchanges in nursing are growing between Korea and China, understanding of the level related to health and quality of life between middle-aged Korean and Chinese women is critical to improve their health and quality of life. AIM: To compare and examine the health perception, anger expression, self-esteem and quality of life between middle-aged Korean and Chinese women. METHODS: A cross-sectional survey was conducted. The participants were comprised of a total 430 middle-aged Korean (n=220) and Chinese (n=210) women aged 40-64 years. The survey included a set of four questionnaires. All measures were self-administered. Data were analysed using the statistical package, SPSS/WIN Ver16.0 (SPSS, Inc., Chicago, IL, USA). RESULTS: Middle-aged Chinese women had higher health perception than middle-aged Korean women. Anger expression, self-esteem and quality of life of middle-aged Korean women were higher than in middle-aged Chinese women. Also, there were the differences in the health perception, anger expression and self-esteem according to the general characteristics in all middle-aged Korean and Chinese women. CONCLUSIONS: Various nursing intervention strategies should be developed and adjusted to improve the self-esteem and quality of life for all middle-aged Korean and Chinese women, especially middle-aged Chinese women. Additionally, the individual characteristics and national culture of the middle-aged women should be considered as a basis for the nursing intervention.

High-performance liquid chromatographic method for the quantification of Mitragyna inermis alkaloids in order to perform pharmacokinetic studies.

In Africa, Mitragyna inermis (Willd.) O. Kuntze (Rubiaceae) is commonly used in traditional medicine to treat malaria. Antimalarial activity is mostly due to the hydromethanolic extract of M. inermis leaves and especially to the main alkaloids, uncarine D and isorhynchophilline. In the present study, we describe for the first time an HPLC method for the simultaneous quantification of uncarine D and isorhynchophylline in biological matrices. SPE was used to extract the components and the internal standard naphthalene from human and pig plasma samples. Chromatographic separation was performed on a C-18 reversed column at a flow rate of 1 mL/min, using methanol-phosphate buffer (10:90, pH 7), as a mobile phase. Good linearity was observed over the concentration ranges of 0.0662-3.31 microg/mL for uncarine D and 0.0476-2.38 microg/mL for isorynchophylline. The precision was less than 12% and the accuracy was from 86 to 107% without any discrepancy between the two species. Uncarine D and isorhynchophylline recoveries were over 80%. These results allowed the quantification of both uncarine D and isorhynchophylline in pig plasma after intravenous administration of M. inermis extract.

Nanojets, electrospray, and ion field evaporation: molecular dynamics simulations and laboratory experiments.

The energetics, interfacial properties, instabilities, and fragmentation patterns of electrosprays made from formamide salt solutions are investigated in a mass spectrometric vacuum electrospray experiment and using molecular dynamics (MD) simulations. The electrospray source is operated in a Taylor cone-jet mode, with the nanojet that forms being characterized by high surface-normal electric field strengths in the vicinity of 1 V/nm. Mass-to-charge ratios were determined for both positive and negative currents sprayed from NaI-formamide solutions with solute-solvent mole ratios of 1:8.4 and 1:36.9, and from KI-formamide solutions with mole ratios of 1:41 and 1:83. The molecular dynamics simulations were conducted on isolated 10 nm NaI-formamide droplets at mole ratios of 1:8 and 1:16. The droplet was subjected to a uniform electric field with strengths ranging between 0.5 and 1.5 V/nm. Both the experiments and simulations demonstrate a mixed charge emission regime where field-induced desorption of solvated ions and charged droplets occurs. The macroscopic parameters, such as average mass-to-charge ratio and maximum surface-normal field strengths deduced from the simulations are found to be in good agreement with the experimental work and consistent with electrohydrodynamic theory of cone-jets. The observed mass spectrometric Na (+) and I (-) solvated ion distributions are consistent with a thermal evaporation process, and are correctly reproduced by the simulation after incorporation of the different flight times and unimolecular ion dissociation rates in the analysis. Alignment of formamide dipoles and field-induced reorganization of the positive and negative ionic charges in the interfacial region are both found to contribute to the surface-normal field near the points of charge emission. In the simulations the majority of cluster ions are found to be emitted from the tip of the jet rather than from the neck region next to the Taylor cone. This finding is consistent with the experimental energy distributions of the solvated ions which demonstrate that indeed most ions are emitted closer to the jet region, that is, beyond the cone-neck region where ohmic losses occur. This observation is also consistent with continuum electrohydrodynamic predictions of cluster-ion evaporation at surface regions of high curvature and therefore maximum surface electric field strengths, which may be the cone-neck region, the breakup region of the jet (usually near the tip of the jet), or the emitted charged droplets. In the nanoscale jets observed in this study, the regions of highest spatial curvature are at the ends of the jets where nascent drops either are forming or have just detached.

The association between anxiety and alcohol versus cannabis abuse disorders among adolescents in primary care settings.

BACKGROUND: Both clinical and population-based studies show that anxiety disorders and substance misuse frequently co-occur in adults, whereas among adolescents, less examination of this association has been done. Adolescence is frequently the time of substance use initiation and its subsequent interaction with anxiety disorders has not been fully explored. It is unknown in adolescents whether anxiety is more related to alcohol abuse versus cannabis abuse. In addition, as depression has been implicated in adolescents with both anxiety and substance misuse, its role in the association should also be considered. OBJECTIVE: To test the association between current anxiety with alcohol versus cannabis abuse disorders. METHOD: Cross-sectional, clinician-administered, structured assessment--using the Primary Care Evaluation of Mental Disorders--to evaluate anxiety, mood and substance abuse disorders among 632 adolescents recruited from primary care settings. RESULTS: Results show a strong association between current anxiety and alcohol [odds ratio = 3.8; 95% confidence interval (CI) 1.2-11.8], but not cannabis (odds ratio = 1.4; 95% CI 0.4-4.7) abuse. CONCLUSION: This association in adolescents reflects the importance for increased awareness of anxiety symptoms and alcohol use patterns in primary care. The lack of association of anxiety with cannabis abuse in this group may reflect differences in cannabis' anxiolytic properties or that this young group has had less exposure thus far. Given adolescence is a time of especially rapid psychosocial, hormonal and brain development, primary care may provide an opportunity for further investigation and, potentially, early screening and intervention.

[Respiratory tract obstruction caused by ballooning of an intubation tube cuff during nitrous oxide inhalation]. / Obstruction des voies aériennes par hernie du ballonnet de la sonde d'intubation au cours d'inhalation de protoxyde d'azote.

A typical case of upper airway obstruction due to deformation of a low pressure tracheal tube cuff is reported. It would seem that this herniation may have been due to nitrous oxide diffusing with in the air-filled cuff, thereby causing it to overdistend. This increase in pressure occurred after 3 hours of inhalation of a mixture of oxygen and nitrous oxide. The deformed cuff may either block the lumen at the end of the tube, or push the tube against the tracheal wall. The result is, in either case, a mechanical obstruction of the airway, with hypoxia, and then anoxia. In the reported case, it was the decrease of SpO2 which alerted the anaesthetist. Pulse oximetry was helpful for an early diagnosis. To avoid such accidents, it is suggested either to inflate the cuff with the gas mixture with which the patient is ventilated, or to deflate it every 30 min.