PURPOSE: Infants at neonatal intensive care units (NICU) are invariably exposed to various procedural and environmental stimuli. The study was performed to compare the pain responses in three NICU stimulants and to examine the clinical feasibility for NICU infants using CRIES, FLACC and PIPP. METHOD: In a correlational study, a total of 94 NICU stimulants including angio-catheter insertions, trunk-rubbings and loud noises, was observed for pain responses among 64 infants using CRIES, FLACC and PIPP. RESULTS: A significant difference was identified among the mean scores in CRIES(F(2, 91)=47.847, p=.000), FLACC(F(2, 91)=41.249, p=.000) and PIPP(F(2, 91)=16.272, p=.000) to three stimulants. In a Post-hoc Scheff test, an angio-catheter insertion showed the highest scores in CRIES, FLACC and PIPP compared to the other two stimulations. A strong correlation was identified between CRIES and FLACC in all three stimulations(.817 < r < .945) while inconsistent findings were identified between PIPP and CRIES or FLACC. CONCLUSIONS: The results of the study support that CRIES and FLACC are reliable and clinically suitable pain measurements for NICU infants. Further studies are needed in data collection time-point as well as clinical feasibility on PIPP administration to assess pain response in infants, including premature infants.
Pain Measurement/*methods ; Male ; *Intensive Care Units, Neonatal ; *Infant, Newborn ; Infant Behavior ; Humans ; Female

PURPOSE: The study was conducted to investigate the skin hydration level in various body sites and identify the influencing factors in neonates. METHODS: An exploratory comparison study was designed to measure the stratum corneum hydration, using a National DM-R2 on the forehead, abdomen, buttocks, and the back of the hands and feet of 198 neonates including 92 premature infants. RESULTS: The results showed 32.7%-36.5% of stratum corneum hydration for all sites. Premature infants revealed a higher hydration level on the peripheral sites (dorsal hand and feet) than those of the full-term infants, possibly resulting from therapeutic regimens including an incubator or radiant warmer. Infants in an incubator showed a higher hydration level than those in radiant warmers, suggesting more attention to fluid management for infants in the open environment. In addition, all stratum corneum hydration measurements except one, from the forehead, showed a positive correlation with postnatal age in full-term infants while showing no relation to any measurements in premature infants. CONCLUSION: The study demonstrated the very low skin hydration levels in hospitalized neonates, particularly in premature neonates with more susceptible skin hydration instability despite therapeutic interventions for fluid balance. More vigilant fluid management is imperative in neonates, particularly those in the open environment.
Body Water/*metabolism ; Demography ; Epidermis/*metabolism ; Female ; Humans ; Incubators, Infant ; Infant, Newborn ; Infant, Premature ; Male ; Phototherapy/methods ; *Skin Physiological Phenomena ; Water Loss, Insensible

The μ-opioid receptor (MOR) is a class of opioid receptors characterized by a high affinity for β-endorphin and morphine. MOR is a G proteincoupled receptor (GPCR) that plays a role in reward and analgesic effects. While expression of MOR has been well established in neurons and microglia, astrocytic MOR expression has been less clear. Recently, we have reported that MOR is expressed in hippocampal astrocytes, and its activation has a critical role in the establishment of conditioned place preference. Despite this critical role, the expression and function of astrocytic MOR from other brain regions are still unknown. Here, we report that MOR is significantly expressed in astrocytes and GABAergic neurons from various brain regions including the hippocampus, nucleus accumbens, periaqueductal gray, amygdala, and arcuate nucleus. Using the MORmCherry reporter mice and Imaris analysis, we demonstrate that astrocytic MOR expression exceeded 60% in all tested regions. Also, we observed similar MOR expression of GABAergic neurons as shown in the previous distribution studies and it is noteworthy that MOR expression is particularly in parvalbumin (PV)-positive neurons. Furthermore, consistent with the normal MOR function observed in the MOR-mCherry mouse, our study also demonstrates intact MOR functionality in astrocytes through iGluSnFr-mediated glutamate imaging. Finally, we show the sex-difference in the expression pattern of MOR in PV-positive neurons, but not in the GABAergic neurons and astrocytes. Taken together, our findings highlight a substantial astrocytic MOR presence across various brain regions.

OBJECTIVES: The purpose of this study was to assess physical illnesses, psychological difficulties, and daily life function of victims' family members one year after the Sewol ferry disaster, in order to establish a basis of strategies to promote their mental health and resilience. METHODS: We statistically analyzed self-reported data collected from a survey conducted between March 22 and 28, 2015 with 139 family members of victims. RESULTS: All respondents complained about one or more psychological difficulties, and 95.4% of them had newly diagnosed or exacerbated physical illnesses. An increased number of psychological difficulties was associated with a greater tendency to present physical illnesses including chronic headache, gastrointestinal, musculoskeletal, obstetrico-gynecological, genitourinary, and cardiovascular disease. In addition, the majority of respondents reported a decrease in life functioning. Specifically, 71.9% reported interpersonal avoidance and 63.9% reported difficulty in returning to work. CONCLUSIONS: Not only psychological trauma but also physical illness and daily functioning should be evaluated in detail and actively addressed in the bereaved family members after a catastrophe.
Cardiovascular Diseases ; Disasters ; Headache Disorders ; Humans ; Mental Health ; Psychological Trauma ; Surveys and Questionnaires

Background: Hematopoietic stem/progenitor cells (HSPCs) have the property to return to the bone marrow, which is believed to be critical in situations such as HSPC transplantation. This property plays an important role in the stemness, viability, and proliferation of HSPCs, also. However, most in vitro models so far have not sufficiently simulated the complicate environment. Here, we proposed a three-dimensional experimental platform for the quantitative study of the migration of HSPCs. Methods: After encapsulating osteoblasts (OBs) in alginate beads, we quantified the migration of HSPCs into the beads due to the physical environment using digital image processing. Intermittent hydrostatic pressure (IHP) was used to mimic the mechanical environment of human bone marrow without using any biochemical factors. The expression of stromal cell-derived factor 1 (SDF-1) under IHP was measured. Results: The results showed that the presence of OBs in the hydrogel scaffold initiate the movement of HSPCs. Furthermore, the IHP promotes the migration of HSPCs, even without the addition of any biochemical factors, and the results were confirmed by measuring SDF-1 levels. Conclusion We believe this suggested three-dimensional experimental platform consisting of a simulated in vivo physical environment and encapsulated OBs should contribute to in vitro migration studies used to investigate the effects of other external factors.

Recently, neuromelanin and nigrosome imaging techniques have been developed to evaluate the substantia nigra in Parkinson’s disease. Previous studies have shown potential benefits of quantitative analysis of neuromelanin and nigrosome images in the substantia nigra, although visual assessments have been performed to evaluate structures in most studies. In this study, we investigate the potential of using deep learning based automatic region segmentation techniques for quantitative analysis of the substantia nigra. The deep convolutional neural network was trained to automatically segment substantia nigra regions on 3D nigrosome and neuromelanin sensitive MR images obtained from 30 subjects. With a 5-fold cross-validation, the mean calculated dice similarity coefficient between manual and deep learning was 0.70 ± 0.11. Although calculated dice similarity coefficients were relatively low due to empirically drawn margins, selected slices were overlapped for more than two slices of all subjects. Our results demonstrate that deep convolutional neural network-based method could provide reliable localization of substantia nigra regions on neuromelanin and nigrosome sensitive MR images.

Recently, neuromelanin and nigrosome imaging techniques have been developed to evaluate the substantia nigra in Parkinson’s disease. Previous studies have shown potential benefits of quantitative analysis of neuromelanin and nigrosome images in the substantia nigra, although visual assessments have been performed to evaluate structures in most studies. In this study, we investigate the potential of using deep learning based automatic region segmentation techniques for quantitative analysis of the substantia nigra. The deep convolutional neural network was trained to automatically segment substantia nigra regions on 3D nigrosome and neuromelanin sensitive MR images obtained from 30 subjects. With a 5-fold cross-validation, the mean calculated dice similarity coefficient between manual and deep learning was 0.70 ± 0.11. Although calculated dice similarity coefficients were relatively low due to empirically drawn margins, selected slices were overlapped for more than two slices of all subjects. Our results demonstrate that deep convolutional neural network-based method could provide reliable localization of substantia nigra regions on neuromelanin and nigrosome sensitive MR images.

Background: Hematopoietic stem/progenitor cells (HSPCs) have the property to return to the bone marrow, which is believed to be critical in situations such as HSPC transplantation. This property plays an important role in the stemness, viability, and proliferation of HSPCs, also. However, most in vitro models so far have not sufficiently simulated the complicate environment. Here, we proposed a three-dimensional experimental platform for the quantitative study of the migration of HSPCs. Methods: After encapsulating osteoblasts (OBs) in alginate beads, we quantified the migration of HSPCs into the beads due to the physical environment using digital image processing. Intermittent hydrostatic pressure (IHP) was used to mimic the mechanical environment of human bone marrow without using any biochemical factors. The expression of stromal cell-derived factor 1 (SDF-1) under IHP was measured. Results: The results showed that the presence of OBs in the hydrogel scaffold initiate the movement of HSPCs. Furthermore, the IHP promotes the migration of HSPCs, even without the addition of any biochemical factors, and the results were confirmed by measuring SDF-1 levels. Conclusion We believe this suggested three-dimensional experimental platform consisting of a simulated in vivo physical environment and encapsulated OBs should contribute to in vitro migration studies used to investigate the effects of other external factors.

Purpose: Melanoma is a potentially fatal cutaneous malignancy and regional lymph node (LN) metastases are the most important predictors of mortality. This study aimed to analyze clinical features and risk factors of complications associated with inguinal LN dissection (LND) to establish treatment protocols. Methods: This single-center retrospective study (2000 to 2018) consisted of patients who underwent inguinal area sentinel LN biopsy (SLNB) or LND due to malignant melanoma. Risk factors and outcomes were analyzed. Results: One hundred patients underwent SLNB alone (n=67; patients with negative SLNB), complete LND (CLND) after positive SLNB (n=19), or radical LND without SLNB (n=14). Five-year overall survival and disease-free survival rates among these groups were 87.3%, 57.4%, and 61.9%, and 59.0%, 22.7%, and 28.1%, respectively. The complication rate in the SLNB alone group was lower than the other groups (22.4% vs. 47.4% and 35.7%, respectively; P=0.048). Seroma was the most common complication in the SLNB alone group (15.0%); lymphedema was most common in the CLND after SLNB group (21.1%). Multivariate analysis of risk factors for postoperative complications found the hazard ratio for body mass index >28 kg/m2 was 4.376 (95% confidence interval [CI], 1.243–15.401; P=0.022). The hazard ratio for LND (including CLND after SLNB and radical LND without SLNB) was 3.263 (95% CI, 1.248–8.529; P=0.016). Conclusion Inguinal LND is a higher risk procedure compared to SLNB and other sites for postoperative complications, irrespective of meticulous surgical techniques. More studies are needed to establish treatment protocols (e.g., observation vs. CLND after a positive SLNB result) and the risks and benefits in Asian populations.

Purpose: Melanoma is a potentially fatal cutaneous malignancy and regional lymph node (LN) metastases are the most important predictors of mortality. This study aimed to analyze clinical features and risk factors of complications associated with inguinal LN dissection (LND) to establish treatment protocols. Methods: This single-center retrospective study (2000 to 2018) consisted of patients who underwent inguinal area sentinel LN biopsy (SLNB) or LND due to malignant melanoma. Risk factors and outcomes were analyzed. Results: One hundred patients underwent SLNB alone (n=67; patients with negative SLNB), complete LND (CLND) after positive SLNB (n=19), or radical LND without SLNB (n=14). Five-year overall survival and disease-free survival rates among these groups were 87.3%, 57.4%, and 61.9%, and 59.0%, 22.7%, and 28.1%, respectively. The complication rate in the SLNB alone group was lower than the other groups (22.4% vs. 47.4% and 35.7%, respectively; P=0.048). Seroma was the most common complication in the SLNB alone group (15.0%); lymphedema was most common in the CLND after SLNB group (21.1%). Multivariate analysis of risk factors for postoperative complications found the hazard ratio for body mass index >28 kg/m2 was 4.376 (95% confidence interval [CI], 1.243–15.401; P=0.022). The hazard ratio for LND (including CLND after SLNB and radical LND without SLNB) was 3.263 (95% CI, 1.248–8.529; P=0.016). Conclusion Inguinal LND is a higher risk procedure compared to SLNB and other sites for postoperative complications, irrespective of meticulous surgical techniques. More studies are needed to establish treatment protocols (e.g., observation vs. CLND after a positive SLNB result) and the risks and benefits in Asian populations.