PURPOSE: The purpose of this study was to identify the extent to which intensive care unit (ICU) nurses' perceptions of life-sustaining treatment decisions and “a good death” affect attitudes toward terminal care.METHOD: Participants included 109 ICU nurses from three university hospitals. Data were collected using structured questionnaires, and collected data were analyzed using a t-test, ANOVA, the Scheffé test, Pearson correlation coefficients, and a multiple regression analysis (SPSS 24.0 program).RESULTS: Perceptions of life-sustaining treatment decisions and a sense of closeness (a constituent for the awareness of “a good death”) were positively correlated with terminal care attitudes. The factors affecting terminal care attitudes were a clinical career in ICU (β=.20, p=.035), a sense of closeness(β=.19, p=.041), and the perception of a life-sustaining treatment decision (β=.22, p=.017). This finding indicates that more than 10 years of experience in ICU, a greater sense of closeness, and a higher view of life-sustaining treatment decisions results in more positive attitudes toward terminal care. The explanatory power of these variables on terminal care attitudes was 14% (F=6.84, p < .001, Adj R2=.140).CONCLUSION: A sense of closeness and the perception of life-sustaining treatment decisions were identified as the factors affecting terminal care attitudes. Thus, various programs must be developed to raise awareness among ICU nurses of “a good death” and perceptions of life-sustaining treatment decisions.
Critical Care ; Hospitals, University ; Intensive Care Units ; Methods ; Terminal Care

B-cell lymphoma (BCL)-2-interacting cell death suppressor (BIS) has diverse cellular functions depending on its binding partners. However, little is known about the effects of biochemical modification of BIS on its various activities under oxidative stress conditions. In this study, we showed that H₂O₂ reduced BIS mobility on SDS–polyacrylamide gels in a time-dependent manner via the activation of extracellular signaling-regulated kinase (ERK). The combined results of mass spectroscopy and computational prediction identified Thr285 and Ser289 in BIS as candidate residues for phosphorylation by ERK under oxidative stress conditions. Deletion of these sites resulted in a partial reduction in the H₂O₂-induced mobility shift relative to that of the wild-type BIS protein; overexpression of the deletion mutant sensitized A172 cells to H₂O₂-induced cell death without increasing the level of intracellular reactive oxygen species. Expression of the BIS deletion mutant decreased the level of heat shock protein (HSP) 70 mRNA following H₂O₂ treatment, which was accompanied by impaired nuclear translocation of heat shock transcription factor (HSF) 1. Co-immunoprecipitation assays revealed that the binding of wild-type BIS to HSF1 was decreased by oxidative stress, while the binding of the BIS deletion mutant to HSF1 was not affected. These results indicate that ERK-dependent phosphorylation of BIS has a role in the regulation of nuclear translocation of HSF1 likely through modulation of its interaction affinity with HSF1, which affects HSP70 expression and sensitivity to oxidative stress.
Cell Death ; Gels ; Heat-Shock Proteins ; Hot Temperature ; Immunoprecipitation ; Lymphoma, B-Cell ; Mass Spectrometry ; Oxidative Stress* ; Phosphorylation* ; Phosphotransferases ; Reactive Oxygen Species ; RNA, Messenger ; Shock ; Transcription Factors

BCL-2 interacting cell death suppressor (BIS), which is ubiquitously expressed, has important roles in various cellular processes, such as apoptosis, the cellular stress response, migration and invasion and protein quality control. In particular, BIS is highly expressed in skeletal and cardiac muscles, and BIS gene mutations result in human myopathy. In this study, we show that mRNA and protein levels of BIS were markedly increased during skeletal myogenesis in C2C12 cells and mouse satellite cells. BIS knockdown did not prevent the early stage of skeletal myogenesis, but did induce muscle atrophy and a decrease in the diameter of myotubes. BIS knockdown significantly suppressed the expression level of myosin heavy chain (MyHC) without changing the expression levels of myogenic marker proteins, such as Mgn, Cav-3 and MG53. In addition, BIS endogenously interacted with MyHC, and BIS knockdown induced MyHC ubiquitination and degradation. From these data, we conclude that molecular association of MyHC and BIS is necessary for MyHC stabilization in skeletal muscle.
Animals ; Apoptosis ; Cell Death* ; Humans ; Mice ; Muscle Development ; Muscle Fibers, Skeletal ; Muscle, Skeletal* ; Muscular Atrophy ; Muscular Diseases ; Myocardium ; Myosin Heavy Chains* ; Myosins* ; Quality Control ; RNA, Messenger ; Ubiquitin ; Ubiquitination

BCL-2 interacting cell death suppressor (BIS), which is ubiquitously expressed, has important roles in various cellular processes, such as apoptosis, the cellular stress response, migration and invasion and protein quality control. In particular, BIS is highly expressed in skeletal and cardiac muscles, and BIS gene mutations result in human myopathy. In this study, we show that mRNA and protein levels of BIS were markedly increased during skeletal myogenesis in C2C12 cells and mouse satellite cells. BIS knockdown did not prevent the early stage of skeletal myogenesis, but did induce muscle atrophy and a decrease in the diameter of myotubes. BIS knockdown significantly suppressed the expression level of myosin heavy chain (MyHC) without changing the expression levels of myogenic marker proteins, such as Mgn, Cav-3 and MG53. In addition, BIS endogenously interacted with MyHC, and BIS knockdown induced MyHC ubiquitination and degradation. From these data, we conclude that molecular association of MyHC and BIS is necessary for MyHC stabilization in skeletal muscle.
Animals ; Apoptosis ; Cell Death* ; Humans ; Mice ; Muscle Development ; Muscle Fibers, Skeletal ; Muscle, Skeletal* ; Muscular Atrophy ; Muscular Diseases ; Myocardium ; Myosin Heavy Chains* ; Myosins* ; Quality Control ; RNA, Messenger ; Ubiquitin ; Ubiquitination

BACKGROUND: This study evaluated the effects of family type and sociodemographic factors on medical treatment, health behavior, and subjective health status in Koreans 60 years and older. METHODS: This study was based on data from the 5th Korea National Health and Nutrition Examination Survey (KNHANES), a nationwide health interview survey using a rolling sampling design involving complex, stratified, multistage, probability cluster. Our subjects included those > or =60 years of age (n=1,946) participating in the KNHANES 2010. Family type was categorized into 7 groups according to cohabitation: alone, couple cohabitation (living with a spouse), parent(s) cohabitation (couple living with parent(s)), offspring cohabitation (no spouse, living with offspring), couple offspring cohabitation (couple living with offspring), couple offspring parents cohabitation (couple living with parent(s) and offspring), and others. Logistic regression analyses were used to examine the association of family type and sociodemographic factors with health care. RESULTS: The most common family type was couple cohabitation (38.26+/-1.8%). In this group, the percentage of non-receipt of needed medical care (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.42 to 0.87) and current smoking rate (OR, 0.32; 95% CI, 0.20 to 0.50) were significantly lower than those living alone. Among the sociodemographic charicteristics, male gender, apartment dwelling, high middle household income, 2 member family, education higher than middle school, and possessing own house were associated with good health care behavior. CONCLUSION: This study shows that couples have better health care behavior than other family types, in particular, limited smoking, appropriate medical treatment, and positive subjective health status. Those living alone visit medical clinics less often and have a negative subjective health status.
Delivery of Health Care ; Family Characteristics ; Health Behavior ; Humans ; Korea ; Logistic Models ; Male ; Nutrition Surveys ; Parents ; Smoke ; Smoking ; Spouses

PURPOSE: To investigate whether the result of RigiScan after intracorporeal injection could predict the result of duplex ultrasonography, and determine the necessity of duplex ultrasonography. MATERIALS AND METHODS: We performed both RigiScan and duplex ultrasonography after intracorporeal injection in 18 men with erectile dysfunction. All of the patients were evaluated by history taking, physical examination, laboratory test, hormonal tests, and neurologic examination before RigiScan and duplex ultrasonography. We measured maximal arterial diameter, peak systolic velocity, end-diastolic velocity using a 7 MHz. color Doppler unit and these results of duplex ultrasonography were compared with penile rigidity and tumescence measured by RigiScan. RESULTS: The positive and negative predictive value of RigiScan were 81.8% and 85.7%, respectively. The result of RigiScan was comparable with that of duplex ultrasonography and the accuracy of RigiScan was resonable. CONCLUSIONS: According to this results, duplex ultrasonography was needed if the response of RigiScan is abnormal after intracorporeal injection. However, duplex ultrasonography can be ommitted if the response of RigiScan is normal after intracorporeal injection.
Erectile Dysfunction ; Humans ; Male ; Mass Screening* ; Neurologic Examination ; Physical Examination ; Ultrasonography*

The clinical concept of coronary artery disease (CAD) has seen a paradigm shift over the last decade. CAD is mostly a progressive disease, and patients with CAD can develop acute coronary syndromes at any point in disease progression. In this clinical context, a new term, “chronic coronary syndrome,” was published in the 2019 European Society of Cardiology guidelines, reflecting the importance of early diagnosis and active management. Recent advances have been made in the evaluation of CAD using coronary CT angiography (CCTA). The clinical usefulness of CCTA in patients with stable angina or chronic coronary syndrome begins with the detection of early asymptomatic CAD. The characterization of atherosclerotic plaque and its role in determining treatment strategies for CAD have been demonstrated for all stages of the disease.This review describes the pathophysiology of stable angina to aid in the understanding of the clinical applications of CCTA.

The Bis protein is known to be involved in a variety of cellular processes including apoptosis, migration, autophagy as well as protein quality control. Bis expression is induced in response to a number of types of stress, such as heat shock or a proteasome inhibitor via the activation of heat shock factor (HSF)1. We report herein that Bis expression is increased at the transcriptional level in HK-2 kidney tubular cells and A172 glioma cells by exposure to oxidative stress such as H2O2 treatment and oxygen-glucose deprivation, respectively. The pretreatment of HK-2 cells with N-acetyl cysteine, suppressed Bis induction. Furthermore, HSF1 silencing attenuated Bis expression that was induced by H2O2, accompaniedby increase in reactive oxygen species (ROS) accumulation. Using a series of deletion constructs of the bis gene promoter, two putative heat shock elements located in the proximal region of the bis gene promoter were found to be essential for the constitutive expression is as well as the inducible expression of Bis. Taken together, our results indicate that oxidative stress induces Bis expression at the transcriptional levels via activation of HSF1, which might confer an expansion of antioxidant capacity against pro-oxidant milieu. However, the possible role of the other cis-element in the induction of Bis remains to be determined.
Apoptosis ; Autophagy ; Cysteine ; Glioma ; Hot Temperature ; Kidney ; Oxidative Stress* ; Proteasome Inhibitors ; Quality Control ; Reactive Oxygen Species ; Shock

Dysphagia often occurs in cancer patients. The primary causes of dysphagia in cancer patients include new local dissemination of cancer cells or metastatic brain lesions, which needs to be accurately differentiated. Dermatomyositis is often associated with cancer and may manifest before or after the cancer diagnosis. Although early diagnosis and immunotherapy can improve dermatomyositis, its identification may be delayed in cancer patients due to complex comorbidities. We report a case of a 33-year-old woman with metastatic breast cancer who presented with dysphagia. The primary consideration was metastatic lesions. However, subsequent diagnosis revealed dermatomyositis.Symptoms, including facial swelling, dysarthria, and dysphagia, emerged 26 months after the cancer diagnosis. No new metastatic lesion was identified through imaging studies. A videofluoroscopic study (VFSS) revealed velopharyngeal insufficiency, reduced pharyngeal contraction, and excessive pharyngeal residue with silent aspiration. After a combination of further clinical, laboratory, and muscle biopsy findings, dermatomyositis was identified as the actual cause of dysphagia. The patient was treated with immunosuppressive and rehabilitative swallowing therapies, which improved her symptoms. This case underscores the critical importance of accurately identifying and promptly treating dysphagia in cancer patients. It particularly emphasizes the need to recognize dermatomyositis as a potential differential diagnosis in cancer patients presenting with dysphagia.