PURPOSE: This study was conducted to explore the impact of registered nurse/nurses' aid (RN/NA) staffing and turnover rate on inpatient health outcomes in long term care hospitals. METHODS: A secondary analysis was done of national data from the Health Insurance Review and Assessment Services including evaluation of long term care hospitals in October-December 2010 and hospital general characteristics in July-September 2010. Final analysis of data from 610 hospitals included RN/NA staffing, turnover rate of nursing staff and 5 patient health outcome indicators. RESULTS: Finding showed that, when variables of organization and community level were controlled, patients per RN was a significant indicator of decline in ADL for patients with dementia, and new pressure ulcer development in the high risk group and worsening of pressure ulcers. Patients per NA was a significant indicator for new pressure ulcer development in the low risk group. Turnover rate was not significant for any variable. CONCLUSION: To maintain and improve patient health outcomes of ADL and pressure ulcers, policies should be developed to increase the staffing level of RN. Studies are also needed to examine causal relation of NA staffing level, RN staffing level and patient health outcomes with consideration of the details of nursing practice.
Activities of Daily Living ; Dementia/physiopathology ; Humans ; Inpatients/*psychology ; Long-Term Care ; National Health Programs ; Nursing Staff, Hospital/psychology/*statistics & numerical data ; Personnel Turnover ; Pressure Ulcer/etiology ; *Quality Indicators, Health Care ; Risk Factors

Purpose: This study examined the factors affecting mortality and clinical severity score (CSS) of male and female patients with Coronavirus Disease 2019 (COVID-19) using clinical epidemiological information provided by the Korea Disease Control and Prevention Agency. Methods: This is a retrospective, observational cohort study. From January 21 to April 30, 2020, a total of 5624 patients who were released from quarantine or died were analyzed. Results: The factors influencing release or death that differed by sex were high heart rate and malignancy in males and chronic kidney disease in females. In addition, the factors influencing progression to severe CSS were high BMI (severe obesity) and rheumatic disease in males and high temperature, sputum production, absence of sore throat and headache, chronic kidney disease, malignancy, and chronic liver disease in females. Older age, low lymphocyte count and platelets, dyspnea, diabetes mellitus, dementia, and intensive care unit (ICU) admission affected mortality in all the patients, and older age, low lymphocyte count and platelets, fever, dyspnea, diabetes mellitus, dementia, and ICU admission affected progression to severe stage of CSS. Conclusions This study is expected to contribute to the general results by analyzing nationally representative data. The results of this study present an important basis for development of differentiated nursing and medical management strategies in consideration of factors that influence treatment effects and outcomes according to sex of patients with COVID-19.

Ultrasound was developed several decades ago as a useful imaging modality, and it became the second most popular diagnostic tool due to its non-invasiveness, real-time capabilities, and safety. Additionally, ultrasound has been used as a therapeutic tool with several therapeutic agents and in nanomedicine. Ultrasound imaging is often used to diagnose many types of cancers, including breast, stomach, and thyroid cancers. In addition, ultrasound-mediated therapy is used in cases of joint inflammation, rheumatoid arthritis, and osteoarthritis. Microbubbles, when used as ultrasound contrast agents, can act as echo-enhancers and therapeutic agents, and they can play an essential role in ultrasound imaging and ultrasound-mediated therapy. Recently, various types of ultrasound contrast agents made of lipid, polymer, and protein shells have been used. Air, nitrogen, and perfluorocarbon are usually included in the core of the microbubbles to enhance ultrasound imaging, and therapeutic drugs are conjugated and loaded onto the surface or into the core of the microbubbles, depending on the purpose and properties of the substance. Many research groups have utilized ultrasound contrast agents to enhance the imaging signal in blood vessels or tissues and to overcome the blood–brain barrier or blood-retina barrier. These agents are also used to help treat diseases in various regions or systems of the body, such as the cardiovascular system, or as a cancer treatment. In addition, with the introduction of targeted moiety and multiple functional groups, ultrasound contrast agents are expected to have a potential future in ultrasound imaging and therapy. In this paper, we briefly review the principles of ultrasound and introduce the underlying theory, applications, limitations, and future perspectives of ultrasound contrast agents.
Arthritis, Rheumatoid ; Blood Vessels ; Breast ; Cardiovascular System ; Contrast Media ; Inflammation ; Joints ; Microbubbles* ; Nanomedicine ; Nitrogen ; Osteoarthritis ; Polymers ; Stomach ; Thyroid Neoplasms ; Ultrasonography*

BACKGROUND: It has been well known that the degree of HLA matching in renal transplantation is important in graft and patient survival. Because HLA-identical living-related donor grafts are free from immunological attacks, they have benefits of one immunosuppressants or early withdrawal of steroids. However, there is acute rejection due to early withdrawal of immunosuppressants and graft loss due to recurrent glomerulonephritis following HLA- identical living-related renal transplantation. The purpose of this study is to determine the graft survival and the impact of recurrent glomerulonephritis on graft survival in HLA-identical living-related donor grafts. METHODS: From December 1984 to March 2004, 44 HLA-identical and 80 HLA-haploidentical living- related renal transplants in Bongsaeng Memorial Hospital were included in this study. We evaluated graft survivals, immunosuppressants and causes of graft failure. RESULTS: The mean graft survival for HLA-identical transplants is 198 months (16.5 years) and for HLA-haploidentical transplants is 166 months (13.8 years), respectively (p=NS). Acute rejection episodes occurred in 2 of the 44 (5%) identical transplants and 17 of the 80 (21%) haploidentical transplants, respectively (p=0.013). 6 grafts were lost in HLA- identical transplants and the causes are 4 recurrent glomerulonephritis (66.7%), 2 chronic rejections (33.4 %). 11 grafts were lost in HLA-haploidentical transplants and the causes are 6 chronic rejections (54.5 %), 1 acute rejection (9.1%), 1 drug toxicity (9.1%), 3 patient deaths (27.3%). Recurrent glomerulonephritis in HLA-identical transplants are three, but in HLA-haploidentical transplants are none. CONCLUSION: Our data revealed that there was no difference in graft survival between the two groups, but lower acute rejection rate in HLA-identical groups. Recurrent glomerulonephritis was the main cause of graft failure in HLA-identical groups and the impact of recurrent disease on graft survival needs to be investigated.
Drug-Related Side Effects and Adverse Reactions ; Glomerulonephritis ; Graft Survival ; Humans ; Immunosuppressive Agents ; Kidney Transplantation ; Steroids ; Tissue Donors* ; Transplants

PURPOSE: Lactobacillus casei (L. casei) is known to exert anti-proliferation effects on many types of cancer cells. However, the effect of L. casei on liver cancer has not been reported. Accordingly, the aim of this study was to determine the anti-cancer effect of L. casei extract on Huh7 cells. MATERIALS AND METHODS: L. casei ATCC393 extract was prepared and purified. After the treatment of L. casei extract on Huh7 cells, cell viability, cell cycle arrest and cell death were analyzed by flow cytometry. The expression levels of tumor necrosis factor-alpha receptor 1 (TNFR1) and death receptor 3 (DR3) mRNA related with extrinsic apoptosis were assessed by reverse transcription polymerase chain reaction. Additionally, P21 and P27 cell cycle proteins as well as Caspase-3, -8, -9, phospho-Bad and Bcl-2 apoptosis proteins were analyzed by western blot analysis. To determine the effect of L. casei extract on cancer stem-like cells, we analyzed changes in side population fraction through flow cytometry. RESULTS: The cell viability of Huh7 cells treated with L. casei extract was decreased by 77%, potentially owing to increases in the rates of Huh7 cells arrested in the G2/M phase (3% increase) and that underwent apoptosis (6% increase). The expression levels of TNFR1 and DR3 mRNA, as well as P21 and P27 cell cycle proteins, were increased. Meanwhile, the expressions of caspase-8, -9, phospho-Bad and Bcl-2 proteins decreased. However, in the case of side population cells, no remarkable changes were observed. CONCLUSION: L. casei extract exerts a potent anti-tumor effect on the viability of liver cancer cells, although not on cancer stem-like cells.
Apoptosis/drug effects ; Carcinoma, Hepatocellular/*pathology ; Caspase 8/metabolism ; Caspase 9/metabolism ; Cell Cycle Checkpoints/drug effects ; Cell Extracts/*pharmacology ; Cell Line, Tumor ; Cell Proliferation/drug effects ; Cyclin-Dependent Kinase Inhibitor p21/metabolism ; Cyclin-Dependent Kinase Inhibitor p27/metabolism ; Cytostatic Agents/*pharmacology ; Flow Cytometry ; Gene Expression Regulation, Neoplastic/drug effects ; Humans ; Lactobacillus casei/*chemistry ; Liver Neoplasms/*pathology ; Proto-Oncogene Proteins c-bcl-2/metabolism ; RNA, Messenger/metabolism ; Receptors, Tumor Necrosis Factor, Member 25/metabolism ; Receptors, Tumor Necrosis Factor, Type I/metabolism ; bcl-Associated Death Protein/metabolism

Streptococcus mutans (S. mutans) is a facultative anaerobic bacterium mainly found in the oral cavity and is known to contribute to tooth decay and gingivitis. Recent studies on intestinal microbiota have revealed that microorganisms forming a biofilm play important roles in maintaining tissue homeostasis through their own metabolism. However, the physiological roles of oral microorganisms such as S. mutans are still unclear. In our current study, we identified that constituents released from S. mutans (CR) reduce arecoline-mediated cytotoxicity without producing toxic effects themselves. Arecoline, as a major alkaloid of areca nut, is known to mediate cytotoxicity on oral epithelial cells and induces a sustained intracellular Ca2+ ([Ca2+]i) increase that is cytotoxic. The exposure of human gingival fibroblast (HGF) cells to CR not only inhibited the sustained [Ca2+]i increase but also the initial [Ca2+]i elevation. In contrast, CR had no effects on the gene regulation mediated by arecoline. These results demonstrate that S. mutans has physiological role in reducing cytotoxicity in HGF cells and may be considered a novel pharmaceutical candidate.
Areca ; Arecoline ; Biofilms ; Epithelial Cells ; Fibroblasts ; Gingivitis ; Homeostasis ; Humans ; Metabolism ; Microbiota ; Mouth ; Nuts ; Streptococcus mutans* ; Tooth

Viridicatol (1) has previously been isolated from the extract of the marine-derived fungus Penicillium sp. SF-5295. In the course of further biological evaluation of this quinolone alkaloid, anti-inflammatory effect of 1 in RAW264.7 and BV2 cells stimulated with lipopolysaccharide (LPS) was observed. In this study, our data indicated that 1 suppressed the expression of well-known pro-inflammatory mediators such as inducible nitric oxide synthase (iNOS) and cyclooxygenase (COX)-2, and consequently inhibited the production of iNOS-derived nitric oxide (NO) and COX-2-derived prostaglandin E2 (PGE2) in LPS stimulated RAW264.7 and BV2 cells. Compound 1 also reduced mRNA expression of pro-inflammatory cytokines such as interleukin-1beta (IL-1beta), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha). In the further evaluation of the mechanisms of these anti-inflammatory effects, 1 was shown to inhibit nuclear factor-kappa B (NF-kappaB) pathway in LPS-stimulated RAW264.7 and BV2 cells. Compound 1 blocked the phosphorylation and degradation of inhibitor kappa B (IkappaB)-alpha in the cytoplasm, and suppressed the translocation of NF-kappaB p65 and p50 heterodimer in nucleus. In addition, viridicatol (1) attenuated the DNA-binding activity of NF-kappaB in LPS-stimulated RAW264.7 and BV2 cells.
Cytokines ; Cytoplasm ; Dinoprostone ; Fungi ; Interleukin-1beta ; Interleukin-6 ; NF-kappa B* ; Nitric Oxide ; Nitric Oxide Synthase Type II ; Penicillium* ; Phosphorylation ; Prostaglandin-Endoperoxide Synthases ; RNA, Messenger ; Tumor Necrosis Factor-alpha

PURPOSE: The purpose of this study was to identify sleep quality, job stress, symptoms of stress (SOS), and coping and to examine factors influencing sleep quality in clinical nurses. METHODS: A cross-sectional study was conducted with 265 clinical nurses at three general hospitals. A self-administrated questionnaire was used for data collection, and data were analyzed using descriptive statistics, Pearson correlation coefficients, t-test, ANOVA, and backward multiple regression with the SAS statistical program. RESULTS: Sleep quality showed significant differences according to the sociodemographic characteristics of age, length of work, education, current workplace, current job position, shift work, and marital status. Sleep quality was negatively associated with SOS and job stress. Significant factors influencing sleep quality of the clinical nurses were cognitive-behavioral SOS, physiological SOS, inappropriate rewards, physical work environment, and shift work. CONCLUSION: The findings indicate that cognitive-behavioral SOS, physiological SOS, job stress regarding inappropriate rewards and physical work environment, and shift work are useful to predict levels of sleep quality of clinical nurses. These factors should be considered when developing nursing interventions to improve sleep quality of clinical nurses through stress management.
Cross-Sectional Studies ; Data Collection ; Education ; Hospitals, General ; Marital Status ; Nursing ; Surveys and Questionnaires ; Reward

Background: When an arteriovenous fistula (AVF) is created using the basilic or deep cephalic vein, it is additionally necessary to transfer the vessels to a position where needling is easy; however, many patients develop wound-related postsurgical complications due to the long surgical wounds resulting from conventional superficialization of a deep AVF or basilic vein transposition. Thus, to address this problem, we performed videoscopic surgery with small surgical incisions. Methods: Data from 16 patients who underwent additional videoscopic radiocephalic superficialization, brachiocephalic superficialization, and brachiobasilic transposition after AVF formation at our institution in 2018 were retrospectively reviewed. Results: Needling was successful in all patients. No wound-related complications occurred. The mean vessel size and blood flow of the AVF just before the first needling were 0.73±0.16 mm and 1,516.25±791.26 mL/min, respectively. The mean vessel depth after surgery was 0.26±0.10 cm. Percutaneous angioplasty was additionally performed in 25% of the patients. Primary patency was observed in 100% of patients during the follow-up period (262.44±73.49 days). Conclusion Videoscopic surgery for AVF dramatically reduced the incidence of postoperative complications without interrupting patency; moreover, such procedures may increase the use of native vessels for vascular access. In addition, dissection using a videoscope compared to blind dissection using only a skip incision dramatically increased the success rate of displacement by reducing damage to the dissected vessels.