Background: Although rhythm control could be the best for symptomatic atrial fibrillation (AF), some patients fail to achieve sinus rhythm (SR). This study aimed to identify clinical risk factors of failed electrical cardioversion (ECV). Methods: A total of 248 patients who received ECV for persistent AF or atrial flutter (AFL) were retrospectivelyreviewed. Patients were divided into three groups: Group 1 maintained SR for > 1 year, group 2 maintained SR ≤ 1 yearafter ECV, and group 3 failed ECV. SR maintenance was assessed using regular electrocardiography or Holter monitoring. Results: Patients were divided into group 1 (73, 29%), group 2 (146, 59%), and group 3 (29, 12%). The mean ageof patients was 60 ± 10 years, and 197 (79%) were male. Age, sex, and baseline characteristics were similar amonggroups. However, increased cardiac size, digoxin use, heart failure (HF), and decreased left ventricular ejection frac‑ tion (LVEF) were more common in group 3. Univariate analysis of clinical risk factors for failed ECV was increasedcardiac size [hazard ratio (HR) 2.14 (95% confidence interval [CI], 1.06–4.34, p = 0.030)], digoxin use [HR 2.66 (95% CI, 1.15–6.14), p = 0.027], HF [HR 2.60 (95% CI, 1.32–5.09), p = 0.005], LVEF < 40% [HR 3.45 (95% CI, 1.00–11.85), p = 0.038], and decreased LVEF [HR 2.49 (95% CI, 1.18–5.25), p = 0.012]. Among them, HF showed clinical significance only by multivariate analysis [HR 3.01 (95% CI, 1.13–7.99), p = 0.027]. Conclusions Increased cardiac size, digoxin use, HF, LVEF < 40%, and decreased LVEF were related to failed ECV for persistent AF or AFL. Among these, HF was the most important risk factor. Further multi-center studies including greater number of participants are planned.

Background/Aims: Obstructive sleep apnea (OSA) is prevalent in older patients with idiopathic pulmonary fibrosis (IPF); however, it is underrecognized. OSA is characterized by intermittent hypoxia (IH) and sleep fragmentation. In this study, we evaluated the effects of IH in an older mouse model of bleomycin-induced lung fibrosis. Methods: Bleomycin-induced mice (C57BL/6, female) were randomly divided into four groups of young vs. old and room air (RA)-exposed vs. IH-exposed. Mice were exposed to RA or IH (20 cycles/h, FiO2 nadir 7 ± 0.5%, 8 h/day) for four weeks. The mice were sacrificed on day 28, and blood, bronchoalveolar lavage (BAL) fluid, and lung tissue samples were obtained. Results: The bleomycin-induced IH-exposed (EBI) older group showed more severe inflammation, fibrosis, and oxidative stress than the other groups. The levels of inflammatory cytokines in the serum and BAL fluid increased in the EBI group. Hydroxyproline levels in the lung tissue increased markedly in the EBI group. Conclusions This study demonstrates the possible harmful impact of OSA in an elderly mouse model of lung fibrosis. This study further suggests that older patients with IPF and OSA may be more of a concern than younger patients with IPF. Further research is required in this area.

Background: Obstructive sleep apnea (OSA) is associated with pulmonary fibrosis. Chronic intermittent hypoxia (CIH) is considered to be a surrogate of OSA. However, its exact role in pulmonary fibrosis remains uncertain. Therefore, we investigated the mechanism underlying CIH-induced pulmonary fibrosis and the role of the anti-fibrotic agent in bleomycin (BLE) induced lung injury. Methods: Mice were divided into eight groups: the normoxia (NOR), CIH, NOR plus BLE, CIH plus BLE, NOR plus pirfenidone (PF), CIH plus PF, NOR plus BLE and PF, and CIH plus BLE and PF groups. BLE was administered intratracheally on day 14 following CIH or NOR exposure. Subsequently, the mice were exposed to CIH or NOR for an additional 4 weeks. PF was administered orally on day 5 after BLE instillation once daily for 3 weeks. Results: In the BLE-treated groups, CIH-induced more collagen deposition in lung tissues than NOR, and significantly increased hydroxyproline and transforming growth factor-β expression. The CIH and BLE-treated groups showed increased lung inflammation compared to NOR or CIH groups. Following CIH with BLE treatment, nuclear factor-κB (NF-κB) protein expression was significantly increased, whereas nuclear factor-erythroid-related factor 2 (Nrf2) and heme oxygenase-1 protein levels were decreased. After PF treatment, NF-κB and Kelch-like ECH-associated protein 1 expression were suppressed, and Nrf2 expression was increased. Conclusion CIH accelerated lung fibrosis in BLE-induced lung injury in mice, potentially by regulating the NF-κB/Nrf2 signaling pathway. Our results implicate PF as a potential therapeutic agent for treating pulmonary fibrosis in individuals with OSA and idiopathic pulmonary fibrosis.

Background: Obstructive sleep apnea (OSA) is associated with pulmonary fibrosis. Chronic intermittent hypoxia (CIH) is considered to be a surrogate of OSA. However, its exact role in pulmonary fibrosis remains uncertain. Therefore, we investigated the mechanism underlying CIH-induced pulmonary fibrosis and the role of the anti-fibrotic agent in bleomycin (BLE) induced lung injury. Methods: Mice were divided into eight groups: the normoxia (NOR), CIH, NOR plus BLE, CIH plus BLE, NOR plus pirfenidone (PF), CIH plus PF, NOR plus BLE and PF, and CIH plus BLE and PF groups. BLE was administered intratracheally on day 14 following CIH or NOR exposure. Subsequently, the mice were exposed to CIH or NOR for an additional 4 weeks. PF was administered orally on day 5 after BLE instillation once daily for 3 weeks. Results: In the BLE-treated groups, CIH-induced more collagen deposition in lung tissues than NOR, and significantly increased hydroxyproline and transforming growth factor-β expression. The CIH and BLE-treated groups showed increased lung inflammation compared to NOR or CIH groups. Following CIH with BLE treatment, nuclear factor-κB (NF-κB) protein expression was significantly increased, whereas nuclear factor-erythroid-related factor 2 (Nrf2) and heme oxygenase-1 protein levels were decreased. After PF treatment, NF-κB and Kelch-like ECH-associated protein 1 expression were suppressed, and Nrf2 expression was increased. Conclusion CIH accelerated lung fibrosis in BLE-induced lung injury in mice, potentially by regulating the NF-κB/Nrf2 signaling pathway. Our results implicate PF as a potential therapeutic agent for treating pulmonary fibrosis in individuals with OSA and idiopathic pulmonary fibrosis.

PURPOSE: The purpose of this study was to develop a scale to assess the transition shock experienced by newly graduated nurses, and test the validity and reliability of the scale. METHODS: The initial items were identified through a review of literature and in-depth interviews with nine newly graduated nurses. Content validation of the items was evaluated by five nurse professors and three nurses. Participants were 269 newly graduated nurses who worked at six acute care hospitals in Busan, Ulsan, and Yangsan, South Korea. Data were analyzed using item analysis, exploratory and confirmatory factor analysis, criterion related validity, and internal consistency. RESULTS: The final scale consisted of 18 items and six factors (conflict between theory and practice, overwhelming workload, loss of social support, shrinking relationship with co-workers, confusion in professional nursing values, and incongruity in work and personal life), which explained 71.3% of the total variance. The six subscale model was validated by confirmatory factor analysis. Cronbach's alpha for the total items was. 89. Convergent validity was evaluated by analyzing total correlation with burnout (r=.71, p<.001) and turnover intention (t=5.84, p<.001). CONCLUSION: This scale can be used in the development of nursing interventions to reduce the transition shock experienced by newly graduated nurses.
Busan ; Factor Analysis, Statistical ; Gyeongsangnam-do ; Humans ; Intention ; Korea ; Nursing ; Psychometrics ; Reproducibility of Results ; Shock* ; Ulsan

BACKGROUND/AIMS: An association between reduced pulmonary function and diabetes has been observed. Our aim was to evaluate the prevalence and risk factors associated with reduced pulmonary function in diabetic patients. METHODS: We analyzed data from the Korea National Health and Nutrition Examination Survey 2011 to 2013. The study population included data from 8,784 participants (including 1,431 diabetics) aged ≥ 40 years. Reduced pulmonary function was defined as patients with restrictive (forced expiratory volume in 1 second/forced vital capacity [FEV₁/FVC] ≥ 0.7 and FVC < 80% of predicted value) or obstructive (FEV₁/FVC < 0.7) patterns. RESULTS: Subjects with diabetes had a higher prevalence of restrictive (18.4% vs. 9.4%, p < 0.001) and obstructive impairments (20% vs. 12.6%, p < 0.001) than those without diabetes. The adjusted odds ratios (aORs) (95% confidence interval [CI]) for obstructive and restrictive pulmonary impairment were 0.91 (0.75 to 1.11) and 1.57 (1.30 to 1.89), respectively. In the diabetes population, age (aOR, 1.04; 95% CI, 1.02 to 1.06), male sex (aOR, 1.40; 95% CI, 1.04 to 1.88), and body mass index (aOR, 1.15; 95% CI, 1.10 to 1.21) were independently associated with restrictive pulmonary impairment. Age (aOR, 1.12; 95% CI, 1.09 to 1.14), male sex (aOR, 4.24; 95% CI, 2.42 to 7.44), and smoking at any point (ever-smoker: aOR, 1.96; 95% CI, 1.16 to 3.33) were independent risk factors for obstructive pulmonary impairment in diabetics. Diabetes duration or glycated hemoglobin had no association with pulmonary impairment in diabetes. CONCLUSIONS: Subjects with diabetes had a higher risk of restrictive pulmonary impairment than those without diabetes after adjusting for confounding factors. Older age, male sex, body mass index, and smoking were associated with reduced lung function in diabetes.
Body Mass Index ; Hemoglobin A, Glycosylated ; Humans ; Korea* ; Lung ; Male ; Nutrition Surveys* ; Odds Ratio ; Prevalence* ; Respiratory Function Tests ; Risk Factors* ; Smoke ; Smoking ; Vital Capacity

OBJECTIVES: The aim of this study was to determine whether chronic kidney disease (CKD) is associated with hearing thresholds in the nationwide, large-scaled Korean population. METHODS: This study analyzed the data of 9,798 subjects of 19 years and older (4,387 males and 5,411 females). Urine albumin-to-creatinine ratio (ACR) was measured from first-voided spot urine samples. The air-conduction hearing threshold was measured at 0.5, 1, 2, 3, 4, and 6 kHz and pure tone audiogram (PTA) average was calculated as the four-frequency average of 0.5, 1, 2, and 4 kHz. RESULTS: Urine ACR was significantly correlated with the PTA average of better ear in both genders, especially at 3 and 6 kHz in males and at 1, 3, 4, and 6 kHz in females. After adjusting, urine ACR also increased the risk of hearing loss in female, especially if urine ACR was 30 mg/g and more (odds ratio, 1.636–2.229. This study showed that the degree of hearing loss was significantly different according to categories of urine ACR in both genders. Hearing loss without disability was found less but that with bilateral hearing disability was found more as urine ACR increased. In generally, prevalence of hearing loss with disability was higher in males than females. CONCLUSION: This study demonstrated that urine ACR was significantly correlated with the PTA average of better ear in Korean adults of both genders. This study suggests that clinicians should carefully monitor the hearing level for subjects with elevated urine ACR, even though high urine ACR within the normal range.
Adult* ; Albuminuria ; Ear ; Epidemiologic Studies ; Female ; Hearing Loss* ; Hearing* ; Humans ; Korea* ; Male ; Nutrition Surveys* ; Prevalence ; Reference Values ; Renal Insufficiency, Chronic

BACKGROUND/AIMS: The pulmonary abnormalities (principally restrictive abnormalities) are characteristic of renal transplant recipients or those with end-stage renal disease. Our aim was to explore whether the prevalence of spirometric abnormalities was influenced by the estimated glomerular filtration rates (GFRs) in a Korean general population. METHODS: We used data obtained during the 2010 to 2012 Korean National Health and Nutrition Examination Survey, a national cross-sectional survey. We analyzed data from subjects for whom spirometric assays and estimated GFRs were of acceptable quality. RESULTS: A total of 8,809 subjects (3,868 male and 4,941 female) was included. In both males and females with GFR values < 60 mL/min/1.73 m², the linear trends toward the presence of obstructive and restrictive patterns were significant. However, the percent predicted forced vital capacity (FVC) decreased with a decline in the estimated GFR, but only in males (p for trend < 0.0031). Multivariate linear regression analysis showed a decline in the estimated GFR was independently associated with falls in the percent predicted FVC and the forced expiratory volume in 1 second/FVC ratio in both males and females. However, the percent predicted FVC was independently predictive only in males (p = 0.002). CONCLUSIONS: Impaired pulmonary function was associated with a decline in the estimated GFR. The percent predicted FVC decrease paralleled the decline in estimated GFR in male only. Careful interpretation of pulmonary function test data is required in patients with decreased GFRs or impaired renal function, especially males.
Accidental Falls ; Cross-Sectional Studies ; Female ; Forced Expiratory Volume ; Glomerular Filtration Rate* ; Humans ; Kidney Failure, Chronic ; Korea* ; Linear Models ; Male ; Nutrition Surveys* ; Prevalence ; Respiratory Function Tests* ; Transplant Recipients ; Vital Capacity

BACKGROUND/AIMS: This study examined prevalence and risk factors of periodontitis in representative samples of Korean adults, with and without diabetes mellitus (DM). METHODS: Data from the 2012 Korean National Health and Nutritional Examination Survey were analyzed. A total of 4,477 adults (≥ 30 years old) were selected from 8,057 individuals who completed a nutrition survey, a self-reported general health behavior questionnaire, an oral examination, an oral hygiene behaviors survey, and laboratory tests. DM was defined as a fasting plasma glucose ≥ 126 mg/dL, or self-reported diagnosed diabetes, or current use of oral hypoglycemic agents and/or insulin. The community periodontal index was used to assess periodontitis status and comparisons between the periodontitis and the non-periodontitis group, were performed, according to the presence of DM. Risk factors for periodontitis in adults with DM and without DM were evaluated by multiple logistic regression analysis. RESULTS: The prevalence of periodontitis was significantly higher in adults with DM (43.7%) than in those without DM (25%, p < 0.001). In adults without DM, risk factors for periodontitis were older age, male, urban habitation, waist circumference, smoking, oral pain, and less frequent tooth brushing. Significant risk factors for periodontitis in adults with DM were the smoking, oral pain, and not-using an oral hygiene product. CONCLUSIONS: Adults with DM have an increased risk of periodontitis than those without DM. Current smoking and oral pain increase this risk. Using an oral hygiene product can reduce risk of periodontal disease in adults with DM.
Adult* ; Blood Glucose ; Diabetes Mellitus* ; Diagnosis, Oral ; Fasting ; Health Behavior ; Humans ; Hypoglycemic Agents ; Insulin ; Logistic Models ; Male ; Nutrition Surveys ; Oral Hygiene ; Periodontal Diseases ; Periodontal Index ; Periodontitis* ; Population Surveillance ; Prevalence* ; Risk Factors* ; Smoke ; Smoking ; Tooth ; Waist Circumference

PURPOSE: To determine the change in lacrimal gland (LG) acinar cells induced by in vivo dry eye (DE). METHODS: Six to 8-week-old (C57BL/6) mice were placed in a controlled environment chamber at <20% humidity for 2 weeks, and a control group was bred in a normal environment. After these 2 weeks of dry eye (DE) induction, the mice were sacrificed and their LGs were collected. Lacrimal gland acinar cell organelle structures were observed with Transmission Electron Microscopy (TEM). TEM images were analyzed using the Image J program. RESULTS: The size of the LGs of DE-induced mice decreased compared to those of normal mice. Terminal deoxynucleotidyl transferase dUTP Nick End Labeling (TUNEL) staining was negative in DE-induced LGs. Under the TEM, the endoplasmic reticulum (ER) lumen was dilated and the lumen density increased in DE-induced mice. Additionally, cell organelles were surrounded by elongated ER lumens. The mitochondrial structure was destroyed and the number of vacuoles increased in the LGs of DE-induced mice. CONCLUSIONS: Structural changes of the LG developed due to DE induction. This suggests that the detailed mechanisms of these changes were ER stress and autophagy. However, there were no definite signs of apoptosis in the acinar cells of the DE-induced LGs. These findings are regarded as an important clue of the pathogenesis of non-Sjogren-type dry eye.
Acinar Cells* ; Animals ; Apoptosis ; Autophagy ; DNA Nucleotidylexotransferase ; Endoplasmic Reticulum ; Environment, Controlled ; Humidity ; Lacrimal Apparatus* ; Mice ; Microscopy, Electron, Transmission ; Organelles ; Vacuoles