Diffuse alveolar hemorrhage (DAH) is associated with severe outcomes. We report a case of acute respiratory failure that required mechanical ventilation and was clinically and pathologically diagnosed as DAH related to exposure to organic dust. A 39-year-old man, who had visited a warehouse to grade beans for purchase, was referred to our hospital for impending respiratory failure. His initial radiographic examinations revealed diffuse bilateral ground-glass opacities in his lungs and bronchoalveolar lavage resulted in progressively bloodier returns, which is characteristic of DAH. He underwent bedside open lung biopsy of his right lower lobe in the intensive care unit. Biopsy results revealed DAH and organization with accumulation of hemosiderin-laden macrophages and a few fibroblastic foci. The patient was treated with empirical antibiotics and high-dose corticosteroids and successfully weaned from mechanical ventilation. DAH might be considered in the differential diagnosis of patients with acute respiratory failure after exposure to organic particles.
Adrenal Cortex Hormones ; Adult ; Anti-Bacterial Agents ; Biopsy ; Bronchoalveolar Lavage ; Diagnosis, Differential ; Dust* ; Fibroblasts ; Hemoptysis ; Hemorrhage* ; Humans ; Intensive Care Units ; Lung ; Macrophages ; Respiration, Artificial ; Respiratory Insufficiency*

Background: The purpose of this study was to examine the association between the consumption frequency of sugar-sweetened beverages including soda and sweet drinks and sleep duration and quality among Korean adolescents. Methods: Data on 137,101 boys and 130,806 girls of students in middle and high school were obtained from the 2014-2017 Korean Youth Risk Behavior Web-based Survey, a national-wide cross-sectional school-based survey. Respondents self-reported soda and sweet drinks consumption, sleep hours, and sleep quality. The associations between these variables were analyzed by complex sampling multivariate logistic regression analysis. Results: 76.4% and 84.7% of respondents consumed soda and sweet drinks at least one time per week. Sleep deprivation (<8 hours/day) was associated with higher soda and sweet drinks consumption (adjusted odds ratio [aOR], 95% confidence interval [CI]) for 5 times a week for soda 1.44 (1.33-1.59) in boys and 1.25 (1.12-1.40) in girls: and sweet drinks 1.54 (1.43-1.66) in boys and 1.41 (1.28-1.55) in girls. Similarly, unsatisfactory sleep quality was also associated with higher soda and sweet drinks consumption (aOR, 95% CI) for 5 times a week for soda 1.19 (1.13-1.26) in boys and 1.27 (1.19-1.35) in girls: and sweet drinks 1.36 (1.29-1.44) in boys and 1.34 (1.28-1.41) in girls. Conclusions Both sleep deprivation and poor sleep quality was associated with higher consumption of soda and sweet drinks among Korean adolescents.

Purpose: This review explored trends in studies on learning outcomes in nursing education using gamification, to provide directions for future research. Methods: This scoping review was conducted according to the Joanna Briggs Institute's guidelines. The literature search date was February 1, 2021. Results: Thirty-two studies were included. The largest proportion of studies were quantitative descriptive studies, including qualitative mixed methods (34.4%). More studies applied gamification in practical classes (53.1%) than in theoretical classes. Virtual simulation games (37.9%) and simple quiz games (34.4%) were most often used. Commonly used gamification elements included scores/points, feedback, badges, countdowns, challenges, competitions, and levels. Two themes emerged regarding the impact of gamification on learning: learners’ experiences and achievement outcomes with cognitive, affective, and psychomotor subthemes. Nursing education using gamification improved engagement, motivation, and learning achievement. However, there was less evidence for affective and psychomotor outcomes than for cognitive outcomes. Conclusion Gamification can be an effective educational strategy if educator's have sufficient understanding and readiness and appropriate gamification elements are applied to nursing education. Further research should investigate knowledge retention in the cognitive domain, collaboration and empathy in the affective domain, and the improvement of nursing skills using new technologies in the psychomotor domain.

PURPOSE: This study is aimed to analyze and clarify the ambiguous concept of insight. METHOD: This study used the process of Walker & Avant's concept analysis. RESULTS: Insight can be defined in terms of its attributes as follows: Insight 1) comes as a release to the tension of inquiry, (2) is the outcome of the process to discover the overall structure of the problem situation and psychologically restructurize it, (3) comes suddenly and unexpectedly, (4) is to clearly perceive the solution of the abstract problem, and (5) promotes obtaining another new insight. The antecedents of insight include inquiry that can not be resolved easily and also a state where basic knowledge related to the inquiry can be utilized. The consequence of the insight is (1) a new judgement is made, (2) the problem is solved, (3) previous insight is retained and transferred, and it also facilitates the generation of fresh insight, and (4) it passes into the habitual texture of one's mind. CONCLUSION: Nurse educators need to facilitate nursing students and nurses to accumulate systematically, various information that can become the basis of insight and provide them with an opportunity to experience a variety of problems. In addition, it is important to provide questions to learners as an education strategy to allow them to gain insight into problem solving. From now on, insight needs to be studied in conjunction with critical thinking and questioning in order to enhance nurses' ability to resolve problems.
*Decision Making ; Education, Nursing ; Humans ; *Self Concept

The obstructive sleep apnea syndrome can occur due to various etiologies in children. In otherwise healthy children, adenotonsillar hypertrophy is the leading cause of childhood obstuctive sleep apnea. Obstructive sleep apnea caused by adenotonsillar hypertrophy can lead to a variety of symptoms and sequelae such as behavioral disturbance, enuresis, failure to thrive, developmental delay, cor pulmonale, and hypertension. So if obstructive sleep apnea is clinically suspected, proper treatment should be administered to the patient after diagnostic examinations. More than 80% improvement is seen in symptoms of obstructive sleep apnea caused by adenotonsillar hypertrophy in children after tonsillectomy and adenoidectomy. However, when it is impossible to treat the patient using surgical methods or residual symptoms remained after tonsillectomy and adenoidectomy, additional treatments such as weight control, sleep position change, and continuous positive airway pressure (CPAP), should be considered. This paper reports a case using weight control and Auto-PAP to control mild sleep apnea and snoring, which in long-term follow-up were not resolved after tonsillectomy and adenoidectomy for severe obstructive sleep apnea.
Adenoidectomy ; Adenoids ; Child ; Continuous Positive Airway Pressure ; Enuresis ; Failure to Thrive ; Follow-Up Studies ; Humans ; Hypertension ; Hypertrophy ; Palatine Tonsil ; Pulmonary Heart Disease ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Snoring ; Tonsillectomy

PURPOSE: To examine and describe perceived health status and depression symptoms among Acute Coronary Syndrome (ACS) survivors, and to examine their relationship during survivors' recovery phase. METHODS: A prospective design was used to test changeability of the key variables over a 1-month period for a cohort group of 82 post ACS patients, prior to their hospital discharge (Time 1) and at 4 weeks post discharge (Time 2). The revised version of Short Form-12 Health Survey and Beck Depression Inventory were used to measure the perceived health status and depression symptoms. The data were collected between 2003 and 2004. RESULTS: Perceived health status including mental health and physical health significantly improved over the 4-week period (t=-2.58, p < .05). Perceived health status during the hospitalization and length of hospital stay were significant predictors of depression symptoms during the early recovery phase. CONCLUSIONS: Patients' own perceptions about their health status need to be closely evaluated during the hospitalization in order to reduce the occurrences of later depression symptoms. Consequently, reducing depression symptoms and improving perceived health status should be addressed both in acute and chronic phases of ACS.
Acute Coronary Syndrome ; Cohort Studies ; Depression ; Health Surveys ; Hospitalization ; Humans ; Length of Stay ; Mental Health ; Prospective Studies ; Survivors

No abstract available.

Fractures of the lateral process of the talus (LPT) are considered rare, accounting for less than 1% of all ankle injuries in the general population. These fractures are nearly 15 times more likely to occur in snowboarders. Recently, the number of population who started enjoying cable-wakeboard is increasing and this sport may cause fracture of the LPT by axial loading occur on the LPT while boarding or trick. We report on a case of involving LPT fracture during cable-wakeboard trick with successful screw osteosynthesis.
Ankle Injuries ; Skiing ; Sports ; Talus

PURPOSE: Solar ultraviolet (UV) radiation causes inflammation and matrix metalloproteinase (MMP) overexpression and extracellular matrix depletion, leading to skin photoaging such as wrinkle formation, dryness, and sagging. Activation of MMP is influenced by various molecules such as reactive oxygen species (ROS), proinflammatory cytokines, and transient receptor potential vanilloid type (TRPV)-1, which are increased in UV-irradiated skin cells. Aralia elata (AE) ethanolic extract was reported to inhibit ROS generation caused by UVB-irradiation in keratinocytes. In this study, we investigated the photoprotective effect of AE ethanolic extract on UVB-irradiated human keratinocytes (HaCaT) and human dermal fibroblasts (HDF). METHODS: AE was freeze-dried, extracted in 70% ethanol, and concentrated. Skin cells were treated with AE extract for 24 h and then exposed to UVB (55 mJ/cm2). After 48 h of incubation, proinflammatory cytokines, MMP-1, type-1 procollagen, and TRPV-1 levels were measured by ELISA or Western blotting. RESULTS: Treatment with AE extract (100 µg/mL) significantly inhibited UVB-induced IL-6, IL-8, and PGE2 production in HaCaT by 25.6%, 5.3%, and 70.2%, respectively, and also inhibited elevation of MMP-1 and TRPV-1 caused by UVB irradiation by 20.0% and 41.9%, respectively (p < 0.05). In HDF, AE extract treatment significantly inhibited both elevation of MMP-1 and reduction of type-1 procollagen caused by UVB irradiation (p < 0.05). In addition, type-1 procollagen was elevated by AE extract treatment in normal HDFs (p < 0.05). CONCLUSION: AE 70% ethanol extract has photoprotective ability via reduction of proinflammatory mediators, TRPV-1 and MMP-1 production, and elevation of collagen synthesis. Our findings suggest that AE extract might be a good natural material to protect against UVB-induced premature skin aging.
Aralia* ; Blotting, Western ; Collagen ; Cytokines ; Dinoprostone ; Enzyme-Linked Immunosorbent Assay ; Ethanol* ; Extracellular Matrix ; Fibroblasts* ; Humans* ; Inflammation ; Interleukin-6 ; Interleukin-8 ; Keratinocytes* ; Procollagen ; Reactive Oxygen Species ; Skin Aging ; Skin*