PURPOSE: This study was a descriptive research to assess the level of and the relationship of related factors in the performance of end-of-life care by intensive care unit (ICU) nurses. METHODS: Participants were 238 ICU nurses from university and general hospitals. Data were collected, using structured questionnaires, and collected data were analyzed using t-test, ANOVA, Scheffé test, Pearson correlation coefficients, and multiple regression analysis with SPSS/WIN 22.0. RESULTS: There were significantly positive effects between performance of end-of-life care and end-of-life care attitudes. Performance end-of-life care was negatively associated with end-of-life care stress and obstacles. Factors that significantly influenced ICU nurses' performance of end-of-life were end-of-life care stress, medical team in obstacles related to end-of-life care, and end-of-life care attitudes, which explained about 53% of the variance in the performance of end-of-life care. CONCLUSION: Findings indicate that hospital organizations should carry out stress management and counseling programs in order to lower ICU nurses' end-of-life care stress, and to enhance end-of-life care attitudes. In addition, concern needs to be given to the medical team which was one of the obstacles to end-of-life care. It is also necessary to decrease the heavy workload and increase the communication with medical workers.
Counseling ; Hospitals, General ; Intensive Care Units ; Terminal Care

The aim of this paper is to introduce basic concepts and methods for calculating sample size in animal studies. At the planning stage of clinical studies, the determination of the sample size is a very important process to show the validity, accuracy, and reliability of the study. However, not all studies require a sample size to be calculated. Before conducting the study, it is essential to determine whether the study objectives suggest a pilot and exploratory study, as well as the purpose of testing the hypothesis of interest. Since most animal experiments are pilot and exploratory studies, it would be more appropriate to review other considerations for conducting an experiment while maintaining scientific and qualitative levels rather than sample size estimation. Sample size is calculated in various situations in animal studies. Therefore, it can be estimated according to the situations and objectives through the methods of precision analysis, power analysis, and so on. In some cases, nonparametric methods can be employed if the assumptions of normality is not met or a small sample is available for the study.

PURPOSE: Tumor necrosis factor-alpha(TNF-alpha) is a pro-inflammatory cytokine that has been implicated in the pathogenesis of cardiovascular disease. Serum levels of TNF-alpha are elevated in many human cardiac related pathogenic conditions, including heart failure. It is well known that TNF-alpha inhibits myocardial contractility and induces apoptosis of adult rat cardiomyocytes via stimulation of TNF receptor 1. But pathophysiologically relevant low levels of TNF-alpha can not induce apoptosis of neonatal cardiomyocytes. So, we evaluated the effects of different concentrations of TNF-alpha in cultured rat neonatal cardiomyocytes : apoptosis or necrosis. METHODS: Neonatal ventricular myocytes were isolated from 3-day-old rats by stepwise collagenase dissociation, and the cells were cultured for 3 days. After that, cardiomyocytes were treated with low(25 ng/mL) and high(250 ng/mL) concentration of TNF-alpha for 48 hours. Apoptosis was determined by terminal deoxynucleotidyl transfer-mediated end labelling(TUNEL) staining, and cell viability was evaluated by lactate dehydrogenase(LDH) measurements using cell culture supernatants. RESULTS: Low dose TNF-alpha did not induce apoptosis compared with controls(10.5 +/- 3.5% : 10.4 +/- 4.3%). And high dose TNF-alpha also did not induce significant apoptosis(10.2 +/- 3.6% : 10.4 +/- 4.3%). There was no detectable morphological changes of cardiomyocytes after low and high concentration of TNF-alpha treatment. LDH levels after TNF-alpha treatment was not significant compared with control(control : low : high, 3.2 +/- 0.1% : 3.1 +/- 0.2% : 3.3 +/- 0.3%). CONCLUSIONS: Our results suggest that high concentration of TNF-alpha alone can not induce apoptosis and significant cytotoxicity in neonatal rat cardiomyocytes.
Adult ; Animals ; Apoptosis ; Cardiovascular Diseases ; Cell Culture Techniques ; Cell Survival ; Collagenases ; Heart Failure ; Humans ; Lactic Acid ; Muscle Cells ; Myocytes, Cardiac* ; Necrosis ; Rats* ; Receptors, Tumor Necrosis Factor ; Tumor Necrosis Factor-alpha*

Amelanotic melanoma is a subtype of malignant melanoma that lacks clinically visible pigmentation. The absence of recognizable pigmentation obscures the clinical hallmark of the more typical form of malignant melanoma. Because it mimics various non-pigmented benign and malignant skin diseases, clinicians have difficulty diagnosing this lesion. An incorrect or delayed diagnosis can result in a worse outcome because the prognosis of melanoma depends on the tumor thickness and tissue invasion at the time of diagnosis. Therefore, early diagnosis is crucial for treating amelanotic melanoma. Dermoscopy is a useful non-invasive technique for diagnosing not only pigmented skin lesions, but also non-pigmented skin lesions because this modality can visualize vascular structures that are not discernible to the naked eye. Analyzing the dermoscopic vascular structures of amelanotic melanoma helps make an early diagnosis. We report here on a case of amelanotic melanoma for which the diagnosis was aided by performing dermoscopy as an adjuvant tool.
Delayed Diagnosis ; Dermoscopy ; Early Diagnosis ; Eye ; Melanoma ; Melanoma, Amelanotic ; Pigmentation ; Prognosis ; Skin ; Skin Diseases

No abstract available.
Granuloma* ; Syphilis, Cutaneous*

BACKGROUND/AIMS: Functional dyspepsia (FD) is characterized as chronic recurrent upper gastrointestinal symptoms in the absence of any organic disorder. We hypothesized that duodenal low-grade inflammation activates superficial afferent nerve sprouting, thereby contributing to hypersensitivity in patients with FD. METHODS: A prospective case-control study was conducted in a tertiary referral center. FD was defined using the Rome III criteria. Standardized endoscopic biopsies were performed in the stomach and duodenum. Hematoxylin and eosin staining and immunohistochemical staining for major basic proteins were performed to detect granulated eosinophil-derived granules, and S-100 staining was performed to detect fine nerve fibers. RESULTS: A total of 51 patients with FD (82% female; mean age 35.8 ± 13.4 years) and 35 controls were enrolled. Activated eosinophil counts in the duodenum were significantly higher in patients with FD than in controls (41.4% vs 17.1%, P = 0.005). Microscopic duodenitis was more frequently detected in patients with FD than in controls. Fine nerve fibers were more abundant in patients with FD than in controls (45.1% vs 11.4%, P = 0.029). The abundance of fine nerve fibers highly correlated with the degree of activated eosinophils. CONCLUSION: Duodenal low-grade inflammation, such as mucosal eosinophilic accumulation with degranulation, promoted mucosal enteric nerve fiber density and sprouting in patients with FD.
Biopsy ; Case-Control Studies ; Duodenitis ; Duodenum ; Dyspepsia ; Eosine Yellowish-(YS) ; Eosinophils ; Female ; Hematoxylin ; Humans ; Hypersensitivity ; Inflammation ; Mucous Membrane ; Nerve Fibers ; Peripheral Nervous System ; Prospective Studies ; Stomach ; Tertiary Care Centers

Coronary air embolism is a rare event. We report a case in which an acute myocardial infarction occurred in the region supplied by the right coronary artery after the removal of a double-lumen hemodialysis catheter. Emergent coronary angiography revealed air bubbles obstructing the mid-segment of the right coronary artery with slow flow phenomenon distally. The patient expired due to myocardial infarction.
Catheters* ; Coronary Angiography ; Coronary Vessels ; Embolism ; Embolism, Air* ; Humans ; Myocardial Infarction ; No-Reflow Phenomenon ; Renal Dialysis*

Necrotizing fasciitis is a rapidly progressing soft-tissue infection that affects the subcutaneous fascia and dermis, and characteristically spares the underlying muscle. Most cases represent a synergistic or mixed bacterial infection of aerobes and anaerobes. A variety of etiologies have been reported. Herein, two cases of necrotizing fasciitis of the right thigh secondary to perforated appendicitis, an extremely rare complication, are reported. Both cases recovered following aggressive surgical and medical therapies. The delay in diagnosis and radical surgical excision are frequent and significant contributory factors in the high reported mortality rate. A high index of suspicion, followed by prompt surgical intervention with broad-spectrum antibiotic therapy, seems to be the most important prognostic factor in these difficult cases.
Appendicitis* ; Bacterial Infections ; Dermis ; Diagnosis ; Fascia ; Fasciitis, Necrotizing* ; Mortality ; Thigh

Breast metastases from extramammary malignancies are uncommon. The most common sources are lymphomas/leukemias and melanomas. Some of the less common sources include carcinomas of the lung, ovary, and stomach, and infrequently, carcinoid tumors, hypernephromas, carcinomas of the liver, tonsil, pleura, pancreas, cervix, perineum, endometrium and bladder. Breast metastases from extramammary malignancies have both hematogenous and lymphatic routes. According to their routes, there are common radiological features of metastatic diseases of the breast, but the features are not specific for metastases. Typical ultrasound (US) features of hematogenous metastases include single or multiple, round to oval shaped, well-circumscribed hypoechoic masses without spiculations, calcifications, or architectural distortion; these masses are commonly located superficially in subcutaneous tissue or immediately adjacent to the breast parenchyma that is relatively rich in blood supply. Typical US features of lymphatic breast metastases include diffusely and heterogeneously increased echogenicities in subcutaneous fat and glandular tissue and a thick trabecular pattern with secondary skin thickening, lymphedema, and lymph node enlargement. However, lesions show variable US features in some cases, and differentiation of these lesions from primary breast cancer or from benign lesions is difficult. In this review, we demonstrate various US appearances of breast metastases from extramammary malignancies as typical and atypical features, based on the results of US and other imaging studies performed at our institution. Awareness of the typical and atypical imaging features of these lesions may be helpful to diagnose metastatic lesions of the breast.
Adenocarcinoma/secondary/ultrasonography ; Adolescent ; Adult ; Breast Neoplasms/*secondary/*ultrasonography ; Breast Neoplasms, Male/secondary/ultrasonography ; Carcinoma/secondary/ultrasonography ; Female ; Humans ; Lymphatic Metastasis/ultrasonography ; Lymphoma, Extranodal NK-T-Cell/pathology/ultrasonography ; Lymphoma, Large B-Cell, Diffuse/pathology/ultrasonography ; Male ; Melanoma/secondary ; Middle Aged ; Multiple Myeloma/secondary/ultrasonography ; Neoplastic Cells, Circulating/pathology