Inflammasome is a cytosolic multiprotein complex to activate caspase-1 leading to the subsequent processing of inactive pro-interleukin-1-beta (Pro-IL-1beta) into its active interleukin-1 beta (IL-1beta) in response to pathogen- or danger-associated molecular pattern. In recent years, a huge progress has been made to identify inflammasome component as a molecular platform to recruit and activate caspase-1. Nucleotide-binding oligomerization domain-like receptor (NLR) family proteins such as NLRP1, NLRP3 or interleukin-1beta-converting enzyme (ICE)-protease activating factor (IPAF) have been first characterized to form inflammasome complex to induce caspase-1 activation. More recently, non-NLR type, pyrin-domain (PYD)-containing proteins such as pyrin or absent in melanoma2 (AIM2) were also proposed to form caspase-1-activating inflammasome machinery with apoptosis-associated speck-like protein containing a CARD (ASC), an essential adaptor molecule. Inflammasome pathways were shown to be crucial for protecting host organisms against diverse pathogen infections, but accumulating evidences also suggest that excessive activation of inflammasome/caspase-1 might be related to the pathogenesis of inflammation-related diseases. Indeed, mutations in NLRP3 or pyrin are closely associated with autoinflammatory diseases such as familial Mediterranean fever (FMF) syndrome or Muckle-Wells syndrome (MWS), indicating that the regulation of caspase-1 activity by inflammasome is a central process in these hereditary inflammatory disorders. Here, recent advances on the molecular mechanism of caspase-1 activation by PYD-containing inflammasomes are summarized and discussed.
Cryopyrin-Associated Periodic Syndromes ; Cytoskeletal Proteins ; Cytosol ; Familial Mediterranean Fever ; Humans ; Immunity, Innate ; Inflammasomes ; Interleukin-1beta ; Proteins

The antidiabetic drug metformin has been found to have beneficial effects in various neurological disorders; however, the molecular mechanisms underlying these effects remain unclear. Here we report that metformin protects neuronal cells from quinolinic acid (QUIN)-induced excitotoxicity. For this, we pretreated N18D3 neuronal cells with metformin prior to QUIN for 24 h. We found that pretreating the cells with metformin significantly improved cell survival rate in a concentration-dependent manner and reduced apoptotic cell death, as revealed by a MTT assay and DAPI staining, respectively. Calcium imaging using fluo-4 showed that metformin (100 µM) inhibited the intracellular calcium increase that was induced by QUIN. In addition, mRNA expression of pro-apoptotic genes, p21 and Bax, was decreased and of anti-apoptotic genes, Bcl-2 and Bcl-xl, was increased with metformin treatment compared to QUIN-induced cells. The immunoreactivity of phosphorylated ERK1/2 was elevated in cells treated with metformin, indicating the ERK1/2 signaling pathway in the neuroprotective effects of metformin in QUIN-induced cell death. Collectively, our data demonstrates that metformin exerts its neuroprotective effects by inhibiting intracellular calcium increases, allowing it to regulate ERK1/2 signaling and modulate cell survival and death genes.
Apoptosis ; Calcium ; Cell Death ; Cell Survival ; Genes, bcl-2 ; Metformin ; Nervous System Diseases ; Neurons ; Neuroprotection ; Neuroprotective Agents ; Quinolinic Acid ; RNA, Messenger

Objectives: The purpose of this study was to evaluate the consumption pattern of sugarsweetened beverages (SSB) and compare body composition changes by SSB consumption based on 28 days of dietary records from a four-week time-restricted eating intervention among young adults in Korea. Methods: A total of 33 participants completed the four-week dietary intervention with 8-hour time-restricted eating (TRE). The body composition was measured by bioelectrical impedance analysis at baseline, and daily dietary records were collected for 28 days during the intervention after 4 weeks. Results: Based on 924 days of dietary records, the average eating occasion of SSB was 0.9 times per day, and the average amount of SSB was 205.8 g/times. Based on an individual’s usual intake of 28 days, the average eating frequency of SSB was 16.6 times out of 28 days, and the average amount of SSB was 184.0 g/day. The average energy intake from SSB was 131.0 kcal /day (8.7% of energy), and sugar intake from SSB was 18.2 g/day (4.9% of energy). The sugar intake was 2.6% of energy from sweetened dairy products, followed by 2.0% from coffee drinks, 0.5% from soda and juice and 0.2% from others.When subjects were divided into high (14 days or more) and low (less than 14 days) SSB groups based on eating frequency, the weight change in the low SSB group was -2.0 kg over 4 weeks, which was significantly lower than -0.7 kg in the high SSB group. However, no significant difference was found in muscle mass, fat mass and body fat percent between the two groups. Conclusions This study suggests that low consumption of sugar-sweetened beverages is more desirable in weight management despite having the dietary intervention of timerestricted eating without counting calories. Thus, further longitudinal studies on the association between SSB and obesity in Korean adults are necessary.

Purpose: The purpose of this study is to better understand nursing education in the early years of the Japanese colonial rule. Methods: We compared the 1918 Textbook on Nursing with the first Textbook on Nursing and to the original text, Grade A Textbook on Nursing, by the Japanese Red Cross Society (JRCS) using the historical research method. The background of its publication and its use in nursing education were exploring, too. Results: After Korea’s annexation by Japan, the nursing textbook by the JRCS was appointed as the standard textbook in nursing education by the Government-General in Korea (GGK). Missionary nurse got the permission for the nursing textbook by JRCS and the Textbook on Nursing was published in 1918 using Korean and Chinese characters in combination. This book, an adaptation of the original text, explained the responsibilities and roles of nurses to guide them in serving patients as well as assisting in treatment or directly performing emergency medical treatment when necessary, with a focus on the treatment of the war wounded. It would have been partially used in actual nursing education among the missionary community. Conclusion Textbook on Nursing in 1918 was published not only for the nursing students of missionary nursing schools but also for other nursing trainees of diverse hospitals, nurses and missionary volunteers and to help them to acquire the licenses. It reflects the enforcement on nursing education by GGK and the reality and resistance in terms of the content of education of nursing in Korea during that period.

PURPOSE: The purpose of this study was to explore the relationship between moral distress, physical symptoms, and burnout among clinical nurses. METHODS: Data were collected by self-report questionnaires targeting 140 nurses from a university hospital in Chungju. The data were analyzed by, Kruskal-Wallis, Pearson correlation coefficient, and stepwise multiple regression. RESULTS: Moral distress due to the general characteristics of the participants showed a statistically significant difference at the current working department (χ2=36.01, p<.001). Hospital nurses' moral distress had a statistically significant correlation with burnout (r=.358, p<.001) and physical symptoms (r=.440, p<.001). Factors influencing hospital nurses' burnout, pro were physical symptoms, moral distress, and marital status, accounting for 36% of the variance. CONCLUSION: The findings indicate that moral distress and physical symptoms influence burnout among hospital nurses. Therefore, interventions for burnout among hospital nurses should include an empowerment program to reduce physical symptoms and moral distress.
Burnout, Professional ; Chungcheongbuk-do ; Marital Status ; Power (Psychology)

PURPOSE: To develop and test the validity and reliability of the Korean version of the Moral Distress Scale-Revised (KMDS-R) to assess its applicability to Korean hospital nurses. METHODS: The KMDS-R was articulated through forward-backward translation methods. Internal consistency reliability, construct and criterion validity was calculated using SPSSWIN(19.0). Survey data were collected from 188 nurses from a university hospital in Gangwon-do, South Korea. RESULTS: The KMDS-R showed reliable internal consistency with a Cronbach's alpha of .69-.87 and a Guttman Split-half of .69-.82 for the total scale. Factor loading of the 21 items on the five subscales ranged from .41-.80. The KMDS-R was validated by factor analysis and explained 63% of moral distress for Korean hospital nurses. Criterion validity compared to Yoo's MDS showed significant correlation. CONCLUSION: The results suggest promising evidence of the KMDS-R's reliability and validity. It is used to measure moral distress for Korean hospital nurses.
Gangwon-do ; Korea ; Reproducibility of Results*

Purpose: This study aimed to describe nurses’ perceived needs and barriers to pediatric palliative care (PPC). Methods: Mixed methods with an embedded design were applied. An online survey was conducted for nurses who participated in the End-of-Life Nursing Education Consortium- Pediatric Palliative Care (ELNEC-PPC) train-the-trainer program, of whom 63 responded. Quantitative data were collected with a survey questionnaire developed through the Delphi method. The 47 items for needs and 15 items for barriers to PPC were analyzed with descriptive statistics. Qualitative data were collected through openended questions and analyzed with topic modeling techniques. Results: The mean scores of most subdomains of the PPC needs were 3.5 or higher out of 4, and those of PPC barriers ranged from 3.22 to 3.56, indicating the items in the questionnaire developed in this study properly reflect each factor. The needs for PPC were divided into 4 categories: “children and adolescents,” “families,” “PPC management system,” and “community-based PPC.” Meanwhile, PPC barriers were divided into 3 categories: “healthcare delivery system,” “healthcare provider,” and “client.” The keywords derived from the topic modeling were perception, palliative, children, and education for necessities and lack, perception, medical care, professional care providers, service, and system for barriers to PPC. Conclusion In this study, by using mixed-methods, items of nurses’ perceived needs and barriers to PPC were identified, categorized, and weighted, and their meanings were explored. For the stable establishment of PPC, the priority should be given to improving perceptions of PPC, establishing an appropriate system, and training professional care providers.

If drug excipients hypersensitivity is not accurately recognized, the patient is at risk of experiencing repeated hypersensitivity to various drugs. Ethylenediaminetetraacetic acid (edetic acid, EDTA), often found as an excipient in injectable drugs and topical agents.Herein, we report a patient who developed anaphylactic shock to an injection containing EDTA and subsequently experienced both immediate and delayed hypersensitivity reactions to EDTA. A 51-year-old female was referred due to perioperative anaphylaxis. It took the patient 2 hours to return to the ward after receiving general anesthesia. Immediately after returning to the ward, the patient received injections of Mucosten (Medica), Traumeel (Saehan), and Botropase (Han Lim), and within 1 minute she experienced an anaphylactic shock. The patient had drug allergy histories to computed tomography contrast agents and injectable drugs as well as repeated contact dermatitis histories to topical agents. A month later, the patient came to the outpatient clinic. As a result, intradermal test for perioperative drugs, Mucosten, and Dexamethasone (Daewon Pharm) were positive. In addition, the 48-hour delay test for Mucosten and Dexamethasone was also positive. Under the suspicion of additive hypersensitivity, skin prick test was performed for disodium acetate, an additive containing Mucosten and Dexamethasone, which showed a positive result. However, skin prick test for N-Acetyl-L-cysteine, a main compound of Mucosten, was negative. This case is a hypersensitivity reaction to EDTA, which was confirmed by drug skin tests. In addition, this case is meaningful in that immediate and delayed hypersensitivity reactions to a single excipient appeared independently in the same patient.

OBJECTIVE: We examined whether childhood exposure to psychological trauma is associated with greater suicidality and whether specific psychiatric disorders modulate this association in a representative sample of Korean adults. METHODS: The Korean version of the Composite International Diagnostic Interview 2.1 was administered to 6,027 subjects aged 18-74 years. Subjects who experienced a traumatic event before the age of 18 years, the childhood-trauma-exposure group, were compared with controls without childhood trauma exposure. RESULTS: Childhood exposure to psychological trauma was associated with lifetime suicidal ideation (OR=3.19, 95% CI=2.42-4.20), suicide plans (OR=4.15, 95% CI=2.68-6.43), and suicide attempts (OR=4.52, 95% CI=2.97-6.88). These associations weakened after further adjustment for any psychiatric disorders, but they were not eliminated. The risk of suicide attempts related to childhood trauma increased with the presence of a concurrent alcohol use, depressive, or eating disorder. CONCLUSION: In terms of clinical implications, patients with these disorders who have a history of childhood trauma should be carefully assessed for their suicide risk and aggressively treated for psychiatric disorders.
Adult ; Feeding and Eating Disorders ; Humans ; Suicidal Ideation ; Suicide*

Innate immune cells sense and respond to the cytoplasmic infection of bacterial pathogens through NLRP3, NLRC4 or AIM2 inflammasome depending on the unique molecular pattern of invading pathogens. The infection of flagellin- or type III secretion system (T3SS)-containing Gram-negative bacteria such as Salmonella enterica serovar Typhimurium (S. typhimurium) or Pseudomonas aeruginosa (P. aeruginosa) triggers NLRC4-dependent caspase-1 activation leading to the secretion of proinflammatory cytokines such as interleukin-1-beta (IL-1beta) and IL-18. Previous studies have shown that apoptosis-associated speck-like protein containing a CARD (ASC) is also required for Salmonella-induced caspase-1 activation, but it is still unclear how ASC contributes to the activation of NLRC4 inflammasome in response to S. typhimurium infection. In this study, we demonstrate that S. typhimurium triggers the formation of ASC oligomer in a potassium depletion-independent manner as determined by in vitro crosslinking and in situ fluorescence imaging. Remarkably, inhibition of potassium efflux failed to block Salmonella-promoted caspase-1 activation and macrophage cell death. These results collectively suggest that ASC is substantially oligomerized to facilitate the activation of caspase-1 in response to S. typhimurium infection. Contrary to NLRP3 inflammasome, intracellular potassium depletion is not critical for NLRC4 inflammasome signaling by S. typhimurium.
Cell Death ; Cytokines ; Cytoplasm ; Gram-Negative Bacteria ; Interleukin-18 ; Macrophages ; Optical Imaging ; Potassium ; Pseudomonas aeruginosa ; Salmonella ; Salmonella enterica