Vitamin D deficiency is a common health issue around the world. We therefore evaluated the associations of semen quality with both serum and seminal plasma vitamin D levels and studied the mechanisms underlying these by incubating spermatozoa with 1,25(OH)₂D In vitro. Two hundred and twenty-two men were included in our study. Vitamin D was detected using an electrochemiluminescence method. Spermatozoa used for In vitro experiments were isolated by density gradient centrifugation. Positive relationships of serum 25(OH)D with semen volume and seminal plasma fructose were identified. Seminal plasma 25(OH)D level showed no relationship with serum 25(OH)D level, while it was inversely associated with sperm concentration and positively correlated with semen volume and sperm kinetic values. In vitro, sperm kinetic parameters increased after incubation with 1,25(OH)₂D, especially upon incubation for 30 min with it at a concentration of 0.1 nmol l^-1. Under these incubation conditions, the upward migration of spermatozoa increased remarkably with increasing adenosine triphosphate (ATP) concentration. The concentration of cyclic adenosine monophosphate (cAMP) and the activity of protein kinase A (PKA) were both elevated, and the PKA inhibitor, N-[2-(p-Bromocinnamylamino)ethyl]-5-isoquinolinesulfonamide dihydrochloride (H89) reversed the increase of ATP production. The concentrations of cytoplasmic calcium ions and nicotinamide adenine dinucleotide (NADH) were both enhanced, while mitochondrial calcium uniporter (MCU) inhibitor, Ruthenium 360 (Ru360) did not reverse the increase of ATP production. Therefore, seminal plasma vitamin D may be involved in regulating sperm motility, and 1,25(OH)₂D may enhance sperm motility by promoting the synthesis of ATP both through the cAMP/PKA pathway and the increase in intracellular calcium ions.
Adenosine Triphosphate/metabolism* ; Adult ; Calcium/metabolism* ; Cyclic AMP/metabolism* ; Cyclic AMP-Dependent Protein Kinases/metabolism* ; Humans ; Male ; Semen/metabolism* ; Semen Analysis ; Signal Transduction/physiology* ; Sperm Motility/physiology* ; Spermatozoa/metabolism* ; Vitamin D/pharmacology* ; Vitamin D Deficiency/blood* ; Wit and Humor as Topic ; Young Adult

There are no reports regarding pneumomediastinum caused by thoracic epidural block complications. We believe that it is possible to experience an occurrence of pneumomediastinum caused by air in the epidural space after performing a thoracic epidural block using the loss of resistance (LOR) technique with air. We report a witnessed case where pneumomediastinum appeared after a thoracic epidural block. Pneumorrrhachis, paravertebral muscle emphysema, and pneumomediastinum were diagnosed by Positron Emission Tomography-Computed Tomography. Although extremely rare, pneumomediastinum can be caused by an epidural block using LOR technique with air. In order to avoid the above danger, the use of saline or very minimal amount of air is required during a careful LOR technique.
Electrons ; Emphysema ; Epidural Space ; Injections, Epidural ; Mediastinal Emphysema ; Muscles ; Wit and Humor as Topic

Youth suicide is like the tip of an iceberg; while many adolescents have died from suicide, many more adolescents have been harmed by suicide attempts and self-injury. Suicide influences not only the victims, but also their family members, friends, teachers, and neighbors. Witnesses can suffer from posttraumatic stress disorder. Suicide is the second leading cause of death among adolescents worldwide and the first cause of death among Korean adolescents. The number of suicides in Korea, especially among high school students and female students, is rapidly increasing when compared with Western countries. Suicide accounted for 28.2% of deaths among Korean adolescents in 2010. There were 4.44% and 18.97% of adolescents who had attempted suicide and had experienced suicidal ideation in their lifetime, which shows that many adolescents have a potential risk for suicide. Previous studies in Western countries have revealed that risk factors for adolescent suicide consist of three categories: sociodemographic factors (male and low socioeconomic and educational status), mental health factors (depression and drug abuse), and individual negative life events and family diversity (family history of suicidal behavior, parental death, and child abuse). In conclusion, suicide is common and rapidly increasing in Korean adolescents. However, the risk factors of suicide and suicide behaviors in Korean adolescents are yet to be determined. A well-designed nationwide survey is needed to investigate the prevalence and risk factors of suicide behaviors and mental disorders among Korean adolescents.
Adolescent ; Cause of Death ; Child ; Female ; Friends ; Humans ; Korea ; Mental Disorders ; Mental Health ; Parental Death ; Prevalence ; Risk Factors ; Stress Disorders, Post-Traumatic ; Suicidal Ideation ; Suicide ; Suicide, Attempted ; Wit and Humor as Topic

In the United States (US) stroke care has undergone a remarkable transformation in the past decades at several levels. At the clinical level, randomized trials have paved the way for many new stroke preventives, and recently, several new mechanical clot retrieval devices for acute stroke treatment have been cleared for use in practice by the US Federal Drug Administration. Furthermore, in the mid 1990s we witnessed regulatory approval of intravenous recombinant tissue plasminogen activator for administration in acute ischemic stroke. In the domain of organization of medical care and delivery of health services, stroke has transitioned from a disease dominated by neurologic consultation services only to one managed by vascular neurologists in geographical stroke units, stroke teams and care pathways, primary stroke center certification according to The Joint Commission, and most recently comprehensive stroke center designation under the aegis of The Joint Commission. Many organizations in the US have been involved to enhance stroke care. To name a few, the American Heart Association/American Stroke Association, Brain Attack Coalition, and National Stroke Association have been on the forefront of this movement. Additionally, governmental initiatives by the US Centers for Disease Control and Prevention and legislative initiatives such as the Paul Coverdell National Acute Stroke Registry program have paved the way to focus on stroke prevention, acute treatment and quality improvement. In this invited review, we discuss a brief history of organized stroke care in the United States, evidence to support the value of primary and comprehensive stroke centers, and the certification criteria and process to become a primary or comprehensive stroke center.
Brain ; Centers for Disease Control and Prevention (U.S.) ; Certification ; Health Services ; Heart ; Joints ; Quality Improvement ; Stroke ; Tissue Plasminogen Activator ; United States ; Wit and Humor as Topic

OBJECTIVES: The aims of this study were 1) to evaluate the effect of isolated uvulopalatopharyngoplasty (UPPP) on subjective obstructive sleep apnea (OSA) symptoms in adult patients regardless of the response to surgery, and ultimately 2) to investigate the differences in changes in subjective OSA symptoms between successful and unsuccessful surgery groups. METHODS: Twenty consecutive adult patients who underwent isolated UPPP were enrolled. Pre- and postoperative subjective OSA symptoms (snoring, witnessed apnea, daytime sleepiness, morning headache, daytime fatigue, restless sleep, difficulty with morning arousal) and polysomnographic data were evaluated in all subjects. Changes in subjective OSA symptoms before and after surgery were investigated in the successful (n=11) and unsuccessful (n=9) groups. Surgical success was defined as a reduction of at least 50% in the preoperative apnea-hypopnea index (AHI) and a postoperative AHI less than 20 per hour. RESULTS: After isolated UPPP, all subjective OSA symptoms changed significantly in the patients, especially in the successful group. In the unsuccessful group, snoring, witnessed apnea and daytime fatigue changed significantly, while other symptoms did not change significantly after surgery. CONCLUSION: Isolated UPPP may improve subjective OSA symptoms in adult patients whom surgery was successful or unsuccessful. However, after isolated UPPP, the improvements in subjective OSA symptoms in the unsuccessful group may be different from those in the successful group.
Adult ; Apnea ; Fatigue ; Headache ; Humans ; Polysomnography ; Sleep Apnea, Obstructive ; Snoring ; Wit and Humor as Topic

PURPOSE: The purpose of this study was to describe the emotional labour experienced by nurses who care for hematopoietic stem cell transplantation (HSCT) patients in Iran. METHODS: Eighteen nurses participated in semi-structured interviews. The interviews were analyzed using qualitative content analysis methods. RESULTS: Three main categories described the emotional labour involved, namely, emotional intimacy, feeling overwhelmed with the sadness and suffering, and changing self. Nurses had compassion for their patients, contributing to a close nurse-patient relationship. The nurses' emotional labour resulted in their feeling overwhelmed with sadness and suffering. Five subcategories described this emotional toll: (a) witnessing suffering, (b) struggling mentally, (c) hurting emotionally, (d) feeling drained of energy, and (e) escaping grief. Dealing with death and dying on an ongoing basis promoted the nurses' changing self. CONCLUSION: Iranian nurses who care for HSCT patients experience a range of positive and negative emotions. Establishing appropriate support systems for nurses might help mediate the negative aspects of emotional labour. thereby improving nursing work life and ultimately the quality of patient care.
Empathy ; Grief ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Iran ; Patient Care ; Stress, Psychological ; United Nations ; Wit and Humor as Topic

OBJECTIVES: Posttraumatic stress disorder (PTSD) in children is prevalent and often persists for many years after the trauma. Therefore, screening and early detection using psychometrically sound instruments is a pivotal element of appropriate management. This study tested the reliability and validity of a Korean version of the Child Reaction to Traumatic Events Scale-Revised (K-CRTES-R) in a sample of recently traumatized school children. METHODS: The K-CRTES was administered to a total of 464 school children aged ten to twelve who had witnessed or had been confronted with a tragic accident involving three deaths. Internal consistency, two week test-retest reliability, and construct validity were assessed. A non-random portion of participants also completed the State Anxiety Inventory and the Subjective Unit of Distress Scale for testing convergent validity. Exploratory factor analysis was conducted for a random half of participants (n=232), and, for the remaining half, we tested the model fit by performance of confirmatory factor analysis. RESULTS: Two week test-retest reliability was high (r=0.85), and internal consistency was excellent (Cronbach alpha=0.92). The total score for the K-CRTES-R showed significant correlation with state anxiety and subjective level of anxiety, thus confirming its convergent validity. In addition, the K-CRTES-R distinguished between direct exposure and indirect confrontation, demonstrating the discriminant validity of the scale. In addition, we confirmed the factorial validity by identifying a two-factor structure (intrusion-hyperarousal and avoidance) that explained 56% of the total variance. This two factor solution and other previously suggested PTSD models showed fit indices that were within an acceptable range. CONCLUSION: Findings of our study indicate that the K-CRTES-R is a good measure of reliability and validity that can be used to assess the impact of trauma in Korean speaking children.
Aged ; Anxiety ; Child ; Humans ; Mass Screening ; Psychometrics ; Reproducibility of Results ; Stress Disorders, Post-Traumatic ; Wit and Humor as Topic

Indoxacarb is an oxadiazine insecticide with selective lethality through blockade of neuronal voltage-dependent sodium channels. It has a low mammalian toxicity, and few cases of human toxicity after indoxacarb ingestion can be found in the literature. A 36 year-old male patient visited our ED after a generalized tonic clonic seizure, which was witnessed by his mother. His past medical history was nonspecific. On initial presentation, he showed a decreased level of consciousness with a Glasgow coma score of 5/15 (E1V1M3), unprotected airway, hypoxia, and cyanosis. The saturation gap and cyanosis after intubation and mechanical ventilation was strongly suggestive of methemoglobinemia due to poisoning. Finally, the methemogobin (metHb) level was 27.4%. Therefore, the patient received 100 mg of methylene blue (2 mg/kg, 1% solution) and 50 g of charcoal. The insecticide was found to be ingested xenobiotic (Steward Gold(R); 5% indoxacarb; 95% inert ingredients and other components). On the second hospital day, the patient became alert. The patient's metHb level was 0.1%. The endotracheal tube was removed. On the fifth hospital day, he was discharged in good condition. Herein we present a case of indoxacarb poisoning with methemoglobiemia and seizure, which are unusual presentations.
Anoxia ; Charcoal ; Coma ; Consciousness ; Cyanosis ; Eating ; Humans ; Intubation ; Male ; Methemoglobinemia ; Methylene Blue ; Mothers ; Neurons ; Oxazines ; Respiration, Artificial ; Seizures ; Sodium Channels ; Wit and Humor as Topic

We report two cases of post-extubation negative pressure pulmonary edema in otherwise healthy patients. The patients underwent laparoscopic appendectomy under general anesthesia and developed negative pressure pulmonary edema immediately after extubation. All cases fully resolved within 24 hours with supplementary oxygen. The literature suggests that post-extubation pulmonary edema occurs more frequently than is generally thought, with a frequency of 0.05-0.1% in all anesthesia, and is often unrecognized or misdiagnosed. Most cases occur in the early post-operative period, and this is potentially life-threatening condition. Therefore, anesthesiologist and surgeon are well placed to witness, investigate and manage this condition.
Anesthesia ; Anesthesia, General ; Appendectomy ; Humans ; Oxygen ; Pulmonary Edema ; Wit and Humor as Topic

ABO-incompatible kidney transplantations have been performed successfully in Korea without splenectomy using plasmapheresis, anti-CD20 monoclonal antibody infusions and other immunosuppressants. However, there is no report of a case of ABO-incompatible kidney transplantation in a Jehovah's Witness. Hence, we report our experience of successful ABO-incompatible kidney transplantation without blood products in a Jehovah's Witness. The recipient was treated with six sessions of plasmapheresis and he received intravenous rituximab before transplantation. Immunosuppressive regimen consisted of tacrolimus, mycophenolate mofetil and steroid. The replacement fluid for plasmapheresis was 5%% albumin solution instead of fresh frozen plasma. We measured the clotting factors before and after plasmapheresis and used cryoprecipitate to prevent bleeding.
Antibodies, Monoclonal, Murine-Derived ; Hemorrhage ; Humans ; Immunosuppressive Agents ; Kidney ; Kidney Transplantation ; Korea ; Living Donors ; Mycophenolic Acid ; Plasma ; Plasmapheresis ; Rituximab ; Splenectomy ; Tacrolimus ; Transplants ; Wit and Humor as Topic