Purpose: To report the clinical characteristics and treatment outcome of dematiaceous fungal keratitis initially misdiagnosed as a corneal foreign body.Case summary: A 51-year-old woman with a history of corneal opacity and recurrent ocular irritation presented with aggravated pain and a brown lesion in the right eye. A well-demarcated, elevated brown lesion located at the central cornea, corneal infiltration and epithelial defects were observed by slit-lamp examination. Anterior segment optical coherence tomography demonstrated posterior signal attenuation behind the brown lesion, with intact anterior chamber. Following removal of the lesion, fungal culture and potassium hydroxide (KOH) smear examination were performed. Yeast-like organisms exhibiting both hyphal and pseudohyphal forms were observed on KOH smear. For accurate identification of the fungus, molecular analysis using DNA sequencing was performed, confirming Cladophialophora boppii. After treatment with topical amphotericin B and oral itraconazole, corneal infiltration and clinical symptoms gradually improved. No recurrence was observed after discontinuation of antifungal therapy. Conclusions The patient presenting with a brown corneal lesion initially misdiagnosed as a corneal foreign body was diagnosed with dematiaceous fungal keratitis through microbiological culture and was successfully treated with antifungal agents.

Purpose: The purpose of this study was to identify the levels of professional autonomy, role conflict, nursing work environment, and clinical decision-making ability among nurses working in hematologic cancer wards, as well as to examine factors associated with nurses’ clinical decision-making ability. Methods: Data were collected from 141 hematologic cancer ward nurses at a general hospital and a general cancer-specialized hospital in City B from May 14 to September 4, 2025. The collected data were analyzed using SPSS/WIN 29 with Pearson’s correlations and multiple regression analyses. Results: Clinical decision-making ability in hematologic cancer ward nurses was found to be positively correlated with nursing work environment (r=.32, p<.001) and professional autonomy (r=.31, p<.001). According to the regression analysis of this research, nursing education level (β=.25, p=.015), nursing work environment (β=.21, p=.017), and professional autonomy (β=.18, p=.040) were the factors that influenced clinical decision-making ability, with an explanatory power of 17% (F=5.70, p<.001). Conclusion To develop clinical decision-making ability, it is essential to strengthen educational preparation, improve the nursing work environment, and enhance professional autonomy. Given the complexity of care in hematologic cancer wards, high level of clinical decision-making ability is required among nurses. Identifying factors associated with clinical decision-making ability can provide a foundation for developing targeted educational and organizational strategies.

Alzheimer’s disease (AD) is increasingly recognized as a disorder with significant vascular involvement, with microvascular damage and thromboinflammation often preceding classical amyloid pathology by several years. Elevated levels of prothrombin and thrombin, along with aberrant platelet activation, have been reported in individuals with AD. We hypothesized that platelet hyperactivity in AD results from an exaggerated response to thrombin in the presence of elevated amyloid beta 1-40 (Aβ₁₋₄₀), a peptide that accumulates during the early stages of AD. Platelet activation in response to Aβ₁₋₄₀ and thrombin was assessed using aggregation assays with an aggregometer, adhesion measurements by confocal microscopy, and spreading via both confocal microscopy and scanning electron microscopy. Reactive oxygen species (ROS) production and integrin α IIbβ 3 activation were quantified by flow cytometry. The roles of NADPH oxidase (NOX), ROS, and integrin signaling were examined using selective inhibitors. Aβ₁₋₄₀ significantly enhanced thrombin-induced platelet adhesion, aggregation, and spreading via NOX-derived ROS and integrin α IIbβ 3 activation. Aβ₁₋₄₀ also promoted platelet binding to fibrinogen and cerebrovascular endothelial cells, accompanied by distinct morphological changes. Inhibition of NOX or integrin α IIbβ 3 significantly reduced these effects. These findings identify a novel Aβ₁₋₄₀–NOX–ROS–integrin α IIbβ 3 axis that drives platelet hyperactivation and cerebrovascular interactions in AD.Targeting this pathway with antithrombotic or antioxidative strategies may offer therapeutic potential in mitigating AD-associated vascular pathology.

Sleep deprivation (SD) disrupts homeostatic regulation and increases vulnerability to stress and mood disorders. This study investigated the duration-dependent effects of SD and elucidated the distinct roles of adenosine A1 receptors (A1R) and A2A receptors (A2AR) in behavioral and molecular alterations induced by 24, 48, and 72 h of SD in mice. SD for 48 h and 72 h, but not 24 h, significantly increased immobility time in the tail suspension test (TST) and forced swim test (FST), accompanied by elevated plasma corticosterone (CORT) levels, indicating a duration-dependent stress response. Hippocampal A1R mRNA expression was significantly reduced, whereas A2AR mRNA expression was markedly increased at 48 h and 72 h of SD. Pharmacological blockade of either A1R (DPCPX) or A2AR (SCH 58261) significantly attenuated SD-induced depression-like behaviors and CORT elevation, whereas activation of A1R with the agonist CPA exacerbated depression-like behavior at 24 h and 48 h of SD. These findings suggest that A2AR upregulation may represent a pathological response to prolonged SD, whereas A1R downregulation may reflect compensatory adaptation to sustained receptor activation. Taken together, our results demonstrate that A1R and A2AR play distinct roles in SD-induced depression-like behaviors.

Sleep–wake regulation is controlled by circadian and homeostatic processes, with adenosine acting as a key molecular mediator of homeostatic sleep pressure. Extracellular adenosine accumulates during wakefulness as a result of neuronal energy metabolism, particularly in the basal forebrain, and declines during recovery sleep, thereby reflecting the physiological need for sleep.The sleep-promoting effects of adenosine are mediated primarily by two G protein–coupled receptor subtypes, the adenosine A1 receptor and the adenosine A2A receptor. The adenosine A1 receptor, coupled to inhibitory Gi/o proteins and widely expressed in the cortex, hippocampus, thalamus, and basal forebrain, suppresses wake-promoting neuronal activity and facilitates slow-wave activity during non-rapid eye movement sleep. In contrast, the adenosine A2A receptor, coupled to stimulatory Golf proteins and enriched in the striatum and nucleus accumbens, promotes sleep by activating neurons in the preoptic hypothalamus and engaging the indirect basal ganglia pathway. Despite these well-established roles, the contributions of dysregulation of the adenosine A1 receptor and the adenosine A2A receptor to specific sleep disorders remain incompletely understood. This review examines how signaling of the adenosine A1 receptor and the adenosine A2A receptor is altered in insomnia, obstructive sleep apnea, narcolepsy, and restless legs syndrome, and evaluates the therapeutic potential of receptor-selective strategies for adenosine receptor–targeted treatment.

Purpose: Digital health literacy is essential for health management among children and adolescents, with multicultural youth being particularly vulnerable to challenges in accessing, appraising, and using digital health information. This study aimed to develop a digital health literacy improvement program (DHL-Up) tailored to multicultural children and adolescents and evaluate its effectiveness. Methods: Guided by the Transactional Model of eHealth Literacy and the ADDIE (Analysis, Design, Development, Implementation, Evaluation) model, a five-session program was developed to strengthen functional, communicative, critical, and translational digital health literacy. A non-equivalent control group pretest–posttest design was used. The participants included 31 multicultural children and adolescents aged 10–15 years (experimental group: 14; control group: 17). The experimental group participated in a 5-week online program (60 minutes per session) delivered to small groups via Zoom. Data were collected before and after the intervention and analyzed using descriptive statistics, independent t-tests, Mann-Whitney U tests, chi-square tests, and Fisher’s exact tests. Results: The experimental group showed significantly greater improvements in digital health literacy (t=2.73, p=.011) and the usefulness of Internet health information (t=3.11, p=.004) than the control group. No significant difference was found for information overload (t=-0.17, p=.854). Conclusion This study developed and validated a tailored digital health literacy intervention for multicultural children and adolescents, demonstrating its applicability in schools, public health centers, and community settings. These findings provide foundational evidence to support the institutionalization of digital health literacy education and highlight its potential to mitigate digital health information disparities among vulnerable populations.

Purpose: To analyze the general, clinical, and sedation-related characteristics of pediatric inpatients who received procedural sedation from pediatric sedation nurses, and to identify the incidence of sedation-related adverse events and sedation failure. Methods: The medical records of 585 patients under 18 years who were hospitalized in the pediatric wards of a tertiary hospital and received procedural sedation from pediatric sedation nurses from April to September 2023 were retrospectively reviewed. Data were analyzed using chi-square and t-tests. Results: Among the 585 participants, 59.3% were male, and the median age was 38 months. The main departments were hemato-oncology (17.9%), neurology (16.1%), and thoracic surgery (11.8%). A total of 671 procedures were performed; the main ones were echocardiography (18.3%), computed tomography (15.1%), and magnetic resonance imaging (14.0%). 84.6% of the patients experienced no adverse events. The main adverse event was oxygen desaturation (13.2%), with interventions including oxygen supplementation (12.1%) and airway repositioning (4.6%). Adverse events occurred significantly more often in patients in American Society of Anesthesiologists class III–IV (χ2=15.35, p<.001), neurology patients (χ2=7.10, p=.008), patients undergoing spinal tapping (χ2=9.49, p=.002), patients undergoing multiple procedures (χ2=7.64, p=.006), and those receiving combined oral and intravenous sedation (χ2=53.82, p<.001). Conclusion Procedural sedation provided by pediatric sedation nurses was performed safely and effectively for pediatric inpatients with various characteristics. Further research is necessary to assess pediatric sedation nurses’ current sedation practices across various medical institutions and clinical settings.

Purpose: North Korean refugee women face multiple vulnerabilities during pregnancy and early childrearing due to fragmented support and limited familiarity with Korea’s health and welfare systems. Existing research has examined isolated barriers. This study used a service design approach to explore their maternal–infant care experiences and identify structural discontinuities across the care pathway. Methods: Data were collected from North Korean refugee mothers and service providers from April to August 2024. A service design approach using user journey mapping, thematic analysis, and service blueprinting was employed to examine user actions, emotional trajectories, frontline interactions, and backstage and interagency processes. Results: Five structural issues were identified: fragmented information, cross-institutional access barriers, cultural and emotional isolation, discontinuity in interagency linkage, and provider resource constraints. These issues accumulated along the pathway, increasing emotional burden, delaying timely care, and reinforcing avoidance behaviors. Misalignment between user needs and multi-agency processes was also evident. Conclusion Maternal and infant care challenges among North Korean refugee women stem from structural fragmentation rather than individual factors. Based on these findings, the NK Mom Care Navigator—a pathway-based, culturally responsive service design model—is proposed to strengthen continuity of care and enhance equitable maternal–infant support for vulnerable refugee families.

Purpose: This pilot study aimed to develop and conduct an initial evaluation of a self-care improvement program for older school-aged children with atopic dermatitis (AD). Methods: A quasi-experimental, non-equivalent control group pretest-posttest design was used with 20 children in grades 4–6 diagnosed with AD. The experimental group (n=12) received a 5-week Information-Motivation-Behavioral Skills (IMB)-based program, which included five 40-minute sessions for children and one 50-minute session for mothers. The control group (n=8) received usual care. Data was collected at baseline, immediately after the intervention, and 4 weeks post-intervention. Outcome variables included AD knowledge, motivation for AD self-care, self-efficacy for managing AD, self-care behaviors, and AD severity. Generalized estimating equations were used for analysis. Results: Time-by-group interaction effects were observed for AD knowledge (p<.001), personal motivation (p=.011), self-efficacy (p=.034), self-care behaviors (p=.027), and AD severity (p=.039). Improvements in knowledge, motivation, and self-efficacy persisted through follow-up, while changes in self-care behaviors and AD severity were significant only at posttest. Conclusion This study provides preliminary evidence that an IMB-based self-care program can improve knowledge, motivation, and self-efficacy in children with AD, leading to better self-care behaviors and reduced symptom severity. These findings support the feasibility and potential usefulness of a structured, theory-based intervention. Further fully powered trials are needed to confirm effectiveness and identify strategies for maintaining long-term outcomes.

Early neurologic deterioration (END) is common and occurs within a few hours to days after an ischemic stroke. Traditionally, END has been treated as a collective entity, including the occurrence of new deficits (recurrence) and the aggravation of pre-existing neurologic deficits (progression). END arises from distinct mechanisms that require different therapeutic approaches. We reviewed clinical and experimental studies addressing the epidemiology, mechanisms, and treatment of END, focusing on differentiating END due to recurrence from END due to progression and on interventions including antiplatelet therapy, direct thrombin inhibition, and induced hypertension. Early recurrence is closely associated with thrombus growth and new ischemic events, particularly in atherothrombotic disease. Early recurrence is also common in patients with cancer-associated stroke. Thrombin and platelet activation play central roles under both conditions. In contrast, progression is mainly driven by infarct growth, that is, the evolution from incomplete infarction to complete infarction due to impaired perfusion, especially in lesions involving the subcortical fiber tracts. Therapeutic implications differ accordingly. Recurrence may respond to potent antithrombotic strategies, including combined antiplatelet and direct thrombin inhibition, whereas progression may benefit from induced hypertension. However, recurrence and progression often occur simultaneously, making clinical differentiation challenging. END should be conceptualized as a spectrum of clinical presentations arising from distinct mechanisms. Recognizing recurrence and progression as separate processes is essential for mechanism-oriented treatments. Future trials should adopt this framework to develop individualized strategies and improve outcomes in patients with acute stroke.