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We aimed to compare psychophysiological responses in adults according to cognitive demand levels for horticultural activities to confirm the feasibility of horticultural activity for improving attention and emotional states. A total of 60 adults in their 20s were included in this crossover design study. Participants performed soil-mixing activities with 2 cognitive demand levels for 2 min each. Electroencephalography (EEG) and electrocardiography (ECG) were performed during these activities. After each activity, the semantic differential method (SDM) was used to evaluate the emotional states of the participants. EEG results revealed that relative fast alpha and low beta power spectrums in the frontal lobes were high during the activity with high cognitive demand compared to those during the low demand activity, which indicates activation in the prefrontal cortex. ECG results showed that during the high cognitive demand activity, the standard deviation of the RR intervals of male adults was high, indicating a high-stress resistance ability of the autonomic nervous system. However, as a result of the SDM, there were no significant differences in emotional states according to the level of activity difficulty. Therefore, this study confirmed the possibility that the intervention of horticultural activities of an appropriate difficulty did not negatively affect subjective emotional changes and could have a positive effect on the improvement of attention levels and emotional stability in adults. [ABSTRACT FROM AUTHOR]

Since indoor, sedentary lifestyles became prevalent in society, humans have lost a sustainable connection to nature. An intervention utilizing outdoor horticultural activities could address such a challenge, but their beneficial effects on the brain and emotions have not been characterized in a quantitative approach. We aimed to investigate brain activity and emotional changes in adults in their 20s during horticultural activity to confirm feasibility of horticultural activity to improve cognitive and emotional states. Sixty university students participated in 11 outdoor horticultural activities at 2-min intervals. We measured brain waves of participants' prefrontal cortex using a wireless electroencephalography device while performing horticultural activities. Between activities, we evaluated emotional states of participants using questionnaires. Results showed that each horticultural activity showed promotion of brain activity and emotional changes at varying degrees. The participants during physically intensive horticultural activities—digging, raking, and pruning—showed the highest attention level. For emotional states, the participants showed the highest fatigue, tension, and vigor during digging and raking. Plant-based activities—harvesting and transplanting plants—made participants feel natural and relaxed the most. Therefore, this pilot study confirmed the possibility of horticultural activity as a short-term physical intervention to improve attention levels and emotional stability in adults. [ABSTRACT FROM AUTHOR]

Background: This study aimed to compare the controlling nutritional status (CONUT) score, prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI) for predicting postoperative outcomes in patients with esophageal squamous cell carcinoma undergoing esophagectomy. Methods: We retrospectively reviewed the data of 1265 consecutive patients who underwent elective esophageal surgery. The patients were classified into no risk, low-risk, moderate-risk, and high-risk groups based on nutritional scores. Results: The moderate-risk (hazard ratio [HR]: 1.55, 95% confidence interval [CI]: 1.24–1.92, p < 0.001 in CONUT; HR: 1.61, 95% CI: 1.22–2.12, p = 0.001 in GNRI; HR: 1.65, 95% CI: 1.20–2.26, p = 0.002 in PNI) and high-risk groups (HR: 1.91, 95% CI: 1.47–2.48, p < 0.001 in CONUT; HR: 2.54, 95% CI: 1.64–3.93, p < 0.001 in GNRI; HR: 2.32, 95% CI: 1.77–3.06, p < 0.001 in PNI) exhibited significantly worse 5-year overall survival (OS) compared with the no-risk group. As the nutritional status worsened, the trend in the OS rates decreased (p for trend in all indexes < 0.05). Conclusions: Malnutrition, evaluated by any of three nutritional indexes, was an independent prognostic factor for postoperative survival. [ABSTRACT FROM AUTHOR]

This study sought to identify the short- and long-term changes in left ventricular ejection fraction (LVEF) after mitral valve repair (MVr) in patients with chronic primary mitral regurgitation according to preoperative LVEF (pre-LVEF) and preoperative left ventricular end-systolic diameter (pre-LVESD). This study evaluated 461 patients. Restricted cubic spline regression models were constructed to demonstrate the long-term changes in postoperative LVEF (post-LVEF). The patients were divided into four groups according to pre-LVEF (<50%, 50–60%, 60–70%, and ≥70%). The higher the pre-LVEF was, the greater was the decrease in LVEF immediately after MVr. In the same pre-LVEF range, immediate post-LVEF was lower in patients with pre-LVESD ≥ 40 mm than in those with pre-LVESD < 40 mm. The patterns of long-term changes in post-LVEF differed according to pre-LVEF (p for interaction < 0.001). The long-term post-LVEF reached a plateau of approximately 60% when the pre-LVEF was ≥50%, but it seemed to show a downward trend after reaching a peak at approximately 3–4 years after MVr when the pre-LVEF was ≥70%. The patterns of short- and long-term changes in post-LVEF differed according to pre-LVEF and pre-LVESD values in patients with chronic primary mitral regurgitation after MVr. [ABSTRACT FROM AUTHOR]

Cystatin C (CysC) may estimate renal function more accurately than serum creatinine (SCr). The clinical impact of renal dose adjustment of cefepime according to CysC rather than SCr has remained uncertain. We investigated the efficacy and safety of CysC-guided cefepime dosing compared with SCr-guided dosing in hospitalized patients with pneumonia. All adults hospitalized with pneumonia between July 2016 and December 2018 who used cefepime for at least 3 days were enrolled. Mortality, acute kidney injury (AKI), cefepime-induced encephalopathy (CIE), and Clostridium difficile infection were compared between the CysC-guided and SCr-guided groups. One hundred and ninety patients were divided into two groups: 129 and 61 received cefepime based on CysC and SCr, respectively. In-hospital mortality did not significantly differ between the groups (12% versus 31%; hazard ratio (HR) 0.74; 95% confidence interval (CI), 0.31–1.77; p = 0.50). CysC-guided cefepime dosing decreased the risk of AKI (13% versus 61%; HR 0.18; 95% CI, 0.07–0.44; p < 0.001) and CIE (2% versus 11%; HR 0.11; 95% CI, 0.03–0.47; p = 0.003) compared with SCr-guided dosing. There was no significant difference in the risk of Clostridium difficile infection. CysC-guided dosing of cefepime was associated with decreased risk of the cefepime-associated morbidities including AKI and CIE without increasing mortality among the hospitalized patients with pneumonia. [ABSTRACT FROM AUTHOR]

We developed a new magnetic resonance indicator for necrotizing fasciitis (MRINEC) algorithm for differentiating necrotizing fasciitis (NF) from severe cellulitis (SC). All adults with suspected NF between 2010 and 2018 in a tertiary hospital in South Korea were enrolled. Sixty-one patients were diagnosed with NF and 28 with SC. Among them, 34 with NF and 15 with SC underwent magnetic resonance imaging (MRI). The MRINEC algorithm, a two-step decision tree including T2 hyperintensity of intermuscular deep fascia and diffuse T2 hyperintensity of deep peripheral fascia, diagnosed NF with 94% sensitivity (95% confidence interval (CI), 80–99%) and 60% specificity (95% CI, 32–84%). The algorithm accurately diagnosed all 15 NF patients with a high (≥8) laboratory risk indicator for necrotizing fasciitis (LRINEC) score. Among the five patients with an intermediate (6–7) LRINEC score, sensitivity and specificity were 100% (95% CI, 78–100%) and 0% (95% CI, 0–84%), respectively. Finally, among the 29 patients with a low (≤5) LRINEC score, the algorithm had a sensitivity and specificity of 88% (95% CI, 62–98%) and 69% (95% CI, 39–91%), respectively. The MRINEC algorithm may be a useful adjuvant method for diagnosing NF, especially when NF is suspected in patients with a low LRINEC score. [ABSTRACT FROM AUTHOR]

Although remote ischemic preconditioning (RIPC) has been shown to have renoprotective effects, few studies have assessed the effects of RIPC on renal function in living kidney donors. This study investigated whether RIPC performed in living kidney donors could improve residual renal function in donors and outcomes in recipients following kidney transplantation. The donors were randomized into a control group (n = 85) and a RIPC group (n = 85). The recipients were included according to the matched donors. Serum creatinine (sCr) concentrations and estimated glomerular filtration rate (eGFR) were compared between control and RIPC groups in donors and recipients. Delayed graft function, acute rejection, and graft failure within one year after transplantation were evaluated in recipients. sCr was significantly increased in the control group (mean, 1.13; 95% confidence interval (CI), 1.07–1.18) than the RIPC group (1.01; 95% CI, 0.95–1.07) (p = 0.003) at discharge. Donors with serum creatinine >1.4 mg/dL at discharge had higher prevalence of chronic kidney disease (n = 6, 26.1%) than donors with a normal serum creatinine level (n = 8, 5.4%) (p = 0.003) after one year. sCr concentrations and eGFR were similar in the RIPC and control groups of recipients over the one-year follow-up period. Among recipients, no outcome variables differed significantly in the RIPC and control groups. RIPC was effective in improving early renal function in kidney donors but did not improve renal function in recipients. [ABSTRACT FROM AUTHOR]

We designed a pilot study to develop a family interaction model-integrated a care farming program with mother-child pairs as the participants. In this pilot study, we aimed to assess the effects of the care farming program on communication skills and psychological health in families. Sixteen mother-child pairs in Sejong, South Korea participated in this study. The families participated in a care farming program once a week for six weeks (90 min per session) between May and July 2018. The care farming program was developed based on parenting education skills, strengths-based cognitive behavioral therapy, and the emotional intelligence model; the result was a family interaction model intended to improve communication and psychological health among mothers and children. The program consisted of gardening activities such as making a garden plot, planting transplants, harvesting, and cooking the harvested crops. Upon completion of the six-session program, we evaluated communication with the Parent-Children Communication Inventory, depression with the Beck Depression Inventory, and resilience with the Connor-Davidson Resilience Scale among the mothers. We also evaluated emotional intelligence among the children with the Emotional Intelligence Scale. According to post-intervention results, mothers showed significantly increased resilience, improved communication skills with their child, and decreased depression, while children showed significantly improved emotional intelligence ( p < 0.05). Despite the study's limitation in establishing causality between the care farming program and the observed effects on family health, the care farming program clearly contributed to the observed improvements of mother-child communication skills, mothers' psychological health, and children's emotional intelligence, which in turn improved overall family health., Competing Interests: The authors declare no conflict of interest.