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[Purpose] The purpose of this study was to compare the muscle activities of upper extremities during a drinking task between the stroke-affected and less-affected sides. [Subjects] Eight stroke patients (8 men; age 45.3 years; stroke duration 21.9 months) participated in this study. [Methods] Electromyography (EMG) was used to measure nine muscle activities of the upper extremity. The drinking task was divided into 5 phases. [Results] Analysis of the EMG data showed that the percentage of maximum voluntary isometric contraction (%MVIC) across all phases of drinking differed between the affected and less-affected sides. Participants used relatively higher levels of %MVIC in the anterior deltoid, flexor muscles, brachioradialis, and infraspinatus on the stoke-affected side. [Conclusion] The difference in muscle activation across all phases of the drinking movement allowed us to determine how upper extremity muscle activation may influence drinking performance on the stroke-affected and less-affected sides.

PURPOSE Porcine proliferative enteropathy (PPE) is known as one of the most important risk factors causing economic losses in swine industry worldwide. This study was conducted to evaluate the efficacy of a commercial oral attenuated Lawsonia intracellularis vaccine (Enterisol Ileitis) against PPE under a commercial pig farm condition in Korea. MATERIALS AND METHODS Thirty two-day-old 672 piglets were randomly allocated into vaccinated and control groups. All piglets in the vaccinated group were inoculated with a commercial attenuated L. intracellularis vaccine as following the manufacturer's instruction. Body weights of all pigs in both groups were measured on the vaccination day and 6, 14, and 20 weeks post vaccination and an average daily weight gain (ADWG) was calculated. Health status was observed biweekly during the whole trial. RESULTS The vaccinated group showed significantly higher body weight (p

Objectives:We compared the efficacy of dexmedetomidine and remifentanil hydrochloride in intraoperative field conditions and recovery during endoscopic sinus surgery.Methods:Sixty-six patients (American Society of Anesthesiologists physical status I and II) scheduled for elective endoscopic sinus surgery were enrolled in this prospective, double-blinded, randomized study. The patients were randomly assigned to two groups. Propofol, 2 to 2.5 mg/kg, was administered to both groups to induce anesthesia, which was maintained with desflurane. One group received dexmedetomidine 1 μg/kg over 10 minutes at anesthesia induction, followed by 0.4 to 0.8 μg/kg per hour infusion during maintenance, whereas the other group received remifentanil 1 μg/kg over 1 minute at anesthesia induction, followed by 0.2 to 0.4 μg/kg per minute infusion during maintenance. Surgical conditions, hemodynamic parameters, intraoperative blood loss, time to extubation, sedation, and pain in the postanesthesia care unit (PACU) were recorded.Results:There were no significant differences between the two groups with respect to surgical field conditions, blood loss, or extubation time. The sedation score (Modified Observer's Assessment of Alertness/Sedation) in the PACU was significantly lower in the dexmedetomidine group than in the remifentanil group (p < 0.001). No differences were found in total blood loss, surgical field conditions, hemodynamic parameters, time to extubation, or pain in the PACU when the two groups were compared (p > 0.05).Conclusions:Although remifentanil and dexmedetomidine both enabled hypotensive anesthesia and good intraoperative fields for endoscopic sinus surgery, recovery was faster with remifentanil than with dexmedetomidine in the immediate postoperative period.

To better understand environmental electromagnetic wave exposure during the use of digital textbooks by elementary school students, we measured numeric values of the electromagnetic fields produced by tablet personal computers (TPCs). Specifically, we examined the distribution of the electromagnetic waves for various students' seating positions in an elementary school that uses digital textbooks. Electric and magnetic fields from TPCs were measured using the HI-3603 Visual Display Terminal/ Very Low Frequency (VDT/VLF) radiation measurement system. Electromagnetic field values from TPCs measured at a student's seat and at a teacher's computer were deemed not harmful to health. However, electromagnetic field values varied based on the distance between students, other electronic devices such as a desktop computers, and student posture while using a TPC. Based on these results, it is necessary to guide students to observe proper posture and to arrange seats at an appropriate distance in the classroom. © The Author(s) 2013.

Background: Sleep disorder is a common problem in adults and affects physical and mental health. We investigated factors associated with poor sleep quality in Korean primary care. Methods: A total of 129 couples (129 husbands and 129 wives) aged 30 to 79 years were included in this study from March,2009 to February, 2010. The subjects were surveyed using a specific questionnaire. Sleep disorder was defined by a Pittsburgh Sleep Quality Index global score greater than 5 (poor sleepers). The subjects were divided into a group of good sleepers (n = 160) and a group of poor sleepers (n = 98). Socio-demographic and clinical covariates including age, sex,depression, spouse sleep disorder, and spouse depression were reported. Results: Poor sleep quality was present in 38.0% of total subjects. According to chi-square test results, female, patients with depression, and low sleep quality of spouse were significantly associated with sleep disorder. In multivariate logistic regression analysis, depression increased the risk of poor sleep quality (odds ratio [OR], 7.775; 95% confidence interval [CI],2.555 to 23.661), and non-risky drinking decreased the risk of poor sleep quality (OR, 0.343; 95% CI, 0.128 to 0.924). Conclusion: In our study, more than one-third of participants had poor sleep quality. Depression was a strong independent factor associated with sleep problems.

Although early detection and successful gastrectomy have improved the survival of patients with gastric cancer, long-term health problems remain troubling. We evaluated the prevalence of osteoporosis and its risk factors in long-term survivors of gastric cancer after gastrectomy. We reviewed the medical records of a tertiary hospital between 2007 and 2014 to identify survivors of gastric cancer who had visited our center at around 5 years after gastrectomy. We evaluated their health status, including bone mineral density (BMD). Dual-energy X-ray absorptiometry was used to measure the BMD of the lumbar spine and femur (total and neck area). The prevalence of osteoporosis, defined by a BMD T score

Author(s): Evangelista, Lorraine S; Ghasemzadeh, Hassan; Lee, Jung-Ah; Fallahzadeh, Ramin; Sarrafzadeh, Majid; Moser, Debra K | Abstract: BackgroundIt is unclear whether subgroups of patients may benefit from remote monitoring systems (RMS) and what user characteristics and contextual factors determine effective use of RMS in patients with heart failure (HF).ObjectiveThe study was conducted to determine whether certain user characteristics (i.e. personal and clinical variables) predict use of RMS using advanced machine learning software algorithms in patients with HF.MethodsThis pilot study was a single-arm experimental study with a pre- (baseline) and post- (3 months) design; data from the baseline measures were used for the current data analyses. Sixteen patients provided consent; only 7 patients (mean age 65.8 ± 6.1, range 58-83) accessed the RMS and transmitted daily data (e.g. weight, blood pressure) as instructed during the 12 week study duration.ResultsBaseline demographic and clinical characteristics of users and non-users were comparable for a majority of factors. However, users were more likely to have no HF specialty based care or an automatic internal cardioverter defibrillator. The precision accuracy of decision tree, multilayer perceptron (MLP) and k-Nearest Neighbor (k-NN) classifiers for predicting access to RMS was 87.5%, 90.3%, and 94.5% respectively.ConclusionOur preliminary data show that a small set of baseline attributes is sufficient to predict subgroups of patients who had a higher likelihood of using RMS. While our findings shed light on potential end-users more likely to benefit from RMS-based interventions, additional research in a larger sample is warranted to explicate the impact of user characteristics on actual use of these technologies.

Background: Oral anticoagulation treatment (OAT) such as warfarin therapy is recommended for older adults with atrial fibrillation, heart failure, or who are at risk for venous thromboembolism. Despite its proven benefits, older adults report both dissatisfaction with OAT and reduced quality of life that can potentially lead to low adherence to OAT and decreased treatment efficacy. Objective: To test the feasibility of Mobile Applications for Seniors to enhance Safe anticoagulation therapy (MASS), a mobile-based health technology intervention designed to promote independence and self-care. Methods: This pilot study used a single-arm experimental pre–post design to test the feasibility of a 3-month intervention using MASS in 18 older adults (male: n = 14; White: n = 9; Hispanic: n = 7; Other: n = 2; M age = 67). MASS was available in English or Spanish. Participants completed surveys about their OAT knowledge, attitudes, quality of life with OAT, and adherence at baseline and at a 3-month follow-up. Satisfaction with the MASS intervention was also assessed at follow-up. Results: Anticoagulation knowledge significantly improved from baseline to follow-up ( Mbase = 12.5 ± 5.51, Mfollow-up = 14.78 ± 3.93, p = .007). Other outcomes were not different, pre- and post-tests. Participants reported they were generally satisfied with MASS, its ease of use and its usefulness. Conclusion: The results showed use of MASS improved older adults’ knowledge of OAT. Using mHealth apps may enhance self-care among older adults with chronic conditions who are also taking oral anticoagulants.

Although several studies have individually investigated the risk factors for erectile dysfunction (ED), premature ejaculation (PE), and late-onset hypogonadism (LOH), few studies have considered ED, PE, and LOH as categories of sexual dysfunction (SD) within the same population. We therefore aimed to investigate the prevalence of SD and its associated risk factors among men in primary care. Study participants were enrolled by 18 family physicians from 15 hospital-based family practices in Korea between August 2010 and May 2011. Participants answered a questionnaire regarding their demographic characteristics and lifestyle factors as well as the Korean versions of the Androgen Deficiency in the Aging Male, the International Index of Erectile Function, and the Premature Ejaculation Diagnostic Tool questionnaires. SD prevalence was 64.9% among study participants who were ≥ 40 years of age. ED prevalence was 43.7%, PE prevalence was 38.6%, and LOH prevalence was 16.8%. SD prevalence was significantly associated with increased age, overweight, hypertension, diabetes, and depression. These findings highlight the importance of screening questions for SD in primary care, especially among older male patients with the identified risk factors.

SummaryBackground The skin brightness is determined according to the amount and type of melanin. People with darker skin have a greater amount of melanin that makes their skin less susceptible to UV damages. They live in lower latitude and receive a greater amount of the intensity of the UV radiation. Aim We wanted to know how the latitude and skin brightness affect skin aging. Methods Three thousand volunteers from seven countries (Korea, China, India, Thailand, Vietnam, Indonesia, and Malaysia), aged 20–59 years, participated in this study. We measured skin brightness, Ra (wrinkles parameter), and R2 (elasticity parameter) under controlled environmental conditions. The skin brightness of the face was measured using the Janus® which is a facial analysis system. Cutometer® the elasticity was measured by on the cheeks, and PRIMOS lite® was used to evaluate wrinkles on crow's feet. Results Latitude and skin brightness showed a positive correlation (0.346). Also, the correlations of Ra and R2 with skin brightness were significantly negative (−0.181) and positive (0.105), respectively. Results of comparison of Ra and R2 with age among the countries showed no significant difference among the 20s, but there was a significant difference among the 50s between countries with high latitude and low latitude. Conclusion The long-term exposure of UV radiation, the natural environmental factor, seems to have more decisive effect on the skin aging process than the photoprotective effect of melanin of epidermal skin. This study helps to understand differences of the skin properties among countries in Asia.

While prior research has examined the relationship between narcissism and self-promoting behaviors on social media (e.g., posting selfies), little is known about the extent to which individuals' level of narcissism relates to how involved they are in other people's feedback (e.g., comments and "likes") received on their selfies, or how observant and responsive they are to other people's selfie postings. The present study investigates how narcissism relates to such selfie-related behaviors, as well as overall evaluation of selfie-posting behavior and intention to post selfies in the future. By employing a total of 315 Korean subjects who take and post selfies on social networking sites, the present study indicates that individuals higher in narcissism are more likely to evaluate selfie-posting behavior favorably, be involved in the feedback provided by others, and be observant of other people's selfies. However, level of narcissism did not moderate the relationship between how much one observes others' selfies and the likelihood of providing a comment or "like" on other people's selfies.

BACKGROUND There are advantages to using digital textbooks, but also health concerns yet to be evaluated. OBJECTIVE This study examines the use of digital textbooks' effects on carpal tunnel, considered one of the potential health risks in students using digital textbooks. METHODS Data were obtained from 43 elementary school students in the sixth grade, selected from two groups who had used digital and paper textbooks, respectively. To assess carpal tunnel function, this study performed median motor nerve and median sensory nerve conduction studies. RESULTS There were no statistically significant differences between the groups, indicating that there were no functional differences related to carpal tunnel syndrome between the groups. CONCLUSION Usage of digital textbook is expanding nationwide in the Republic of Korea. There is no short-term risk of carpal tunnel syndrome in this population of elementary school students.

Cell-permeable peptides (CPPs) have been widely studied as an attractive drug delivery system to deliver therapeutic macromolecules such as DNA, RNA, and protein into cells. However, its clinical application is still limited and controversial due to the lack of a complete understanding of delivery efficiency in target cells. Previously we identified and characterized the novel and superior CPP, named dNP2, and here we comparatively analyzed intracellular delivery efficiency of dNP2 and TAT in various immune cells of mouse spleen to demonstrate their cell type preference. dNP2-or TAT-conjugated fluorescent proteins were most efficiently taken up by phagocytic cells such as dendritic cells and macrophages while little protein uptake was seen by lymphocytes including T cells, B cells, and NK cells. Interestingly CD8(+) lymphoid dendritic cells and CD62L(lo)CD44(hi) memory like T cell subsets showed significantly better uptake efficiency in vitro and in vivo relative to other dendritic cells or T cells, respectively. In addition, activated macrophages, T cells, and B cells took up the proteins more efficiently relative to when in the resting state. Importantly, only dNP2, not TAT, shows significant intracellular protein delivery efficiency in vivo. Collectively, this study provides important information regarding heterogeneous intracellular delivery efficiency of CPPs such as dNP2 and TAT with cell type preference in the spleen needed for its application in phagocytic cells or activated immune cells.

This study aims to investigate the idea that an active-resistive training with an EMG-based exoskeleton robot could be beneficial to muscle strength and antagonist muscle cocontraction control after 4-week intensive elbow flexion/extension training. Three older people over 65 years participated the training for an hour per session and completed total 20 sessions during four weeks. Outcome measures were chosen as the maximum joint torque and cocontraction ratio between the biceps/triceps brachii muscles at pre-/post-training. The Wilcoxon signed-ranks test was performed to evaluate paired difference for the outcome measures. As a result, there was no significant difference in the maximum flexion or extension torque at pre- and post-training. However, the cocontraction ratio of the triceps brachii muscle as the antagonist was significantly decreased by 9.8% after the 4-week intensive training. The active-resistive training with the exoskeleton robot in the older people yielded a promising result, showing significant changes in the antagonist muscle cocontraction.

Mesenchymal stem cells (MSCs) are attractive agents for cellular therapy in rheumatoid arthritis (RA). The receptor for advanced glycation end products (RAGE) serves as a pattern recognition receptor for endogenous inflammatory ligands. Soluble RAGE (sRAGE) is a truncated form of RAGE that functions as a decoy and acts as an anti-inflammatory molecule. The aim of this study was to determine whether sRAGE has therapeutic effects and the mechanisms active in sRAGE-overexpressing MSCs (sRAGE-MSCs) in an experimental model of RA. sRAGE-MSCs were generated by DNA transfection of human adipose tissue-derived MSCs (Ad-hMSCs). MSCs showed increased expression of VEGF, IL-1β, IL-6, and HMGB-1 under inflammatory conditions. However, sRAGE-MSCs showed significantly lower production of these proinflammatory molecules. Expression of immunomodulatory molecules such as IL-10, TGF-β, and indoleamine 2, 3-dioxygenase was higher in sRAGE-MSCs than in mock-MSCs. sRAGE-MSCs showed enhanced migration potential. Transplantation of sRAGE-MSCs into arthritic IL-1Ra-knockout mice markedly suppressed inflammatory arthritis, decreased Th17 cells, and reciprocally increased regulatory T cells. The differentiation of IFN-γ+CD4+ and IL-17+CD4+ cells was inhibited by incubation with sRAGE-MSCs compared with mock-MSCs. These findings suggest that sRAGE overexpression in Ad-hMSCs optimizes their immunoregulatory properties, which may be useful as a novel cellular therapy for RA.

Author(s): Guo, Yuqing; Pimentel, Pamela; Lessard, Jared; Rousseau, Julie; Lee, Jung-Ah; Bojorquez, Yvette; Silva, Michele; Olshansky, Ellen | Abstract: BackgroundMOMS Orange County is a coordinated home visitation program in which trained paraprofessional home visitors work under the close supervision of registered nurses. This model was developed to address health disparities in birth outcomes in a Hispanic community in Orange County, CA.PurposeThe primary objective was to test the impact of MOMS Orange County on birth outcomes. The second objective was to examine the breadth of prenatal health education topics as a mediator of the relationship between home visits and birth outcomes.MethodsA retrospective cohort design was used. Paraprofessional home visitors collected prenatal and postnatal data during home visits. Only those whose birth outcomes were obtained were included in the analysis (N = 2,027 participants). Regression models were conducted to test the associations between prenatal home visits and birth outcomes, adjusting for 10 covariates.ResultsNumber of prenatal home visits predicted higher birthweight and greater gestational age at birth. Breadth of health education topics partially mediated the associations between home visits and birthweight. The same mediation was revealed with gestational age at birth.Clinical implicationsThe MOMS Orange County prenatal home visitation program may be a promising approach to decrease adverse birth outcomes in disadvantaged communities. Rigorously designed studies are needed to further test this model.

Limited data are available on the in vivo expression of fibronectin, one of the main extracellular matrix components. We investigated the expression of fibronectin in abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and the associations of leptin, adiponectin, and vaspin gene expression with metabolic parameters in obese women.We recruited female subjects undergoing bariatric surgery for obesity (n = 24) and patients undergoing benign gynecological surgery as the control group (n = 23). We measured anthropometric variables, abdominal fat distribution, metabolic parameters, serum concentrations of leptin, adiponectin, and vaspin, and depot-specific mRNA expression of fibronectin, leptin, adiponectin, and vaspin.Fibronectin expression in both VAT and SAT was significantly lower in the obese group than in the control group. Fibronectin expression in both VAT and SAT were negatively correlated with body mass index or waist circumference, with higher prominence in VAT. In multiple regression analysis, fibronectin expression in both VAT and SAT was negatively correlated with serum leptin concentration. Fibronectin expression in VAT was negatively correlated with leptin expression in VAT. Additionally, fibronectin expression in SAT was negatively correlated with leptin expression in SAT and positively correlated with adiponectin expression in VAT and SAT.We found significant negative associations between depot-specific fibronectin expression in human adipose tissue and obesity indices and obesity-related biomarkers. Our results suggest that fibronectin expression may contribute to obesity and metabolic dysregulation in humans.

Shoulder pain, for which acupuncture has been used, is a common complication after a stroke that interferes with the function of the upper extremities. The aim of this systematic review is to summarize and evaluate the effects of acupuncture for shoulder pain after stroke.Randomized controlled trials (RCTs) involving the effects of acupuncture for shoulder pain, published between January 1990 and August 2009, were obtained from the National Libraries of Medicine, MEDLINE(®), CINAHL, AMED, Embase, Cochrane Controlled Trials Register 2009, Korean Medical Database (Korea Institute of Science Technology Information, DBPIA, KoreaMed, and Research Information Service System), and the Chinese Database (China Academic Journal).Among the 453 studies that were obtained (300 written in English, 137 in Chinese, and 16 in Korean), 7 studies met the inclusion criteria for this review. All of them were RCTs published in China and reported positive effects of the treatment. The quality of the studies was assessed by the Modified Jadad Scores (MJS) and the Cochrane Back Review Group Criteria List for Methodologic Quality Assessment of RCTs (CBRG); the studies scored between 2 and 3 points on MJS, and between 4 and 7 points on CBRG.It is concluded from this systematic review that acupuncture combined with exercise is effective for shoulder pain after stroke. It is recommended that future trials be carefully conducted on this topic.

The purpose of this study was to investigate the effect of the home-based virtual reality (VR) on upper extremity motor function in hemiparetic stroke patients. Two matched subjects with left hemiplegia were volunteered to participate in this study. One subject received the home-based VR whereas the other subject recovered a modified home-based constraint-induced movement therapy (CIMT). Both interventions were given for 4 hours x 5 times a week for 4 weeks. Outcome measures included Fugl-Meyer Assessment (FMA), Motor Activity Log (MAL), and Wolf Motor Function Test (WMFT). The VR-trained subject showed considerable improvement in all the tested motor functions when compared with the home-based CIMT. Specifically, the FMA measure demonstrated that the VR subject showed 17% enhancement whereas the CIMT subject showed 5% increase. Similarly, Amount of Use (AOU) and Quality of Movement (QOM) of the MAL scores of the VR subject showed 40% and 20% increase whereas the CIMT subject showed 0% and 20% increase, respectively. The WMFT scores of the VR subject and CIMT subject showed 20% increase. Our home-based VR was effective in upper extremity motor recovery of chronic hemiparetic patients even when compared with the well-established CIMT approach in stroke victims.요 약

This prospective randomized study evaluated the effects of ketamine with remifentanil to improve the quality of anaesthesia and postoperative recovery, following brief procedures, in 60 paediatric patients undergoing middle-ear ventilation tube insertion (MEVTI). Patients were randomly assigned to either ketamine 2 mg/kg intravenous [i.v.] bolus plus normal saline by i.v. infusion (K group, n = 30) or ketamine 2 mg/kg i.v. bolus, plus remifentanil 0.15 μg/kg per min i.v. infusion (KR group, n = 30). Parameters that were assessed included intraoperative patient movement, surgeon satisfaction, anaesthesia time, total ketamine dose, postoperative recovery time, agitation and side-effects. Intraoperative patient movement scores were significantly lower, and surgeon satisfaction scores were significantly higher, in the KR group than in the K group. Time to recovery was significantly shorter in the KR group than in the K group. In conclusion, remifentanil was a good adjuvant to ketamine, improving the quality of anaesthesia and postoperative recovery in children undergoing MEVTI.

This study was conducted to examine the contents of lead (Pb), cadmium (Cd), arsenic (As), and mercury (Hg) in meat and meat products in Korea. The contents of Pb, Cd, As, and Hg in 466 samples of beef, pork, chicken, duck, ham, and sausage were measured using inductively coupled plasma mass spectrometry or a mercury analyzer. Wet ashing and microwave method were compared, and the recovery and reproducibility of the microwave method were better than those of wet ashing for meat and meat products. The recovery of the microwave method was 98.1% for Pb, 104.6% for Cd, and 103.4% for As, respectively. The best result was obtained through digestion using an acid mixture (HNO3/H2O2, 6:2). Hg content was measured using a mercury analyzer. As a result, the contents of Hg and Cd in samples were lower than those of Pb and As. The average contents of Pb were 0.009 mg/kg in beef, 0.010 mg/kg in pork, 0.006 mg/kg in chicken, 0.007 mg/kg in duck, 0.005 mg/kg in ham, and 0.009 mg/kg in sausage. The average Cd contents were 0.0004 mg/ kg in beef, 0.0004 mg/kg in pork, 0.0005 mg/kg in chicken, 0.0012 mg/kg in duck, 0.0015 mg/kg in ham, and 0.0019 mg/ kg in sausage. The average As contents were 0.016 mg/kg in beef, 0.004 mg/kg in pork, 0.021 mg/kg in chicken, 0.010 mg/ kg in duck, 0.014 mg/kg in ham, and 0.018 mg/kg in sausage. The average Hg contents were 0.713 µg/kg in beef, 0.902 µg/ kg in pork, 0.710 µg/kg in chicken, 0.796 µg/kg in duck, 1.141 µg/kg in ham, and 1.052 µg/kg in sausage. Based on the results of the National Health and Nutrition Survey 2005, the levels of dietary exposure to heavy metal contaminants in meat and meat products were compared with the provisional tolerable weekly intake(PTWI) established by the Joint FAO/WHO Expert Committee on Food Additives. The average dietary exposure of the general population from meat and meat products was 0.03-0.2% of PTWI for Pb, Cd, As, and Hg, which indicates a safe level for public health at present.

This prospective, randomized, double-blind study compared the effects of dexmedetomidine and remifentanil on haemodynamic stability, sedation and postoperative pain control in the postanaesthetic care unit (PACU). Fifty consecutive patients scheduled for total laparoscopic hysterectomy were randomly assigned to receive infusions of either dexmedetomidine (1 μg/kg) i.v. over 10 min followed by 0.2-0.7 μg/kg per h continuous i.v. infusion or remifentanil (0.8-1.2 μg/kg) i.v. over 1 min followed by 0.05-0.1 μg/kg i.v. per min, starting at the end of surgery to the time in the PACU. Modified observer's assessment of alertness scores were significantly lower in the dexmedetomidine group than in the remifentanil group at 0, 5 and 10 min after arrival in the PACU. Blood pressure and heart rate in the dexmedetomidine group were significantly lower than that recorded in the remifentanil group in the PACU. Dexmedetomidine, at the doses used in this study, had a significant advantage over remifentanil in terms of postoperative haemodynamic stability.

Purpose: Distant metastasis and recurrence are major prognostic factors associated with breast cancer. Both lymphovascular invasion (LVI) and blood vessel invasion (BVI) are important routes for metastasis to regional lymph nodes and for systemic metastasis. Despite the importance of vascular invasion as a prognostic factor, application of vascular invasion as a histopathological criterion is controversial. The aim of this study was to distinguish LVI from BVI in prognosis and recurrence of breast cancer using an endothelial subtype specific immunohistochemical stain (podo planin, D2-40, and CD31). Methods: Sections from 80 paraffinembedded archival specimens of invasive breast cancer were stained for podoplanin, D2-40, or CD31 expression. Immunohistochemical staining results were correlated with clinicopathological features, such as tumor size, status of lymph node metastases, estrogen receptor status, progesterone receptor status, human epidermal growth factor receptor-2 expression, and recurrence. Patients with ductal carcinoma in situ and stage IV breast cancer were excluded. Results: A significant correlation was found between D2-40 LVI positivity and lymph node metastasis (p= 0.022). We found a significant correlation between D2-40 LVI positivity and recurrence of breast cancer (p= 0.014). However, no significant correlation was found between BVI and recurrence. A poorer disease free survival was shown for D2-40 positive LVI (p= 0.003). In a multivariate analysis, the presence of D2-40 LVI positivity revealed a significant association with decreased disease-free survival. Conclusion: D2-40 LVI positivity was a more prognostic predictor of breast cancer than BVI.

We present a 32-year-old, extremely obese, pregnant woman who developed severe hypotension and water intoxication after an accidental injection of large bolus of oxytocin during cesarean section under general anesthesia. The patient was initially thought to have an amniotic fluid embolism because of the abrupt hemodynamic changes developed immediately after fetal delivery and lack of recognition of medication error. It is highly recommended that careful attention should be paid not only to the possibility of hemodynamic deterioration and water intoxication if oxytocin is given rapidly in excessive doses, but to the confirmation of the proper use of the drug before it is injected.

A novel linear-dendritic block copolymer has been synthesized and evaluated for targeted delivery. The use of the dendron as the micellar exterior block in this architecture allows the presentation of a relatively small quantity of ligands in clusters for enhanced targeting, thus maintaining a long circulation time of these “patchy” micelles. The polypeptide linear hydrophobic block drives formation of micelles that carry core-loaded drugs, and their unique design gives them extremely high stability in vivo. We have found that these systems lead to extended time periods of increased accumulation in the tumor (up to 5 days) compared with nontargeted vehicles. We also demonstrate a fourfold increase in efficacy of paclitaxel when delivered in the targeted nanoparticle systems, while significantly decreasing in vivo toxicity of the chemotherapy treatment., National Institute for Biomedical Imaging and Bioengineering (U.S.), National Cancer Institute (U.S.) (R01EB008082-01A2)

The evidence that nuclear proteins can be degraded by cytosolic proteasomes has received considerable experimental support. However, the presence of proteasome subunits in the nucleus also suggests that protein degradation could occur within this organelle. We determined that Sts1 can target proteasomes to the nucleus and facilitate the degradation of a nuclear protein. Specific sts1 mutants showed reduced nuclear proteasomes at the nonpermissive temperature. In contrast, high expression of Sts1 increased the levels of nuclear proteasomes. Sts1 targets proteasomes to the nucleus by interacting with Srp1, a nuclear import factor that binds nuclear localization signals. Deletion of the NLS in Sts1 prevented its interaction with Srp1 and caused proteasome mislocalization. In agreement with this observation, a mutation in Srp1 that weakened its interaction with Sts1 also reduced nuclear targeting of proteasomes. We reported that Sts1 could suppress growth and proteolytic defects of rad23Δ rpn10Δ. We show here that Sts1 suppresses a previously undetected proteasome localization defect in this mutant. Taken together, these findings explain the suppression of rad23Δ rpn10Δ by Sts1 and suggest that the degradation of nuclear substrates requires efficient proteasome localization.

Endocrine disruptors such as bisphenol A (BPA) are environmental pollutants that interfere with the body's endocrine system because of their structural similarity to natural and synthetic hormones. Due to their strong oxidizing potential to decompose such organic pollutants, colloidal metal oxide photocatalysts have attracted increasing attention for water detoxification. However, achieving both long-term physical stability and high efficiency simultaneously with such photocatalytic systems poses many challenges. Here a layer-by-layer (LbL) deposition approach is reported for immobilizing TiO 2 nanoparticles (NPs) on a porous support while maintaining a high catalytic efficiency for photochemical decomposition of BPA. Anatase TiO 2 NPs ≈7 nm in diameter self-assemble in consecutive layers with positively charged polyhedral oligomeric silsesquioxanes on a high surface area, porous electrospun polymer fiber mesh. The TiO 2 LbL nanofibers decompose approximately 2.2 mg BPA per mg of TiO 2 in 40 h of illumination (AM 1.5G illumination), maintaining first-order kinetics with a rate constant (k) of 0.15 h -1 for over 40 h. Although the colloidal TiO 2 NPs initially show (significantly higher photocatalytic activity (k≈ 0.84 h -1 ), the rate constant drops to k ≈ 0.07 h -1 after 4 h of operation, seemingly due to particle agglomeration. In the BPA solution treated with the multilayered TiO 2 nanofibers for 40 h, the estrogenic activity, based on human breast cancer cell proliferation, is significantly lower than that in the BPA solution treated with colloidal TiO 2 NPs under the same conditions. This study demonstrates that water-based, electrostatic LbL deposition effectively immobilizes and stabilizes TiO 2 NPs on electrospun polymer nanofibers for efficient extended photochemical water remediation.

This study explores the adaptation of unaccompanied Sudanese refugee minors resettled in the US. Seven years after resettlement, in-depth interviews were conducted with 19 Sudanese youths and 20 foster parents regarding factors that contributed to successful adaptation. The youths emphasized personal agency and staying focused on getting an education. Foster parents emphasized the contribution of youths’ developmental histories to individual differences in personal attributes that, with contextual supports, influenced their trajectories after resettlement. Parents and youths differed in their views on the role that mental health and cultural obligations to family members in Africa played in successful adaptation.

Venous thromboembolism (VTE) is one of the most common preventable disorders among hospital inpatients. Advancing age is a major risk factor for VTE. The purpose of this study was to describe and compare prevention practices and clinical outcomes in older (age 65 and older) versus younger (ages 18 to 64) hospitalized patients at risk for or diagnosed with VTE. Medical charts of 210 older and 450 younger inpatients undergoing diagnostic tests to rule out VTE were reviewed at an academic medical center. Acute VTE was diagnosed in 17.1% of older and 22.7% of younger inpatients. Pharmacological prophylaxis was used in 70% of eligible older and 57% of eligible younger inpatients. Nearly one quarter of eligible older inpatients did not receive any VTE prevention measures. The 3-month mortality was higher in older inpatients (13.9%) compared with younger inpatients (9.8%) with VTE, despite the lower rate of VTE in older inpatients. Prevention measures for VTE were underused in both older and younger inpatients.

Breathable chemical and biological detoxifying protective fabrics are obtained via functionalization of electrospun fiber mats using a layer-by-layer electrostatic assembly technique. The chemically reactive polyanion, poly(N-hydroxyacrylamide) or poly(hydroxamic acid) (PHA), and bactericidal polycation, poly(N-vinylguanidine) (PVG), were synthesized and assembled electrostatically to generate multifunctional coatings on prefabricated polyacrylonitrile (PAN) fiber mats. Reactivity of PHA in the hydrolysis of diisopropyl fluorophosphate (DFP), a close analog of the chemical warfare agent sarin, was demonstrated. The DFP degradation rate with PHA is comparable to that with compounds such as isonicotinhydroxamic acid methiodide, an efficient catalyst of organophosphate ester hydrolysis. Protective fabrics functionalized with PVG/PHA layers are able to degrade DFP mists, with DFP hydrolysis rates 60-fold higher than those with unmodified fabrics under identical conditions. Fabrics modified with PVG/PHA layers...

Three novel heterometallic complexes containing two bridging ligands bpa and benzoate, formulated as [M2M′(O2CC6H5]n(bpa)n (bpa = 1,2-bis(4-pyridyl)ethane, M2M′ = Zn2Co (1), Zn2Cd (2), and Co2Cd (3)), have been synthesized. All three compounds show one-dimensional structures containing linear heteronuclear coordination units linked by bridging bpa ligands. Reactivity study of the compounds 1–3 for the transesterification of a variety of esters has shown that they are very efficient and 2 is the best among them.

Cranial distraction osteogenesis has been applied as a mode of therapy to patients with various types of craniosynostosis. Several minor complications during distraction have been reported in the previous literature, including infection, device exposure, and dislocation and distortion of the device. To our knowledge, this is the first report of 2 cases of spontaneous device breakage during cranial distraction osteogenesis. Two infant patients were diagnosed with shunt-induced microcephalies. The ages of the 2 patients were 8 and 12 months. Their head circumferences were 3 percentiles below that of normal children of the same age. Distraction osteogenesis advancement to the frontal skull and the orbital bar was performed with two distractors. We distracted a total of 7.0 and 14.4 mm at a rate of 0.6–1.5 mm per day before device breakage occurred 7 and 25 days after the distraction activation, respectively. Both patients underwent reoperation to exchange the broken device for further distraction. To prevent further device breakage, we suggest increasing the rate of distraction, placing stronger or more devices, or relieving the scalp retraction pressure probably by extensive dissection of the subcutaneous layers or multiple incisions into the galeal layers.

Cultured adults of ezo abalone, Haliotis discus hannai (shell length, 89.3 ± 6.4 mm and flesh dry weight, 13.0 ± 1.6 g; n = 12) were exposed to different temperatures (10 and 25 °C) to determine whether respiration effects were induced by artificial closure of the second and third tremata (respiratory pores). A respirometer was used to determine the oxygen consumption rates (OCRs) as measures of metabolic activity. The closed tremata were the second and third of the four open tremata anterior to the head of the abalone. The OCRs of starved abalone were measured under constant conditions (CC: constant dark and constant temperature) during a 240-h period, consisting of 120 h before and 120 h after the closure of tremata. The endogenous rhythm of the OCRs in cultured ezo abalone exhibited a dominant circadian rhythm (unimodal rhythm) in the latter half of the experimental period and occasionally showed a weaker but similar circatidal rhythm (bimodal rhythm) in the first half of the experimental period regardless of temperature. The results from the present study indicate that the rhythmicity of the OCRs in starved abalone is not affected by closure of the second and third tremata. This study offers essential physiological information for utilizing tremata in developing a tagging technique in abalone.

The surface oxidation of polyethylene (PE) and the surface reduction of Teflon (FEP) were studied with regard to the surface topography of the film samples that were used and the resulting water wettability. Anodized aluminum membranes were used as nanomolds to impart fibrillar topographies to the polymer surfaces. Water contact angles of smooth PE (θA/θR = 93°/75°) decreased to θA/θR = 68°/46° upon oxidation with potassium chlorate/sulfuric acid solution. Smooth FEP film samples changed from θA/θR = 111°/100° to θA/θR = 64°/45° upon reduction with sodium naphthalide solution. Contact angles of PE and FEP increased to 172°/160° and 174°/172°, respectively, upon introduction of the fibrillar topography and both decreased to ∼0°/0° after oxidation and reduction, respectively. That topography can be used as a tool in polymer surface modification is emphasized.

Background: Older adults with cardiovascular diseases who require oral anticoagulation therapy (AT) report difficulty managing medications and diet, which affects therapeutic benefit and quality of life (QOL). Mobile health (mHealth) tools such as health applications (app) via smartphones or tablets can assist in managing AT but such tools have not been tested among older adults including Spanish speaking elders. Objective: The objective of the study was to test the feasibility of an mHealth intervention composed of culturally appropriate and age-sensitive components to improve QOL in older adults on AT. Methods: The pilot study used a single-arm, experimental, pre-post design to assess the feasibility of a 12-week mHealth-based intervention in older adults with AT by examining changes in outcomes (ie, knowledge, adherence, QOL, perception, depression) and usability of the warfarin app on a 10-inch tablet computer after 3-month use. Results: Twenty older patients from two anticoagulation clinics have enrolled in the study - average age 67.7 ± 9.8 years; predominantly male (14/20, 70%); Caucasians (9/20, 45%), Hispanics (8/20, 40%); high school completion (13/20, 65%); living with family (16/20, 80%); average number of comorbidity 3.4 (±1.4). Fifteen participants completed 3-month follow-ups; two dropped due to inability to use the app; one died; two are currently on use of the app. Outcomes were improved from baseline to 3 months (see Table). The mean satisfaction with and mean usefulness of the app were 5.4 of 7 (±1.5) and 5.4 of 7 (±1.4) in usability survey after 3 months. Conclusions: Our findings suggest that on-going mHealth intervention for older adults with chronic diseases show promise in being able to enhance anticoagulation knowledge and QOL with the treatment. The satisfaction of mHealth intervention using the health app was moderate to high in this sample. The findings can be used to modify the health app to make the mHealth intervention more elder-friendly.

The prevalence of gastric cancer in Korea is increasing, and anemia is one of the most common complications of a gastrectomy. The purpose of this study was to estimate the incidence of anemia and assess its associated factors in long-term gastric cancer survivors.This study was a retrospective cohort study of gastric cancer patients who visited a single medical center from January 2009 to December 2014 in Korea. We included 385 patients who survived for at least five years after gastrectomy with no recurrence or metastasis. Anemia was defined by World Health Organization criteria (Hb12 g/dL in women and13 g/dL in men).Hemoglobin levels decreased from 14.24 ± 1.23 mg/dL before surgery to 13.60 ± 1.57 mg/dL one year after surgery (P0.001). The cumulative incidence rate of anemia after surgery increased linearly from 18.7% in the first year to 39.5% in the fifth year. The risk of anemia was higher in females (RR, 2.00; 95% CI, 1.26-3.18), patients that received total gastrectomy (RR, 3.00; 95% CI, 2.09-4.30) and patient with diabetes (RR, 1.87; 95% CI, 1.05-3.22). A higher postoperative BMI decreased the risk of anemia (RR, 0.38; 95% CI, 0.22-0.67).During five years of follow-up after gastrectomy, the incidence of anemia steadily increased, and the risk of anemia was higher in females, total gastrectomy patients, patients with diabetes, low BMI patients.

Central nervous system (CNS)-infiltrating effector T cells play critical roles in the development and progression of multiple sclerosis (MS). However, current drugs for MS are very limited due to the difficulty of delivering drugs into the CNS. Here we identify a cell-permeable peptide, dNP2, which efficiently delivers proteins into mouse and human T cells, as well as various tissues. Moreover, it enters the brain tissue and resident cells through blood vessels by penetrating the tightly organized blood–brain barrier. The dNP2-conjugated cytoplasmic domain of cytotoxic T-lymphocyte antigen 4 (dNP2-ctCTLA-4) negatively regulates activated T cells and shows inhibitory effects on experimental autoimmune encephalomyelitis in both preventive and therapeutic mouse models, resulting in the reduction of demyelination and CNS-infiltrating T helper 1 and T helper 17 cells. Thus, this study demonstrates that dNP2 is a blood–brain barrier-permeable peptide and dNP2-ctCTLA-4 could be an effective agent for treating CNS inflammatory diseases such as MS., Most of the cell penetrating peptides can transport therapeutic agents across plasma membranes but barely across the blood-brain barrier. Here the authors develop a peptide that can enter the brain, and show that its fusion to immunomodulatory protein ctCTLA-4 is effective in a mouse model of multiple sclerosis.

We investigated the prevalence and correlates of electronic cigarette (e-cigarette) use in a representative sample of Korean adults. This cross-sectional study used data from the Korean National Health and Nutrition Examination Survey of 2013. We analyzed 5338 subjects (≥19 years old) who provided data on e-cigarette use, sex, age, socioeconomic status, and health risk behaviors. Multivariate analyses were performed using logistic regression. Using weighted samples, the prevalence of ever and current e-cigarette use were 6.6 and 1.1 %, respectively (11.2 and 2.0 % in men and 2.0 and 0.4 % in women). In multivariate analysis, the probability of ever e-cigarette use was highest in current smokers (OR 29.3, 95 % CI 15.5–55.3), former smokers (OR 6.1, 95 % CI 3.3–11.2), and daily heavy drinkers (OR 1.9, 95 % CI 1.1–3.4). Current e-cigarette use was associated with current smoking (OR 16.2, 95 % CI 4.7–55.4) and weekly heavy drinking (OR 2.7, 95 % CI 1.1–6.7). E-cigarette use was strongly associated with conventional cigarette use and with frequent heavy drinking. Dual use e-cigarettes and conventional cigarette use as well as the association between heavy alcohol use and e-cigarettes need further exploration.

Porcine reproductive and respiratory syndrome (PRRS) is one of the most economically significant diseases in the swine industry. The PRRS virus (PRRSV) has genetically diverse populations, like other RNA viruses, and various field strains continue to be reported worldwide. The molecular epidemiological study of PRRSV can provide important data for use in controlling the disease. In this study, 50 oral fluid samples from conventional farms in Korea were taken to analyze nucleotide sequences of the open reading frame 5 of PRRSV. The viruses present in more than 80% of oral fluid samples genetically originated from the type 2 PRRSV, which is North American (NA) lineage. In addition 8.9% of samples contained both of the type 1 PRRSV, which is European (EU) lineage and the type 2 PRRSV. About 60% of farms involved in this study had more than two strains of PRRSV. In phylogenetic analysis, the Korean field strains of PRRSV detected from the oral fluid samples were divided into several subgroups: four subgroups of Korean field strains clustered with the type 1 PRRSV, and other five subgroups of Korean field strains clustered with the type 2. These results suggest that the type 2 PRRSV is more prevalent than the type 1 in Korea and heterologous strains of PRRSV can simultaneously infect a single pig farm.

Background Brain-derived neurotrophic factor (BDNF), a neurotrophin that regulates neuronal function and development, is implicated in several neurodegenerative conditions. Preliminary data suggest that a reduction of BDNF concentrations may lead to postchemotherapy cognitive impairment. We hypothesized that a single nucleotide polymorphism (rs6265) of the BDNF gene may predispose patients to cognitive impairment. This study aimed to evaluate the effect of BDNF gene polymorphism on chemotherapy-associated cognitive impairment. Methods Overall, 145 patients receiving chemotherapy for early-stage breast cancer (mean age: 50.8 ± 8.8 y; 82.1% Chinese) were recruited. Patients' cognitive functions were assessed longitudinally using the validated Functional Assessment of Cancer Therapy–Cognitive Function (v.3) and an objective computerized tool, Headminder. Genotyping was performed using Sanger sequencing. Logistic regression was used to evaluate the association between BDNF Val66Met polymorphism and cognition after adjusting for ethnicity and clinically important covariates. Results Of the 145 patients, 54 (37%) reported cognitive impairment postchemotherapy. The Met/Met genotype was associated with statistically significant lower odds of developing cognitive impairment (odds ratio [OR] = 0.26; 95% CI: 0.08–0.92; P = .036). The Met carriers were less likely to experience impairment in the domains of verbal fluency (OR = 0.34; 95% CI: 0.12–0.90; P = .031) and multitasking ability (OR = 0.37; 95% CI: 0.15–0.91; P = .030) compared with the Val/Val homozygote. No associations were observed between Headminder and the BDNF Val66Met polymorphism. Conclusions This is the first study to provide evidence that carriers of the BDNF Met allele are protected against chemotherapy-associated cognitive impairment. Further studies are required to validate the findings.

Background: To evaluate the effectiveness of a curriculum for achieving high levels of cultural competence, we need to be able to assess education intended to enhance cultural competency skills. We therefore translated the Cultural Awareness Scale (CAS) into Korean (CAS-K). The purpose of this study was to evaluate the cross-cultural applicability and psychometric properties of the CAS-K, specifically its reliability and validity.Methods: A cross-sectional descriptive design was used to conduct the evaluation. A convenience sample of 495 nursing students was recruited from four levels of nursing education within four universities in the city of Daejeon, South Korea.Results: This study provided beginning evidence of the validity and reliability of the CAS-K and the cross-cultural applicability of the concepts underlying this instrument. Cronbach’s alpha ranged between 0.59 and 0.86 (overall 0.89) in the tests of internal consistency. Cultural competency score prediction of the experience of travel abroad (r=0.084) and the perceived need for cultural education (r=0.223) suggested reasonable criterion validity. Five factors with eigenvalues >1.0 were extracted, accounting for 55.58% of the variance; two retained the same items previously identified for the CAS.Conclusion: The CAS-K demonstrated satisfactory validity and reliability in measuring cultural awareness in this sample of Korean nursing students. The revised CAS-K should be tested for its usability in curriculum evaluation and its applicability as a guide for teaching cultural awareness among groups of Korean nursing students.

Objective: This study was conducted to evaluate the feasibility, usability, and acceptability of using remote monitoring systems (RMS) in monitoring health status (e.g., vital signs, symptom distress) in older adults (≥55) with chronic heart failure (HF). Method: Twenty-one patients (52.4% women, mean age 73.1 ± 9.3) were trained to measure and transmit health data with an RMS. Data transmissions were tracked for 12 weeks. Results: All participants initiated use of RMS within 1 week; 71%, 14%, and 14% of patients transmitted daily health data 100%, ≥75%, and

Diadromous fish often enter freshwater directly from seawater via fish ladders or channels built in estuarine dams. The oxygen consumption rates (OCR) of glass eel, Anguilla japonica, were determined using an automatic intermittent flow respirometer under various salinity and temperature regimes to physiologically explain this direct movement. The endogenous rhythm of the OCR in wild glass eels, freshly collected from estuaries, was nearly synchronous with the tidal pattern at the estuarine collection site. When the salinity was changed from 20 psu (12°C) at a constant temperature to that of freshwater, the OCR of the glass eels decreased by 21.6±7.0% (mean ± SD) (P

In order to study changes in the marine ecosystem of the East China Sea derived by the global warming and construction of the Three Gorges Dam in the middle of the Changjiang, temperature, salinity, nutrients, and chlorophyll-a were studied intensively in the northern part of the East China Sea during the summer of 2003 and spring of 2004. According to the previous studies, the upwelling of the Kuroshio Current and the Changjiang resulted in a major inputs of nutrients in the East China Sea, but these two inputs may not contribute gently to a build up of nutrients in the northern East China Sea. In spring, relatively high concentrations of nitrates and phosphates were observed in the western part of the study area, which resulted from the supply of high concentrations of nutrients showing up in the surface waters as a result of vertical mixing from the ocean bottom. The concentrations of nitrates and phosphates observed in summer were lower than those in spring, since the surface waters were well stratified by the larger discharge of fresh water from the Changjiang in summer. The surface nitrate/phosphate ratios ranged from 1.3 to 16 in spring and from 1.1 to 15 in summer and were lower than the Redfield ratio of 16, indicating that the growth of phytoplankton is limited by nitrogen. This results are contrary to the previous results, in which the growth of phytoplankton was limited by phosphate in the East China Sea. The reason for this contrary result is that most nutrients in the surface waters are supplied by vertical mixing from the bottom waters with low nitrate/phosphate ratios, not directly influenced by the Changjiang with high nitrate/phosphate ratios. The depth-integrated chlorophyll observed in summer was similar to the previous results, but those measured in spring were almost twice as high as those found in previous results. The depth-integrated chlorophyll in spring was higher than that of summer, which results from high concentrations of nitrates and phosphates in the surface waters in spring due to active vertical mixing.

Two species of fish and five species of marine invertebrate showed different tolerances to the toxicity of composite slag and bituminaus coal. Especially, Hemicentrotus pulcherrimus and young Haliotis discus hannai displayed marked differences in tolerance from. H. pulcherrimus and young H. discus hannai showed lethal effects at higher concentrations than those concentrations of the composite slag in the 1.0 and range, respectively. H. pulcherrimus showed no lethal effects at a lower concentration of composite slag and some differences in the rate of oxygen consumption with this concentration of composite slag. The lethal effects of bituminous coal on marine and fisheries organisms, even with higher concentrations, were not observed. At a higher concentration than that of 500 mg/L (ppm) of bituminous coal, decrease effects appeared in the rate of oxygen consumption of the experimental organisms. Taking into consideration that the experimental concentration of composite slag and bituminous coal were impracticable in the ocean, the results of this experiment suggest that composite slag and bituminous coal pose no real threat to marine or fisheries organisms.