IL-37 Attenuates Lung Fibrosis by Inducing Autophagy and Regulating TGF-ß1 Production in Mice.

Idiopathic pulmonary fibrosis (IPF) is a progressive and destructive lung disease with a poor prognosis resulting in a high mortality rate. IL-37 is an anti-inflammatory cytokine that inhibits innate and adaptive immunity by downregulating proinflammatory mediators and pathways. However, the exact role of IL-37 in lung fibrosis is unclear. In this study, we found that the IL-37 protein was expressed in alveolar epithelial cells (AECs) and alveolar macrophages in healthy controls but significantly reduced in patients with IPF. IL-37 significantly inhibited oxidative stress-induced primary mouse AEC death in a dose-dependent manner, and knockdown of IL-37 significantly potentiated human lung cancer-derived AEC (A549 cells) death. IL-37 attenuated constitutive mRNA and protein expression of fibronectin and collagen I in primary human lung fibroblasts. IL-37 inhibited TGF-ß1-induced lung fibroblast proliferation and downregulated the TGF-ß1 signaling pathway. Moreover, IL-37 enhanced beclin-1-dependent autophagy and autophagy modulators in IPF fibroblasts. IL-37 significantly decreased inflammation and collagen deposition in bleomycin-exposed mouse lungs, which was reversed by treatment with the autophagy inhibitor 3-methyladenine. Our findings suggested that a decrease in IL-37 may be involved in the progression of IPF and that IL-37 inhibited TGF-ß1 signaling and enhancement of autophagy in IPF fibroblasts. Given its antifibrotic activity, IL-37 could be a therapeutic target in fibrotic lung diseases, including IPF.

Sequential Two-Stage Network and Thematic Analysis for Exploring an Interdisciplinary Care Approach in Nursing Homes.

Since various groups of older adults with different conditions and levels of function coexist in nursing homes, it is necessary to develop integrated care strategies through collaboration among experts across related fields. The purposes of this study are to identify the regularity of information sharing in managing daily function for older adults, with a special focus on interdisciplinary cooperation, and to explore a practical care strategy for nursing home residents. The collaborative methods of network and thematic analysis were done by conducting in-depth interviews with 33 interdisciplinary experts working at seven nursing homes. This study proposed three relationships and three themes as interrelated key factors for providing interdisciplinary care to the elderly at various levels of function based on the experiences accumulated by the practitioners. First, independent sharing is required to make professional judgments about how daily function in older adults changes from reported baselines. Second, practitioners accurately judge clinical situations and supplement experts' judgments through partial sharing. Finally, all interdisciplinary consensus through complete sharing achieves the ultimate goal of maintaining remaining function in older adults. These findings can be the first step in developing practical care guidelines for interdisciplinary use, and the results can be used to develop integrated assessment and intervention strategies.

Involvement of Alveolar Epithelial Cell Necroptosis in Idiopathic Pulmonary Fibrosis Pathogenesis.

Alveolar epithelial cell (AEC) injury leading to cell death is involved in the process of fibrosis development during idiopathic pulmonary fibrosis (IPF). Among regulated/programmed cell death, the excessive apoptosis of AECs has been widely implicated in IPF pathogenesis. Necroptosis is a type of regulated/programmed necrosis. A multiprotein complex composed of receptor-interacting protein kinase (RIPK)-1 and -3 plays a key regulatory role in initiating necroptosis. Although necroptosis participates in disease pathogeneses through the release of damage-associated molecular patterns, its association with IPF progression remains elusive. In this study, we attempted to illuminate the involvement of RIPK3-regulated necroptosis in IPF pathogenesis. IPF lung tissues were used to detect necroptosis, and the role of RIPK3 was determined using cell culturing models of AECs. Lung fibrosis models of bleomycin (BLM) treatment were also used. RIPK3 expression levels were increased in IPF lungs, and both apoptosis and necroptosis were detected mainly in AECs. Necrostatin-1 and RIPK3 knockout experiments in AECs revealed the participation of necroptosis in BLM and hydrogen peroxide-induced cell death. BLM treatment induced RIPK3 expression in AECs and increased high-mobility group box 1 and IL-1ß levels in mouse lungs. The efficient attenuation of BLM-induced lung inflammation and fibrosis was determined in RIPK3 knockout mice and by necrostatin-1 with a concomitant reduction in high-mobility group box 1 and IL-1ß. RIPK3-regulated necroptosis in AECs is involved in the mechanism of lung fibrosis development through the release of damage-associated molecular patterns as part of the pathogenic sequence of IPF.

Exploring the Knowledge Structure of Nursing Care for Older Patients With Delirium: Keyword Network Analysis.

Prevention of delirium is considered a critical part of the agenda for patient safety and an indicator of healthcare quality for older patients. As the incidence rate of delirium for older patients has increased in recent years, there has been a significant expansion in knowledge relevant to nursing care. The purposes of this study were to analyze the knowledge structure and trends in nursing care for older adults with delirium based on a keyword network analysis, and to provide a foundation for future research. Data analysis showed that knowledge structure in this area consists of three themes of research: postoperative acute care for older patients with delirium, prevention of delirium for older patients in intensive care units, and safety management for the improvement of outcomes for patients with delirium. Through research trend analysis, we found that research on care for patients with delirium has achieved both quantitative and qualitative improvements over the last decades. Concerning future research, we propose the expansion of patient- and family-centered care, community care, specific nursing interventions, and the integration of new technology into care for patients with delirium. These results provide a reference framework for understanding and developing nursing care for older adults with delirium.

Nursing home nurses conceptualize how to care for residents with cardiac vulnerability.

BACKGROUND: With ageing, older people face cardiovascular problems as the major cause of disability and death. Although immediate medical attention is a major factor in determining outcomes of cardiac problems, lack of personnel (i.e. registered nurse, certified nursing assistant and home care aide) in nursing homes without residing doctor limits the awareness of such problems, thus making it difficult to initiate timely and appropriate intervention. AIM: The aim of this study was to conceptualize critical care for nursing home residents with cardiac vulnerability and develop practical knowledge in nursing practice. METHODS: Conventional content analysis was performed on date from interviews with 30 nurses from 10 nursing homes in South Korea between July and November 2010. RESULTS: The analysis revealed three major cardiac problems resulting from residents' cardiac vulnerability: angina, myocardial infarction (MI) and cardiogenic shock. Through content analysis, we extracted 6 themes and 21 subthemes for nurses' conceptualization of critical care for nursing home residents with cardiac vulnerability. In nursing homes without a residing doctor, nurses assessed the physical, functional and cognitive conditions along with the responses and symptoms of residents when emergency situations related to the cardiac problems occurred. Moreover, with a lack of infrastructures of a hospital, nurses provided critical care to the elderly by using personal practice strategies based on their personal experience in facilities along with practical knowledge of nurses while following the management principles of emergencies. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE: We found that nurses conceptualized critical nursing care for cardiac problems at nursing homes, which are different from those of general hospitals. The results of this study will provide basis for the development of care guidelines and educational materials that can be used by novice nurses or nursing students.

Nurses' clinical decision-making for preserving nursing home residents' remaining abilities.

AIMS AND OBJECTIVES: This study was conducted to clarify and conceptualise nurses' clinical decision-making for preserving the remaining abilities of nursing home residents suffering from physical-cognitive functional decline. BACKGROUND: Older adults experience physical, psychological and social changes, but their remaining abilities differ across individuals. DESIGN: This study used a qualitative research to gain a deeper understanding of nursing homes nurses' clinical decision-making. METHODS: In-depth interviews with 32 experienced nurses were undertaken. The data were analysed using conventional content analysis. RESULTS: Six categories and 58 subcategories of nursing practice related to managing the remaining abilities of residents with physical-cognitive functional decline were generated. The results of this study revealed five themes: (1) seeing residents' potential, (2) physical, emotional and psychosocial care in daily routines, (3) keeping personalised charts, (4) encouraging, promoting and physical and emotional support and (5) preparing residents for more independent living. The results were categorised into nurses' personal strategies based on their experience, practical nursing knowledge, nursing interventions and nursing evaluation criteria. CONCLUSIONS: The themes reflected positive views on the residents' functional abilities and the nursing homes nurses' perception that their goal was to help residents achieve their highest level of independence. RELEVANCE TO CLINICAL PRACTICE: Preserving nursing home residents' remaining abilities represents nurses' optimistic view of residents' functional status. Routine care tailored for preserving the remaining abilities of individual nursing home residents with physical-cognitive functional decline is needed. Preserving the remaining abilities of nursing home resident is supported by therapeutic interactions including close contact as well as physical and emotional support. Nurses' main goal in working with residents with remaining abilities is improving their independence.

Decreasing incidence of Trichophyton mentagrophytes in Korea: analysis of 6,250 cases during the last 21-year-period (1992-2012).

Trichophyton mentagrophytes is the second common dermatophyte in Korea. However, few reports have been issued on the epidemiological and mycological characteristics of T. mentagrophytes in Korea based on long-term, large-scale study. The purpose of this study was to elucidate the epidemiological and mycological characteristics of T. mentagrophytes in Korea. During the 21-yr-period from 1992 to 2012, 6,250 patients with T. mentagrophytes were surveyed to determine annual incidence and the distribution of subjects by age, sex, season, involved sites, and place of residence. T. mentagrophytes infections were confirmed by fungal culture. In addition, the colony appearance of T. mentagrophytes was classified as granular, persicolor, powdery, or downy. Epidemiological analysis showed that annual incidence reached a peak in 2005, and then gradually decreased. T. mentagrophytes infection was most common in July, and was found predominantly in middle-aged adults, especially in those in their forties. Mycological analysis showed a powdery colony appearance was the most common, followed by persicolor and granular colonies. Toewebs were most frequently involved. This investigation on T. mentagrophytes provides insights into its incidence and characteristics.

Analyzivng Demand for Customized Obesity Prevention and Management Across Adult Age Groups Using Focus Group Interview.

With the increasing obesity rates, many studies on obesity prevention and management have been implemented. However, few studies focused on obesity in adulthood and different perceptions of obesity between life cycles. Thus, this study aimed to investigate the demand for customized obesity prevention and management (OPM) strategies across adult age groups. Focus group interviews were conducted to gather insights from three age groups: young adults (20-34 years), middle-aged adults (35-49 years), and seniors (50-64 years). A total of 17 participants took part in the study, with 5 participants in Group 1, 6 participants in Group 2, and 6 participants in Group 3. Thematic analysis and the use of NetMiner version 4.4.3 facilitated data categorization and scrutiny. The study employed qualitative methods to explore perceptions of obesity and preferences for personalized OPM strategies among participants. Diverse perspectives on obesity as a health threat were found among the age groups. While all stressed the importance of personalized OPM, preferences for strategies varied. Diet and exercise combination emerged as a common preference. This study highlighted the need for customized OPM approaches aligned with age-specific preferences.

An Overview of Cognitive Reserve in Aging Based on Keyword Network Analysis.

Many studies have reported that Cognitive reserve is a critical mechanism affecting cognitive statuses, such as dementia. The purposes of this study were to identify the knowledge structure and the research trend on cognitive reserve by conducting keyword analysis on research papers ranging from the earliest to the most recent studies done on the topic and to suggest directions for future research. The Web of Science (WOS) database was used to search for articles on cognitive reserve in aging from 2001 to 2020. NetMiner version 4 (cyram, KOREA), a social network analysis program, was used for keyword network analysis. Data analysis showed keywords that could be categorized as cognitive reserve related keywords (cognitive reserve related concepts, cognitive reserve related factor, cognitive reserve diagnosis and measurement, cognitive reserve outcomes) and cognitive reserve research keywords (research subject/disease, research method, intervention, research field). Through trend analysis, we found that various keywords appeared, indicating that the research has gradually developed conceptually and methodically. Based on these findings, future CR studies require the development of multimodal interface-based tools by applying modern digital technology that can be used to more accurately diagnose and monitor CR; remotely, in real time. In addition, to improve CR, it is suggested that the development of cognitive stimulation interventions utilizing VR which fuses AI based interaction technology with the subjects. Finally, CR could develop further through a cooperation of multidisciplinary professionals such as psychology, medicine and nursing.

The Shared Subjective Frames of Interdisciplinary Practitioners Involved in Function-Focused Care in a Nursing Home: Q-Methodology.

BACKGROUND: An interdisciplinary team-based approach in nursing homes has been suggested in the literature as a strategy for delaying functional decline in residents. Function-focused care is a philosophy-based approach in which interdisciplinary practitioners assess functional capacity and help older adults to optimize and maintain their remaining abilities. PURPOSE: This study explored and described the shared subjective frames of interdisciplinary practitioners as regards function-focused care for nursing home residents. METHODS: Q-methodology was used to analyze the subjectivity of each factor of function-focused care for nursing home residents. Data were collected from August to September 2016. Thirty-four Q-statements were selected and scored by the 30 interdisciplinary practitioners on a 9-point scale with a normal distribution. Data were analyzed using the PQ Method 2.33 program. RESULTS: The results revealed four factors of function-focused care, including (a) using a wait-and-see approach to encourage self-care, (b) maintaining interactive communications to identify and respond to changes, (c) reinforcing residents' inner and outer strengths for homeostasis, and (d) using a tailored approach based on comparisons between the past and the present. Shared subjectivity may provide an important collaborative framework to identify and solve complex problems related to the functional needs of nursing home residents. CONCLUSIONS: The results of this study elucidate the subjectivities of interdisciplinary practitioners and better enable their provision of effective care in support of the remaining functional abilities of older adults living in nursing homes. The findings may be used as a reference to establish communication methods and shared documentation for interdisciplinary practitioners in nursing homes and construct interdisciplinary function-focused care practice guidelines.

Toward a conceptual framework for the interdisciplinary function-focused care in nursing homes.

AIM: To develop a conceptual framework to structure the shared roles and tasks of interdisciplinary teams for efficient function-focused care of nursing home (NH) residents. METHODS: A qualitative study using focus groups. Two focus group interviews were conducted on NH practitioners and professors. Focus group 1 consisted of six practitioners with more than 5 years of practical experience in NHs. Focus group 2 consisted of six professors with more than 5 years of educational experience in geriatrics or gerontology and who are capable of adopting theoretical approaches to older adults' functions. RESULTS: The post-acute care-rehabilitation quality framework furnished the underlying structure for the focus group interview questionnaire to develop the shared interdisciplinary function-focused care framework. The focus of the framework is how resident care processes should be based on individuality of the residents and include holistic continuous assessments, integration of care, and professional interventions by each discipline. An interdisciplinary process involves setting shared goals, communicating and coordinating roles and tasks of interdisciplinary teams, and providing complementary care. Shared final outcomes are defined as improving residents' independence and quality of life and reducing hospital transfer and admission rates. CONCLUSION: In this study, we have developed the first conceptual framework of interdisciplinary function-focused care in NHs, which will provide an evidence-based foundation for integrated and continuous function-focused care for NH residents. The results of this study will contribute to efficient communication among the interdisciplinary teams and improvement of the outcomes of function-focused care subjects.

The Effectiveness of Function-Focused Care Interventions in Nursing Homes: A Systematic Review.

BACKGROUND: Since the Omnibus Budget and Reconciliation Act was passed in South Korea in 1987, function-focused care (FFC) has been used in long-term care to achieve the highest possible levels of self-care and independence for older adults. However, many perceive nursing home residents with cognitive function impairments as having little restorative potential. PURPOSE: The purpose of this review is to report on evidence and strategies relating to FFC interventions in nursing home settings and to summarize the effects of FFC on the functional abilities of resident subgroups. METHODS: A literature review using EMBASE, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature was conducted for articles published between January 1, 2000, and February 20, 2016. Twenty-two eligible studies were identified. Relevant data were extracted, and the results were synthesized into an integrated literature review. Study quality was appraised using the Cochrane Risk of Bias tool and the Risk of Bias Assessment tool for Non-randomized Studies. RESULTS: This review included 22 trials that were of moderate to high quality. Our systematic review confirmed the FFC interventions as integrated and dedicated processes; the five key strategies underpinning effective FFC interventions; and the effectiveness of FFC interventions on physical, psychosocial, and cognitive functions. The five key strategies underpinning FFC interventions included interactive learning for caregivers, the content of learning programs for caregivers, residents' preferences and interests, optimizing approaches according to residents' functional status, and the conceptual frameworks of FFC interventions. Most of the studies (n = 15) evaluated psychosocial functions and found significant improvements in aspects such as mood, affect, and behavioral problems. Likewise, the 13 studies assessing physical function found significant improvements in effectiveness in aspects such as movement, balance, and activities of daily living. Only four studies looked at cognitive function effectiveness, using measures such as place finding, verbal use, and memory. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Our review found scientific evidence that FFC interventions improve functional abilities across various levels of cognitive function in nursing homes. Nursing homes may employ effective strategies to maximize the effects of FFC interventions and use educational materials to teach caregivers to implement FFC interventions competently.

Guide Map for Preserving Remaining Ability of Nursing Home Residents With Physical-Cognitive Functional Decline.

As the population ages, preserving the remaining ability of residents is emphasized in nursing homes. Establishing the nursing knowledge of nursing home-specific practice should be included in the continuing education of new nursing home nurses. This study developed a practical guide map for preserving the remaining ability of nursing home residents by analyzing 144 residents' case data pertaining to the nursing care provided by 19 nurses skilled in nursing homes, as well as conducting a literature review. From the collected data, 236 nursing diagnoses were given to the 144 cases. As the residents' physical conditions and psychosocial characteristics were linked with the nursing process, various steps were needed to plan the nursing process of preserving the remaining ability of nursing home residents. This practical guide map will be useful for new nurses in nursing homes to improve the quality care of elderly residents. J Contin Educ Nurs. 2017;48(2):73-80.

Blood Pressure-Lowering Effects of Alacalase-Hydrolyzed Camellia Seed Hull In Vitro and in Spontaneous Hypertensive Rats.

High blood pressure is one of the major risk factors for various diseases and angiotensin-converting enzyme (ACE) plays a critical role in blood pressure regulation. In our study, the responsive surface methodology was adopted to establish optimal Alcalase-hydrolysis conditions of camellia seed hull against ACE activity. The optimum conditions are hydrolysis temperature of 50.98°C, enzyme/substrate ratio of 2.85%, and hydrolysis pH of 7.12. In an animal feeding study, spontaneously hypertensive rats were treated with either a low or high dose of hydrolyzed Camellia japonica seed cake over 5 weeks. Even though systolic blood pressure was not statistically different, the high dose of C. japonica hydrolysate lowered diastolic blood pressure (106 ± 4.4 mmHg vs. 145 ± 5.9 mmHg) at the 5th week. A similar trend was also observed in serum ACE activity. Considering that this camellia seed hull is a major resource of this plant, our study provides important data to utilize this plant for both academic and industrial applications.

Time course effects of fermentation on fatty acid and volatile compound profiles of Cheonggukjang using new soybean cultivars.

In this study, we investigated the effects of the potential probiotic Bacillus subtilis CSY191 on the fatty acid profiles of Cheonggukjang, a fermented soybean paste, prepared using new Korean brown soybean cultivars, protein-rich cultivar (Saedanbaek), and oil-rich cultivar (Neulchan). Twelve fatty acids were identified in the sample set-myristic, palmitic, palmitoleic, stearic, oleic, vaccenic, linoleic, α-linolenic, arachidic, gondoic, behenic, and lignoceric acids-yet, no specific changes driven by fermentation were noted in the fatty acid profiles. To further explore the effects of fermentation of B. subtilis CSY191, complete profiles of volatiles were monitored. In total, 121, 136, and 127 volatile compounds were detected in the Saedanbaek, Daewon (control cultivar), and Neulchan samples, respectively. Interestingly, the content of pyrazines-compounds responsible for pungent and unpleasant Cheonggukjang flavors-was significantly higher in Neulchan compared to that in Saedanbaek. Although the fermentation period was not a strong factor affecting the observed changes in fatty acid profiles, we noted that profiles of volatiles in Cheonggukjang changed significantly over time, and different cultivars represented specific volatile profiles. Thus, further sensory evaluation might be needed to determine if such differences influence consumers' preferences. Furthermore, additional studies to elucidate the associations between B. subtilis CSY191 fermentation and other nutritional components (e.g., amino acids) and their health-promoting potential are warranted.

Responsive Surface Methodology Optimizes Extraction Conditions of Industrial by-products, Camellia japonica Seed Cake.

BACKGROUND: The central nervous system is easily damaged by oxidative stress due to high oxygen consumption and poor defensive capacity. Hence, multiple studies have demonstrated that inhibiting oxidative stress-induced damage, through an antioxidant-rich diet, might be a reasonable approach to prevent neurodegenerative disease. OBJECTIVE: In the present study, response surface methodology was utilized to optimize the extraction for neuro-protective constituents of Camellia japonica byproducts. MATERIALS AND METHODS: Rat pheochromocytoma cells were used to evaluate protective potential of Camellia japonica byproducts. RESULTS: Optimum conditions were 33.84 min, 75.24%, and 75.82°C for time, ethanol concentration and temperature. Further, we demonstrated that major organic acid contents were significantly impacted by the extraction conditions, which may explain varying magnitude of protective potential between fractions. CONCLUSIONS: Given the paucity of information in regards to defatted C. japonica seed cake and their health promoting potential, our results herein provide interesting preliminary data for utilization of this byproduct from oil processing in both academic and industrial applications. SUMMARY: Neuro-protective potential of C. japonica seed cake on cell viability was affected by extraction conditionsExtraction conditions effectively influenced on active constituents of C. japonica seed cakeBiological activity of C. japonica seed cake was optimized by the responsive surface methodology. Abbreviations used: GC-MS: Gas chromatography-mass spectrometer, MTT: 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, PC12 cells: Pheochromocytoma, RSM: Response surface methodology.