Turning points of recovery from cardiac surgery during the intensive care unit transition.

OBJECTIVE: To explore the turning points of recovery from cardiac surgery of patients during the intensive care unit recovery transition. DESIGN: A descriptive qualitative design. SETTING: Three hospitals in northern Taiwan, Republic of China. PATIENTS: A convenience sample consisting of 30 adult patients (15 men and 15 women) who had undergone cardiac surgery. Age range was 20 to 67 years (mean, 46.6 years). OUTCOME MEASURES: The component, context, type, and positive or negative impact of turning points on patients' health. INTERVENTION: Data were collected through semistructured interviews and then analyzed by using qualitative content analysis. RESULTS: Turning points, which included events, nursing actions, and time, were examined in terms of the preceding conditions and the positive or negative health outcomes. Participants in this study fell into four main groups with regard to turning point experiences during the intensive care unit transition: those having experiences of turning points with both positive and negative outcomes (57%); those having experiences of turning points with a positive outcome only (33%); those having no experience of a turning point with either a positive or negative outcome (7%); and those having experiences of turning points with a negative outcome only (3%). Four classes of turning point experiences identified from the data encompassed "precedingness," inclusiveness, comparativeness, and multiplicity. CONCLUSIONS: We delineated the components, context, types, and positive or negative impact of turning points on patients' health after cardiac surgery during the intensive care unit transition. We also drew information on the nature, definition, and conceptual frameworks from data analysis to describe this phenomenon.

Taiwanese patients' concerns and coping strategies: transition to cardiac surgery.

OBJECTIVE: To explore patients' concerns during the admission transition to cardiac surgery. DESIGN: A descriptive qualitative design. SETTING: Four hospitals in northern Taiwan, Republic of China. PATIENTS: A purposive sample consisting of 40 adult patients (20 men and 20 women) who planned to have cardiac surgery. Age range was 20 to 70 years (mean 50.1 years). OUTCOME MEASURES: The types, levels, components, coping strategies, context, and conceptual framework of patients' concerns. INTERVENTION: Data were collected through semistructured interviews, and then analyzed using qualitative content analysis. RESULTS: Ninety percent of subjects (N = 36) reported two types of concerns: certain (80%) and uncertain (10%). Their certain concerns reflected three levels of concerns: "Caring about" or "Thinking about" (52%); "Worrying about" or "Being afraid of" (43%); and "Experiencing a mortal fear of" (30%), ordered from the weakest to the strongest. The components of patients' concerns were the process of recovery; hospital experiences, including maintaining daily activities, pain at admission, and expectant discomforts and disabilities in the intensive care unit; death; unfinished responsibilities and life goals, significant persons, and places; financial needs; and poor quality of care. Strategies developed to manage their concerns included (1) The use of person-focused effort (both cognitive and psychomotor), (2) Seeking help from others, including family members, friends, other patients, and health professionals, and (3) Turning to metaphysical power. The context for the phenomenon of Taiwanese subjects' concerns concerning cardiac surgery during the admission transition were "Being a person," resuming normality, and empowerment of self. CONCLUSION: The types, levels, components, and coping strategies of patients' concerns during the admission transition to cardiac surgery were discovered and delineated. The background context and conceptual framework for the phenomenon also were developed from the data analysis to describe and depict this phenomenon.

Thrombin cleaves the high molecular weight forms of basic fibroblast growth factor (FGF-2): a novel mechanism for the control of FGF-2 and thrombin activity.

The fgf-2 gene encodes low molecular weight (LMW, 18 kDa) and high molecular weight (HMW, 22-24 kDa) forms that originate from alternative translation of a single mRNA and exhibit diverse biological functions. HMW fibroblast growth factor-2 (FGF-2) inhibits cell migration and induces cell transformation or growth arrest in a cell type- and dose-dependent fashion. Conversely, LMW FGF-2 upregulates both cell proliferation and migration in most cell types. Although transcriptional and translational regulation of HMW and LMW FGF-2 has been extensively investigated, little is known about post-translational control of their relative expression. Here we report that thrombin, a key coagulation factor and inflammatory mediator, cleaves HMW FGF-2 into an LMW FGF-2-like form that stimulates endothelial cell migration and proliferation. The effect of thrombin on these cell functions requires HMW FGF-2 cleavage. This post-translational control mechanism adds a novel level of complexity to the regulation of FGF-2, and links the activities of thrombin and FGF-2 in patho-physiological processes in which both molecules are expressed.

The genetics of mitral valve prolapse.

Mitral valve prolapse (MVP) is a very common clinical condition that refers to a systolic billowing of one or both mitral valve leaflets into the left atrium. Improvements of echocardiographic techniques and new insights in mitral valve anatomy and physiology have rendered the diagnosis of this condition more accurate and reliable. MVP can be sporadic or familial, demonstrating autosomal dominant and X-linked inheritance. Three different loci on chromosomes 16, 11 and 13 have been found to be linked to MVP, but no specific gene has been described. Another locus on chromosome X was found to cosegregate with a rare form of MVP called 'X-linked myxomatous valvular dystrophy'. MVP is more frequent in patients with connective tissue disorders including Marfan syndrome, Ehlers-Danlos and osteogenesis imperfecta. The purpose of this review is to describe previous studies on the genetics and prevalence of MVP. The report warrants the need for further genetically based studies on this common, albeit not fully understood, clinical entity.

[Isolation of bacteria which could perform nitrification and denitrification simultaneously by gene probe].

The bacteria which could perform nitrification and denitrification simultaneously from nitrogen containing wastes in Taiwan were isolated by using the probes made from random DNA fragments of Thiosphaera pantotropha. Two isolates were identified and named Alcaligenes faecalis subsp. faecalis strain 1 and strain 2 respectively. The effects on nitrification and denitrification by different medium pH, oxygen content, addition of different electron donors or inhibitors were studied. The isolates not only could perform nitrification, but also denitrification even in the presence of oxygen. Potassium cyanide could inhibit denitrification; hydrazine and hydroxyamine could inhibit nitrification. Alcaligenes faecalis subsp. faecalis strain 2 shows better denitrification.