Uncertainty in surrogate decision-making about end-of-life care for people with dementia: An integrative review.

AIM: To describe uncertainty in surrogate decision-making regarding end-of-life care for people with dementia using Mishel's reconceptualized uncertainty in illness theory. DESIGN: Integrative literature review using Whittemore and Knafl's approach. DATA SOURCES: PubMed, CINAHL, EMBASE, Scopus and Web of Science were searched using terms such as uncertainty/unpredictability, decision-making/advance care planning/end-of-life care planning, surrogate/family/caregiver/proxy and dementia. The search was initially conducted on 28 September 2021 and updated on 31 July 2023. REVIEW METHODS: Through systematic screening, 20 research articles were included in the analysis. Content related to uncertainty in surrogate decision-making regarding end-of-life care was extracted and analysed, focusing on the reconceptualized uncertainty in illness theory. RESULTS: First, surrogate uncertainty exists in various areas of surrogate decision-making regarding end-of-life care. Second, antecedents of surrogate uncertainty include numerous intrinsic and extrinsic factors. Third, surrogates exhibited some negative psychological responses to uncertainty but continually processed and structured their uncertainty through certain approaches, leading them to grow as decision-makers. Finally, research-based evidence on surrogates' processing of uncertainty and shifts to new life perspectives remains limited. CONCLUSION: Surrogates' uncertainty in decision-making regarding end-of-life care for people with dementia is well characterized using the reconceptualized uncertainty in illness theory. Healthcare providers should help surrogates manage their uncertainty in surrogate decision-making more constructively throughout the dementia trajectory. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The findings highlight the importance of assessing how surrogates process uncertainty and gauging how to help them process uncertainty and transition to new life perspectives. IMPACT: This review contributes to healthcare professionals' understanding of surrogates' uncertainty in end-of-life care planning for people with dementia, especially what they are uncertain about, what influences their uncertainty and how they process it. REPORTING METHOD: This study adheres to the PRISMA reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Effects of Infection Control Education for Nursing Students Using Standardized Patients vs. Peer Role-Play.

This study was conducted to identify and compare the effects of two education programs for infection control-a simulation using standardized patients and a peer role-play-on standard precaution knowledge, standard precaution awareness, infection-related anxiety, and infection control performance. This study used a nonequivalent control group pretest-posttest design. A total of 62 undergraduate nursing students in their 3rd year participated in the study, and were assigned to the experimental and control groups, accordingly. The infection control education program was developed based on the analysis, design, development, implementation, and evaluation model. The program for the experimental group included lectures, skills training, simulation using standardized patients, and debriefing, while the control group participated in the usual infection control education, consisting of lectures, skills training, and peer tutoring practices. Both groups exhibited statistically significant increases in knowledge, awareness of standard precaution, and infection control performance after the intervention. Infection-related anxiety and infection control performance were significantly higher in the simulation using a standardized patient group. Both education programs influenced compliance with the standard precaution for infection control. The results of this study contribute to the evidence regarding effective educational methods to improve infection control.

Tangeretin triggers melanogenesis through the activation of melanogenic signaling proteins and sustained extracellular signal- regulated kinase in B16/F10 murine melanoma cells.

In order to test the effectiveness of tangeretin at ameliorating melanoma and melanoma-associated depigmentation, western blotting was used to assess the melanin content of treated melanoma cells. Tangeretin, a 4',5,6,7,8-pentamethoxyflavone, was found to trigger intracellular melanin production in a concentration-dependent manner in B16/F10 murine melanoma cells. Melanin content increased 1.74-fold in response to treatment with 25 µM of tangeretin, compared to that in non-treated cells. Examination of melanogenic protein expression showed that tyrosinase, tyrosinase-related protein (TRP)-1, and extracellular signal-regulated kinase (ERK) 1/2 levels increased in a dose-dependent manner. Furthermore, the expression of cyclic adenosine monophosphate response element binding protein (CREB) and microphthalmia transcription factor (MITF) was increased by tangeretin in 1 h and 4 h, respectively. Tangeretin- upregulated melanogenesis was suppressed by ERK 1/2 inhibitor and not by ERK1 inhibitor. These results suggest that tangeretin has therapeutic potential for melanoma and melanoma-associated depigmentation because it can induce hyperpigmentation through the activation of melanogenic signaling proteins and initiation of sustained ERK2 expression.

Chemical composition and anti-inflammation activity of essential oils from Citrus unshiu flower.

Though many essential oils from citrus peels are claimed to have several medicinal functions, the chemical composition and biological activities of the essential oils of Citrus flowers have not been well described. Therefore, this study intended to investigate the chemical composition and anti-inflammatory potential of essential oils from C. unshiu flower (CEO) to support its purported beneficial health effects. The chemical constituents of the CEO, analyzed by gas chromatography-mass spectrometry (GC-MS), included y-terpinene (24.7%), 2-beta-pinene (16.6%), 1-methyl-2-isopropylbenzene (11.5%), L-limonene (5.7%), beta3-ocimene (5.6%), and alpha-pinene (4.7%). The effects of the CEO on nitric oxide (NO) and prostaglandin E2 (PGE2) production in lipopolysaccharide (LPS)-activated RAW 264.7 macrophages were also examined. The results indicate that the CEO is an effective inhibitor of LPS-induced NO and PGE2 production in RAW 264.7 cells. Additionally, CEO was shown to suppress the production of inflammatory cytokines including interleukin (IL)-1beta, tumor necrosis factor (TNF)-alpha, and IL-6. Based on these results, CEO may be considered a potential anti-inflammatory candidate with human health benefits.

Down-regulation of tyrosinase, TRP-1, TRP-2 and MITF expressions by citrus press-cakes in murine B16 F10 melanoma.

OBJECTIVE: To investigate the suitability of citrus-press cakes, by-products of the juice industry as a source for the whitening agents for cosmetic industry. METHODS: Ethylacetate extracts of citrus-press cakes (CCE) were examined for their anti-melanogenic potentials in terms of the inhibition of melanin production and mechanisim of melanogenesis by using Western Blot analysis with tyrosinese, tyrosinase-related protein-1 (TRP-1), TRP2, and microphthalmia-associated transcription factor (MITF) proteins. To apply the topical agents, citrus-press cakes was investigated the safety in human skin cell line. Finally flavonoid analysis of CCE was also determined by HPLC analysis. RESULTS: Results indicated that CCE were shown to down-regulate melanin content in a dose-dependent pattern. The CCE inhibited tyrosinase, TRP-2, and MITF expressions in a dose-dependent manner. To test the applicability of CCE to human skin, we used MTT assay to assess the cytotoxic effects of CCE on human keratinocyte HaCaT cells. The CCE exhibited low cytotoxicity at 50 µg/mL. Characterization of the citrus-press cakes for flavonoid contents using HPLC showed varied quantity of rutin, narirutin, and hesperidin. CONCLUSIONS: Considering the anti-melanogenic activity and human safety, CCE is considered as a potential anti-melanogenic agent and may be effective for topical application for treating hyperpigmentation disorders.

Anti-melanogenesis constituents from the seaweed Dictyota coriacea.

This study was conducted to identify the anti-melanogenesis constituents from a seaweed Dictyota coriacea (Holmes). Three known compounds, viz. 1,9-dihydroxycrenulide (1), epiloliolide (2) and D-mannitol (3), were isolated from the ethanol extract. The melanin synthesis inhibition activities were evaluated using B16F10 melanoma cells for the isolates. Compared with the positive control, arbutin, compounds 1 and 2 exhibited more potency, showing 27.8 and 22.6% inhibition activities at a substrate concentration of 30 microg/mL. Our studies also indicate that these compounds are not cytotoxic. Hence, they might prove to be useful therapeutic agents for treating hyperpigmentation and effective components of whitening cosmetics.

Neolitsea aciculata essential oil inhibits drug-resistant skin pathogen growth and Propionibacterium acnes-induced inflammatory effects of human monocyte leukemia.

This study examined the chemical composition of Neolitsea aciculata essential oil (NAE) and its biological activities. NAE was obtained by hydro-distillation of N. aciculata leaves collected in Jeju Island and analyzed by gas chromatography equipped with a mass spectrometer detector. 1-Dodecen-3-yne (12.5%), calarene (11.5%) and elemol (9.5%) were identified as the major components of NAE. The antibacterial and anti-inflammatory activities of NAE against skin pathogens were examined to determine the protective properties against acne vulgaris. NAE exhibited moderate to strong antibacterial activity against drug-susceptible and -resistant Propionibacterium acnes and Staphylococcus epidermidis, which are known as acne-causing bacteria. In addition, NAE reduced the P. acnes-induced secretion of tumor necrosis factor-alpha (TNF-alpha) and interleukin-8 (IL-8) in THP-1 cells, highlighting its anti-inflammatory effects. The DPPH radical scavenging activities of NAE also revealed moderate antioxidant properties (IC50, 21.3 microL/mL). Overall, NAE is an attractive candidate as an ingredient in skin care products.

Inhibitory effects of Fortunella japonica var. margarita and Citrus sunki essential oils on nitric oxide production and skin pathogens.

A number of essential oils from citrus peels are claimed to have biological activities. Citrus peel, called 'Jin-Pi', is used in traditional medicine for digestion, severe cold, and fever. However, the antibacterial activities against skin pathogens and anti-inflammatory effects of the essential oils of Citrus sunki (JinGyul) and Fortunella japonica var. margarita (GumGyul) have not yet been described. Therefore, in this study, the essential oils of the citrus species C. sunki (CSE) and F. japonica var. margarita (FJE), both native to the island of Jeju, Korea, were examined for their anti-inflammatory and antimicrobial activities against skin pathogens. Four human skin pathogenic microorganisms, Staphylococcus epidermidis CCARM 3709, Propionibacterium acnes CCARM 0081, Malassezia furfur KCCM 12679, and Candida albicans KCCM 11282, were studied. CSE and FJE exhibited strong antimicrobial activity against most of the pathogenic bacteria and yeast strains that were tested. Interestingly, CSE and FJE even showed antimicrobial activity against antibiotic-resistant S. epidermidis CCARM 3710, S. epidermidis CCARM 3711, P. acnes CCARM9009, and P. acnes CCARM9010 strains. In addition, CSE and FJE reduced the lipopolysaccharide (LPS)-induced secretion of nitric oxide (NO) in RAW 264.7 cells, indicating that they have anti-inflammatory effects. We also analysed the chemical composition of the oils by gas chromatography-mass spectrometry (GC-MS) and identified several major components, including dl-limonene (68.18%) and beta-myrcene (4.36%) for CSE, and dl-limonene (61.58%) and carvone (6.36%) for FJE. Taken together, these findings indicate that CSE and FJE have great potential to be used in human skin health applications.

Tyrosinase inhibitory constituents from the stems of Maackia fauriei.

Bioassay-guided investigation of the stems of Maackia fauriei led to the isolation of seven flavonoid constituents, formononetin (1), genistein (2), daidzein (3), texasin (4), tectorigenin (5), odoratin (6) and mirkoin (7). Their structures were elucidated on the basis of spectral studies as well as by comparison with literature data. Tyrosinase inhibition activities were carried out on the isolated compounds. Among these, mirkoin (7) was identified as a potent tyrosinase inhibitor. It inhibited mushroom tyrosinase with an IC(50) value of 0.005 mm, which is ten times more active than kojic acid (IC(50) = 0.045 mm). The inhibition kinetics, analysed by Lineweaver-Burk plots, indicated mirkoin (7) to be a competitive inhibitor of tyrosinase when L-tyrosinase was used as a substrate. The results suggest that hydroxyl groups at C-4' in the B ring of flavonoids play an important role in the tyrosinase inhibition activities. Interestingly, compounds 4-7 were isolated for the first time from this plant.

Cryptomeria japonica essential oil inhibits the growth of drug-resistant skin pathogens and LPS-induced nitric oxide and pro-inflammatory cytokine production.

In this study, the chemical composition of Cryptomeria japonica essential oil (CJE) was analyzed and its biological activities were tested. CJE was obtained by steam distillation from leaves collected from Jeju Island and analyzed by gas chromatography (GC)-flame ionization detection (FID) and GC-MS. Kaurene (17.20%), elemol (10.88%), gamma-eudesmol (9.41%), and sabinene (8.86%) were the major components in CJE. The antibacterial and anti-inflammatory activities of CJE against drug-susceptible and -resistant skin pathogens have been not reported previously. Thus, we determined the anti-bacterial activities of CJE using the disk diffusion method and minimum inhibitory concentration (MIC) values. CJE showed excellent antibacterial activities against Propionibacterium acnes and Staphylococcus epidermidis, which are acne-causing bacteria. The MIC of CJE against drug-susceptible and -resistant P. acens and S. epidermidis ranged from 0.16 to 10.0 microl/ml. In addition, the effects of CJE on nitric oxide (NO), prostaglandin E2 (PGE2), tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, and IL-6 production in lipopolysaccharide (LPS)-activated RAW 264.7 macrophages were also examined. Pro-inflammatory cytokine and mediator tests indicated that CJE has excellent dose-dependent inhibitory activities. Therefore, based on these results, we propose that CJE is an attractive acne-mitigating candidate for skin health.

Chemical composition and anti-inflammatory effects of essential oil from Farfugium japonicum flower.

In this study, the chemical composition and anti-inflammatory activities of hydrodistilled essential oil from Farfugium japonicum were investigated for the first time. The chemical constituents of the essential oil were further analyzed by GC-MS and included 1-undecene (22.43%), 1-nonene (19.83%), beta-caryophyllene (12.26%), alpha-copaene (3.70%), gamma-curcumene (2.86%), germacrene D (2.69%), and 1-decene (2.08%). The effects of the essential oil on nitric oxide (NO) and prostaglandin E2 (PGE(2)) production in lipopolysaccharide (LPS)-activated RAW 264.7 macrophages were also examined. The results indicate that the F. japonicum essential oil is an effective inhibitor of LPS-induced NO and PGE(2) production in RAW 264.7 cells. These inhibitory effects of the F. japonicum essential oil were accompanied by dose-dependent decreases in the iNOS and COX-2 mRNA expression. In order to determine whether F. japonicum essential oil can safely be applied to human skin, the cytotoxic effects of F. japonicum essential oil were determined by colorimetric MTT assays in human dermal fibroblast and keratinocyte HaCaT cells. F. japonicum essential oil exhibited low cytotoxicity at 100 mug/mL. Based on these results, we suggest that F. japonicum essential oil may be considered a potential anti-inflammatory candidate for topical application.

Antibacterial and anti-inflammatory effects of Jeju medicinal plants against acne-inducing bacteria.

Propionibacterium acnes and Staphylococcus epidermidis are pus-forming bacteria that trigger inflammation in acne. The present study was conducted to evaluate the antimicrobial activities of Jeju medicinal plants against these etiologic agents of acne vulgaris. Ethanol extracts of Jeju plants were tested for antimicrobial activities by disc diffusion and broth dilution methods. The results from the disc diffusion assays revealed that four medicinal plants, Mollugo pentaphylla, Angelica anomala, Matteuccia orientalis, and Orixa japonica inhibited the growth of both pathogens. Among these, A. anomala had strong inhibitory effects. Its MIC values were 15.6 microg/ml and 125 microg/ml against P. acnes and S. epidermidis, respectively. The cytotoxic effects of the four extracts were determined by colorimetric MTT assays using two animal cell lines: human dermal fibroblasts and HaCaT cells. Although the M. orientalis root extract had moderate cytotoxicity in HaCaT cells at 200 microg/ml, most extracts exhibited low cytotoxicity at 200 microg/ml in both cell lines. In addition, the extracts reduced the P. acnes-induced secretion of interleukin-8 and tumor necrosis factor-alpha (TNF-alpha) in THP-1 cells, an indication of their anti-inflammatory effects. Based on these results, we suggest that M. pentaphylla, A. anomala, M. orientalis, and O. japonica are attractive acne-mitigating candidates for topical application.

Involvement of nuclear factor-kappaB in the inhibition of pro-inflammatory mediators by pinosylvin.

Nuclear factor-kappaB (NF-kappaB) is a critical transcription factor for maximal expression of many of the cytokines that are involved in the pathogenesis of inflammatory diseases. In this study, we found that pinosylvin, a natural stilbenoid that is a component of the pine leaf (Pinus densiflora), significantly inhibited LPS-induced NF-kappaB activation in a concentration-dependent manner. Additionally, pinosylvin was found to inhibit the LPS-induced phosphorylation and degradation of IkappaB alpha in THP-1 cells. Therefore, we have attempted to determine whether pinosylvin can inhibit the expression of cytokines possessing NF-kappaB binding sites in their promoter regions. In a consistent result, pinosylvin inhibited LPS-induced production of TNF alpha and interleukin-8 (IL-8). Taken together, these results show that pinosylvin suppresses the production of pro-inflammatory mediators through the inhibition of the NF-kappaB signaling pathway.