Antibiotic-induced intestinal microbiota depletion can attenuate the acute kidney injury to chronic kidney disease transition via NADPH oxidase 2 and trimethylamine-N-oxide inhibition.

Intestinal microbiota and their metabolites affect systemic inflammation and kidney disease outcomes. Here, we investigated the key metabolites associated with the acute kidney injury (AKI)-to chronic kidney disease (CKD) transition and the effect of antibiotic-induced microbiota depletion (AIMD) on this transition. In 61 patients with AKI, 59 plasma metabolites were assessed to determine the risk of AKI-to-CKD transition. An AKI-to-CKD transition murine model was established four weeks after unilateral ischemia-reperfusion injury (IRI) to determine the effects of AIMD on the gut microbiome, metabolites, and pathological responses related to CKD transition. Human proximal tubular epithelial cells were challenged with CKD transition-related metabolites, and inhibitory effects of NADPH oxidase 2 (NOX2) signals were tested. Based on clinical metabolomics, plasma trimethylamine N-oxide (TMAO) was associated with a significantly increased risk for AKI-to-CKD transition [adjusted odds ratio 4.389 (95% confidence interval 1.106-17.416)]. In vivo, AIMD inhibited a unilateral IRI-induced increase in TMAO, along with a decrease in apoptosis, inflammation, and fibrosis. The expression of NOX2 and oxidative stress decreased after AIMD. In vitro, TMAO induced fibrosis with NOX2 activation and oxidative stress. NOX2 inhibition successfully attenuated apoptosis, inflammation, and fibrosis with suppression of G2/M arrest. NOX2 inhibition (in vivo) showed improvement in pathological changes with a decrease in oxidative stress without changes in TMAO levels. Thus, TMAO is a key metabolite associated with the AKI-to-CKD transition, and NOX2 activation was identified as a key regulator of TMAO-related AKI-to-CKD transition both in vivo and in vitro.

Effect of diesel exhaust particles on RANK/RANKL expression in in vivo and in vitro models of middle ear inflammation.

OBJECTIVE: Increasing evidence suggests a link between middle ear inflammation and the development of diesel exhaust particles (DEPs). Chronic middle ear inflammation can lead to bone damage and remodeling. This study aimed to explore the impact of DEPs on the expression of interleukin (IL)-6 and RANKL under conditions of middle ear inflammation. METHODS: DEPs were collected by burning fuel in a diesel engine at the Gwangju Institute of Science and Technology. Human middle ear epithelial cells were cultured to 70-80% confluence in culture plates and then treated with DEPs at concentrations of 0, 5, 10, 20, 40, and 80 µg/mL for 24 h. Cell viability was assessed manually. B6.SJL mice, aged 9 weeks, were exposed to DEPs at a concentration of 200 µg/m3 for 1 h daily over a period of 28 days. The expression levels of IL-6, tumor necrosis factor α, RANKL, and RANK were evaluated using hematoxylin and eosin staining and western blot analysis of the harvested middle ear samples. RESULTS: The viability of human middle ear epithelial cells was found to decrease in a dose-dependent manner after 24 h. The mRNA expression level of IL-6 exhibited the most significant increase at the 48-h mark. In contrast, the mRNA expression levels of RANKL and RANK showed a marked increase as early as 6 h post-exposure, with both genes subsequently displaying a time-dependent decrease. Histological analysis revealed that the middle ear mucosa was thicker in the group exposed to DEPs compared to the control group. Additionally, the protein expression levels of IL-6 and RANKL were elevated in the DEP-exposed group relative to the normal control group. CONCLUSIONS: We confirmed the expression of osteoclast-related proteins in the mouse middle ear. These results imply that air pollutants might affect RANKL/RANK signaling, which is associated with bone remodeling.

Targeting the m6A RNA methyltransferase METTL3 attenuates the development of kidney fibrosis.

Kidney fibrosis is a major mechanism underlying chronic kidney disease (CKD). N6-methyladenosine (m6A) RNA methylation is associated with organ fibrosis. We investigated m6A profile alterations and the inhibitory effect of RNA methylation in kidney fibrosis in vitro (TGF-ß-treated HK-2 cells) and in vivo (unilateral ureteral obstruction [UUO] mouse model). METTL3-mediated signaling was inhibited using siRNA in vitro or the METTL3-specific inhibitor STM2457 in vivo and in vitro. In HK-2 cells, METTL3 protein levels increased in a dose- and time-dependent manner along with an increase in the cellular m6A levels. In the UUO model, METTL3 expression and m6A levels were significantly increased. Transcriptomic and m6A profiling demonstrated that epithelial-to-mesenchymal transition- and inflammation-related pathways were significantly associated with RNA m6A methylation. Genetic and pharmacologic inhibition of METTL3 in HK-2 cells decreased TGF-ß-induced fibrotic marker expression. STM2457-induced inhibition of METTL3 attenuated the degree of kidney fibrosis in vivo. Furthermore, METTL3 protein expression was significantly increased in the tissues of CKD patients with diabetic or IgA nephropathy. Therefore, targeting alterations in RNA methylation could be a potential therapeutic strategy for treating kidney fibrosis.

Periostin deficiency attenuates kidney fibrosis in diabetic nephropathy by improving pancreatic ß-cell dysfunction and reducing kidney EMT.

Diabetic nephropathy (DN) is associated with kidney fibrosis. A previous study revealed that periostin (POSTN) contributes to kidney fibrosis. This study examined the role of POSTN in DN. The urinary concentrations of POSTN and TNC increased according to the severity of DN in human samples. Streptozotocin (STZ) was administered after unilateral nephrectomy (UNXSTZ) to induce DN in wild-type and Postn-null mice. Four experimental groups were generated: wild-typeham (WT Sham), wild-type UNXSTZ (WT STZ), Postn-null Sham (KO Sham), and Postn-null UNXSTZ (KO STZ). After 20 weeks, the KO STZ group had lower levels of urine albumin excretion, glomerular sclerosis, and interstitial fibrosis than those of the WT STZ group. Additionally, the KO STZ group had lower expression of fibrosis markers, including TNC. The KO STZ group showed better glucose regulation than the WT STZ model. Furthermore, the KO STZ group exhibited significantly preserved pancreatic islet integrity and insulin expression. HK-2 cells were used to observe the aggravation of fibrosis caused by POSTN under TGF-ß conditions. We stimulated INS-1 cells with streptozotocin and evaluated the viability of these cells. The anti-POSTN antibody treatment of INS-1 cells with streptozotocin resulted in higher cell viability than that with treatment with streptozotocin alone. The absence of POSTN in DN contributes to renal fibrosis alleviation by improving pancreatic ß-cell function. Additionally, there is an association between POSTN and TNC.

Development of the "living well" concept for older people with dementia.

BACKGROUND: An important goal in dementia care is how people with dementia can be supported in living well. To this end, we need a conceptualization of "living well" that is suitable for older people with dementia and then develop this conceptualization from the perspectives of both older people and caregivers. This study analyzed the concept of "living well" among older people with dementia. METHODS: Following Schwartz-Barcott and Kim's hybrid model, this study comprised theoretical, fieldwork, and final analytic phases. In the theoretical phase, we reviewed the extant literature. In the fieldwork phase, we conducted in-depth interviews with 12 participants (five older people with dementia, two family members, and five nurses), followed by qualitative content analysis. In the final analytic phase, we defined the concept of "living well" by comprehensively analyzing the data from the theoretical phase and results from the fieldwork phase. RESULTS: We derived physical, mental, and social relationship dimensions of the conceptualization of "living well" for older people with dementia. The physical dimensions were "ability for daily living" and "symptom management." The mental dimensions were "psychological health," "psychological stability," "maintaining identity and growth," and "human dignity." Finally, the social relationship dimensions were "maintaining social relations and community connectivity" and "government support." CONCLUSIONS: Our analysis of the concept of "living well" can be used for developing tools and interventions to improve the ability of older people with dementia to live well.

Influence of the Clinical Nurse's Self-Acceptance and Experiential Acceptance on Leadership Versatility.

Introduction: This study identifies how the self-acceptance and experiential acceptance of nurses working in hospitals influences leadership versatility to utilize the information as basic data for developing strategies for improving nursing quality through effective manpower management. Objective: This study aims to identify the relationships of nurses' self-acceptance, experiential acceptance, and leadership versatility and verify the influence of experiential acceptance and self-acceptance on leadership versatility. Methods: This study used a descriptive design. The convenience subjects were 100 nurses at the one territory hospital in Korea. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and multiple regressions. Results: There were significant positive correlations between self-acceptance and leadership versatility (r = .39, p < .001). Among predictors, self-acceptance had statistically significant influences on leadership versatility (ß = 0.35, p < .001). Self-acceptance indicated an explanation power of 24.0% of the total variance and was shown to be statistically significant (F = 6.89, p < .001). Conclusions: Self-acceptance and experiential acceptance and factors according to nurses' clinical experience and position should be identified in depth, and subsequent studies on factors related to this should be conducted.

Concept Analysis of the Empowerment of Patients With Coronary Artery Disease Using a Hybrid Model.

This study aimed to conceptualize the empowerment of patients with coronary artery disease (CAD) using a hybrid model. In the final phase, "perceived competence and knowledge on lifestyle management," "sense of control of one's own health care," "self-acceptance to change," and "motivation for voluntary behavior" were identified as intrapersonal aspects; "information search," "active communication between patients and health care professionals," and "supportive relationships" were identified as interactional aspects; "self-management in one's life" and "coping behavior with disease" were identified as behavioral aspects. A concept accurately reflecting CAD characteristics may facilitate the implementation of risk factor management.

Cancer coping, healthcare professionals' support and posttraumatic growth in brain-tumor patients.

The purpose of this study was to explore the influence of cancer coping and healthcare professionals' support on posttraumatic growth in patients with brain tumors. A cross-sectional, correlational design was used, in which a structured questionnaire was administered to 114 patients at a tertiary university hospital. Data were analyzed using descriptive statistics, independent t-test or one-way ANOVA, Pearson correlation, and hierarchical multiple regression analysis. Cancer coping (r = .33, p < .001) and healthcare professionals' support (r = .28, p = .002) correlated with posttraumatic growth. Among predictors, primary caregivers (brothers and sisters; ß = .28), interpersonal coping (ß = .26), and healthcare professionals' support (ß = .20) had statistically significant influences on posttraumatic growth. The regression model explained approximately 22.0% of posttraumatic growth. These results contribute to cancer coping and healthcare professionals' support to significantly influence posttraumatic growth.

Effect of an Infertility Counseling Education Program on Education Satisfaction and Counseling Competency of Nurses.

The purpose of this study is to investigate the effects of an infertility counseling education program on education satisfaction and counseling competency of nurses. The study used a one-group pretest-posttest design. Participants were 135 nurses in Korea. Data on demographic characteristics on education satisfaction, and counseling competency were collected. After participating in the infertility counseling education program, the level of counseling competency increased significantly over that before participating in the infertility counseling education program. The infertility counseling education program improved the counseling competency of the participating nurses. Use of such an infertility counseling education program is recommended when nurses counsel patients facing infertility. It is necessary to repeat this study in the future to clarify the effects of these counseling education programs.

[An Evaluation of the Validity and Reliability of the Face Mask Use Scale's Korean Version among Community-Dwelling Adults].

PURPOSE: This study evaluated the validity and reliability of the Korean version of the Face Mask Use Scale (K-FMUS) among community-dwelling adults. METHODS: The participants of the study were community-dwelling adults in Korea using face masks during the COVID-19 pandemic. The English FMUS was translated into Korean using forward and backward translation procedures. The construct validity and reliability of the K-FMUS were evaluated using the exploratory and confirmatory factor analyses and the internal consistency reliability test. RESULTS: The K-FMUS comprised 6 items divided into 2 factors. The variance of the factors was approximately 79.1%, which suggested that the scale indicated the effectiveness of face mask usage. The two factors were labeled as face mask use in society (4 items) and face mask use at home (2 items). Cronbach's α value for the overall scale was .88. CONCLUSION: The K-FMUS is a valid and reliable scale that can be used to measure face mask usage among community-dwelling adults in Korea during the COVID-19 pandemic.

Development and Application of a Web-based Integrated Support Service Program for Infertile Women.

Online-based infertility education provides a health management system to patients using electronic information and technology and no face-to-face interaction with patients and experts. This is a study to develop a web-based integrated support service system to meet the health care and nursing needs of infertile women. To develop a system that is most suitable and practically helpful to infertile women, who are end users of this system, research was conducted. This education system consists of introduction to women's health care, information on women's health, information on organizations for women, community for infertile women, and request for consultation for health management and nursing education of infertile women. This study introduced and applied a user-centered design that maximizes the value of use by first understanding the user's convenience and needs when developing a program.

Development and evaluation of the Coronary Artery Disease Empowerment Scale (CADES) in Korea.

The study aimed to develop and test the Coronary Artery Disease Empowerment Scale in Korea and assess its initial aspects of validity and reliability. The participants included 301 patients diagnosed with coronary artery disease, receiving regular outpatient and inpatient care. Data were collected from August to December 2019. The exploratory factor analysis resulted in extracting 25 items and three factors-self-determination, emotional self-regulation, and personal competence of disease management perception-with a cumulative explanatory power of 55.40%. A significant correlation was found between the Korean versions of the Cardiac Self-efficacy Scale (r = .31, p < .001) and the Health Empowerment Scale (r = .45, p < .001). The internal consistency reliability of all items was .93. The developed instrument can be used to evaluate empowerment in patients with coronary artery disease and identify an improved instrument to measure empowerment. However, further testing of the newly developed Coronary Artery Disease Empowerment Scale is required.

Sexual Experiences of Patients with Acute Onset of Coronary Artery Disease in Korea.

Research on the sex life experiences of patients with acute onset of coronary artery disease (CAD) in Korea is limited. This study explored the sex life experiences of Korean patients with acute onset of CAD. In-depth interviews were conducted from April 2019 to March 2020 and responses were analyzed using Colaizzi's phenomenological method. Participants were nine patients with acute onset of CAD. Five theme clusters were discovered: clearing some doubts about CAD and sex, but remains confused; becoming disheartened after disease onset in a society that considers discussion about sex as taboo; avoiding sexual intercourse after recognizing changes in sexual function; experiencing an imbalance in their relationship with their spouse; and hoping to overcome sex life difficulties and return to their old self. Overall, participants experienced challenges in their sex lives after diagnosis and treatment of CAD. The study results contribute to the nursing knowledge on sexual experiences after CAD.

[Nursing needs assessment scale for women with infertility: development and validation]. / 난임 여성의 간호 요구 ì¸¡ì • 도구 개발 및 타당도 ê²€ì •.

Purpose: High-quality nursing care must be provided for women with infertility, and their nursing care needs must be identified. Although scales have been developed to assess infertility-related stress, quality of life, and psychosocial status, there is a lack of scales that assess the nursing care needs of women with infertility. The purpose of this study was to develop a needs assessment scale for nursing care in women with infertility and to verify its reliability and validity. Methods: The 250 subjects in this study were women with infertility recruited from four hospitals. The scale was developed following the framework of DeVellis, through a literature review, in-depth interviews, development of preliminary items, verification of content validity, development of secondary items, verification of construct validity, and extraction of the final items. Date were analyzed using item analysis, factor analysis, confirmatory factor analysis, Pearson correlation coefficients, and Cronbach's alpha. Reliability was tested using Cronbach's alpha, and validity was evaluated using item analysis, exploratory factor analysis, and criterion validity. Results: The final version of the nursing needs assessment scale for woman with infertility consisted of 18 items. Four factors (physical and psychological nursing needs, needs for information regarding treatment, needs for infertility-related understanding and concern, and supportive needs) explained 66.0% of the total variance. Cronbach's alpha was .92 for the overall instrument and ranged from .88 to .91 for the subscales. Conclusion: These results suggest that this needs assessment scale for nursing care in women with infertility demonstrated acceptable validity and reliability and contained items suitable for assessing the level of nursing care needed by women with infertility.

Physiological Factor Evaluation of the Warm Humidification of Anesthetic Gas Nursing Care.

OBJECTIVE: This study aimed to evaluate the effects of warm humidification of anesthetic gas nursing care on physiological factors in elderly patients during laparoscopic cancer surgery. METHODS: Sixty elderly laparoscopic surgical patients were recruited from a medical center in Korea. The participants' physiological factors (blood pressure, body temperature, and leukocyte and neutrophil counts) were measured four times. RESULTS: After warm humidification of anesthetic gas nursing care, there were significant differences in body temperatures. CONCLUSIONS: These findings indicate that warm humidification of anesthetic gas nursing care is effective in maintaining body temperature. Thus, this type of nursing care can be effective in elderly cancer patients undergoing laparoscopic surgery.

[The Effects of Oral Cryotherapy on Oral Mucositis, Reactive Oxygen Series, Inflammatory Cytokines, and Oral Comfort in Gynecologic Cancer Patients Undergoing Chemotherapy: A Randomized Controlled Trial].

PURPOSE: The purpose of this study was to examine the effects of oral cryotherapy on oral mucositis, reactive oxygen series, inflammatory cytokines, and oral comfort in patients undergoing chemotherapy for gynecologic cancers. METHODS: Participants were randomly assigned to the experimental group (n=25, receiving oral cryotherapy during chemotherapy) and the control group (n=25, receiving the usual care consisting of 0.9% normal saline gargles three times before meals). Oral mucositis was assessed using the oral assessment guide, while oral comfort was assessed using the oral perception guide. Reactive oxygen series was measured as total oxidant stress, and the level of two inflammatory markers, interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), were examined. The data were analyzed using t-test, chi-square test, Fisher's exact test, Mann-Whitney U-test, and repeated measures analysis of variance. RESULTS: There was a significant difference in the oral mucositis score, reactive oxygen series score, TNF-α level, and oral comfort score between the two groups, and there were significant changes over time and in the group-by-time interactions. There was a significant difference in the IL-6 score between the two groups, but there were no significant changes over time or in the group-by-time interactions. CONCLUSION: The study results revealed that oral cryotherapy was more effective than the usual care regime of normal saline gargles for reducing oral mucositis, reactive oxygen series, and inflammatory cytokines and for improving oral comfort in gynecologic cancer patients undergoing chemotherapy.

Development of Nurses' Practical Educational Needs Scale for Women with Infertility.

PURPOSE: To develop nurses' educational needs scale for woman with infertility. METHODS: A total of 201 nurses in charge of infertility health services in 4 infertility hospitals and 1 public health center were enrolled for this study. The scale was developed through literature review, in-depth interview, development of preliminary items, verification of content validity, development of secondary items, verification of construct validity, and extraction of final items. Data were analyzed using item analysis, exploratory factor analysis, Pearson's correlation coefficients, and Cronbach's α. RESULTS: Nurses' educational needs scale for women with infertility consisted of 41 items. Three factors (education for disease and symptom of infertility, supporting and counselling for infertility patients, and education for daily life of infertile patients) explained 63.7% of the total variance. CONCLUSIONS: Nurses' educational needs scale for woman with infertility demonstrated acceptable validity and reliability. Its items could be used to assess the level of educational needs for nurses in charge of infertility health services.

The Effect of Intentional Nursing Rounds Based on the Care Model on Patients' Perceived Nursing Quality and their Satisfaction with Nursing Services.

PURPOSE: This study examined the effects of intentional nursing rounds based on the care model on patients' perceived nursing quality and their satisfaction with nursing services. METHODS: The study design was a nonequivalent control group pretest-posttest design. The participants were assigned to the intervention group or the control group in two orthopedic wards of a teaching hospital. A total of 9 rounds (at 7 AM, 9 AM, 12 PM, 3 PM, 5 PM, 8 PM, 10 PM, 2 AM, and 5 AM) were performed every 2 or 3 hours to the experimental group. The intentional nursing rounding intervention was developed through a theoretical development program involving six basic principles which are maintaining belief, knowing, being with, doing for, enabling, and patients' wellness. To evaluate the effects of intentional nursing rounds, data were collected through the Perception of Quality Nursing Care Scale and the Patients' Satisfaction with Nursing Care Quality Questionnaire. RESULTS: The participants were 70 patients (experimental group) and 75 patients (control group). Results of difference-in-difference analysis confirmed that the patient-perceived nursing quality level from the experimental group was 0.85 points (out of 5.00) higher (p = .041) and the satisfaction with nursing services level was 8.28 points (out of 110.00) higher (p < .001) than the control group. CONCLUSIONS: These results proposed that intentional nursing rounds based on the care model were effective in improving perception of quality nursing care and patients' satisfaction with nursing care. Structured patient-oriented intentional nursing rounds based on the care model are expected to expand to a variety of clinical settings further.

[The Relationships among Perceived Parental Bonding, Illness Perception, and Anxiety in Adult Patients with Congenital Heart Diseases].

PURPOSE: The purposes of this study were to identify the relationships among perceived parental bonding, illness perception, and anxiety and to determine the influences of perceived parental bonding and illness perception on anxiety in adult patients with congenital heart diseases. METHODS: In this study a descriptive correlational design with survey method was utilized. The participants were 143 adult patients with congenital heart disease being cared for in the cardiology out-patient clinic of A medical center. Data were collected using the Parental Bonding Instrument, Illness Perception Questionnaire Revised Scale, and Cardiac Anxiety Questionnaire Scale. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation analysis, and hierarchial regression analyses. RESULTS: There showed significant positive relationships of anxiety with maternal overprotection, consequences, and personal control respectively. Among predictors, maternal overprotection (ß=.45), consequence (ß=.26), and personal control (ß=-.03) had statistically significant influence on anxiety. CONCLUSION: Nursing interventions to decrease maternal overprotection and negative consequence, and to enhance personal control are essential to decrease the anxiety of adult patients with congenital heart diseases.