Design, synthesis and evaluation of 3-(2-(substituted benzyloxy)benzylidene) pyrrolidine-2,5-dione derivatives for novel ATX inhibitor.

Autotaxin (ATX) has emerged as a promising therapeutic target for liver diseases. In this study, we identified potential drug candidates through in silico high-throughput screening. Subsequently, we synthesized a series of small molecules, specifically KR-40795 (2c), a pyrrolidine-2,5-dione-based analogue that binds to the allosteric tunnel and hydrophobic pocket of ATX. This compound was designed to inhibit the enzymatic activity of ATX for the treatment of liver diseases. The inhibitory potency of KR-40795 was evaluated using a biochemical assay that measured the hydrolysis of a specific substrate (FS-3). Notably, KR-40795 demonstrated significant inhibition of both collagen formation and lipid accumulation in liver cells, suggesting its potential as a therapeutic agent for liver diseases, particularly fibrosis and steatosis.

Shifting perspectives: From "Epilepsy" to "Cerebroelectric Disorder".

BACKGROUND & OBJECTIVE: Epilepsy has long been associated with stigma and misconceptions. In response, the Korean Epilepsy Society initiated the Epilepsy Renaming project in 2008 to replace the stigmatizing term with a neutral and scientifically grounded name, "cerebroelectric disorder". This study explores the impact of changing terminology on the public discourse surrounding epilepsy. METHODS: Online news articles from distinct time periods (2001-2003, 2011-2014, 2017-2018, and 2020-2022) were analyzed using text data analysis techniques, including Latent Dirichlet Allocation topic modeling, frequency analysis, and sentiment analysis. The inclusion of data from 2017 to 2018 allowed for an examination of discourse trends independent of the COVID-19 pandemic's influence. Correlation of words in each period was visualized via network maps. Migraine was set as control term to highlight changes in perception devoid of significant stigma intervention efforts. RESULTS: The analysis revealed a significant shift in terminology preference, with cerebroelectric disorder gradually replacing epilepsy in news articles. The discourse surrounding epilepsy evolved over time from focusing on healthcare and economic aspects to patient-centered discussions, emphasizing the daily lives of individuals with epilepsy. This shift towards more empathetic and less stigmatized language was contrasted against the discourse on migraine, highlighting the specific impact of the terminological change on epilepsy's perception. CONCLUSION: The adoption of the neutral term "cerebroelectric disorder" in South Korea has influenced the discourse surrounding epilepsy, leading to more patient-centered discussions and a reduction in stigma. This study highlights the importance of terminology in shaping public perceptions of diseases and suggests that changing terminology can positively impact the understanding and destigmatization of epilepsy.

The relationship between patterns of negative life experiences and clinical presentation in a psychiatric sample.

BACKGROUND: Attempts have been made to classify the patterns of polytraumatization using a person-centered approach. However, most studies have only focused on maltreatment and interpersonal trauma and have been unable to examine various clinical symptoms. OBJECTIVES: This study aimed to explore patterns of negative life experiences, including maltreatment, lifetime trauma, and recent stressful life events, and compare diverse dimensions of the clinical manifestations among the subtypes in a clinical sample. METHOD: We investigated childhood maltreatment, lifetime trauma, and recent stressful events using a self-report method in 1410 psychiatric patients; we classified the patterns of lifelong negative life experiences using latent profile analysis (LPA). We used the rates of psychiatric diagnosis, the Beck Depression Inventory, the Impact of Event Scale-Revised (IES-R-K), and the Multiphasic Minnesota Personality Inventory-2-Restructured Form to compare various symptom dimensions among the derived subtypes. RESULTS: LPA indicated a four-class solution: mild, recent stress, maltreatment, and multiple adversity group. The multiple adversity group experiencing both lifetime trauma and recent stressful life events, in addition to maltreatment, including sexual abuse, had a high rate of severe mental illness and more symptom dimensions of thought and behavior problems. However, the rates of depressive disorders and emotional/internalizing symptoms were not more than those in the other two groups (recent stress and maltreatment groups) experiencing moderate levels of lifetime trauma. There was no significant difference between the recent stress and maltreatment groups for most symptom dimensions. CONCLUSIONS: The findings indicate that distinct symptom profiles may be associated with the pattern of negative experiences, suggesting that negative experiences need multidimensional investigation in clinical settings.

Preparation, characterization, and in vitro diffusion study of nonwoven electrospun nanofiber of curcumin-loaded cellulose acetate phthalate polymer.

Novel curcumin (CUR)-loaded cellulose acetate phthalate (CAP) nonwoven electrospun nanofiber (NF) transdermal mat was developed and evaluated for its in vitro CUR diffusion properties. Various CAP solutions from 5 to 20 wt% were tested; 17.5 wt% was found to be a suitable concentration for NF fabrication without defects, such as bubble or ribbon structures. The selected wt% CAP solution was loaded with CUR and electrospun into NFs. The prepared CUR-loaded NFs were characterized using scanning electron microscopy, X-ray diffraction, ultraviolet-visible spectroscopy, thermogravimetric analysis (TGA), and in vitro diffusion studies. The as-prepared fibers demonstrated controlled in vitro transdermal delivery of CUR for up to 24 h.

Decrease of serum total ghrelin in extensive atrophic gastritis: comparison with pepsinogens in histological reference.

OBJECTIVE: Ghrelin is mainly secreted by the gastric oxyntic mucosa and its production is impaired in chronic atrophic gastritis. This study aimed at evaluating how serum total ghrelin correlates with the extent of atrophy, and to compare its performance as a serologic marker with that of pepsinogen (PG). MATERIAL AND METHODS: Data were collected from 154 patients with atrophic gastritis. The histological extent of atrophy was assessed by three paired biopsies from the antrum, corpus lesser curvature (CLC), and corpus greater curvature (CGC). Fasting serum concentrations of total ghrelin, pepsinogen I and II were measured. Regression analysis was performed to evaluate the factors associated with serum total ghrelin. The serologic performance was compared with that of pepsinogen using receiver-operating characteristic (ROC) curves. RESULTS: The Helicobacter pylori infection rate was 85%, and extensive atrophic gastritis involving CGC was found in 24%. Serum total ghrelin was significantly decreased in patients with extensive CGC atrophy (median: 170.4 pg/mL, vs 201.1 pg/mL in patients without atrophy; p < 0.001), and its levels correlated with those of pepsinogen I and I/II ratio. The decrease of serum total ghrelin was independent of age, gender, body mass index (BMI), and H. pylori infection status. The sensitivity and specificity of serum total ghrelin in predicting extensive atrophy were 57% and 79%, respectively. The discriminatory ability was similar to that of pepsinogen I/II ratio (p = 0.612), and lower than that of pepsinogen I (p = 0.040). CONCLUSIONS: Serum total ghrelin is decreased during extensive atrophy involving CGC. The serologic performance is lower than that of pepsinogen I.

Coping and resilience of adolescents with congenital heart disease.

BACKGROUND: Congenital heart disease has come to be regarded as a chronic rather than terminal disease owing to dramatic advances in its medical and surgical management. Thus, it is salient for healthcare providers to help adolescents with congenital heart disease increase their resilience by using effective coping strategies. OBJECTIVES: The purpose of this study was to examine the relationship between resilience and task-oriented coping in Korean adolescents with congenital heart disease. METHOD: This descriptive and exploratory study was designed to explore the effectiveness of task-oriented coping for improving resilience in Korean adolescents with congenital heart disease. After approval of the institutional review board was obtained, 103 adolescents with congenital heart disease who had undergone a corrective operation or procedure for heart malformation were recruited from a congenital heart clinic between November 1, 2009, and February 28, 2010. We measured adolescents' coping strategies and resilience using the Coping Inventory for Stressful Situation and the Resilience Scale. RESULTS: Among these adolescents with congenital heart disease, resilience was significantly related to perceived economic status (P < .01), task-oriented coping (P < .01), and avoidance-oriented coping (P < 0.05). The R change of 0.30 in hierarchical linear regression analysis indicated that task-oriented coping increased the explanation of resilience by 30% (P < .001). Adolescents who used task-oriented coping reported the highest resilience compared with those who used other coping strategies. CONCLUSION: Task-oriented coping may be an effective means to increase resilience among Korean adolescents with congenital heart disease. Korean healthcare professionals and researchers should thus test programs to increase task-oriented coping, such as comprehensive education programs and support groups that encourage adolescents in the same situation to discuss issues of importance.

Determinants of health and mortality in undiagnosed diabetes: A nationally representative US adult, 2011-2020.

AIM: This study examines the determinants of health and mortality associated with undiagnosed diabetes among a nationally representative sample of US adults. METHODS: Data are from the National Health and Nutrition Examination Survey between 2011 and 2012 and 2019-2020. Diabetes status is categorized into three groups: undiagnosed diabetes, diagnosed diabetes, and no diabetes. Multiple logistic regression is used to estimate the association between undiagnosed diabetes and three domains of risk factors, including sociodemographic and health behavioral and clinical factors. Cox proportional hazards models are performed to compare excess mortality risk between the three groups. RESULTS: Young adults, racial minorities, the foreign-born, and individuals with limited access to health care are more likely to be unaware of their diabetes. Moreover, adults without a family history of diabetes and chronic conditions have a higher chance of undiagnosed diabetes. No health behavioral factors are found to be associated with undiagnosed diabetes. Adults with undiagnosed diabetes have a lower risk of all-cause and cardiovascular disease mortality compared to those with diagnosed diabetes, but a higher risk of all-cause mortality than those with no diabetes. CONCLUSION: Targeted public health approaches should address sociodemographic and clinical factors to reduce the burden of undiagnosed diabetes.

Evaluation and characteristic analysis of SSRs from the transcriptomic sequences of Perilla crop (Perilla frutescens L.).

Perilla crop is a self-fertilizing annual plant, cultivated and used mainly in East Asia. Perilla frutescens var. frutescens seeds are rich in unsaturated fatty acids, which have health benefits, and Perilla frutescens var. crispa leaves are rich in anthocyanins. However, genomic analysis such as whole genome sequencing or genetic mapping has not been performed on Perilla crop. This current study confirms the abundance and diversity of 15,991 simple sequence repeats (SSRs) classified in previous studies in the Perilla genome, selects and designs 1,538 SSR primer sets, and confirms which SSR primer sets exhibit high polymorphism. Of the 15,991 SSRs classified, there were 9,910 (62%) dinucleotide repeats, 5,652 (35.3%) trinucleotide repeats, and 429 (2.7%) tetranucleotide repeats. Among these, the most identified was (CT)n with a total of 4,817. The 15,991 SSRs had 4 to 26 repeats. Four repeats were the most frequent with 11,084 (69.3%). A total of 1,538 SSR primers were selected and designed to confirm polymorphism, of which 157 showed persistent and clear polymorphism. Among these 157 SSR primer sets, 98 (62.4%) were dinucleotide repeats, 39 (24.8%) were trinucleotide repeats, and 20 (12.7%) were tetranucleotide repeats. Among 549 SSR primers that showed polymorphism, trinucleotide repeats showed persistent polymorphism at a high rate. Therefore, when developing SSR primer sets for Perilla crop in the future, it is recommended that trinucleotide repeats be selected first. These research results will be helpful in future genomic analysis and development of SSR primers in Perilla crop.

Telomerase and telomere length in pulmonary fibrosis.

In addition to its expression in stem cells and many cancers, telomerase activity is transiently induced in murine bleomycin (BLM)-induced pulmonary fibrosis with increased levels of telomerase transcriptase (TERT) expression, which is essential for fibrosis. To extend these observations to human chronic fibrotic lung disease, we investigated the expression of telomerase activity in lung fibroblasts from patients with interstitial lung diseases (ILDs), including idiopathic pulmonary fibrosis (IPF). The results showed that telomerase activity was induced in more than 66% of IPF lung fibroblast samples, in comparison with less than 29% from control samples, some of which were obtained from lung cancer resections. Less than 4% of the human IPF lung fibroblast samples exhibited shortened telomeres, whereas less than 6% of peripheral blood leukocyte samples from patients with IPF or hypersensitivity pneumonitis demonstrated shortened telomeres. Moreover, shortened telomeres in late-generation telomerase RNA component knockout mice did not exert a significant effect on BLM-induced pulmonary fibrosis. In contrast, TERT knockout mice exhibited deficient fibrosis that was independent of telomere length. Finally, TERT expression was up-regulated by a histone deacetylase inhibitor, while the induction of TERT in lung fibroblasts was associated with the binding of acetylated histone H3K9 to the TERT promoter region. These findings indicate that significant telomerase induction was evident in fibroblasts from fibrotic murine lungs and a majority of IPF lung samples, whereas telomere shortening was not a common finding in the human blood and lung fibroblast samples. Notably, the animal studies indicated that the pathogenesis of pulmonary fibrosis was independent of telomere length.

The effect of P2X7 receptor activation on nuclear factor-κB phosphorylation induced by status epilepticus in the rat hippocampus.

Nuclear factor-kappa B (NFκB) signal is essential for neuronal survival and its activation may protect neuron against various stimuli. Since purinergic signals activate NFκB through the P2X7 receptor, we investigated the distinct pattern of NF-κB phosphorylation in neurons by P2X7 receptor activation following status epilepticus (SE) in an effort to understand the role of P2X7 receptor in epileptogenic insult. In non-SE animals, 2'(3')-O-(4-benzoyl)benzoyl adenosine 5'-triphosphate (BzATP, a P2X7R agonist) treatment increased only p52-Ser869 NF-κB phosphorylation in neuron. Following SE, p52-Ser865, p52-Ser869, p65-Ser276, p65-Ser311, p65-Ser468, and p65-Ser529 NF-κB phosphorylation was significantly decreased in CA1 and CA3 neurons. However, BzATP treatment prevented reductions in p65-Ser276, p65-Ser311, p65-Ser529, and p52-Ser869 NF-κB phosphorylations in CA1 and/or CA3 neurons induced by SE. Furthermore, BzATP treatment reduced SE-induced p65-Ser311, p65-Ser468, p65-Ser536, and p52-Ser869 NF-κB phosphorylations in astrocytes. These findings indicate that P2X7 functions may be involved in the regulation of SE-induced reactive astrocytes and neuronal degeneration via NF-κB phosphorylations in response to pilocarpine-induced SE in the rat hippocampus.

Inhibition of p53 transcriptional activity by human cytomegalovirus UL44.

Human cytomegalovirus (HCMV) stimulates cellular synthesis of DNA and proteins and induces transition of the cell cycle from G(1) to S and G(2) /M phase, in spite of increased amounts of p53 in the infected cells. The immediate early protein IE2-86  kDa (IE86) tethers a transcriptional repression domain to p53; however, its repression of p53 function is not enough to abrogate the G(1) checkpoint function of p53. Other HCMV proteins that suppress the activity of p53 were investigated in this study. Of the HCMV proteins that bind to p53 when assessed by immunoprecipitation and immunoblot analysis, HCMV UL44 was chosen as a candidate protein. It was found that reporter gene containing p53 consensus sequence was activated by transfection with wild type p53, but when plasmids of p53 with IE86 or UL44 were co-transfected, p53 transcriptional activity was decreased to 3-7% of the p53 control in a dose-dependent manner. When the deletion mutant of UL44 was co-transected with p53, the carboxyl one-third portion of UL44 had little effect on inhibition of p53 transcriptional activity. The amount of mRNA p21 was measured in H1299 by real time PCR after transfection of the combination of p53 and UL44 vectors and it was found that p21 transcription by p53 was inhibited dose-dependently by UL44. Increased G0/G1 and decreased S phases in p53 wild type-transfected H1299 cells were recovered to the level of p53 mutant type-transfected ones by the additional transfection of UL44 in a dose-dependent manner. In conclusion, the transcriptional activity of p53 is suppressed by UL44 as well as by IE86.

Factors Affecting Professional Self-Concept among Psychiatric Nurses in South Korea.

Background: We aimed to investigate factors affecting ego-resilience, emotional labor, and job satisfaction and their relationship with professional self-concept among psychiatric nurses. Methods: The study was conducted among nurses working in four psychiatric wards: Sung Eun Medical Foundation Reference Hospital (Medical Corporation) in Jeongeup City, Korea; Dasarang Hospital in Gwangju, Korea; Saemirae Hospital in Gwangju (metropolitan city), Korea; and Jangseong Hospital in Jangseong-eup City, Korea. All nurses fully understood the purpose of the study and voluntarily agreed to participate. From August 14 to September 24, 2020, direct survey data were collected by a researcher using a structured questionnaire. Of the 136 questionnaires retrieved, 129 were used for analysis, while 7 were excluded due to incomplete or missing responses. Results: Significantly different effects on professional self-concept were noted for the following general characteristics: age (P<0.001), religion (P=0.024), duration of nursing career (P=0.041), position (P=0.021), salary (P=0.016), nursing job satisfaction (P=0.022), and psychiatric nursing job satisfaction (P=0.010). Moreover, professional self-concept was correlated with ego-resilience (r=0.62, P<0.001) and job satisfaction (r=0.41, P<0.001). In the multiple regression analysis, factors affecting professional self-concept included no religious preference (ß=0.25, P<0.001), employment as a charge nurse (ß= -0.20, P=0.034), and ego-resilience (ß=0.58, P<0.001). The explanatory power was 42.1%. Conclusion: Ego-resilience is the factor most strongly influencing professional self-concept. Furthermore, professional self-concept was stronger among those without religious preferences and those who held senior positions (charge nurse).

Assessment of Device Neoendothelialization With Cardiac Computed Tomography Angiography After Transcatheter Closure of Atrial Septal Defect.

BACKGROUND: Although the transcatheter closure of atrial septal defect was established as the treatment of choice several decades ago, the process of device neoendothelialization (NE) in humans is not well understood. We aimed to measure the extent of device NE using cardiac computed tomography angiography and analyze its risk factors. METHODS: Between January 2005 and February 2021, we retrospectively reviewed 164 devices of 112 patients on cardiac computed tomography angiography. We investigated device shape, contrast opacification within the device that differentiated device NE, and device-related thrombosis or vegetation. Risk factor analysis for major adverse cardiovascular events and incomplete NE according to the postprocedural period was performed. RESULTS: Seventy patients (62.5%) were women, with a median (range) age at the time of device closure of 44.5 (0.6-79.2) years. The mean (±SD) defect size was 16.6 (±7.8) mm, and patients were followed for 35.9±33.9 months. After 6 months of device implantation, 35% of the devices (42/120) had incomplete NE. The intensity of intradevice opacification shifted from complete to partial or nonopacification over time (P<0.001), and a similar pattern was observed in the shunt flow (P<0.001). The bulkiness of devices also decreased in proportion to the postprocedural period (P<0.001). Risk analysis revealed device diameter (hazard ratio, 1.18 [95% CI, 1.04-1.27]; P<0.001) as the only significant factor of incomplete NE and major adverse events. CONCLUSIONS: Incomplete NE of atrial septal defect devices was identified on cardiac computed tomography angiography in significant numbers after 6 months of the procedure. The device diameter was related to incomplete NE and major adverse events. Further prospective and multicenter studies are warranted to validate this new assessment of device NE.

Asbestosis diagnosis algorithm combining the lung segmentation method and deep learning model in computed tomography image.

BACKGROUND: Early detection of asbestosis is important; hence, quick and accurate diagnostic tools are essential. This study aimed to develop an algorithm that combines lung segmentation and deep learning models that can be utilized as a clinical decision support system (CDSS) for diagnosing patients with asbestosis in segmented computed tomography (CT) images. METHODS: We accurately segmented the lungs in CT images of patients examined at Seoul St. Mary's Hospital using a threshold-based method. Lungs with asbestosis and normal lungs were classified by applying the segmented image to the long-term recurrent convolutional network deep learning model. Performance was evaluated using the area under the receiver operating characteristic curve (AUROC) and F1 score from the test data. RESULTS: The algorithm developed using the DenseNet201pre-trained model showed excellent performance, with a sensitivity of 0.962, specificity of 0.975, accuracy of 0.970, AUROC of 0.968, and F1 score of 0.961. CONCLUSIONS: We developed an algorithm with significantly better diagnostic accuracy than a radiologist (0.970 vs. 0.73-0.79). Our developed algorithm is expected to be an excellent support tool if used as a CDSS to diagnose asbestosis using CT images.

Dyslipidemia Is Associated With Increased Risk of Achilles Tendon Disorders in Underweight Individuals to a Greater Extent Than Obese Individuals: A Nationwide, Population-Based, Longitudinal Cohort Study.

BACKGROUND: The association between dyslipidemia and Achilles tendinopathy (AT) or Achilles tendon rupture (ATR) remains controversial, although some studies have examined this topic. PURPOSE: To evaluate the correlation of dyslipidemia and the risk of AT or ATR, and its association with body mass index (BMI), by assessing data from a nationwide population-based cohort. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We used the National Health Insurance database, which includes the entire population of the Republic of Korea, to evaluate participants in the National Health Screening Program between January 2009 and December 2010. Participants diagnosed with AT or ATR before December 31, 2017, were selected. The variables assessed were age, sex, frequency of high-intensity exercise per week, BMI, waist circumference, systolic blood pressure, and levels of low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and fasting blood glucose. Multivariate Cox proportional hazards regression was used for data analysis. RESULTS: A total of 16,830,532 participants were included. Of these, 125,814 and 31,424 participants developed AT and ATR, respectively. A higher level of LDL-C was associated with an increased risk of AT (adjusted hazard ratio [HR], 1.16) and ATR (adjusted HR, 1.18). A slightly increased risk of AT was observed in participants with higher TG levels (adjusted HR, 1.03), whereas higher HDL-C level was associated with a slight risk reduction for AT (adjusted HR, 0.95). However, no significant association was observed between higher TG or HDL-C levels and ATR. In the underweight group (BMI <18.5 kg/m2), a higher LDL-C level was associated with an increased risk of AT and ATR by 37% and 116%, respectively, compared with lower LDL-C. Higher LDL-C level was associated with an increased risk of AT and ATR by 10% and 16%, respectively, in the obese group (BMI ≥25 kg/m2). CONCLUSION: Dyslipidemia was related to the development of AT and ATR. The association of higher LDL-C levels with AT and ATR risk was more pronounced in underweight than in overweight and obese individuals.

Vasorelaxant effects of 50 commonly used traditional herbal prescriptions on isolated rat aortic rings.

OBJECTIVE: To investigate the vasorelaxant activities of 50 common traditional herbal prescriptions (THPs) on isolated rat aortic rings. METHODS: An electric extractor was used to extract THPs. Rat aortic rings were precontracted using phenylephrine in organ chambers containing Krebs-Henseleit solution. Decoctions of THPs were added in increasing concentrations (10-1000 µg/mL) to investigate vasorelaxant activities. The vasorelaxant effects of THPs were calculated as percentage of contraction in response to phenylephrine. RESULTS: Several THPs such as Tianwangbuxin Dan, Banxiaxiexin Tang, and Mahuang Tang, significantly relaxed precontracted aortic rings. In contrast, Xiaochaihu Tang, Shensuyin, and Guizhifuling Wan significantly contracted aortic rings. Furthermore, these THPs increasingly relaxed or contracted aortic rings relaxed by amlodipine. CONCLUSION: Our findings suggest that hypertension can be treated using THPs. However some THPs can counteract treatment of hypertension. Further studies should be developed on use of THPs for treatment of hypertension are critical, and guidelines for use of traditional herbal medicines to treat hypertension.

Effects of Critical Thinking Disposition, Digital Literacy, and Nursing Informatics Competence on the Competency in Evidence-Based Practice among Clinical Nurses / 임상간호연구

Purpose@#This study aimed to investigate the competency in evidence-based practice, critical thinking disposition, digital literacy, and nursing informatics competence, and to identify the factors influencing the competency in evidence-based practice among nurses. @*Methods@#The participants in this study were 196 nurses from a university hospital in J-city. Data were collected from December 1 to December 30, 2023. The collected data were analyzed with the SPSS 26.0 program using descriptive statistics, independent t-test, one-way analysis of variance, Scheffé test, Pearson's correlation coefficients, and multiple regression analysis. @*Results@#The results showed that the factors influencing the competency in evidence-based practice included nursing informatics competence, critical thinking disposition, digital literacy, and having a master's degree. The participants with a master's degree demonstrated higher competency in evidence-based practice compared to those with a three-year degree or a four-year degree, and a total explanatory power was 53.1%. @*Conclusion@#In this study, critical thinking disposition, digital literacy, and nursing informatics competence were influential factors in competency of evidence-based practice. Therefore, a variety of intervention programs should be developed to enhance the impact of these factors on nurses’ competency in evidence-based practice.

The unexpected complications of the left bundle branch area pacing (LBBAP) maneuver:a case report

Background@#The lead of left bundle branch area pacing (LBBAP) inserted into the muscular septum will make the transvenous lead extraction (TLE) of LBBAP more challenging and because in LBBAP ventricular lead (V lead) should be inserted into the part of the septum, damage to the vessel near the lead could occur. The case reports introduced the complications of LBBAP previously introduced, but not being considered in detail.Case presentation The two patients (76-year-old man, 90-year-old man) with a complete atrioventricular block (CAVB) undergoing the LBBAP procedure experienced complications related to the procedure. The complications were abrupt dysfunction of V lead and damage to the septal vein in the process of the procedure, respectively. Fortu‑ nately, they were discharged without any other complications. @*Conclusions@#A deliberate approach for the procedure would be needed as well as successful insertion appropriate for the protocol of LBBAP. And long-term follow-up of complications should be needed.

Effect of an Intervention Using Voice Recording of a Family Member on Patients Undergoing Mechanical Ventilator Weaning Process

Purpose@#This study aimed to determine the impact of an intervention using voice recording of family members on pain, anxiety, and agitation in patients undergoing weaning from mechanical ventilation. @*Methods@#A randomized control pre-post experimental design was implemented to 53 participants, with 27 and 26 participants in the experimental and control groups, respectively. A 70-second voice recording of a family member, repeated three times at 10-minute intervals was used as an intervention for the experimental group. Meanwhile, participants in the control group used headset for 30 minutes. Structured instruments were utilized to measure pain, anxiety, agitation, and the weaning process. Wilcoxon Signed Ranks test and the Mann-Whitney U test, or χ2 test, were used for data analysis. @*Results@#The experimental group exhibited significant decrease in pain (Z = - 3.53, p < .001), anxiety (t = 5.45, p < .001), and agitation (Z = - 2.99, p = .003) scores compared with those of the control group. However, there was no significant difference between groups in the weaning process’ simplification (χ2 = 0.63, p = .727). @*Conclusion@#Intervention using family members’ voice recording effectively reduces pain, anxiety, and agitation in patients undergoing weaning from mechanical ventilation. This can be actively utilized to provide a more comfortable process for patients.

Atraumatic Sport-Related Medial Sesamoid Pain:Conservative Treatment Outcome and Magnetic Resonance Imaging Features

Background@#This study aimed to evaluate the effectiveness of conservative treatment in selected patients with atraumatic medial sesamoid pain (MSP) that developed during sports activities. The secondary aim was to determine the detailed underlying pathology in patients who did not respond to conservative treatment using magnetic resonance imaging (MRI). @*Methods@#From March 2015 to August 2022, we prospectively followed 27 patients who presented to our outpatient clinic with atraumatic sports-related MSP. The conservative treatment protocol for MSP included the use of oral analgesics, activity restriction, insole modification, local corticosteroid injections, and boot walker application with crutches. MRI was performed for all patients who experienced persistent pain despite the completion of conservative treatment. @*Results@#After the completion of the conservative treatment protocol, 48.1% of the patients reported a reduction in pain. Patients with younger age at pain onset (p = 0.001), higher body mass index (p = 0.001), and a bipartite medial sesamoid (p = 0.010) were more likely to experience persistent pain after conservative treatment. The type of sports activity was also a factor since runningand dancing-related MSP tended to respond better to conservative treatment compared to MSP originating from golf, futsal, and weightlifting with squatting. On MRI, 42.8% of patients showed no specific abnormal findings, with signal changes in soft tissues such as the subcutaneous fat and bursa being the most common, followed by intraosseous signal changes of the medial sesamoid bone and chondral or subchondral lesions of the medial sesamoid metatarsal joint (28.6% each). @*Conclusions@#Conservative treatment was successful in less than half of the patients who experienced MSP due to sports activity. Practitioners should be aware of the numerous possible causes of conservative treatment failure, such as bursitis, medial sesamoiditis, stress fracture, or chondral lesions between the medial sesamoid and metatarsal. MRI evaluation may be helpful in MSP patients who do not respond to conservative treatment.