Development and validation of a quality of healthy work environment instrument for shift nurses.

BACKGROUND: As the importance of a healthy work environment for nurses' good practice and patient safety has been recognized, there is a need to assess nurses' perceptions of the quality of a healthy work environment. METHODS: A conceptual framework and construct components were extracted through a literature review and in-depth interviews with shift nurses. The initial items of the instrument were developed according to the conceptual attributes, and the items were selected through content validity by ten experts. Two hundred and forty-seven shift nurses participated in this study through face-to-face surveys to test the reliability and validity of the instrument. The evaluation was used for item and confirmatory factor analyses to assess the criterion-related validity and internal consistency of the instrument. Test-retest reliability was analyzed using data from thirty-two nurses. RESULTS: The final instrument consisted of 23 items with five components identified through confirmatory factor analysis. Criterion-related validity was established using the K-PES-NWI (r = .54). Cronbach's alpha for the total items was 0.85, and test-retest reliability was 0.73. CONCLUSION: The quality of the healthy work environment instrument developed in this study was considered reliable and valid. The instrument developed in this study can be used to measure the quality of a healthy work environment as perceived by shift nurses and to identify preventive measures needed to improve the quality of the work environment.

Assessment of EGFR mutation status using cell-free DNA from bronchoalveolar lavage fluid.

BACKGROUND: Much attention has been focused on epidermal growth factor receptor (EGFR) mutation testing since the introduction of EGFR-tyrosine kinase inhibitors have improved survival in EGFR-positive lung cancer patients. Liquid biopsy using circulating tumor cells or cell-free DNA (cfDNA) has enabled less invasive testing, but requires a highly sensitive method. To date, liquid biopsy using bronchoalveolar lavage (BAL) fluid has rarely been used. METHODS: From 20 patients with lung adenocarcinoma, we isolated cfDNA from 20 samples of cell-free BAL fluid and 19 cell-free bronchial washing samples. cfDNA was examined for EGFR mutations using peptide nucleic acid (PNA)-mediated PCR clamping method. In cases where the results from the tumor biopsy and BAL-derived cfDNA test were not consistent, PANAMutyper™ R EGFR kit was used along with PNA clamping-assisted fluorescence melting curve analysis. RESULTS: We included 17 patients with advanced stage disease and three with non-advanced stage disease. Tumor biopsy detected EGFR mutations in 12 of the patients. One patient had a p.L858R mutation and a de novo p.T790M mutation. The results from PNA-mediated PCR clamping were 75.0% (9/12) concordant with the tumor biopsy results for EGFR mutation status. PANAMutyper with fluorescence melting curve analysis was performed in three cases, which detected EGFR mutations in two more patients (11/12, 91.7%). EGFR mutations were detected in the cfDNA extracted from two bronchial washing samples. CONCLUSIONS: cfDNA from BAL fluid could be used for molecular testing of EGFR mutations and identification of p.T790M mutations, with an easily applicable method.

Mediating effects of patient safety perception and willingness to participate in patient safety on the relationship between health literacy and patient participation behavior among inpatients.

Introduction: In recent years, patient safety activities have shifted from being centered on healthcare providers to involving patients themselves. Health literacy of inpatients has a direct impact on patient participation behavior. Patient safety perception was also associated with willingness to participate in patient safety and patient participation behavior. Therefore, this study aimed to investigate the mediating effects of patient safety perception and willingness to participate in patient safety on the relationship between health literacy and patient participation behavior among inpatients. Methods: This cross-sectional study was conducted to confirm the relationship between study variables. A total of 262 inpatients were recruited from patients admitted to the ward of a tertiary general hospital between October and November 2023. Participants were invited to complete self-reported questionnaires that measured health literacy, patient safety perception, willingness to participate in patient safety, patient participation behavior, and demographic information. Data were analyzed using a dual mediation model applying the PROCESS macro (Model 6) with 95% bias-corrected bootstrap confidence intervals. Results: This study analyzed the direct effects of health literacy on patient safety perceptions and patient participation behavior. Health literacy indirectly affected patient participation behavior through patient safety perceptions and willingness to participate in patient safety. Regarding the relationship between health literacy and patient participation behavior, patient safety perceptions and willingness to participate in patient safety showed a significant dual mediating effect. Conclusions: This study identified the factors that promote patient participation behavior among inpatients. The mediating effect of patient safety perception on the relationship between health literacy and patient participation behavior was found to be strong. Building health literacy among inpatients ensures patient safety by increasing patient safety perceptions.

Influence of patient safety perception and attitude on inpatients' willingness to participate in patient safety: An observation study.

Patient safety (PS) in clinical settings focuses primarily on ensuring active patient participation. However, there is limited understanding of patients' willingness to participate. This study aimed to investigate the association between PS perception, attitude, and inpatients' willingness to participate in PS. This cross-sectional study was conducted with 295 inpatients admitted to a tertiary hospital in South Korea between May and July 2023. Structured questionnaires were used to collect the data. The collected data were subjected to various analytical techniques including descriptive statistics, t tests, Pearson correlation analysis, and multiple regression analysis. Willingness to participate in PS of inpatients showed a statistically significant difference in PS education experience (t = -2.69, P = .008). There was a significant positive correlation between PS perception and attitude (r = .54, P < .001). Additionally, willingness to participate in PS had significant positive correlations with PS perception (r = .62, P < .001) and PS attitude (r = .48, P < .001). The factors influencing willingness to participate in PS were PS perception (ß = .51, P < .001) and attitude (ß = .20, P < .001). Based on these research findings, it is important to provide inpatients with education and campaigns to improve their perceptions and attitudes toward PS. In addition, it is essential to develop programs that encourage and support patient engagement in PS in hospitals. These efforts will promote active implementation of PS activities by inpatients in clinical settings.

Experiences of Patient Safety Education and Factors Affecting the Willingness to Participate in Patient Safety in Undergraduate Nursing Students in South Korea.

Patient safety (PS) education must be provided to medical personnel who deal with life and death situations. This study aimed to examine the current state of PS education and to investigate the factors affecting the willingness of undergraduate nursing students to participate in PS. This study was a cross-sectional descriptive correlational survey. In this study, an online survey targeting members of an online café in South Korea that prepares nursing students was conducted from 19-21 April 2023. In total, 296 undergraduate nursing students in their fourth grade at 132 nursing colleges across the country participated. The results showed that 94.6% (280 students) had experience in PS education and 45.6% (135 students) had witnessed a PS incident in clinical practice. Most students (90.9%) responded that PS education was necessary and that 'clinical practice at the hospital' was the most effective method of PS education. PS perception increased as PS knowledge increased, and it was confirmed that an increase in PS perception increased the willingness to participate in PS. Factors that increased nursing students' willingness to participate in PS were high satisfaction with clinical practice, high PS education needs, and high PS perception scores. To increase nursing students' willingness to participate in PS, it is important to improve their PS perception and ensure that they have a variety of PS education experiences, which requires the development of a standardized PS education program.

Mediating Effect of Quality of Sleep Moderated by Meaning in Life on the Relationship between Hwabyung and Suicidal Ideation in Middle-Aged Korean Women.

The purpose of this study was to determine the role of the quality of sleep and meaning in life in the process by which Hwabyung symptoms affect suicidal ideation in middle-aged Korean women. A total of 265 women aged 40-65 years were enrolled in an online survey. The study variables were measured using the Hwabyung, quality of sleep, meaning in life, and suicidal ideation scales. The data were analyzed using the PROCESS Procedure for SPSS Release 3.5 (Model 14) program with a 95% bias-corrected bootstrap confidence interval. Hwabyung symptoms in middle-aged women had a significant direct effect on suicidal ideation, and an indirect effect through the quality of sleep was also statistically significant. Meaning in life was found to significantly moderate the indirect effect of Hwabyung on suicidal ideation through the quality of sleep. In other words, the greater the meaning in life, the weaker the effect of Hwabyung on suicidal ideation through the quality of sleep. The Hwabyung of middle-aged women caused a psychological crisis and was a great threat to physical health by lowering the quality of sleep. The low quality of sleep and the increase in suicidal ideation due to Hwabyung pose a great threat to the survival of middle-aged women. It was found that it is very important to find meaning in one's life as an effective way to reduce suicidal ideation in middle-aged women.

Effects of Nursing Work Environment, Need Satisfaction, and Depression on Turnover Intention in Korea.

This study examined the effects of the nursing work environment, need satisfaction, and depression on turnover intention in South Korean nurses through a mediating model. This study was a descriptive cross-sectional research study and was conducted through an online questionnaire. A total of 248 nurses were recruited for this study. Data were collected in August 2022. Participants were invited to complete self-reported questionnaires that measure nursing work environment, need satisfaction, depression, turnover intention, and demographic information. The data obtained were analyzed using the dual mediation model applying the PROCESS macro (Model 6). This study analyzed the direct effects of the nursing work environment on need satisfaction, depression, and turnover intention. The nursing work environment also had indirect effects on their turnover intention via need satisfaction and depression. The mediating effect of need satisfaction, which affects the turnover intention by increasing the satisfaction of the nursing work environment, was found to be the greatest. It has been shown that the more positive a nurse's experience of the nursing work environment, the higher the nurse's need satisfaction. According to the study results, the increase in nurses' need satisfaction greatly contributes to the decrease in depression and turnover intention. Therefore, active efforts should be made to improve the nursing work environment to fulfill basic needs.

Matrigel-based sprouting endothelial cell culture system from mouse corpus cavernosum is potentially useful for the study of endothelial and erectile dysfunction related to high-glucose exposure.

INTRODUCTION: A proper cavernous endothelial cell culture system would be advantageous for the study of the pathophysiologic mechanisms involved in endothelial dysfunction and erectile dysfunction (ED). AIM: To establish a nonenzymatic technique, which we termed the "Matrigel-based sprouting endothelial cell culture system," for the isolation of mouse cavernous endothelial cells (MCECs) and an in vitro model that mimics in vivo situation for diabetes-induced ED. METHODS: For primary MCEC culture, mouse cavernous tissue was implanted into Matrigel and sprouting cells from the tissue were subcultivated. To establish an in vitro model for diabetes-induced ED, the primary cultured MCECs were exposed to a normal-glucose (5 mmoL) or a high-glucose (30 mmoL) condition for 48 hours. MAIN OUTCOME MEASURES: The purity of isolated cells was determined by fluorescence-activated cell sorting analysis. MCECs incubated under the normal- or the high-glucose condition were used for Western blot, cyclic guanosine monophosphate (cGMP) quantification, and in vitro angiogenesis assay. RESULTS: We could consistently isolate high-purity MCECs (about 97%) with the Matrigel-based sprouting endothelial cell culture system. MCECs were subcultured up to the fifth passage and no significant changes were noted in endothelial cell morphology or purity. The phosphorylation of Akt and eNOS and the cGMP concentration were significantly lower in MCECs exposed to high glucose than in those exposed to normal glucose. MCECs exposed to the normal-glucose condition formed well-organized capillary-like structures, whereas derangements in tube formation were noted in MCECs exposed to high glucose. The protein expression of transforming growth factor-ß1 (TGF-ß1) and phospho-Smad2 was significantly increased by exposure to high glucose. CONCLUSION: The Matrigel-based sprouting endothelial cell culture system is a simple, technically feasible, and reproducible technique for isolating pure cavernous endothelial cells in mice. An in vitro model for diabetic ED will be a valuable tool for evaluating the angiogenic potential of novel endogenous or synthetic modulators.

A before- and after-intervention trial for reducing unexpected events during the intrahospital transport of emergency patients.

BACKGROUND: This study was aimed to explore the effect of intervention in safe intrahospital transport on the incidence of unexpected events (UEs) occurring during the transport of emergency patients. METHODS: This study was performed in an urban tertiary teaching hospital emergency department (ED) from May 17 to October 30, 2010. Patients older than 15 years who were transported to general wards; intensive care units; and magnetic resonance imaging, intervention, or operation rooms were enrolled. Demographics and data on all UEs related to the devices, clinical situations, and tubes or lines were measured by registered nurses at pre- and postintervention period. The intervention was that acting nurses were required to use a designed transport checklists before the patients were transported. Primary outcomes were the rate of all and serious UEs during the pre- and postintervention periods. Serious UEs were defined as any worsening of a patient's clinical status. Statistical values were measured with 95% confidence intervals (CIs) and compared using Student t tests or χ(2) tests. RESULTS: In total, there were 680 transports before interventions and 605 transports after interventions. Overall, UEs decreased significantly from a value of 36.8% (95% CI, 33.1-40.5) in the preintervention period to a value of 22.1% (95% CI, 18.9-25.7) in the postintervention period (P = .001). Serious UEs in clinical status also decreased significantly from 9.1% (95% CI, 7.1-11.5) in the preintervention period to a value of 5.2% (95% CI, 3.6-7.4) in the postintervention period (P = .005). CONCLUSION: A significant reduction in the rate of total and serious UEs during intrahospital transport from the ED was found through using transport checklists.

Associations between Fear of COVID-19, Depression, and Internet Addiction in South Korean Adults.

This study investigates the associations between Internet addiction and psychological distress, including fear of coronavirus disease 2019 (COVID-19), and depression in South Korean adults during the COVID-19 pandemic. A population-based cross-sectional online survey was conducted from 14 to 18 May 2021. Potential adult survey respondents aged 20 years or older were randomly extracted from one of the largest online survey panels in South Korea, matching the South Korean national demographic proportions (i.e., region, gender, and age). Subsequently, 1155 participants were included in the study. Descriptive and logistic regression analyses were performed to investigate the participants' characteristics and analyze the adjusted odds ratios (aORs). Of the South Korean adults, 11.17%, 15.15%, and 37.23% were at risk of Internet addiction, COVID-19 fear, and depression, respectively. Internet addiction was positively associated with COVID-19 fear (aOR = 3.25, 95% CI [2.10, 5.04]) and depressive symptoms (aOR = 6.40, 95% CI [4.15, 9.86]). Addictive Internet use was significantly associated with psychological distress during the COVID-19 pandemic. The development of public health strategies that mitigate addictive Internet use and increase eHealth literacy will be useful for securing the public's psychological well-being.

Physiochemical Properties of Chicken Breast Sausage with Red Ginseng Marc Powder.

This study explored the physiochemical and rheological properties of chicken breast sausages containing red ginseng marc (RGM) which contains useful components but is discarded. When compared to the control group, the use of RGM significantly increased the water holding capacity (WHC) as the particle size increased. As for the change in color value, addition of RGM resulted in an increase in a and b values; as the quantity was increased and particle size decreased, the a and b values increased significantly. The smaller the particle size of RGM, the greater was the radical scavenging activity. According to the results of the measurement of the viscoelasticity of chicken breast sausage containing RGM, the G' and G'' values increased with increasing amounts of RGM and particle size. Neither the addition of RGM nor its amount or particle size had any significant effect on gel formation temperature. The texture profile analysis (TPA) experiment examined the average TPA measurements of each sample under different measurement conditions, and no significant difference between the RGM and control groups were observed. In conclusion, when RGM is used in chicken breast sausages, the WHC, antioxidant capacity, and viscoelastic properties are affected. RGM can possibly be utilized in high value-added processed meat products if its quantity and particle size are altered based on product characteristics.

Smoking Awareness and Intention to Quit Smoking in Smoking Female Workers: Secondary Data Analysis.

Although the smoking rate among women has been continuously increasing recently, it is very difficult to explore the actual situation because of negative social views. This study aimed to analyze the effects of smoking awareness and living environment on the intention to quit smoking among female smokers. After receiving approval from the Research Ethics Committee in September 2021, secondary data analysis was performed for this study. A total of 378 working women who smoked were included in this study. The mean age was 34.4 years. The results showed that women living alone had significantly lower intentions to quit smoking, and women with experience in smoking cessation education had significantly higher intentions to quit smoking. In addition, it was found that the group having awareness of smoking cessation policy and smoking cessation treatment had high intention to quit smoking. As a result of the analysis of decision trees using data mining techniques, the strongest predictor of the intention of female workers who smoke to quit smoking was their perception of smoking cessation policies. In addition, it was found that the state's policy support was important in that the group with the highest intention to quit smoking was the one with high awareness of both the smoking cessation policy and smoking cessation treatment. Finally, the risk group with the lowest intention to quit smoking was the group with low awareness of the anti-smoking policy, living alone, and having low awareness of the harmfulness of cigarettes. The importance of establishing policies for this vulnerable group, smoking cessation policies and treatment of female smokers, and improving awareness of the harmful effects of tobacco are discussed.

Effects of Health Belief, Knowledge, and Attitude toward COVID-19 on Prevention Behavior in Health College Students.

This study aimed to identify the factors affecting the practice of COVID-19 prevention behaviors among college students as future medical workers. A cross-sectional online survey was conducted in September 2021. A total of 526 health college students were included in this study. A hierarchical regression analysis was performed to examine the effect on the practice of COVID-19 prevention behavior. As a result of the analysis, experiences of education on infectious diseases had significant positive effects on the practice of prevention behavior (ß = 0.22, p < 0.001). Additionally, a higher COVID-19 health belief had a significant positive effect on the practice of prevention behavior (ß = 0.15, p = 0.004). Increased smoking and drinking among lifestyle changes after COVID-19 had significant negative effects on the practice of prevention behavior compared with decreased physical activity (ß = -0.12, p = 0.007). Based on these findings, the study discussed the importance of education on the prevention of infectious diseases among health college students, promotion of health beliefs related to infectious diseases, and formation of healthy lifestyle habits in daily life.

Increased cavernous expression of transforming growth factor-ß1 and activation of the Smad signaling pathway affects erectile dysfunction in men with spinal cord injury.

INTRODUCTION: Transforming growth factor-ß1 (TGF-ß1) is implicated in bladder fibrosis after spinal cord injury (SCI) and in the fibrosis in the corpus cavernosum tissue after cavernous nerve injury. AIM: We investigated the differential expression of TGF-ß1 and the Smad transcription factor, the key molecule for the initiation of TGF-ß-mediated fibrosis, in cavernous tissue from SCI patients. METHODS: After obtaining informed consent and approval from the patients and our institutional review board, we enrolled 5 patients with psychogenic erectile dysfunction (ED) (mean age 36.8 years; range 20-50 years) and 10 patients with neurogenic ED from SCI (mean age 38.8 years; range 18-50 years). Cavernous tissues were obtained by percutaneous biopsy and stained with Masson trichrome, terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL), or antibodies to TGF-ß1 and phospho-Smad2. MAIN OUTCOME MEASURES: Semi-quantitative analysis of TGF-ß1 and phospho-Smad2 was performed, and the numbers of apoptotic cells were counted. We also quantified the cavernous collagen area with the use of an image analyzer system. RESULTS: The expression of TGF-ß1 and phospho-Smad2 protein was significantly higher in the SCI group than in the psychogenic group. The TUNEL assay revealed a higher apoptotic index in the SCI group than in the psychogenic group. Higher TGF-ß1 and phospho-Smad2 expression and more apoptotic cells were noted mainly in endothelial cells, smooth muscle cells, and fibroblasts of the SCI group. Double labeling of cavernous tissue with TUNEL and antibody to phospho-Smad2 revealed that most TUNEL-positive cells showed immunoreactivity to phospho-Smad2 staining. Cavernous collagen content was significantly greater in the SCI group than in the psychogenic group. CONCLUSION: Upregulation of TGF-ß1 and activation of the Smad signaling pathway may play important roles in SCI-induced cavernous fibrosis and deterioration of erectile function, which warrants early pharmacological intervention to protect erectile tissue from irreversible damage.

Variation in Significant Difference of Sausage Textural Parameters Measured by Texture Profile Analysis (TPA) under Changing Measurement Conditions.

This study examined the measurement conditions of the texture profile analysis (TPA) experiments that are typically used to measure the physical properties of sausage. As the measurement conditions (compression ratio and cross-head speed) were changed, the significant differences between the values of textural parameters (hardness, adhesiveness, springiness, cohesiveness, chewiness) of samples changed. Furthermore, among the measurement conditions, there was more variation in the significant difference between the value of samples due to a change in the compression ratio than due to a change in the cross-head speed. The highest variation in significant difference was observed between the values of cohesiveness of samples due to changes in measurement conditions, whereas the lowest variation in significant difference was observed between the values of springiness of samples due to change in measurement conditions. Therefore, it is desirable to provide a clear basis for setting specific measurement conditions for TPA test, since significant differences in the values of textural parameters of samples were caused by differences in cross-head speed or compression ratio, not by a difference in samples, when analyzing the cohesiveness of sausage, especially.

Development and Effectiveness of a Patient Safety Education Program for Inpatients.

BACKGROUND: Patient safety is considered an important issue in the field of healthcare, and most advanced countries. PURPOSE: This study was designed to evaluate a patient safety education program among hospitalized patients. Of the 69 participants, 33 completed the patient safety education program while the 36 remaining participants were given educational booklets. The program was used to measure knowledge about patient safety, patient safety perception, and willingness to participate in patient safety. METHODS: Patient safety education was developed by the analysis-design-development-implementation-evaluation model considering expert advice, patient needs, and an extensive literature review. Data were collected from 20 July to 13 November 2020. Data were analyzed using SPSS statistical program. The effectiveness of the experimental and control groups before and after education was analyzed using paired t-tests, and the difference in the amount of increase in the measured variables for each group was analyzed using independent t-tests. RESULTS: The experimental group had significantly higher patient safety scores (t = 2.52, p = 0.014) and patient safety perception (t = 2.09, p = 0.040) than those of the control group. However, there was no significant difference between the two groups regarding the willingness to participate in patient safety. CONCLUSION: The patient safety education program developed using mobile tablet PCs could be an effective tool to enhance patient involvement in preventing events that may threaten the safety of patients. Further studies are recommended to develop a variety of educational interventions to increase patient safety knowledge and perceptions of patients and caregivers.

A mouse model of cavernous nerve injury-induced erectile dysfunction: functional and morphological characterization of the corpus cavernosum.

INTRODUCTION: With the advent of genetically engineered mice, it seems important to develop a mouse model of cavernous nerve injury (CNI). AIM: To establish a mouse model of CNI induced either by nerve crushing or by neurectomy and to evaluate time-dependent derangements in penile hemodynamics in vivo and subsequent histologic alterations in the cavernous tissue. METHODS: Twelve-week-old C57BL/6J mice were divided into 4 groups (N=36 per group): control, sham operation, bilateral cavernous nerve crush, and bilateral cavernous neurectomy group. MAIN OUTCOME MEASURES: Three days and 1, 2, 4, 8, and 12 weeks after CNI, erectile function was measured by electrical stimulation of the cavernous nerve. The penis was then harvested and TUNEL was performed. Immunohistochemical analysis was performed assaying for caspase-3, transforming growth factor-ß1 (TGF-ß1), phospho-Smad2, PECAM-1, factor VIII, and smooth muscle α-actin. The numbers of apoptotic cells and phospho-Smad2-immunopositive cells in endothelial cells or smooth muscle cells were counted. RESULTS: Erectile function was significantly less in the cavernous nerve crushing and neurectomy groups than in the control or sham group. This difference was observed at the earliest time point assayed (day 3) and persisted up to 4 weeks after nerve crushing and to 12 weeks after neurectomy. The apoptotic index peaked at 1 or 2 weeks after CNI and decreased thereafter. Cavernous TGF-ß1 and phospho-Smad expression was also increased after CNI. The numbers of apoptotic cells and phospho-Smad2-immunopositive cells in cavernous endothelial cells and smooth muscle cells were significantly greater in the cavernous nerve crush and cavernous neurectomy groups than in the control or sham group. Conclusion. The mouse is a useful model for studying pathophysiologic mechanisms involved in erectile dysfunction after CNI. Early intervention to prevent apoptosis in smooth muscle cells and endothelial cells or to inhibit cavernous tissue fibrosis is required to restore erectile function.

Transforming growth factor (TGF)-ß type I receptor kinase (ALK5) inhibitor alleviates profibrotic TGF-ß1 responses in fibroblasts derived from Peyronie's plaque.

INTRODUCTION: Transforming growth factor-ß1 (TGF-ß1) has been identified as an important fibrogenic cytokine associated with Peyronie's disease (PD). AIM: The aim of this study was to study the differential expression of the TGF-ß1 and Smad transcription factors in plaque tissue from PD patients and to determine the antifibrotic effect of SKI2162 (SK Chemicals, Seoul, South Korea), a novel small-molecule inhibitor of activin receptor-like kinase 5 (ALK5), a type I receptor of TGF-ß, in primary fibroblasts derived from human PD plaque. METHODS: Plaque tissue was isolated from five PD patients, and tunica albuginea tissue was obtained from four control patients. Plaque tissues from a patient with PD were used for primary fibroblast culture. Fibroblasts were pretreated with SKI2162 (10 µM) and then stimulated with TGF-ß1 (10ng/mL). MAIN OUTCOME MEASURES: The plaque or tunica albuginea tissue was stained with Masson's trichrome or antibody to TGF-ß1, phospho-Smad2 (P-Smad2), and P-Smad3. Protein was extracted from treated fibroblasts for Western blotting, and the membranes were probed with antibody to P-Smad2/Smad2, P-Smad3/Smad3, plasminogen activator inhibitor-1, fibronectin, collagen I, and collagen IV. We also determined the inhibitory effect of SKI2162 on TGF-ß1-induced nuclear translocation of Smad2/3 in fibroblasts. RESULTS: The plaque tissue from PD patients showed higher TGF-ß1, P-Smad2, and P-Smad3 immunoreactivity than did the tunica albuginea tissue from control patients. SKI2162 not only blocked TGF-ß1-induced phosphorylation and nuclear translocation of Smad2 and Smad3, but also inhibited the production of extracellular matrix markers in fibroblasts derived from human PD plaque. CONCLUSION: In light of the pivotal role of TGF-ß and Smads in the pathogenesis of PD, pharmacologic inhibition of ALK5 may represent a novel targeted approach to treating PD.

Intracavernous delivery of synthetic angiopoietin-1 protein as a novel therapeutic strategy for erectile dysfunction in the type II diabetic db/db mouse.

INTRODUCTION: Patients with erectile dysfunction (ED) associated with type II diabetes often have impaired endothelial function and tend to respond poorly to oral phosphodiesterase type 5 inhibitors. Therefore, neovascularization is a promising strategy for curing diabetic ED. AIM: To determine the effectiveness of a soluble, stable, and potent angiopoietin-1 (Ang1) variant, cartilage oligomeric matrix protein (COMP)-Ang1, in promoting cavernous angiogenesis and erectile function in a mouse model of type II diabetic ED. Methods. Sixteen-week-old male db/db mice (in which obesity and type II diabetes are caused by a mutation in the leptin receptor) and control C57BL/6J mice were used and divided into four groups (N=14 per group): age-matched controls; db/db mice receiving two successive intracavernous injections of phosphate-buffered saline (PBS) (days -3 and 0; 20 µL); db/db mice receiving a single intracavernous injection of COMP-Ang1 protein (day 0; 5.8 µg/20 µL); and db/db mice receiving two successive intracavernous injections of COMP-Ang1 protein (days -3 and 0; 5.8 µg/20 µL). MAIN OUTCOME MEASURES: Two weeks later, erectile function was measured by electrical stimulation of the cavernous nerve. The penis was then harvested and stained with antibodies to platelet/endothelial cell adhesion molecule-1 (PECAM-1) (endothelial cell marker), phosphohistone H3 (PH3, a nuclear protein indicative of cell proliferation), phospho-endothelial nitric oxide synthase (eNOS), and eNOS. Penis specimens from a separate group of animals were used for cyclic guanosine monophosphate (cGMP) and cyclic adenosine monophosphate (cAMP) quantification. RESULTS: Local delivery of COMP-Ang1 protein significantly increased eNOS phosphorylation and cGMP and cAMP expression compared with that in the group treated with PBS. Repeated intracavernous injections of COMP-Ang1 protein completely restored erectile function and cavernous endothelial content through enhanced cavernous neoangiogenesis as evaluated by PECAM-1 and PH3 immunohistochemistry and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling assay, whereas a single injection of COMP-Ang1 protein elicited partial improvement. CONCLUSION: Cavernous neovascularization using recombinant Ang1 protein is a novel therapeutic strategy for the treatment of ED resulting from type II diabetes.

[Analysis of Subgroups with Lower Level of Patient Safety Perceptions Using Decision-Tree Analysis].

PURPOSE: This study was aimed to investigate experiences, perceptions, and educational needs related to patient safety and the factors affecting these perceptions. METHODS: Study design was a descriptive survey conducted in November 2019. A sample of 1,187 Koreans aged 20-80 years participated in the online survey. Based on previous research, the questionnaire used patient safety-related and educational requirement items, and the Patient Safety Perception Scale. Descriptive statistics and a decision tree analysis were performed using SPSS 25.0. RESULTS: The average patient safety perception was 71.71 (± 9.21). Approximately 95.9% of the participants reported a need for patient safety education, and 88.0% answered that they would participate in such education. The most influential factors in the group with low patient safety perceptions were the recognition of patient safety activities, age, preference of certified hospitals, experience of patient safety problems, and willingness to participate in patient safety education. CONCLUSION: It was confirmed that the vulnerable group for patient safety perception is not aware of patient safety activities and did not prefer an accredited hospital. To prevent patient safety accidents and establish a culture of patient safety, appropriate educational strategies must be provided to the general public.