Comparison of sedation outcome according to the dose of chloral hydrate in children requiring laceration repair

Purpose To compare the sedation outcome according to the dose of per os chloral hydrate in children who underwent laceration repair in the emergency department (ED). Methods This retrospective study was performed to the children who underwent sedation using chloral hydrate for laceration repair in the ED from January 2015 through November 2015. A total of 370 children aged younger than 6 years underwent the sedation. We compared the induction time, duration of sedation, and ED length of stay (EDLOS) between the single dose (50 mg/kg) and additional dose (plus 25 mg/kg) groups. Results Of 370 children, 335 (90.5%) were sedated successfully, 284 (76.8%) were sedated with initial dose (the single dose group), and 51 (13.8%) were sedated with additional dose (the additional dose group). The induction time and EDLOS were longer in the additional dose group (induction time: 31.0 ± 17.2 minutes vs. 96.2 ± 25.4 minutes, P < 0.001; EDLOS: 137.2 ± 35.5 minutes vs. 193.0 ± 36.0 minutes, P < 0.001). The duration of sedation showed no difference between the 2 groups (44.4 ± 24.0 minutes vs. 42.0 ± 20.8 minutes; P = 0.500). No one had serious adverse reactions. Conclusion Additional dose of chloral hydrate can increase the induction time and EDLOS without increasing the duration of sedation and causing serious adverse reactions. This information may improve the efficiency of ED workflow when shared with parents of the children

Infective endocarditis caused by methicillin-resistant Staphylococcus aureus in a young woman after ear piercing: a case report

<p>Abstract</p> <p>Introduction</p> <p>Ear piercing is a common practice among Korean adolescents and young women and usually is performed by nonmedical personnel, sometimes under suboptimal hygienic conditions. Consequently, ear piercing has been associated with various infectious complications, including fatal infective endocarditis. We report a case of infective endocarditis that was caused by community-associated methicillin-resistant <it>Staphylococcus aureus </it>after ear piercing and that was accompanied by a noticeable facial rash.</p> <p>Case presentation</p> <p>A 29-year-old Korean woman underwent ear piercing six days before hospitalization. On admission, she had fever, erythematous maculopapular rashes on her face, signs of generalized emboli, vegetation in her mitral valve, and methicillin-resistant <it>S. aureus </it>bacteremia. On the basis of the blood culture results, she was treated with vancomycin in combination with gentamicin. On day six of hospitalization, a rupture of the papillary muscle of her mitral valve developed, and emergency cardiac surgery replacing her mitral valve with a prosthetic valve was performed. After eight weeks of antibiotic therapy, she was treated successfully and discharged without significant sequelae.</p> <p>Conclusions</p> <p>Numerable cases of body piercing-related infective endocarditis have been reported, and since ear piercing is commonplace nowadays, the importance of risk recognition cannot be overemphasized. In our report, a patient developed infective endocarditis that was caused by methicillin-resistant <it>S. aureus </it>after ear piercing and that was accompanied by an interesting feature, namely facial rash.</p

Increased Glutathione Synthesis Following Nrf2 Activation by Vanadyl Sulfate in Human Chang Liver Cells

Jeju ground water, containing vanadium compounds, was shown to increase glutathione (GSH) levels as determined by a colorimetric assay and confocal microscopy. To investigate whether the effects of Jeju ground water on GSH were specifically mediated by vanadium compounds, human Chang liver cells were incubated for 10 passages in media containing deionized distilled water (DDW), Jeju ground water (S1 and S3), and vanadyl sulfate (VOSO4). Vanadyl sulfate scavenged superoxide anion, hydroxyl radical and intracellular reactive oxygen species. Vanadyl sulfate effectively increased cellular GSH level and up-regulated mRNA and protein expression of a catalytic subunit of glutamate cysteine ligase (GCLC), which is involved in GSH synthesis. The induction of GCLC expression by vanadyl sulfate was found to be mediated by transcription factor erythroid transcription factor NF-E2 (Nrf2), which critically regulates GCLC by binding to the antioxidant response elements (AREs). Vanadyl sulfate treatment increased the nuclear translocation of Nrf2 and the accumulation of phosphorylated Nrf2. Extracellular regulated kinase (ERK) contributed to ARE-driven GCLC expression via Nrf2 activation. Vanadyl sulfate induced the expression of the active phospho form of ERK. Taken together, these results suggest that the increase in GSH level by Jeju ground water is, at least in part, due to the effects of vanadyl sulfate via the Nrf2-mediated induction of GCLC

Emodin Regulates Glucose Utilization by Activating AMP-activated Protein Kinase

AMP-activated protein kinase has been described as a key signaling protein that can regulate energy homeostasis. Here, we aimed to characterize novel AMP-activated kinase (AMPK)-activating compounds that have a much lower effective concentration than metformin. As a result, emodin, a natural anthraquinone derivative, was shown to stimulate AMPK activity in skeletal muscle and liver cells. Emodin enhanced GLUT4 translocation and [C-14]glucose uptake into the myotube in an AMPK-dependent manner. Also, emodin inhibited glucose production by suppressing the expression of key gluconeogenic genes, such as phosphoenolpyruvate carboxykinase and glucose-6-phosphatase, in hepatocytes. Furthermore, we found that emodin can activate AMPK by inhibiting mitochondrial respiratory complex I activity, leading to increased reactive oxygen species and Ca2+/calmodulin-dependent protein kinase kinase activity. Finally, we confirmed that a single dose administration of emodin significantly decreased the fasting plasma glucose levels and improved glucose tolerance in C57Bl/6J mice. Increased insulin sensitivity was also confirmed after daily injection of emodin for 8 days using an insulin tolerance test and insulin-stimulated PI3K phosphorylation in wild type and high fat diet-induced diabetic mouse models. Our study suggests that emodin regulates glucose homeostasis in vivo by AMPK activation and that this may represent a novel therapeutic principle in the treatment of type 2 diabetic models.close

The Current Contexts of Newly Graduated Nurses&rsquo; Competence: A Content Analysis

Producing and sustaining a competent nursing workforce is imperative to protect the public. Identifying current issues and trends in nursing competence can strengthen insights and provide direction for the future nursing workforce. A summative content analysis was performed; PubMed, CINAHL, and Scopus were searched for content from the last ten years. A total of 3225 titles and abstracts regarding nursing competence were identified and analysed using the big-data analysis software Leximancer. Five themes were discovered from the analysis: (1) standardisation of nursing competencies with emerging competencies, (2) assessment competency levels, (3) graduates&rsquo; expectations and achievement, (4) safe and quality practice with teamwork, and (5) competency curriculum development. This found standardised nursing competencies, which suggests prioritising which core competencies should be focused on during education to produce competent generalist professional nurses, and employers could help nursing graduates improve their competence in specialised areas. This review also suggests that further education strategies should be developed to better prepare graduates for culturally safe practice to meet the needs of diverse minority populations and for informatics competency during the COVID-19 pandemic. Competence assessment methods must be extensively investigated to measure nursing competencies both longitudinally and cross-sectionally

Exploration of the expected and achieved competency levels of new graduate nurses

Aim: To explore the expected and achieved competency levels of new graduate nurses. Background: There are global concerns about a perceived disconnect between the educational preparation of new graduates and the expectations of employers about their work readiness. It is important to understand competency levels expected and achieved of new graduate nurses. Method(s): The study was conducted in three phases: the identification of competencies, development of a survey instrument and exploration of levels of competency from the perspectives of key stakeholders. Results: New graduates were well prepared for demonstrating respect to patients, but needed to be closely supported when providing emergency care. Results highlighted that new graduates felt less competent than graduating students in those competencies related to legal and ethical practice. Importantly, expectations about new graduates’ competency varied between educators and managers. Conclusion(s): The findings provide important information about new graduates’ competency levels, revealing a mismatch in the perception of key stakeholders about competency levels. This has important implications for building new graduates readiness for practice and highlights the importance of collaboration between key stakeholders to address competency gaps. Implications for Nursing Management: Supportive opportunities should be provided to new graduate nurses to fill gaps in beginner competency