Discrepant incidence has been reported regarding the incidence of herb-induced liver injury (HILI). To address the growing worldwide concern of HILI, we evaluated the risk of HILI in a nationwide prospective study. Between April 2013 and January 2016, 1001 inpatients (360 males and 641 females) from 10 tertiary hospitals throughout South Korea were treated with herbal drugs and had their liver enzymes periodically measured. A total of six patients met the criteria for HILI with RUCAM scores ranging from 4 to 7. All these participants were women and developed the hepatocellular type of HILI. One HILI participant met the criteria for Hy’s law; however, none of six cases presented clinical symptoms related to liver injury. This is the first nationwide prospective study that estimated the extent of the incidence of HILI [total: 0.60%, 95% confidence interval (CI) 0.12–1.08; women: 0.95%, 95% CI 0.19–1.68] and described its features in hospitalized participants.Electronic supplementary materialThe online version of this article (doi:10.1007/s00204-017-2007-9) contains supplementary material, which is available to authorized users.

The regeneration of mitochondria by regulated biogenesis plays an important homeostatic role in cells and tissues and furthermore may provide an adaptive mechanism in certain diseases such as sepsis. The heme oxygenase (HO-1)/carbon monoxide (CO) system is an inducible cytoprotective mechanism in mammalian cells. Natural antioxidants can provide therapeutic benefit, in part, by inducing the HO-1/CO system. This study focused on the mechanism by which the natural antioxidant quercetin can induce mitochondrial biogenesis in HepG2 cells. We found that quercetin treatment induced expression of mitochondrial biogenesis activators (PGC-1α, NRF-1, TFAM), mitochondrial DNA (mtDNA), and proteins (COX IV) in HepG2 cells. The HO inhibitor SnPP and the CO scavenger hemoglobin reversed the effects of quercetin on mitochondrial biogenesis in HepG2 cells. The stimulatory effects of quercetin on mitochondrial biogenesis could be recapitulated in vivo in liver tissue and antagonized by SnPP. Finally, quercetin conferred an anti-inflammatory effect in the liver of mice treated with LPS and prevented impairment of mitochondrial biogenesis by LPS in vivo. These salutary effects of quercetin in vivo were also antagonized by SnPP. Thus, our results suggest that quercetin enhances mitochondrial biogenesis mainly via the HO-1/CO system in vitro and in vivo. The beneficial effects of quercetin may provide a therapeutic basis in inflammatory diseases and sepsis.

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The purpose of this study was to investigate the influence of stress, spousal support, and resilience on the types of coping among women with breast cancer. Method: Using a cross-sectional survey design, a total of 120 participants, diagnosed with breast cancer, had a mass removal surgery, and were fluent in Korean, were recruited at a cancer center in Seoul, Korea. Self-reported questionnaires of stress, spousal support, resilience, and ways of coping were administered upon the permission from the original developers. Data were analyzed using SPSS 22.0 Win program. Result: Ways of coping was positively correlated with spousal support, resilience, and stress. Positive correlations were found between problem-focused coping, spousal support, and resilience. Positive correlations were found between emotion-focused coping with stress and resilience. Hierarchical multiple regressions revealed that spousal support had significant moderating effect on the relationship between stress and emotion-focused coping. Conclusion: Women perceived their diagnosis and surgery as more stressful, they more like to use emotion-focused coping. Women with more spousal support and resilience were found to use problem-focused coping more. Based on the findings of this study, a tailored intervention for women with breast cancer for improving their coping is expected in future research.

Scapula-oriented exercise had beneficial effects on pain, quality of life and aspects of strength. The sample size required in a larger definitive study is 32 subjects per group.

This study developed smartphone-based virtual experiential nursing applications to care for patients with chronic illness, especially patients with hypertension and diabetes, and evaluated the effect of the applications on nursing students' knowledge, self-efficacy, and learning experiences. Applications using gamification elements were developed according to the steps of assessment, design, development, implementation, and evaluation. Knowledge and self-efficacy were assessed via questionnaires, while learning experiences were assessed via six focus group interviews after the applications were used for 1 week. Quantitative data were analyzed using descriptive analysis, χ test, Fisher's exact test, t test for the homogeneity of participants (experimental, 49; control, 43), an independent t test, and a paired t test for effectiveness in each group. Qualitative data were analyzed using qualitative thematic analysis. Knowledge on hypertension (t = 4.41, P < .001) and diabetes (t = 2.45, P < .009), as well as self-efficacy for hypertension (t = 3.08, P < .002) and diabetes (t = 1.75, P < .043), significantly improved in the experimental group compared to the control group. Students may use the applications as complementary learning resources without the limitations of time and space, and students were satisfied overall with their use. The chronic illness care smartphone applications are effective learning resources that assist students in assessing patients' health problems and implementing nursing care plans to improve patient conditions.

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