The Implementation of ISO 9001:2015 to Improve the Supportive Care Services for the Cancer Survivors

Background and context: Cancer has been the leading cause of death in Taiwan since 1982. According the most updated cancer registry published by the Ministry of Health and Welfare, a total of 105,156 new cases (302/100,000 population) were diagnosed and 46,829 people (128/100,000 population) died of cancer which accounted for 28.6% of all deaths. Currently, around 500,000 people live with cancers in Taiwan. The Formosa Cancer Foundation (FCF) operates two Cancer Survivor Supportive Care Centers in Taipei and Kaohsiung cities which provide comprehensive, professional services to cancer survivors and their families. These centers regularly offer free medical, nutritional and psychological counseling, nutrition and transportation subsidies for low-income survivor households, critical emergency relief as well as hold a regular courses of body and mind rehabilitation to help cancer survivors successfully navigate their road to optimal recovery. As the number of cancer survivors needed supportive care services are rapidly increasing, the resources allocated for the services is not proportionately increased. Therefore, how to improve both the quantity and quality for the survivors' supportive care services becomes an essential issue. Aim: To ensure service standardization as well as to improve the quantity and quality of the supportive care services for the cancer survivors. Strategy/Tactics: FCF began the process necessary to certify its Survivor Supportive Care Service Quality Management System under ISO 9001 since 2015. Program/Policy process: To certify the FCF Survivor Supportive Care Service Quality Management System under ISO 9001:2015 by (1) Clearly defining the assessment and service goals (2) Systemized management and control of service delivery procedures (3) Regular collection and utilization of client-satisfaction data and comments (4) Systemized tracking and management of documents (5) Standard method for records storage and maintenance (6) Standardized procedures for managing and maintaining service facilities; and (7) Standardized procedures for evaluating and training staff. Outcomes: After implementation of the ISO 9001:2015 quality management system, FCF's overall service capacity has increased by 18-20%. Each service now covered by a standardized procedure, high levels of service quality and teamwork have been well maintained even under reduced staffing conditions. Survivors’ satisfaction with FCF services has risen significantly from an average of 4.0 prior to implementation of the quality management system to 4.7 afterward (full score: 5). The survivor´s family members also indicate strong satisfaction with FCF services. What was learned: Implementing the ISO 9001:2015 quality management system in the cancer survivor supportive care service has assisted FCF not only to increase the quality and quantity of its service deliveries but also to enhance the effectiveness of its professional team.

Cryo-EM analysis of the T3S injectisome reveals the structure of the needle and open secretin

The bacterial type III secretion system, or injectisome, is a syringe shaped nanomachine essential for the virulence of many disease causing Gram-negative bacteria. At the core of the injectisome structure is the needle complex, a continuous channel formed by the highly oligomerized inner and outer membrane hollow rings and a polymerized helical needle filament which spans through and projects into the infected host cell. Here we present the near-atomic resolution structure of a needle complex from the prototypical Salmonella Typhimurium SPI-1 type III secretion system, with local masking protocols allowing for model building and refinement of the major membrane spanning components of the needle complex base in addition to an isolated needle filament. This work provides significant insight into injectisome structure and assembly and importantly captures the molecular basis for substrate induced gating in the giant outer membrane secretin portal family.

Co-pyrolysis kinetics of sewage sludge and bagasse using multiple normal distributed activation energy model (M-DAEM)

In this study, the kinetic models of bagasse, sewage sludge and their mixture were established by the multiple normal distributed activation energy model. Blending with sewage sludge, the initial temperature declined from 437 K to 418 K. The pyrolytic species could be divided into five categories, including analogous hemicelluloses I, hemicelluloses II, cellulose, lignin and bio-char. In these species, the average activation energies and the deviations situated at reasonable ranges of 166.4673-323.7261 kJ/mol and 0.1063-35.2973 kJ/mol, respectively, which were conformed to the references. The kinetic models were well matched to experimental data, and the R² were greater than 99.999%y. In the local sensitivity analysis, the distributed average activation energy had stronger effect on the robustness than other kinetic parameters. And the content of pyrolytic species determined which series of kinetic parameters were more important.

Electro-acupuncture at ST37 and ST25 induce different effects on colonic motility via the enteric nervous system by affecting excitatory and inhibitory neurons

BACKGROUND

On the basis of the importance of the enteric nervous system (ENS) in gastrointestinal motility, we hypothesized that the ENS may mediate the therapeutic efficacy of electro-acupuncture (EA) in constipation by regulating the mechanisms underlying the effects of EA on gastrointestinal function.

METHODS

Model mice with constipation were generated by gastric instillation of 0-4°C normal saline. Defecation time and stool (form and wet and dry weight) were assessed. The effect of EA at ST37 or ST25 on colorectal motility and proximal colonic motility was assessed using a water-filled balloon. The expression of protein gene product 9.5 (PGP9.5), the cholinergic neuron marker acetyltransferase (ChAT) and the anticholinergic neuron marker nitric oxide synthase (nNOS) was detected by immunohistochemistry, real-time quantitative polymerase chain reaction (qPCR) and western blot analysis.

KEY RESULTS

ST37 and ST25 improved colorectal pressure; however, ST37 but not ST25 improved proximal colonic pressure. In the proximal colon, the expression of PGP9.5 returned to normal after EA at ST 37, while EA at ST25 did not have this effect. In addition, qPCR and western blot analysis showed that ST37 could downregulate the expression of nNOS and upregulate the expression of ChAT to normal levels, while ST25 could only downregulate the expression of nNOS to normal levels.

CONCLUSIONS AND INFERENCES

Electro-acupuncture at specific acupoints can improve intestinal motility in constipation by altering the ENS and differentially affecting excitatory and inhibitory neurons, restoring the coordination between contraction and relaxation muscles, and working in concert with the central nervous system and peripheral neural pathways.

Ultrasonic pretreatment effects on the co-pyrolysis of municipal solid waste and paper sludge through orthogonal test

In this study, the influences of ultrasonic pretreatment factors (frequency, power, treatment time) on blends of municipal solid waste (MSW) and paper sludge (PS) with additive (MgO) was explored, through orthogonal experiments design. The optimum operating condition wanted to be acquired. However, for the ultimate (H/C) and ash analysis after pretreatment, solid residue mass and oxygenates compounds contents in products, the influences of factors were in different results. With adding PS unceasingly, the contents of hydrocarbon compounds decreased. And the ultrasonic pretreatment had the obvious influence with high PS percentage. Longer treatment time resulted to the lower content of oxygenates compounds. After adding MgO, the residue mass reduced, which meant MgO had the catalytic action, and the oxygenates compounds content reduced only with 100 kHz, which had the sonochemical effect.

Clinical and molecular insights into Glanzmann's thrombasthenia in China

Glanzmann's thrombasthenia (GT) is a rare bleeding disorder characterized by spontaneous mucocutaneous bleeding. The disorder is caused by quantitative or qualitative defects in integrin αIIbβ3 (encoded by ITGA2B and ITGB3) on the platelet and is more common in consanguineous populations. However, the prevalence rate and clinical characteristics of GT in non-consanguineous populations have been unclear. We analyzed 97 patients from 93 families with GT in the Han population in China. This analysis showed lower consanguinity (18.3%) in Han patients than other ethnic populations in GT-prone countries. Compared with other ethnic populations, there was no significant difference in the distribution of GT types. Han females suffered more severe bleeding and had a poorer prognosis. We identified a total of 43 different ITGA2B and ITGB3 variants, including 25 previously unidentified, in 45 patients. These variants included 14 missense, 4 nonsense, 4 frameshift, and 3 splicing site variants. Patients with the same genotype generally manifested the same GT type but presented with different bleeding severities. This suggests that GT clinical phenotype does not solely depend on genotype. Our study provides an initial, yet important, clinical and molecular characterization of GT heterogeneity in China.

Adaptive Neural Output Feedback Control for Nonstrict-Feedback Stochastic Nonlinear Systems With Unknown Backlash-Like Hysteresis and Unknown Control Directions

This paper investigates the problem of output feedback adaptive stabilization for a class of nonstrict-feedback stochastic nonlinear systems with both unknown backlashlike hysteresis and unknown control directions. A new linear state transformation is applied to the original system, and then, control design for the new system becomes feasible. By combining the neural network's (NN's) parameterization, variable separation technique, and Nussbaum gain function method, an input-driven observer-based adaptive NN control scheme, which involves only one parameter to be updated, is developed for such systems. All closed-loop signals are bounded in probability and the error signals remain semiglobally bounded in the fourth moment (or mean square). Finally, the effectiveness and the applicability of the proposed control design are verified by two simulation examples.

A study on microwave-assisted fast co-pyrolysis of chlorella and tire in the N2 and CO2 atmospheres

The microwave-assisted fast co-pyrolysis of chlorella and tire with additive under N₂ and CO₂ atmospheres were investigated. The pyrolysis profiles, yields of three-phase, the chemical composition of liquid and the ultimate analyses of solid residues were gained. With the tire ratio increasing, all the characters had the changes. The finial temperature had a wave change. The yield of liquid decreased and the chemical composition obtained in liquid of oxygenates compounds decreased, while hydrocarbon compounds increased, among which aromatic hydrocarbons had the highest content. The yield of solid increased, the HHV had a wave change and the values of H/C decreased. Under CO₂ atmosphere, the final temperatures were lower with 70% and 100% chlorella ratios, the yield difference of liquid reached the minimal with 70% and 30% chlorella ratios. According to the quantity and quality of liquid and solid, and the former results, 50% percentage of tire was the suitable ratio.

Short communication: Does early-life administration of a Megasphaera elsdenii probiotic affect long-term establishment of the organism in the rumen and alter rumen metabolism in the dairy calf?

Megasphaera elsdenii is a bacterial species of the rumen that can utilize lactate to produce butyrate, a key volatile fatty acid often implicated in driving calf rumen development. Because lactate is abundant in the rumen of young calves, administration of M. elsdenii to increase butyrate production and thus promote calf rumen development is an appealing possibility. The main objective of this study was to determine whether M. elsdenii administration to calves via oral drench at 14 d of age affected its long-term establishment at 70 d postadministration. Ruminal volatile fatty acid and lactate profiles and blood glucose and β-hydroxybutyrate concentrations were also examined to determine potential influence on rumen metabolism. Six neonatal Holstein heifer calves were blocked on d 1 by body weight (41.3 ± 1.8 kg) and total serum protein (5.23 ± 0.16 g/dL) and assigned to either the M. elsdenii (n = 3) or control (n = 3) treatment groups. On d 14, calves in the M. elsdenii group orally received 25 mL of a commercially available M. elsdenii suspension, whereas calves in the control group received 25 mL of the same product that had been autoclaved. Rumen contents and blood samples were collected weekly from each animal until 84 d of age. The oral administration of M. elsdenii at 14 d did not increase the abundance of M. elsdenii 70 d postdosing, alter rumen fermentation, or change blood metabolites associated with butyrate. These results suggest that a single administration of the M. elsdenii probiotic may not affect the rumen establishment of the organism.

Hydrothermal carbonization of typical components of municipal solid waste for deriving hydrochars and their combustion behavior

In this work, five typical components were employed as representative pseudo-components to indirectly complete previous established simulation system during hydrothermal carbonization (HTC) of municipal solid waste. The fuel characteristics and combustion behavior of HTC-derived hydrochars were evaluated. Results clearly illustrated that the energy ranks of hydrochars were upgraded after HTC. For paper and wood, superior combustion performances of their hydrochars could achieve under suitable conditions. While for food, none positive enrichments on combustion loss rate were observed for hydrochars due to its high solubilization and decomposition under hot compressed water. It was noteworthy that a new weight loss peak was detected for paper and food, suggesting that new compounds were formed. For rubber, the HTC process made the properties of styrene butadiene rubber more close to natural rubber. Therefore, the first peak of hydrochars became significantly intense. While for plastic, only physical changes of polypropylene and polyethylene were observed.

[Neurosyphilis and HIV co-infection with the initial symptom of sudden deafness and optic atrophy: a case report]

A 46-year-old male presented with left ear hearing loss,vertigo,tinnitus and left eye blurred vision. Pure tone audiometry showed left ear had been total deafness. Treponema pallidum particle agglutination (TPPA) assay was reactive. The serum rapid plasma regain (RPR) was 1∶16. Human immunodeficiency virus(HIV) 1/2 antibody immunoassay was positive，and the CD4 cell count was low at 100 cells/μl. Cerebrospinal fluid (CSF) TPPA was positive,with a white blood cell count of 53×10 ⁶ /L and protein level of 1.08 g/L.The diagnosis was:①left ear sudden deafness(total deafness type);②neurosyphilis;③acquired immune deficiency syndrome(AIDS).

Effects of particle-fluid density ratio on the interactions between the turbulent channel flow and finite-size particles

A parallel direct-forcing fictitious domain method is employed to perform fully resolved numerical simulations of turbulent channel flow laden with finite-size particles. The effects of the particle-fluid density ratio on the turbulence modulation in the channel flow are investigated at the friction Reynolds number of 180, the particle volume fraction of 0.84%, and the particle-fluid density ratio ranging from 1 to 104.2. The results show that the variation of the flow drag with the particle-fluid density ratio is not monotonic, with a larger flow drag for the density ratio of 10.42, compared to those of unity and 104.2. A significant drag reduction by the particles is observed for large particle-fluid density ratios during the transient stage, but not at the statistically stationary stage. The intensity of particle velocity fluctuations generally decreases with increasing particle inertia, except that the particle streamwise root-mean-square velocity and streamwise-transverse velocity correlation in the near-wall region are largest at the density ratio of the order of 10. The averaged momentum equations are derived with the spatial averaging theorem and are used to analyze the mechanisms for the effects of the particles on the flow drag. The results indicate that the drag-reduction effect due to the decrease in the fluid Reynolds shear stress is counteracted by the drag-enhancement effect due to the increase in the total particle stress or the interphase drag force for the large particle-inertia case. The sum of the total Reynolds stress and particle inner stress contributions to the flow drag is largest at the density ratio of the order of 10, which is the reason for the largest flow drag at this density ratio. The interphase drag force obtained from the averaged momentum equation (the balance theory) is significantly smaller than (but agrees qualitatively with) that from the empirical drag formula based on the phase-averaged slip velocity for large density ratios. For the neutrally buoyant case, the balance theory predicts a positive interphase force on the particles arising from the negative gradient of the particle inner stress, which cannot be predicted by the drag formula based on the phase-averaged slip velocity. In addition, our results show that both particle collision and particle-turbulence interaction play roles in the formation of the inhomogeneous distribution of the particles at the density ratio of the order of 10.

BNIP3 induces apoptosis and protective autophagy under hypoxia in esophageal squamous cell carcinoma cell lines: BNIP3 regulates cell death

Bcl-2/adenovirus E1B 19-kDa interacting protein (BNIP3), a pro-apoptosis protein regulated by the methylation status of its promoter, has been implicated in inducing autophagy. However, the roles of BNIP3 and BNIP3-induced autophagy under hypoxia remain uncertain in esophageal squamous cell carcinoma (ESCC). Two esophageal squamous cancer cell lines, CAES17 and KYSE140, were selected on the basis of the expression and methylation status of BNIP3 to investigate the features of BNIP3 under hypoxia. Hypoxia increased cell death and the expression of BNIP3, whose promoter status was lower methylation, in a time-dependent manner. BNIP3 knockdown by RNA interference downregulated cell death. These studies demonstrated that the exposure of ESCC cells to hypoxia increased the autophagic punctate distribution of MDC staining and GFP-LC3 and that autophagy rate could be inhibited by BNIP3-siRNA. In addition, under hypoxia, cells transfected with BNIP3-siRNA exhibited a lower apoptosis rate than the control, and the apoptosis induced by BNIP3 exhibited a caspase-independent manner. Furthermore, the administration of the autophagic inhibitor 3-methyladenine (3-MA) could augment BNIP3-induced cell apoptosis and death, suggesting that autophagy plays a protective role under hypoxia. Together, our studies indicated that BNIP3 exerts prodeath effects through the induction of caspase-independent apoptosis under hypoxia in ESCC, though BNIP3-induced autophagy acting as a survival mechanism.

Salinomycin enhances doxorubicin sensitivity through reversing the epithelial-mesenchymal transition of cholangiocarcinoma cells by regulating ARK5

Chemotherapy response rates in patients with cholangiocarcinoma remain low, primarily due to the development of drug resistance. Epithelial-mesenchymal transition (EMT) of cancer cells is widely accepted to be important for metastasis and progression, but it has also been linked to the development of chemoresistance. Salinomycin (an antibiotic) has shown some potential as a chemotherapeutic agent as it selectively kills cancer stem cells, and has been hypothesized to block the EMT process. In this study, we investigated whether salinomycin could reverse the chemoresistance of cholangiocarcinoma cells to the chemotherapy drug doxorubicin. We found that combined salinomycin with doxorubicin treatment resulted in a significant decrease in cell viability compared with doxorubicin or salinomycin treatment alone in two cholangiocarcinoma cell lines (RBE and Huh-28). The dosages of both drugs that were required to produce a cytotoxic effect decreased, indicating that these two drugs have a synergistic effect. In terms of mechanism, salinomycin reversed doxorubicin-induced EMT of cholangiocarcinoma cells, as shown morphologically and through the detection of EMT markers. Moreover, we showed that salinomycin treatment downregulated the AMP-activated protein kinase family member 5 (ARK5) expression, which regulates the EMT process of cholangiocarcinoma. Our results indicated that salinomycin reversed the EMT process in cholangiocarcinoma cells by inhibiting ARK5 expression and enhanced the chemosensitivity of cholangiocarcinoma cells to doxorubicin. Therefore, a combined treatment of salinomycin with doxorubicin could be used to enhance doxorubicin sensitivity in patients with cholangiocarcinoma.

Effects of Teriparatide on Joint Erosions in Rheumatoid Arthritis: A Randomized Controlled Trial

OBJECTIVE

Articular erosions correlate with disability in rheumatoid arthritis (RA). Biologic agents reduce erosion progression in RA, but erosion healing occurs infrequently. This study was undertaken to assess the effects of the anabolic agent teriparatide on joint erosion volume in RA patients treated with a tumor necrosis factor inhibitor (TNFi).

METHODS

We conducted a randomized controlled trial in 24 patients with erosive RA, osteopenia, and disease activity controlled by TNFi treatment for at least 3 months. Half were randomized to receive teriparatide for 1 year and the others constituted a wait-list control group. Subjects and primary rheumatologists were not blinded with regard to treatment assignment, but all outcomes were assessed in a blinded manner. The primary outcome measure was change in erosion volume determined by computed tomography at 6 anatomic sites. Significance within each hand and anatomic site was based on a 2-tailed test, with P values less than 0.05 considered significant.

RESULTS

Baseline characteristics of the treatment groups were well balanced. After 52 weeks, the median change in erosion volume in the teriparatide group was -0.4 mm³ (interquartile range [IQR] -34.5, 29.6) and did not differ significantly from that in controls (median change +9.1 mm³ [IQR -29.6, 26.4]) (P = 0.28). No significant difference in change in erosion volume was noted at the radius, ulna, or metacarpophalangeal joints. Bone mineral density improved at the femoral neck and lumbar spine in the teriparatide group.

CONCLUSION

Our findings indicate that teriparatide treatment for 1 year does not significantly reduce erosion volume in the hands or wrists of patients with established RA with disease activity controlled by TNFi treatment.

Efficiency, effectiveness and treatment stability of clear aligners: A systematic review and meta-analysis

OBJECTIVES

The objective of this study was to perform a systematic review of the orthodontic literature with regard to efficiency, effectiveness and stability of treatment outcome with clear aligners compared with treatment with conventional brackets.

METHODS

An electronic search without time or language restrictions was undertaken in October 2014 in the following electronic databases: Google Scholar, the Cochrane Oral Health Group's Trials Register, Scopus, CENTRAL, MEDLINE via OVID, EMBASE via OVID and Web of Science. We also searched the reference lists of relevant articles. Quality assessment of the included articles was performed. Two authors were responsible for study selection, validity assessment and data extraction.

RESULTS

Four controlled clinical trials including a total of 252 participants satisfied the inclusion criteria. We grouped the trials into four main comparisons. One randomized controlled trial was classified as level 1B evidence, and three cohort studies were classified as level 2B evidence. Clear aligners appear to have a significant advantage with regard to chair time and treatment duration in mild-to-moderate cases based on several cross-sectional studies. No other differences in stability and occlusal characteristics after treatment were found between the two systems.

CONCLUSIONS

Despite claims about the effectiveness of clear aligners, evidence is generally lacking. Shortened treatment duration and chair time in mild-to-moderate cases appear to be the only significant effectiveness of clear aligners over conventional systems that are supported by the current evidence.