Mechanisms of action of nonpeptide hormones on resveratrol-induced antiproliferation of cancer cells

Nonpeptide hormones, such as thyroid hormone, dihydrotestosterone, and estrogen, have been shown to stimulate cancer proliferation via different mechanisms. Aside from their cytosolic or membrane-bound receptors, there are receptors on integrin α_v β₃ for nonpeptide hormones. Interaction between hormones and integrin α_v β₃ can induce signal transduction and eventually stimulate cancer cell proliferation. Resveratrol induces inducible COX-2-dependent antiproliferation via integrin α_v β₃ . Resveratrol and hormone-induced signals are both transduced by activated extracellular-regulated kinases 1 and 2 (ERK1/2); however, hormones promote cell proliferation, while resveratrol induces antiproliferation in cancer cells. Hormones inhibit resveratrol-stimulated phosphorylation of p53 on Ser15, resveratrol-induced nuclear COX-2 accumulation, and formation of p53-COX-2 nuclear complexes. Subsequently, hormones impair resveratrol-induced COX-2-/p53-dependent gene expression. The inhibitory effects of hormones on resveratrol action can be blocked by different antagonists of specific nonpeptide hormone receptors but not integrin α_v β₃ blockers. Results suggest that nonpeptide hormones inhibit resveratrol-induced antiproliferation in cancer cells downstream of the interaction between ligand and receptor and ERK1/2 activation to interfere with nuclear COX-2 accumulation. Thus, the surface receptor sites for resveratrol and nonpeptide hormones are distinct and can induce discrete ERK1/2-dependent downstream antiproliferation biological activities. It also indicates the complex pathways by which antiproliferation is induced by resveratrol in various physiological hormonal environments. .

The effect of acetazolamide on sleep apnea at high altitude: a systematic review and meta-analysis

Background:

Acetazolamide has been investigated for treating sleep apnea in newcomers ascending to high altitude. This study aimed to assess the effect of acetazolamide on sleep apnea at high altitude, determine the optimal therapeutic dose, and compare its effectiveness in healthy trekkers and obstructive sleep apnea (OSA) patients.

Methods:

PubMed, Embase, Scopus, Cochrane Library, and Airiti Library databases were searched up to July 2015 for randomized controlled trials (RCTs) performed above 2500 m in lowlanders and that used acetazolamide as intervention in sleep studies. Studies including participants with medical conditions other than OSA were excluded.

Results:

Eight studies of 190 adults were included. In healthy participants, the pooled mean effect sizes of acetazolamide on Apnea–Hypopnea Index (AHI), percentage of periodic breathing time, and nocturnal oxygenation were 34.66 [95% confidence interval (CI) 25.01–44.30] with low heterogeneity (p = 0.7, I² = 0%), 38.56% (95% CI 18.92–58.19%) with low heterogeneity (p = 0.24, I² = 28%), and 4.75% (95% CI 1.35–8.15%) with high heterogeneity (p < 0.01, I² = 87%), respectively. In OSA patients, the pooled mean effect sizes of acetazolamide on AHI and nocturnal oxygenation were 13.18 (95% CI 9.25–17.1) with low heterogeneity (p = 0.33, I² = 0%) and 1.85% (95% CI 1.08–2.62%) with low heterogeneity (P = 0.56, I² = 0%).

Conclusions:

Acetazolamide improves sleep apnea at high altitude by decreasing AHI and percentage of periodic breathing time and increasing nocturnal oxygenation. Acetazolamide is more beneficial in healthy participants than in OSA patients, and a 250 mg daily dose may be as effective as higher daily doses for healthy trekkers.

Screening Mammography Efficacy: A Comparison Between Screen-Film, Computed Radiography and Digital Mammography in Taiwan

Breast cancer screening has been proven effective in Western countries, and our National Health Bureau also started to offer free screening mammography for women aged between 50 and 69, since July 2004. This study aims to compare the efficacy between distinctive mammography screening modalities. Prompting the assessment of digital screening in the radiological sciences, we provide insight into the practical informatics application of such tools.

Health care satisfaction among foreign residents in Taiwan - An assessment and improvement

BACKGROUND

In 2012, almost half-million foreigners (2.3% of the total population) from 160 countries were estimated to live in Taiwan. In 2010, approximately eighty-seven percent of the population expressed high satisfaction in the national health care system of Taiwan. However, satisfaction level among foreign residents towards the Taiwanese health care system has not been clearly documented in the literature.OBJECTIVE: In this study, we assessed satisfaction level among foreign residents for receiving healthcare facility in Taiwanese hospital. In addition, the study came out with some potential solutions to improve health care received by them.

METHODS

Human-Centered Design (HCD) approach was deployed, which included three phases: observation, pattern recognition, and ideation and delivery. Each phase involved various steps. Techniques, such as ethnography, interview, discussion, and survey were used in accomplishing various steps within each phase. Four participants and two facilitators from Taiwan took part in the study.

RESULTS

The study revealed various stories, insights, and themes about the health care received by the foreigners in Taiwan. In addition, some potential solutions and immediate available opportunities were recommended to improve their health care.

CONCLUSIONS

The results provided a deeper understanding into the satisfaction level among foreign residents in Taiwan. For instance, this study pointed out the need to improve English proficiency of hospital's administrative staffs because a lack of English language proficiencies was found to be a major barrier in delivering quality health care to foreign residents. Therefore, adoption of various training modalities, such as English training using mobile device based games, role-play, and hospital's workflow depiction using English posters were recommended.

Targeted therapy in gastrointestinal stromal tumor (GIST): A nationwide database analysis from Taiwan

437

Background: Gastrointestinal stromal tumor (GIST) is a visceral sarcoma that arises from the gastrointestinal tract. Currently, imatinib (first-line) and sunitinib (second-line) are two reimbursed targeted therapies for GIST in Taiwan. This study aimed to evaluate the real world data of targeted therapies in GIST treatment among Taiwanese population. Methods: We conducted a nationwide retrospective cohort study based on data from the National Health Insurance Research Database (NHIRD) between January 2005 and December 2010. NHIRD is a comprehensive database of administrative and claim data which covers over 99% of entire population in Taiwan. Patients were selected with ICD codes and targeted therapy utilization, imatinib (IMA) or sunitinib (SUN). Time to treatment discontinuation (DC) due to any reasons (such as death, intolerance and disease progression) was estimated using Kaplan-Meier analysis. Results: From 2005 to 2010, the incidence rate of GIST in Taiwan was between 20 and 30 cases per million. A total of 3,436 GIST patients were identified; the mean age was 63.2 years and 57 % were male. Most patients (94.7%) received standard dose IMA (…400mg/day). Among these patients, 136 patients (4.0%) required IMA dose escalation and 44 (1.3%) patients switched to SUN after IMA. The probability of the 1st-line treatment DC was 20%, 30.7%, 38.9%, 43.2%, and 47.1% for years 1 to 5, respectively. The probability of a change in treatment pattern (defined as either IMA dose escalation or switch to SUN) was 4% 6.8%, 9.6%, 10.5% and 11.7% for years 1 to 5. Lastly, the probability of the 2nd-line treatment DC was 20.5%, 33.7%, 41.1%, 44.8%, 51.7% for years 1 to 5, respectively. Conclusions: First-line IMA plus other treatment modalities may provide additional benefits to progression-free survival. Taiwanese GIST patients who failed first-line treatment still gained benefit from either IMA dose escalation or a switch to SUN. Additional analysis is required for the detailed comparison in different treatment patterns.

Deployment of an in-house designed training process in a quaternary care hospital

BACKGROUND

Healthcare providers, such as doctors and nurses, have been famous for high resistance to change. A careful change management plan, particularly training process, is utmost necessary. A quaternary care hospital in India changed its system, from manual to Electronic Medical Record/Health Information System (EMR/HIS). The hospital management wanted to train its 4000 diverse end-users on the EMR/HIS in two months' time.

OBJECTIVE

This paper describes an in-house designed training process and its deployment in the given healthcare organizational settings.

METHODS

We designed a training process named DRIPDA. The training process was deployed to train 4000 end-users of EMR/HIS, in the quaternary care hospital. Various factors, such as methods and tools of training, constraints of trainees, trainers, and organization were considered while deploying the training process. The effectiveness of the DRIPDA was assessed using the Kirkpatrick model.

RESULTS

End-users received training on the new system only in 25% of estimated time and 28% of the projected expense, without having any distraction in their usual workflow, or any productivity loss.

CONCLUSION

We found that the DRIPDA training process could train all employees effectively and efficiently. A decent training process can help in managing the change, thereby reduce the training time and cost.

AUTOMATIC DIAGNOSIS OF INTRACRANIAL HEMATOMA ON BRAIN CT USING KNOWLEDGE DISCOVERY TECHNIQUES: IS FINER RESOLUTION BETTER?

Computed tomography (CT) of the brain is the study of choice for neurological emergencies. Physicians use CT to diagnose various types of intracranial hematomas, including epidural, subdural, and intracerebral hematomas according to their locations and shapes. We have proposed a novel method that can automatically diagnose intracranial hematomas by combining machine vision and knowledge discovery techniques. In this paper, we attempted segmentation of intracranial hematomas in multiple resolutions using image pyramids. The features of the segmented hematoma and the diagnoses made by physicians were used by C4.5 algorithm to construct a decision tree. The algorithm was evaluated on 48 pathological images treated in a single institute. The two discovered rules in all resolutions closely resembled those used by human experts, and were able to make correct diagnoses in all cases. Results of tenfold cross-validation were also satisfactory.

Automatic segmentation of meningioma from non-contrasted brain MRI integrating fuzzy clustering and region growing

Background

In recent years, magnetic resonance imaging (MRI) has become important in brain tumor diagnosis. Using this modality, physicians can locate specific pathologies by analyzing differences in tissue character presented in different types of MR images.

This paper uses an algorithm integrating fuzzy-c-mean (FCM) and region growing techniques for automated tumor image segmentation from patients with menigioma. Only non-contrasted T1 and T2 -weighted MR images are included in the analysis. The study's aims are to correctly locate tumors in the images, and to detect those situated in the midline position of the brain.

Methods

The study used non-contrasted T1- and T2-weighted MR images from 29 patients with menigioma. After FCM clustering, 32 groups of images from each patient group were put through the region-growing procedure for pixels aggregation. Later, using knowledge-based information, the system selected tumor-containing images from these groups and merged them into one tumor image. An alternative semi-supervised method was added at this stage for comparison with the automatic method. Finally, the tumor image was optimized by a morphology operator. Results from automatic segmentation were compared to the "ground truth" (GT) on a pixel level. Overall data were then evaluated using a quantified system.

Results

The quantified parameters, including the "percent match" (PM) and "correlation ratio" (CR), suggested a high match between GT and the present study's system, as well as a fair level of correspondence. The results were compatible with those from other related studies. The system successfully detected all of the tumors situated at the midline of brain.

Six cases failed in the automatic group. One also failed in the semi-supervised alternative. The remaining five cases presented noticeable edema inside the brain. In the 23 successful cases, the PM and CR values in the two groups were highly related.

Conclusions

Results indicated that, even when using only two sets of non-contrasted MR images, the system is a reliable and efficient method of brain-tumor detection. With further development the system demonstrates high potential for practical clinical use.

Inter-rater and intra-rater reliability of nursing process records for patients with schizophrenia

AIMS

This study explored the inter-rater and intra-rater reliability to evaluate the consistency of nursing process records for patients with schizophrenia.

BACKGROUND

By writing accurate and complete nursing process records, nurses can quickly communicate the care that has been delivered. However, little is known about the accuracy of nursing records to reflect the patients' problems, especially in psychiatry.

DESIGN

A prospective observational study.

METHODS

Two nurses with similar work experience in psychiatric wards assessed patient records produced by 14 psychiatric nurses to compute inter-rater reliability of nursing diagnoses and their defining characteristics. Collecting the records and the time spans between the first and the second data collection took one month to compute the intra-reliability of the nursing diagnoses by the same nurse.

RESULTS

The greatest intra-rater consistency was in identifying 'disturbed thought processes' (kappa = 0.77, 95% CI: 0.56-0.98). A moderate level of inter-rater agreement among nurses was observed for the nursing diagnoses of 'disturbed thought process' and 'disturbed sleep pattern' from 0.41-0.53. Furthermore, the inter-rater agreement of among nurses with less work experience (less than four years) showed greater higher consistency on 'disturbed thought process' (kappa = 0.56, 95% CI: 0.23-0.89) and 'disturbed sleep pattern' (kappa = 0.41, 95% CI: 0.07-0.73) than that observed among nurses with more work experience (more than four years).

CONCLUSIONS

Overall, intra-rater reliability was greater than inter-rater reliability for psychiatric nursing process records. Furthermore, more inter-rater and intra-rater agreement were observed among records from less experienced nurses than among records produced by more experienced ones. To evaluate the consistency of nursing process records, both the intra-rater reliability and the inter-rater reliability show the importance of using standardised terms and more detailed nursing records.

RELEVANCE TO CLINICAL PRACTICE

Our results clearly indicate that using standardised terms to describe patient symptoms and more detailed descriptions of the nursing process could improve the accuracy of nursing records.

Computer-aided diagnosis of intracranial hematoma with brain deformation on computed tomography

Physicians evaluate computed tomography (CT) of the brain to quantitatively and qualitatively identify various types of intracranial hematomas for patients with neurological emergencies. We propose a novel method that can perform this task in a totally automatic fashion, based on a multiresolution binary level set method. The skull regions are segmented in downsized images generated with a maximum filter. The intracranial regions are located using the average gray levels and connectivity. These regions compose the regions of interest (ROIs) for segmenting the hematoma from the normal brain. The gray levels of the voxels within these ROIs are generated with an averaging filter in a multiresolution fashion. After identifying the candidate hematoma voxels using adaptive thresholds and connectivity, binary level set algorithm is applied repeatedly until the original resolution is reached. We apply our method to non-volumetric non-contrast CT images of 15 surgically proven intracranial hematomas and the results were quantitatively evaluated by a human expert. The correlation coefficient between the volumes measured manually and automatically is 0.97. The overlap metrics ranged from 0.97 to 0.74, with an average of 0.88. The average precision and recall are 0.89 and 0.87, respectively. We use decision rules to classify these hematomas and were able to make correct diagnoses in all cases.

Low-cost telepathology system for intraoperative frozen-section consultation: our experience and review of the literature

We have established a low-cost noncommercial system of dynamic real-time telepathology for light microscopic diagnosis that was used to aid intradepartmental consultation for frozen-section diagnosis. Fifty cases were performed. For each case, multiple diagnoses were made and compared, namely, those made by the pathologist on duty (D1), by a subspecialist or senior using telepathology (D2), by the same pathologist using a light microscope (D3), and the final diagnosis (D4). A comparison of D1 and D2 revealed that 37 cases (74%) were diagnosed more precisely by D2. In 9 (18%) of 50 cases, there was a positive major impact on the operation as a result of teleconsultation. The results of D2 and D3 showed good agreement (kappa = 0.97). The average time span required for telepathology is short compared with routine intradepartmental consultation. Our experience showed that telepathology is a good tool for frozen-section consultation and imposes little additional cost.

EBCPG: A visualized evidence-based clinical practice guideline system

Evidence-based clinical practice guidelines (CPG) have been recognized as an important guide to physicians for decision-making. These guidelines can assist physicians in giving good clinical care to their patients. Based on the overall healthcare improvements, medical care quality can be preserved while practice discrepancies and errors can be eliminated. Clear representation and accessible guideline content at the point care are also critical. One way to make implementation easier is through computerized and visualized guidelines combined with evidence-based literature. Therefore, this paper presents a computerized guideline system, EBCPG, which is composed of three main components: CPGs exploration, EBM exploration and Web-base management to accommodate clinician decision-making and maintainability. Two tasks based on CPGs exploration and visualization technologies are involved in facilitating the presentation of the CPG model. EBCPG provides a comprehensive way to assist clinicians in making decisions according to the visualized clinical practice guidelines while dealing with patients.

Development and evaluation of an integrated pharmaceutical education system

There is increasing evidence that patient safety can be improved by the introduction of an integrated computer-based medical care system in hospital settings. In this paper, we describe an integrated pharmaceutical information system (IPIS) in which a patient's profile including his/her medication records and prescriptions are collected from physician order entry systems and pharmaceutical systems along with the history of patient care in the hospital. Based on an individual patient's profile the IPIS can provide pharmaceutical education information specifically to meet the patient's needs. The IPIS has been developed and installed at Taipei Medical University Wanfang Hospital (TMUWFH) since July 2002. Evaluation of the system showed that it can help patients to effectively acquire drug information. This enables them to have a much better understanding of the pharmacological properties of the medicines they are taking, including adverse drug reactions and side-effects. In our opinion the system has the potential to improve both patient safety and treatment outcomes.