Comparison of senhance and da vinci robotic radical prostatectomy: short-term outcomes, learning curve, and cost analysis

BACKGROUND

The Senhance® Robotic System is a new laparoscopy-based platform that has been increasingly used in radical prostatectomy (RP) procedures. The purpose of this study is to compare the outcome of Senhance RP (SRP) with da Vinci RP (DRP) cases.

METHODS

From August 2019 to April 2022, we prospectively recruited 63 cases of SRP. We compared the perioperative data, postoperative complication rates, short-term surgical outcomes (3-month postoperative undetectable prostate-specific antigen (PSA) and incontinence rates), learning curves, and cost analysis with data from 63 matched da Vinci Xi RP cases.

RESULTS

There was no difference in BL (180 versus 180 ml, p = 0.86) and postoperative surgical complication rate (Clavient -Dindo grade I-IV, 25.3 versus 22.2%, p = 0.21) between the SRP cases and the DRP. Regarding the oncologic and continence function, there was no difference between positive margin rate (36.5% versus 41.3%, p = 0.58), rate of undetectable PSA level at postoperative 3 months (68.3 versus 66.7%, p = 0.85), and incontinence rate (14.3 versus 15.9%, p = 1.0) at postoperative 3 months between the two cohorts. The learning curve showed a quick downward slope for laparoscopic experienced surgeons. The median pocket cost for SRP patients in our hospital was $4170, which was lower than $7675 for the DRP patients.

CONCLUSIONS

Safety and short-term outcomes are comparable between SRP and DRP. For experienced LRP surgeons, using the Senhance system to perform RP is straightforward. With a more affordable price as its biggest advantage, the Senhance system may serve as a safe and effective alternative for robotic RP.

Comparison of contrast-enhanced ultrasonography and MRI results obtained by expert and novice radiologists indicating short-term response after transarterial chemoembolisation for hepatocellular carcinoma

AIM

To evaluate inter-reader agreement between novice and expert radiologists in assessing contrast-enhanced ultrasonography (CEUS) and magnetic resonance imaging (MRI) images for detecting viable tumours with different sizes after conventional transarterial chemoembolisation (cTACE).

MATERIALS AND METHODS

This prospective study included patients who had less than five hepatomas and who underwent cTACE. Hepatomas with one or two feeding arteries were selected as target lesions. CEUS and MRI were performed within 1 week after cTACE to evaluate viable tumours.

RESULTS

The expert group had higher kappa values in evaluating all tumour sizes via CEUS compared with MRI. The novice group had similar kappa values. In patients with tumours measuring ≤3 cm, the expert group had higher kappa values in reading CEUS compared with MRI images; however, in the novice group, the kappa value was lower in evaluating CEUS compared with MRI images. In patients with tumours measuring >3 cm, the expert and novice groups had good to excellent kappa values. The confidence level of the two groups in reading MRI images was high; however, the novice group had a lower confidence level.

CONCLUSION

CEUS is a convenient, cost-effective, and easy to apply imaging tool that can help interventionists perform early detection of viable hepatocellular carcinoma post-TACE. It has a higher inter-rater agreement in interpreting CEUS images compared with MRI images among expert radiologists even when they are extremely familiar with post-cTACE MRI images. In novice radiologists, there may be a learning curve to achieve good consistency in CEUS interpretation.

The Effectiveness of an Upper Limb Rehabilitation Program on Quality of Life in Breast Cancer Patients after Mastectomy: A Randomized Controlled Trial

OBJECTIVE

This study aims to investigate the effectiveness of an upper limb rehabilitation program on the quality of life in patients who had been first diagnosed breast cancer and subsequently underwent mastectomy.

DATA SOURCES

This randomized controlled trial enrolled 48 breast cancer patients who underwent mastectomy at a medical center in Taiwan. The patients were randomly assigned to either the intervention group (n = 24) or control group (n = 24). The patients in the intervention group participated in a 12-week upper limb rehabilitation program involving face-to-face upper limb rehabilitation education and once-a month monitoring of their upper extremity activity. The control group received standard nursing care. Quality of life was assessed through EORTC QLQ-C30 and QLQ-BR 23 questionnaires at baseline and weeks 4, 8, and 12 after enrollment.

RESULTS

Both the intervention and control groups had significantly improved their levels of functioning, symptoms, and quality of life from baseline to week 12 after enrollment. The intervention group showed greater improvements in functioning and symptom levels after the intervention compared to the control group; however, no statistically significant differences were found. Additionally, the levels of global health status/quality of life in both groups gradually increased from baseline to week 12 CONCLUSION: An upper limb rehabilitation program is effective in improving the functioning and symptoms of breast cancer patients who have undergone mastectomy.

IMPLICATIONS FOR NURSING PRACTICE

Patients are encouraged to undergo upper limb rehabilitation in order to improve their functioning, symptoms and quality of life.

The significance of dense fine speckled pattern in antinuclear antibody-associated rheumatic disease and coexisting autoantibodies: A propensity score-matched cohort study

AIM

To investigate the relationship between the prevalence of antinuclear antibody (ANA) -associated rheumatic diseases (AARD) and the presence of dense fine speckled (DFS) and homogeneous patterns in ANA tests.

METHODS

This retrospective study enrolled adult patients with either a DFS or homogeneous pattern in their ANA test. A mixed pattern was defined as the presence of more than one pattern reported in the test. The presence of anti-DFS70 antibodies and other common autoantibodies were detected using EUROLINE ANA Profile 23. A 1:2 propensity score matching was applied to control for demographic and other interfering factors.

RESULTS

A total of 59 patients with a DFS pattern were enrolled and compared with a matched homogeneous group. The DFS group had a significantly lower prevalence of AARD (3.4% vs. 16.9%, p = .008) and the subgroup with anti-DFS70 antibodies showed an even lower prevalence (2% vs. 20%, p = .002). Among the 33 patients with monospecific anti-DFS70 antibodies, five had a mixed pattern, and all patients with common autoantibodies had an isolated DFS pattern.

CONCLUSIONS

The findings of this study suggest that patients with a DFS pattern in their ANA test may have a lower prevalence of AARD compared with those with a homogeneous pattern. However, an isolated DFS pattern in ANA testing does not necessarily indicate the presence of monospecific anti-DFS70 antibodies or AARD. Confirmatory testing for the monospecific anti-DFS70 antibody is mandatory to exclude AARD.

Mixed-linker strategy for suppressing structural flexibility of metal-organic framework membranes for gas separation

Structural flexibility is a critical issue that limits the application of metal-organic framework (MOF) membranes for gas separation. Herein we propose a mixed-linker approach to suppress the structural flexibility of the CAU-10-based (CAU = Christian-Albrechts-University) membranes. Specifically, pure CAU-10-PDC membranes display high separation performance but at the same time are highly unstable for the separation of CO₂/CH₄. A partial substitution (30 mol.%) of the linker PDC with BDC significantly improves its stability. Such an approach also allows for decreasing the aperture size of MOFs. The optimized CAU-10-PDC-H (70/30) membrane possesses a high separation performance for CO₂/CH₄ (separation factor of 74.2 and CO₂ permeability of 1,111.1 Barrer under 2 bar of feed pressure at 35°C). A combination of in situ characterization with X-ray diffraction (XRD) and diffuse reflectance infrared Fourier transform (DRIFT) spectroscopy, as well as periodic density functional theory (DFT) calculations, unveils the origin of the mixed-linker approach to enhancing the structural stability of the mixed-linker CAU-10-based membranes during the gas permeation tests.

Characteristics of rectal chlamydia among men who have sex with men in southern Taiwan, 2020-2022: An emerging threat of rectal lymphogranuloma venereum L2b

BACKGROUND

The prevalence of rectal chlamydia among men who have sex with men (MSM) without human deficiency virus infection (non-HIV) remains uncertain in Taiwan, and rectal lymphogranuloma venereum (LGV) among MSM has never been reported in the Far East.

MATERIAL AND METHODS

From January 2020 to April 2022, MSM coming for anonymous voluntary counseling and testing, for pre-exposure prophylaxis, and for antiretroviral therapy were enrolled. All participants submitted his fecal samples and completed a QR-code questionnaire. Medical records of those who took regular medical visits for HIV were recorded. Multiplex polymerase chain reaction (PCR) was performed for all fecal samples, and ompA gene sequencing was therefore performed for each Chlamydia-positive fecal sample.

RESULTS

Among 341 MSM during 2020-2022 in southern Taiwan, 21 (6.2%) had rectal chlamydia infection. Risk factors of rectal chlamydia included co-infection with rectal gonorrhea (adjusted odds ratio [AOR] 6.78, 95% confidence interval [CI] 1.44-31.91, P = 0.015) and multiple sexual partners (AOR 1.373, 95% CI 1.002-1.882, P = 0.048). Further ompA gene sequencing from 19 Chlamydia-positive fecal samples revealed that the prevalent genotypes or genovariants were Da (26.3%) and L2b (26.3%), followed by B (21.1%), J (14.3%), and G (9.5%). All cases of rectal LGV genovariant L2b presented as acute proctitis with diarrhea, anal pain, or discharge and were treated successfully with prolonged treatment of doxycycline.

CONCLUSIONS

Rectal gonorrhea and multiple sexual partners are risk factors for rectal chlamydia. Clinicians in Taiwan should be aware of the emerging threat of rectal LGV among MSM with acute proctitis.

Risk of Hepatitis B Virus (HBV) Reactivation in HBsAg-Negative, Anti-HBc-Negative Patients Receiving Rituximab for Autoimmune Diseases in HBV Endemic Areas

Background/Aims

Rituximab is known to be associated with high hepatitis B virus (HBV) reactivation rate in patients with resolved HBV infection and hematologic malignancy. However, data regarding HBV reactivation (HBVr) in rheumatic patients receiving rituximab is limited. To assess the HBVr rate in hepatitis B surface antigen (HBsAg)-negative patients receiving rituximab for autoimmune diseases in a large real-world cohort.

Methods

From March 2006 to December 2019, 900 patients with negative HBsAg receiving at least one cycle of rituximab for autoimmune diseases in a tertiary medical center in Taiwan were retrospectively reviewed. Clinical outcome and factors associated with HBVr were analyzed.

Results

After a median follow-up period of 3.3 years, 21 patients developed HBVr, among whom 17 patients were positive for hepatitis B core antibody (anti-HBc) and four were negative. Thirteen patients had clinical hepatitis flare, while eight patients had HBsAg seroreversion without hepatitis. Old age, anti-HBc positivity, undetectable serum hepatitis B surface antibody level at rituximab initiation and a higher average rituximab dose were associated with a higher HBVr rate. There was no significant difference in the HBVr risk between rheumatoid arthritis and other autoimmune diseases. Among anti-HBc-negative patients, subjects without HBV vaccination at birth had an increased risk of HBVr (4/368, 1.1%) compared with those who received vaccination (0/126, 0%).

Conclusions

In HBV endemic areas where occult HBV is prevalent, anti-HBc-negative patients, may still be at risk for HBVr after rituximab exposure. HBVr may still be considered in HBsAg-negative patients developing abnormal liver function after rituximab exposure, even in patients with negative anti-HBc.

Comparative Analysis of Uncoupled Mode Approximations for Molecular Thermochemistry and Kinetics

The accurate prediction of thermochemistry and kinetic parameters is an important task for reaction modeling. Unfortunately, the commonly used harmonic oscillator model is often not accurate enough due to the absence of anharmonic effects. In this work, we improve the representation of an anharmonic potential energy surface (PES) using uncoupled mode (UM) approximations, which model the full-dimensional PES as a sum of one-dimensional potentials of each mode. We systematically analyze different PES sampling schemes and coordinate systems for constructing the one-dimensional potentials, and benchmark the performance of UM methods on data sets of molecular thermochemistry and kinetic properties. The results show that the accuracy of the UM approach strongly depends on how the one-dimensional potentials are defined. If one-dimensional potentials are constructed by sampling along normal mode directions (UM-N) or along the directions that minimize intermode coupling (E- and E'-optimized), the accuracies of the predicted properties are not significantly improved compared to the harmonic oscillator model. However, significant improvements can be achieved by sampling the torsional modes separately from the vibrational modes (UM-T and UM-VT). In this work, three types of coordinate systems are examined, including redundant internal coordinates (RIC), hybrid internal coordinates (HIC), and translation-rotation-internal coordinates (TRIC). The HIC and TRIC coordinate systems can outperform RIC since transition state species may contain large-amplitude interfragmentary motions that regular internal coordinates can not describe adequately. Among all the methods we examined, the activation energies and pre-exponential factors calculated using UM-VT with either TRIC or HIC best agree with the reference values. Since UM-VT requires only a number of additional single point energy calculations for each independent mode, the scaling of computational costs of UM-VT is the same as that of the standard harmonic oscillator model, making UM-VT an appealing way of calculating the thermochemistry and kinetic properties for large-size systems.

Biomarker of neutrophil extracellular traps is associated with deep-seated infections and predicts mortality and cardiovascular morbidity in commensal streptococcal bacteremia

BACKGROUND

Neutrophil extracellular traps (NETs) play important roles in sepsis and deep-seated infections, but whether NET formation correlates with clinical outcomes of patients with streptococcal bloodstream infections (BSIs) is unclear.

METHODS

We analyzed serum levels of complexes of myeloperoxidase and DNA (MPO-DNA) in patients with streptococcal-BSIs. In vitro assay of NET induction by serum from BSI patients was performed.

RESULTS

MPO-DNA values for the Streptococci-BSI group (n = 59) were significantly higher than those for healthy controls (p < 0.00001) and matched control groups (n = 59, p = 0.004). The rate of higher MPO-DNA levels (>1.87 μg/mL) were higher in abscess-prone streptococcal groups (streptococcus milleri group) (72.2% vs. 52.5%, p = 0.02). For patients with BSIs due to highly infective endocarditis (IE)-prone pathogens, the values of serum MPO-DNA were also higher in patients diagnosed of IE compared to their counterparts (p = 0.009). Notably, serum from patients with leukopenia could induce higher amounts of in vitro NET formation, despite having low MPO-DNA levels, suggesting that NET formation could be influenced by WBC counts. Therefore, we combined WBC counts with MPO-DNA to predict all-cause 30-day mortality in patients with commensal streptococcal-BSIs. The mortality risk was lowest among patients who had neither high MPO-DNA levels nor abnormal WBC counts (p = 0.058). Furthermore, this group of patients also had a favorable composite outcome consisting of major adverse cardiovascular events (MACE) and all-cause mortality (p = 0.026).

CONCLUSION

Together, these study data suggested that serum MPO-DNA can be a biomarker for predicting a composite outcome consisting of MACE and all-cause mortality in patients with commensal streptococcal-BSIs.

Dinaciclib inhibits the stemness of two subtypes of human breast cancer cells by targeting the FoxM1 and Hedgehog signaling pathway

Cyclin‑dependent kinase (CDK)4/6 inhibitors in combination with endocrine therapy are the current standard of care used in the first‑line treatment of hormone receptor‑positive/HER2‑negative metastatic breast cancer (BC). Although CDK4/6 inhibitors mainly target the cell cycle, emerging evidence has indicated further potential roles of CDKs other than regulating cell cycle progression. The G₁ and G₂/M transition regulators, including cyclins D and E, as well as their catalytic partners, CDK2, CDK4 and CDK6, have been reported to play crucial roles in pluripotency maintenance and cell fate decisions of human pluripotent stem cells by controlling transcription factors, signaling pathways and epigenetic regulators. Dinaciclib, a CDK1/2/5/9 inhibitor, is currently being evaluated in clinical trials against various cancer types, including BC. However, the underlying molecular mechanisms of CDK1/2/5/9 inhibitors in regulating BC stemness remain poorly understood. The present study aimed to examine the stemness‑inhibitory effects of dinaciclib in MCF‑7 (luminal) and HCC‑1806 (triple‑negative) BC cells. We found that this drug not only effectively reduced the self‑renewal abilities and other malignant properties, but also dose‑dependently decreased the protein expression levels of three BC stem cell markers, CD44, aldehyde dehydrogenase 1 family member A1 (ALDH1A1) and BMI1 proto‑oncogene, polycomb ring finger (Bmi1), as well as three embryonic stem cell markers, Oct4, Nanog and Sox2. Moreover, the dinaciclib‑induced decrease of Oct4 and Nanog protein expression was able to be restored by co‑treatment with MG‑132, a proteasome inhibitor. Forkhead box M1 (FoxM1), both a stemness‑stimulating transcription factor and a cell cycle regulator, along with the Hedgehog signaling pathway, were identified as the therapeutic targets of dinaciclib. Collectively, the present results demonstrated a novel role of dinaciclib in suppressing BC stemness and indicated its potential use for future cancer treatments.

Development and psychometric testing of the safety climate instrument suitable for nurses handling chemotherapy drugs

AIM

To develop and test the psychometric properties of the Taiwanese safety climate instrument suitable for nurses handling chemotherapy drugs.

DESIGN

This is an instrument development study.

METHOD

All four stages, including questionnaire design, expert consultation, cognitive testing and psychometric validation, were used in this study. The data were collected between August and December 2018. Nurses with experience in handling chemotherapy drugs (N = 484) at one medical centre and two regional hospitals in Taiwan completed this instrument. Data were randomly split into two groups: one group (N = 237) for exploratory factor analysis and the other (N = 247) for confirmatory factor analysis.

RESULTS

The instruments' items were based on qualitative research, and the content validity index levels exceeded the acceptable value. An exploratory factor analysis revealed 43 items remaining in six factors, which accounted for 74.4% of variance. The result of the confirmatory factor analysis verified the acceptability of a 43-item model. The composite reliability values, Cronbach's alpha values, convergent validity and discriminant validity for each factor exceeded the acceptable value.

CONCLUSION

Most climate safety instruments used in the health care sector focus mainly on patient safety outcomes. Furthermore, there is no safety climate instrument for handling chemotherapy drugs, and there is a cultural difference. Through the development and validation process, we have developed a new instrument suitable for nurses handling chemotherapy drugs, which has good psychometric properties.

IMPACT

This instrument is valuable as its development was based on the concept of a safety climate for health care perceptions and qualitative survey findings. Hospital managers can use this instrument regularly to evaluate nurses' perceptions of the safety climate to determine the strengths and weaknesses of their workplace, thereby assisting organizational managers in proposing concrete actions.

Differences between Gamblers and Non-Gamblers on Sports Betting Websites

Online sports gambling is a popular recreational activity. Using the Theory of Planned Behaviour as the theoretical foundation, the aim of this study was to examine for differences between gamblers and non-gamblers in terms of their attitudes, subjective norms and perceived behavioral control towards online sports gambling. 173 male students from a tertiary educational institution were recruited for this study of which 56 respondents (32%) were gamblers. A series of regression analysis revealed differences between gamblers and non-gamblers. While subjective norms and perceived behavioural control were significant predictors of gambling intentions for the gamblers group, only attitude was a significant predictor for the non-gamblers group. Further analysis showed that subjective norms had a larger effect on the gamblers group in comparison to the non-gamblers group. Physiological data from an eye tracker provided further empirical evidence that there were differences between gamblers and non-gamblers. Gamblers, perhaps because they are more familiar with gambling websites, take less time to process information. The findings from this study suggests that there are differences between gamblers and non-gamblers. To prevent problem gambling, there is a need to develop different communication messages for gamblers and non-gamblers.

Experience of the use of hydroxychloroquine on patients with COVID-19: A perspective on viral load and cytokine kinetics

Until now, there are no approved treatment against COVID-19. Hydroxychloroquine (HCQ) was hypothesized to be active against SARS-CoV2 via antiviral and anti-inflammatory effect; however, HCQ for COVID-19 in clinical use remained debating. In this preliminary report, we presented six patients with mild to moderate COVID-19. They were treated with HCQ for 14 days from the day of COVID-19 diagnosis. Serial viral load from respiratory specimens were performed every other day. Cytokine profile was checked before HCQ initiation and on the 14th day of HCQ treatment. All patients receiving HCQ completed 14-day course without complication. Among the six patients, the mean duration from symptom onset to last detectable viral load was 34 ± 12 days, which was similar to those without specific treatment in previous reports. Low level of interferon-gamma was noted in all patients of different stage of infection and three patients had elevation of IL-17 level. Prolonged virus shedding is still observed regardless HCQ. The impact of HCQ on cytokine kinetics remained unclear; however, IL-17 could be an inflammatory marker for disease status monitor and a potential therapeutic target.

Red blood cell tension protects against severe malaria in the Dantu blood group

Malaria has had a major effect on the human genome, with many protective polymorphisms-such as the sickle-cell trait-having been selected to high frequencies in malaria-endemic regions1,2. The blood group variant Dantu provides 74% protection against all forms of severe malaria in homozygous individuals3-5, a similar degree of protection to that afforded by the sickle-cell trait and considerably greater than that offered by the best malaria vaccine. Until now, however, the protective mechanism has been unknown. Here we demonstrate the effect of Dantu on the ability of the merozoite form of the malaria parasite Plasmodium falciparum to invade red blood cells (RBCs). We find that Dantu is associated with extensive changes to the repertoire of proteins found on the RBC surface, but, unexpectedly, inhibition of invasion does not correlate with specific RBC-parasite receptor-ligand interactions. By following invasion using video microscopy, we find a strong link between RBC tension and merozoite invasion, and identify a tension threshold above which invasion rarely occurs, even in non-Dantu RBCs. Dantu RBCs have higher average tension than non-Dantu RBCs, meaning that a greater proportion resist invasion. These findings provide both an explanation for the protective effect of Dantu, and fresh insight into why the efficiency of P. falciparum invasion might vary across the heterogenous populations of RBCs found both within and between individuals.

Tunable light absorption of graphene using topological interface states

A tunable light absorption of graphene using topological interface states (TISs) is presented. The monolayer graphene is embedded in the interface of asymmetric topological photonic crystals (ATPCs). A strong absorption phenomenon occurs by the excitation of TISs. It is found that the absorption spectra are intensively dependent on the chemical potential of graphene and the periodic number of the ATPCs. Furthermore, the absorption can be rapidly switched in a slight variation of chemical potential, which is modulated by the applied gate voltage on graphene. This study not only opens up a new approach for enhancing light-monolayer graphene interactions, but also provides for practical applications in high absorption optoelectronic devices. This strong absorption phenomenon is different from those in Fabry-Perot resonators, nano-cavities photonic crystal, and traditional topological photonic crystals (TPCs).

Morphological and genetic characteristics of F1 hybrids introgressed from Brassica napus to B. rapa in Taiwan

BACKGROUND

Unintentional introgression from genetically modified (GM) oilseed rape (Brassica napus) to a relative is inevitable in the open field. A feasible and practical strategy for restricting the spread of GM offspring is to set a reasonable isolated distance between GM B. napus and the relatives. To define the isolated distance, a pollen donor/recipient pair is a prerequisite to conducting the field trial of pollen flow. However, because the cultivation of GM B. napus is prohibited in Taiwan, it is difficult to obtain relevant information. Thus, this study explored the morphological and genetic characteristics of five varieties of B. napus (donor), three varieties of B. rapa (recipient), and the 15 corresponding F₁ hybrids, aiming to construct phenotypic data and genetic variation data and to select the most appropriate pollen donor/recipient for future field trials of pollen flow.

RESULTS

The genome size of all F₁ hybrids estimated using flow cytometry showed intermediate DNA content between B. napus and B. rapa varieties. Most of the F₁ hybrids had intermediate plant height and blooming period, and the rosette leaves type and colors resembled those of B. napus varieties. The results of sequence-related amplified polymorphism (SRAP) showed an average of 9.52 bands per primer combination and 67.87 polymorphic bands among the F₁ hybrid population. Similarity and cluster analyses revealed higher similarity between F₁ hybrids and B. napus varieties than between F₁ hybrids and B. rapa varieties. Furthermore, we identified a specific 1100-bp band (LOC106302894) in F₁ hybrids and B. napus varieties but not in B. rapa varieties.

CONCLUSIONS

The rosette leaves and the DNA marker LOC106302894 observed in F₁ hybrids are consistent phenotypic and genetic characteristics that can be used to identify the presence of unintentional hybridization from B. napus to B. rapa in Taiwan. Due to the prohibition of GM crop cultivation, the hybridization system of non-GM Brassica species in this study can be utilized as a mimic scheme to conduct pollen flow trials, thus facilitating the determination of the proper isolated distance.

Media Freedom is the Primary Culprit for Depressive Disorders: A Cross-National Analysis

Background

There has been much speculation about social environments causing an epidemic of depression. The objectives of this study are to examine how media freedom influences prevalence of depressive disorders. A direct effect of free media is great levels of information complexity causing poor mental health. Two indirect effects are that media freedom facilitates modernization, which is associated with competition-related stress, and government investment in social protection, which impedes the person’s ability to manage stress.

Methods

The study used a cross-sectional analysis on determinants of prevalence of depressive disorders in 2015 covering 98 democratic countries. Media freedom was measured as the degree to which a country allows the freedom of news and information of print media, television, and radio broadcasting (0-100: least to most free). Control variables were then added, including GDP per capita growth, population density, country latitude, and religious affiliations. Further, a mediation analysis was applied to test if there is a causal pathway that links the degrees of media freedom and the levels of economic development or/and social protection to prevalence of depression.

Results

We found that an increase in the score of media freedom by 10 resulted in a 0.20 percentage point increase in prevalence of depressive disorders (%) (0.20, CI = 0.10-0.30). Our theoretical expectations were still confirmed when this study examined the relationship for each year between 2011 and 2014 (e.g. in 2014, 0.19, CI = 0.09-0.29), used an alternative index of media freedom from a practitioners’ view (0.17, CI = 0.02-0.32), or measured each country’s level of internet and digital media freedom (0.30, CI = 0.10-0.49). Further, a mediation test showed that 39.88% and 21.38% of the total effect was mediated through the economic and social pathway respectively.

Conclusions

The findings suggest that great levels of media freedom matter in increasing prevalence of depression.

Key messages

Great levels of media freedom matter in increasing prevalence of depression. There are direct and two indirect effects of media freedom on prevalence of depression.

P1880Entropy-based algorithm for atrial fibrillation detection using photoplethysomgraphic signal recorded by a smart watch

Background

Atrial fibrillation (AF) is the most common arrhythmia, and its paroxysmal and short duration nature makes its detection challenging. The most important limitation of current smartwatches is that patients need to touch to the sensor of the watch to record signals when patients feel discomfort. We developed a wearable smart watch and evaluated its accuracy to differentiate AF from sinus rhythm, which can continuously detecting heart rhythm without hand touching the device.

Methods and results

A wearable smart watch with PPG sensor and electrocardiogram (ECG) recording function was used for signal acquisition. A total 399 patients with a mean age of 67 years old were enrolled in the study, of whom 237 (81.5%) were male, and 101 have been diagnosed with AF. Pulse wave extracted from the green light spectrum of the signal and ECG were recorded for about 10 minutes for each patient. Pulse-to-pulse intervals (PPI) were automatically identified. All ECG signals were verified by two cardiologists. The correlation between R-to-R interval on ECG and PPI were excellent, with a correlation coefficient R >0.99 (p<0.05). An entropy-based algorithm which combined Shannon entropy of successive difference of PPI and sample entropy of PPI was used to discriminate between AF and sinus rhythm. This method had high sensitivity and specificity (96% and 98%, respectively), the area under receiver operating characteristic curve reached 0.98.

Conclusions

We developed an entropy-based algorithm for AF detection with PPG signal recorded by a wearable smart watch. This algorithm discriminates AF from sinus rhythm accurately. This advance in technology overcomes an important clinical obstacle and can increase the AF detection rate tremendously.

[Clinical analysis of five cases of autism spectrum disorder complicated with epilepsy with chromosome copy number variation]

Objective: To explore the clinical features and genetic causes of autism spectrum disorder (ASD) patients with epilepsy. Methods: The clinical data of five patients with ASD and epilepsy admitted to Xuanwu Hospital between September 2017 and September 2018 were collected, including medical history, intelligence level, developmental level, physical examination, neuroimaging and electroencephalogram. High-throughput whole-genome sequencing was applied to five patients and their parents. Results: Of five patients, four were male and one was female. All five patients had mild mental retardation, and one patient had significant growth retardation and craniofacial deformity. The average epilepsy onset age was 6.3 years old (7 months to 16 years). The main epileptic type was tonic-clonic seizure with abnormal EEG results. All patients have a favorable response to anti-epileptic drugs. Whole-exome sequencing (WES) revealed copy number variation in all 5 patients. Among them, 3 cases were reported to be pathogenic, and 2 cases were not reported (chromosome 16p13.3 duplication and chromosome 21q22.3 deletion). Conclusions: The results of current study support that autism spectrum disorders with seizures is often associated with copy number variations, such as Williams-Beuren region duplication syndrome, chromosome 15q11.2 duplication syndrome and chromosome 15q11.2 deletion syndrome. We reported two novel copy number variations (chromosome 16p13.3 duplication and chromosome 21q22.3 deletion) in two autism spectrum disorder patients with epileptic seizures.

Visual, sensitive and rapid event-specific detection of genetically modified potato EH92-527-1 by loop-mediated isothermal amplification method

To date, studies on the application of loop-mediated isothermal amplification (LAMP) in the detection of genetically modified organisms (GMOs) are stably increasing and demonstrates LAMP is a potential and promising method for on spot identification of GMOs. However, little information is known for detection of GM potato events by LAMP. In this report, we developed an optimized and visual LAMP assay with high specificity and sensitivity to rapidly amplify genomic DNA of potato EH92-527-1 within 45 min. The limit of detection of LAMP in our study is 10-fold higher than the conventional PCR. Furthermore, LAMP products can be directly observed via naked eyes by addition of SYBR Green I without gel electrophoresis analysis and PCR-based equipment. Therefore, the LAMP assay developed in this paper provides an efficient, convenient and cost-effective tool for the detection of GM potato EH92-527-1.

Hydrogen Bonding-Induced Assembled Structures and Photoresponsive Behavior of Azobenzene Molecule/Polyethylene Glycol Complexes

We investigated the self-assembled structures and photoresponsive and crystallization behaviors of supramolecules composed of 4-methoxy-4'-hydroxyazobenzene (Azo) molecules and polyethylene glycol (PEG) that were formed through hydrogen-bonding interactions. The Azo/PEG complexes exhibited the characteristics of photoresponse and crystallization, which originated from Azo and PEG, respectively. When Azo/PEG complexes were dissolved in solvents, hydrogen-bonding interaction hindered the rotation and inversion of mesogens, causing a reduction in the photoisomerization rate compared with the photoisomerization rate of the neat Azo. The confinement of Azo/PEG complexes in thin films further resulted in a substantial decrease in the photoisomerization rate but an increase in the amounts of H-aggregated and J-aggregated mesogens. Regarding PEG crystallization, ultraviolet irradiation of Azo/PEG complexes increased the quantity of high-polarity cis isomers, which improved the compatibility between mesogens and PEG, subsequently increasing the crystallization temperature of PEG. Moreover, the complexation of Azo and PEG induced microphase separation, forming a lamellar morphology. Within the Azo-rich microphases, mesogens aggregated to form tilted monosmectic layers. By contrast, PEG crystallization within the PEG-rich microphases was hard confined, indicating that the domain size of the lamellar morphology was unchanged during PEG crystallization.

Factors Influencing Nurses' Use of Hazardous Drug Safe Handling Precautions

PROBLEM IDENTIFICATION

Nurses taking measures regarding the safe handling of hazardous drugs (HDs) can reduce their risk of exposure and environmental contamination. However, the findings of studies examining factors influencing the use of HD safe handling precautions by nurses have been inconsistent.

LITERATURE SEARCH

An integrative review of the Embase® and Scopus® electronic databases was performed.

DATA EVALUATION

The search strategy yielded 907 articles. Ten quantitative studies and two qualitative studies met the inclusion criteria. The Health Evidence Bulletin Wales checklist was used to evaluate the quality of the articles.

SYNTHESIS

The outcome variables were categorized as engineering controls, work practice controls, and personal protective equipment (PPE) use. The frequency of PPE use was measured as an outcome variable in all reviewed studies. Associated factors were based on the behavioral-diagnostic model. Perceived barriers to PPE use, perceived safety climate, and workload were common factors related to the use of safety precautions.

IMPLICATIONS FOR PRACTICE

Nurses should proactively obtain information about the safe handling of HDs and share their perceptions and experiences of it with their colleagues. Managers should actively construct a safe environment by adopting high reliability principles and provide nurses with sufficient and easy-to-use PPE.

Synchronous renal cell carcinoma and pheochromocytoma presenting as acute decompensated heart failure

We report a 49-year-old woman who presented with a hypertensive crisis and acute heart failure and reduced left ventricular systolic function. An abdominal ultrasonography revealed a huge lobulated heterogeneous mass at the lower pole of the right kidney and a mass over the left suprarenal area, which were further delineated by magnetic resonance imaging. The patient underwent laparoscopic right radical nephrectomy and left adrenalectomy. Histopathological analysis confirmed the diagnoses of clear cell renal cell carcinoma of the right kidney with metastasis to the lung; and atypical pheochromocytoma of the left adrenal gland. Target therapy was initiated, which resulted in stabilization of the patient's tumors and the recovery of her heart function. To avoid a delayed diagnosis and catastrophic outcome, clinicians should consider such rare causes of acute decompensated heart failure.

Intralenticular foreign body: A case report and literature review

day, a zonal cortical cataract and posterior subcapsular cataract formed rapidly. Left-eye bare vision dramatically decreased from 20/100 to counting fingers. One month later, the patient received elective extracapsular cataract extraction. A fine metal thread was completely embedded in the lens; the lens and FB were removed together during the operation. The posterior capsule was not injured; an intraocular lens was implanted in the capsular bag. Two months postoperatively, left-eye vision had returned to 20/25. No adverse events were noted during the follow-up period. In addition to the case report, some 28 previously reported cases of intralenticular FB are reviewed here. Patient demographics, time and course of management, and visual outcome are all summarized and compared.

[Clinical features and gene analysis of TBC1D24 gene mutation related early-onset focal myoclonic epilepsy]

Objective: To investigate the clinical features and genetic characteristics of patients with TBC1D24 gene mutation related early-onset focal myoclonic epilepsy. Methods: Clinical data of 3 patients with TBC1D24 gene mutation related early-onset focal myoclonic epilepsy of Xuanwu Hospital from November 2016 to June 2017 was collected and analyzed.Candidate gene mutations were screened by second generation sequencing. Results: Among the 3 patients, 1 was male and 2 were females.Seizure onset age was 4 months, 3 years and 5 years after birth respectively. Two patients had family history of epilepsy.They all had prolonged episodes of focal myoclonus. Two patients had mental retardation.Scalp electroencephalograms (EEG) was recorded in all 3 cases and myoclonic seizures were captured.The ictal EEGs were normal in all cases. In one patient, the ictal EEG of generalized seizure showed alpha rhythm originating from left fronto-central region. Brain magnetic resonance imaging (MRI) was normal in 2 patients. Abnormal signal was found bilaterally in cerebellum in 1 patient. The gene screening showed that two patients carried compound heterozygous mutation of TBC1D24 gene and one carried homozygous mutation, all of which were de novo mutations.All the patients were treated with multiple antiepileptic drugs (AEDs) and seizures were uncontrolled in 2 patients. One patient was followed up for 10 months without recurrence. Conclusions: TBC1D24 gene related early-onset focal myoclonic epilepsy is clinically characterized by early onset, prolonged focal myoclonus which relieved with sleep, mental retardation and poor response to AEDs.The interictal and ictal EEG usually show normal. Genetic analysis can assist in diagnosis and genetic counseling.

Ultra-slow light in one-dimensional Cantor photonic crystals

Ultra-slow light and complete transmission properties in one-dimensional Cantor photonic crystals are presented. In contrast to traditional dielectric photonic crystals, the proposed structure has large group delay, slower group velocity, and a high quality factor within the same layers and materials. This study shows that larger than 1 μs group delay and slower than 1 m/s group velocity are achieved in the fifth-order Cantor photonic crystal with 52.75 μm length. This ultra-slow-light structure is very promising for application in advanced slow-light devices. A high quality factor of 10⁹ and multiband filters with complete transmission can also be obtained by using this approach.

Time-resolved inline digital holography for the study of noncollinear degenerate phase modulation

Recent works demonstrated that digital time-resolved holography is the prospective approach to study nonlinear light-matter interaction processes. In this Letter, we present a straightforward inline holographic approach for studying degenerate phase modulation induced by an inclined collimated pump beam in the isotropic sample. The method is based on a minimization of the difference between experimentally acquired data and simulated inline holograms obtained from a numerical model of pump-probe interaction in optical nonlinear media. A sophisticated experimental data processing algorithm is implemented to provide high sensitivity and a signal-to-noise ratio eligible for soft interaction with a collimated pump beam. The integral phase shift determined by our method can be used to estimate the nonlinear refractive index and the relaxation time for material with a low damage threshold. We validated our approach for the case of soda-lime and BK7 glasses.

Inflammatory bowel disease and its treatment in 2018: Global and Taiwanese status updates

The global incidence and prevalence of inflammatory bowel disease (IBD) has increased over the last 2-4 decades, likely because of the adoption of a more "western" lifestyle as well as improved detection and awareness, and Taiwan is no exception. To characterize the increasing burden of IBD, we conducted a comprehensive review of IBD in the existing literature. The following parameters were reviewed: background knowledge and current standard care for IBD, including natural history, epidemiology, pathogenesis, diagnosis, monitoring, and treatment. In addition, new imaging modalities and treatment options such as combined positron emission tomography and magnetic resonance enterography, new biologic agents, small-molecule therapy, biosimilar therapeutics, mesenchymal stem cell transplantation, and fecal microbiota transplantation, all of which have been introduced for IBD management, were reviewed. We also used the hospital-based as well as population-based Taiwan National Health Insurance Research Database to assess Taiwan-specific trends for comparison with global trends.

Optimization of dietary zinc for egg production and antioxidant capacity in Chinese egg-laying ducks fed a diet based on corn-wheat bran and soybean meal

The aim of this study was to evaluate the effect of zinc supplementation on productive performance and antioxidant status in laying ducks. Five-hundred-four laying ducks were divided into 7 treatments, each containing 6 replicates of 12 ducks. The ducks were caged individually and fed a corn-soybean meal and wheat bran basal diet (37 mg Zn/kg) or the basal diet supplemented with 15, 30, 45, 60, 75, or 90 mg Zn/kg (as zinc sulfate). During the early laying period of 10 d (daily egg production <80%), egg production, daily egg mass, and FCR increased quadratically with increasing dietary Zn levels (P < 0.05). The highest egg production and daily egg weight were obtained when 30 or 45 mg Zn/kg diet was supplemented, with lowest FCR. Similarly, the highest egg production and daily egg mass were observed in the group supplemented with 30 or 45 mg Zn/kg during the peak laying period of the subsequent 120 d (daily egg production >80%). Average egg weight and feed intake did not differ among the groups of graded Zn supplementation.The egg quality was not affected by dietary Zn, including the egg shape index, Haugh unit, yolk color score, egg composition, and shell thickness. The activities of plasma activities of total superoxide dismutase (T-SOD) and glutathione peroxidase (GSH-PX) increased in a quadratic manner (P < 0.001) with increasing supplemental Zn. Plasma concentration of Zn increased quadratically (P < 0.05) as dietary Zn increased. The hepatic activity of Cu/Zn-SOD and GSH-PX increased quadratically (P < 0.05) with increasing dietary Zn. Plasma Zn concentrations were positively correlated with activities of T-SOD (P < 0.05), and positively with plasma Cu. Plasma concentration of reduced glutathione was correlated with plasma Cu. In conclusion, supplementation of Zn at 30 or 45 mg/kg to a corn-wheat bran and soybean basal diet may improve the productive performance and enhance the antioxidant capacity.

[Self-Supporting Care Model for Older Adults]

Self-supporting care is an emerging concept in the geriatric care system of Taiwan. The traditional care model tends to prioritize aspects such as "safety" and "convenient and effective". For older adult patients, this situation has led to excessive restrictions, enforced bedrest, and the use of adult diapers, which seriously deteriorate quality of life. The present article introduces the development and current status of self-supporting care and international empirical research results from the perspective of holistic care for older adults as well as describes the intervention strategies that are currently used in Taiwan. We look forward to the caregivers of older adults being able to apply self-supporting care in their care settings, which is expected to enhance quality of life and dignity for older adults.

Prevailing Ethical Dilemmas Encountered by Physicians in Terminal Cancer Care Changed After the Enactment of the Natural Death Act: 15 Years' Follow-up Survey

CONTEXT

Advance directive laws have influences on ethical dilemmas encountered by physicians caring for terminal cancer patients.

OBJECTIVES

To identify the prevailing ethical dilemmas among terminal care physicians 15 years after the Natural Death Act was enacted in Taiwan.

METHODS

This study is a cross-sectional survey from April 2014 to February 2015 using the clustering sampling method and a well-structured questionnaire. Targeted participants included physicians at oncology and related wards or palliative care units where terminal cancer care may be provided in Taiwan.

RESULTS

Among the 500 physicians surveyed, 383 responded (response rate 76.6%) and 346 valid questionnaires were included in the final analysis (effective response rate 69.2%). The most frequently identified ethical dilemma was "place of care," followed by "use of antimicrobial agents" and "artificial nutrition and hydration." The dilemma of "truth telling," which ranked first in the 2005-2006 survey, now ranked at the fourth place. Stepwise logistic regression analysis revealed that female gender and knowledge of palliative care were negatively correlated with the extent of dilemmas regarding issues of "life and death."

CONCLUSION

The prevailing ethical dilemmas have changed in Taiwan 15 years after the enactment of the Natural Death Act, supporting that some previous strategies had worked. Our results suggest that education on the core values of palliative care, improvement of community-based hospice care program, and creating treatment guidelines with prognostication may resolve the current dilemmas. This type of survey should be adapted by individual countries to guide policy decisions on end-of-life care.

[The Application of Grief Theories to Bereaved Family Members]

Loss is an inevitable experience for humans for which grief is a natural response. Nurses must have an adequate understanding of grief and bereavement in order to be more sensitive to these painful emotions and to provide appropriate care to families who have lost someone they love deeply. This article introduces four important grief theories: Freud's grief theory, Bowlby's attachment theory, Stroebe and Schuts' dual process model, and Neiyemer's meaning reconstruction model. Freud's grief theory holds that the process of grief adaptation involves a bereaved family adopting alternative ways to connect with the death of a loved one and to restore their self-ego. Attachment theory holds that individuals who undergo grieving that is caused by separation from significant others and that triggers the process of grief adaptation will fail to adapt if they resist change. The dual process model holds that bereaved families undergo grief adaptation not only as a way to face their loss but also to restore normality in their lives. Finally, the meaning reconstruction model holds that the grief-adaptation strength of bereaved families comes from their meaning reconstruction in response to encountered events. It is hoped that these theories offer nurses different perspectives on the grieving process and provide a practical framework for grief assessment and interventions. Additionally, specific interventions that are based on these four grief theories are recommended. Furthermore, theories of grief may help nurses gain insight into their own practice-related reactions and healing processes, which is an important part of caring for the grieving. Although the grieving process is time consuming, nurses who better understand grief will be better able to help family members prepare in advance for the death of a loved one and, in doing so, help facilitate their healing, with a view to the future and to finally returning to normal daily life.

Promoting Photocatalytic Overall Water Splitting by Controlled Magnesium Incorporation in SrTiO3 Photocatalysts

SrTiO₃ is a well-known photocatalyst inducing overall water splitting when exposed to UV irradiation of wavelengths <370 nm. However, the apparent quantum efficiency of SrTiO₃ is typically low, even when functionalized with nanoparticles of Pt or Ni@NiO. Here, we introduce a simple solid-state preparation method to control the incorporation of magnesium into the perovskite structure of SrTiO₃ . After deposition of Pt or Ni@NiO, the photocatalytic water-splitting efficiency of the Mg:SrTiO_x composites is up to 20 times higher compared to SrTiO₃ containing similar catalytic nanoparticles, and an apparent quantum yield (AQY) of 10 % can be obtained in the wavelength range of 300-400 nm. Detailed characterization of the Mg:SrTiO_x composites revealed that Mg is likely substituting the tetravalent Ti ion, leading to a favorable surface-space-charge layer. This originates from tuning of the donor density in the cubic SrTiO₃ structure by Mg incorporation and enables high oxygen-evolution rates. Nevertheless, interfacing with an appropriate hydrogen evolution catalyst is mandatory and non-trivial to obtain high-performance in water splitting.

First-line icotinib versus cisplatin/pemetrexed plus pemetrexed maintenance therapy for patients with advanced EGFR mutation-positive lung adenocarcinoma (CONVINCE): a phase 3, open-label, randomized study

BACKGROUND

Icotinib has been previously shown to be non-inferior to gefitinib in non-selected advanced non-small-cell lung cancer patients when given as second- or further-line treatment. In this open-label, randomized, phase 3 CONVINCE trial, we assessed the efficacy and safety of first-line icotinib versus cisplatin/pemetrexed plus pemetrexed maintenance in lung adenocarcinoma patients with epidermal growth factor receptor (EGFR) mutation.

PATIENTS AND METHODS

Eligible participants were adults with stage IIIB/IV lung adenocarcinoma and exon 19/21 EGFR mutations. Participants were randomly allocated (1 : 1) to receive oral icotinib or 3-week cycle of cisplatin plus pemetrexed for up to four cycles; non-progressive patients after four cycles were maintained with pemetrexed until disease progression or intolerable toxicity. The primary end point was progression-free survival (PFS) assessed by independent response evaluation committee. Other end points included overall survival (OS) and safety.

RESULTS

Between January 2013 and August 2014, 296 patients were randomized, and 285 patients were treated (148 to icotinib, 137 to chemotherapy). Independent response evaluation committee-assessed PFS was significantly longer in the icotinib group (11.2 versus 7.9 months; hazard ratio, 0.61, 95% confidence interval 0.43-0.87; P = 0.006). No significant difference for OS was observed between treatments in the overall population or in EGFR-mutated subgroups (exon 19 Del/21 L858R). The most common grade 3 or 4 adverse events (AEs) in the icotinib group were rash (14.8%) and diarrhea (7.4%), compared with nausea (45.9%), vomiting (29.2%), and neutropenia (10.9%) in the chemotherapy group. AEs (79.1% versus 94.2%; P < 0.001) and treatment-related AEs (54.1% versus 90.5%; P < 0.001) were significantly fewer in the icotinib group than in the chemotherapy group.

CONCLUSIONS

First-line icotinib significantly improves PFS of advanced lung adenocarcinoma patients with EGFR mutation with a tolerable and manageable safety profile. Icotinib should be considered as a first-line treatment for this patient population.

Concept analysis of safety climate in healthcare providers

AIM AND OBJECTIVE

To report an analysis of the concept of safety climate in healthcare providers.

BACKGROUND

Compliance with safe work practices is essential to patient safety and care outcomes. Analysing the concept of safety climate from the perspective of healthcare providers could improve understanding of the correlations between safety climate and healthcare provider compliance with safe work practices, thus enhancing quality of patient care.

DESIGN

Concept analysis.

DATA SOURCES

The electronic databases of CINAHL, MEDLINE, PubMed and Web of Science were searched for literature published between 1995-2015. Searches used the keywords 'safety climate' or 'safety culture' with 'hospital' or 'healthcare'.

METHOD

The concept analysis method of Walker and Avant analysed safety climate from the perspective of healthcare providers.

RESULTS

Three attributes defined how healthcare providers define safety climate: (1) creation of safe working environment by senior management in healthcare organisations; (2) shared perception of healthcare providers about safety of their work environment; and (3) the effective dissemination of safety information. Antecedents included the characteristics of healthcare providers and healthcare organisations as a whole, and the types of work in which they are engaged. Consequences consisted of safety performance and safety outcomes. Most studies developed and assessed the survey tools of safety climate or safety culture, with a minority consisting of interventional measures for improving safety climate.

CONCLUSION

More prospective studies are needed to create interventional measures for improving safety climate of healthcare providers. This study is provided as a reference for use in developing multidimensional safety climate assessment tools and interventional measures.

RELEVANCE TO CLINICAL PRACTICE

The values healthcare teams emphasise with regard to safety can serve to improve safety performance. Having an understanding of the concept of and interventional measures for safety climate allows healthcare providers to ensure the safety of their operations and their patients.

[Implementing and Promoting Advance Care Planning for Community Older Adults]

Advance care planning (ACP) is an emerging issue in the primary care system of Taiwan. Previous studies have attributed benefits to various types of ACP in diverse ranges of healthcare settings and populations. However, few older adults in Taiwan have had the opportunity to discuss ACP or to complete their advance directives. The present article takes the perspective of community health nursing to describe the international development and current status of ACP in the community in Taiwan. Furthermore, the intervention models and available resources of ACP are described. We look forward to healthcare professionals using ACP to assist greater numbers of community older adults, thus enhancing their terminal-stage quality of life.

Acidification and sulfide formation control during reductive dechlorination of 1,2-dichloroethane in groundwater: Effectiveness and mechanistic study

To enhance the reductive dechlorination of 1,2-dichloroethane (DCA) in groundwater, substrate injection may be required. However, substrate biodegradation causes groundwater acidification and sulfide production, which inhibits the bacteria responsible for DCA dechlorination and results in an odor problem. In the microcosm study, the effectiveness of the addition of ferrous sulfate (FS), desulfurization slag (DS), and nanoscale zero-valent iron (nZVI) on acidification and sulfide control was studied during reductive dechlorination of DCA, and the emulsified substrate (ES) was used as the substrate. Up to 94% of the sulfide was removed with FS and DS addition (0.25 wt%) (initial DCA concentration = 13.5 mg/L). FS and DS amendments resulted in the formation of a metal sulfide, which reduced the hydrogen sulfide concentration as well as the subsequent odor problem. Approximately 96% of the DCA was degraded under reductive dechlorination with nZVI or DS addition using ES as the substrate. In microcosms with nZVI or DS addition, the sulfide concentration was reduced to less than 15 μg/L. Acidification can be controlled via hydroxide ions production after nZVI oxidation and reaction of free CaO (released from DS) with water, which enhanced DCA dechlorination. The quantitative polymerase chain reaction results confirmed that the microcosms with nZVI added had the highest Dehalococcoides population (up to 2.5 × 10(8) gene copies/g soil) due to effective acidification control. The α-elimination mechanism was the main abiotic process, and reductive dechlorination dominated by Dehalococcides was the biotic mechanism that resulted in DCA removal. More than 22 bacterial species were detected, and dechlorinating bacteria existed in soils under alkaline and acidic conditions.

PGE2 /EP4 Signaling Controls the Transfer of the Mammary Stem Cell State by Lipid Rafts in Extracellular Vesicles

Prostaglandin E₂ (PGE₂ )-initiated signaling contributes to stem cell homeostasis and regeneration. However, it is unclear how PGE₂ signaling controls cell stemness. This study identifies a previously unknown mechanism by which PGE₂ /prostaglandin E receptor 4 (EP₄ ) signaling regulates multiple signaling pathways (e.g., PI3K/Akt signaling, TGFβ signaling, Wnt signaling, EGFR signaling) which maintain the basal mammary stem cell phenotype. A shift of basal mammary epithelial stem cells (MaSCs) from a mesenchymal/stem cell state to a non-basal-MaSC state occurs in response to prostaglandin E receptor 4 (EP₄ ) antagonism. EP₄ antagonists elicit release of signaling components, by controlling their trafficking into extracellular vesicles/exosomes in a lipid raft/caveolae-dependent manner. Consequently, EP₄ antagonism indirectly inactivates, through induced extracellular vesicle/exosome release, pathways required for mammary epithelial stem cell homeostasis, e.g. canonical/noncanonical Wnt, TGFβ and PI3K/Akt pathways. EP₄ antagonism causes signaling receptors and signaling components to shift from non-lipid raft fractions to lipid raft fractions, and to then be released in EP₄ antagonist-induced extracellular vesicles/exosomes, resulting in the loss of the stem cell state by mammary epithelial stem cells. In contrast, luminal mammary epithelial cells can acquire basal stem cell properties following ingestion of EP₄ antagonist-induced stem cell extracellular vesicles/exosomes, and can then form mammary glands. These findings demonstrate that PGE₂ /EP₄ signaling controls homeostasis of mammary epithelial stem cells through regulating extracellular vesicle/exosome release. Reprogramming of mammary epithelial cells can result from EP₄ -mediated stem cell property transfer by extracellular vesicles/exosomes containing caveolae-associated proteins, between mammary basal and luminal epithelial cells. Stem Cells 2017;35:425-444.

Single-agent capecitabine as maintenance therapy after induction of XELOX (or FOLFOX) in first-line treatment of metastatic colorectal cancer: randomized clinical trial of efficacy and safety

BACKGROUND

The optimal strategy of maintenance therapy for patients with mCRC is controversial. This study was to evaluate the efficacy and safety of maintenance therapy with capecitabine versus observation following inductive chemotherapy in patients with metastatic colorectal cancer.

PATIENTS AND METHODS

In this randomized, open-label, multicenter, phase III trial, patients who received 18-24 weeks of induction chemotherapy with XELOX or FOLFOX and achieved disease control were randomly assigned centrally (1:1) to receive maintenance therapy of capecitabine or only observation until disease progression. The primary end point was progression-free survival (PFS) from randomization; the secondary end points included overall survival (OS), PFS from induction treatment (PFS2) and safety. Analyses were done by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02027363.

RESULTS

Between 30 July 2010 and 15 September 2013, 274 patients were enrolled in the study from 11 sites in China and randomly assigned to maintenance group (n = 136) or observation group (n = 138). Clinicopathological characteristics were balanced in two groups. The median follow-up time from randomization was 29.0 months [interquartile range (IQR) 21-36 months]. The primary end point of PFS was statistically significantly longer in capecitabine maintenance group than in observation group {6.43 [95% confidence interval (CI) 5.26-7.71] versus 3.43 (2.83-4.16) months, HR 0.54 (0.42-0.70), P < 0.001}. The median OS of capecitabine maintenance group was longer than that of observation group, but not statistically significant [25.63 (22.46-27.80) versus 23.30 (19.68-26.92) months; HR 0.85 (0.64-1.11), P = 0.2247]. Similar safety profiles were observed in both arms. The most common grade 3 or 4 toxicities in capecitabine maintenance group versus observation group were neutropenia, hand-foot syndrome, and mucositis.

CONCLUSIONS

Maintenance therapy with a single agent of capecitabine can be considered an appropriate option following the induction of XELOX or FOLFOX in mCRC patients with acceptable toxicities.

CLINICAL TRIALS NUMBER

NCT02027363.

Upregulation of Haploinsufficient Gene Expression in the Brain by Targeting a Long Non-coding RNA Improves Seizure Phenotype in a Model of Dravet Syndrome

Dravet syndrome is a devastating genetic brain disorder caused by heterozygous loss-of-function mutation in the voltage-gated sodium channel gene SCN1A. There are currently no treatments, but the upregulation of SCN1A healthy allele represents an appealing therapeutic strategy. In this study we identified a novel, evolutionary conserved mechanism controlling the expression of SCN1A that is mediated by an antisense non-coding RNA (SCN1ANAT). Using oligonucleotide-based compounds (AntagoNATs) targeting SCN1ANAT we were able to induce specific upregulation of SCN1A both in vitro and in vivo, in the brain of Dravet knock-in mouse model and a non-human primate. AntagoNAT-mediated upregulation of Scn1a in postnatal Dravet mice led to significant improvements in seizure phenotype and excitability of hippocampal interneurons. These results further elucidate the pathophysiology of Dravet syndrome and outline a possible new approach for the treatment of this and other genetic disorders with similar etiology.

The Changes of Ethical Dilemmas in Palliative Care. A Lesson Learned from Comparison Between 1998 and 2013 in Taiwan

The current ethical dilemmas met by healthcare professionals were never compared with those 15 years ago when the palliative care system was newly developing in Taiwan. The aim of the study was to investigate the ethical dilemmas met by palliative care physicians and nurses in 2013 and compare the results with the survey in 1998. This cross-sectional study surveyed 213 physicians and nurses recruited from 9 representative palliative care units across Taiwan in 2013. The compared survey in 1998 studied 102 physicians and nurses from the same palliative care units. All participants took a questionnaire to survey the "frequency" and "difficulty" of 20 frequently encountered ethical dilemmas, which were grouped into 4 domains by factor analysis. The "ethical dilemma" scores were calculated and then compared across 15 years by Student's t tests. A general linear model analysis was used to identify significant factors relating to a high average "ethical dilemma" score in each domain. All of the highest-ranking ethical dilemmas in 2013 were related to insufficient resources. Physicians with less clinical experience had a higher average "ethical dilemma" score in clinical management. Physicians with dissatisfaction in providing palliative care were associated a higher average "ethical dilemma" score in communication. Nurses reported higher "ethical dilemma" scores in all items of resource allocation in 2013. Further analysis confirmed that, in 2013, nurses had a higher average "ethical dilemma" score in resource allocation after adjustment for other relating factors. Palliative care nursing staff in Taiwan are more troubled by ethical dilemmas related to insufficient resources than they were 15 years ago. Training of decision making in nurses under the framework of ethical principles and community palliative care programs may improve the problems. To promote the dignity of terminal cancer patients, long-term fundraising plans are recommended for countries in which the palliative care system is in its early stages of development.

Effects of a gerotranscendence educational program on gerotranscendence recognition, attitude towards aging and behavioral intention towards the elderly in long-term care facilities: A quasi-experimental study

BACKGROUND

Caregivers in long-term care (LTC) facilities have to uphold a positive attitude toward the elderly, so they will be more willing to provide the elderly with care of higher quality. Theory of Gerotranscendence is a theory which can assist the elderly in developing more mature and intellectual state of mind. It is hoped that the caregivers who receive gerotranscendence education may apply its concept to the care for the elderly.

OBJECTIVES

To evaluate the effects of the gerotranscendence educational program on caregivers' gerotranscendence recognition, attitude towards aging, and behavioral intention towards caring for the elderly.

DESIGN

A quasi-experimental design with repeated measures was conducted.

PARTICIPANTS

A total of 41 caregivers in LTC facilities participated and completed the study.

METHODS

Participants were invited to participate in a 2-day gerotranscendence educational program, and measurement took place at baseline, the end of the program (post-test) and three months after the program (follow-up test). The research tools included Gerotranscendence Recognition Scale-Chinese version, Aging Attitude scale, and Caregivers' Behavioral Intention Scale. This study used GLM repeated measures to perform analysis.

RESULTS

There was a statistically significant difference in three repeated measures of participants' gerotranscendence recognition and behavior intention toward caring for the elderly (p=.002, .002, respectively) but not in the aging attitude score (p=.21). The post hoc comparison showed that the scores of these two outcomes in the post-test were significantly higher than those in the pre-test (p=.000; .024). However, the scores in the follow-up test were almost the same as those in the pre-test.

CONCLUSIONS

The gerotranscendence educational program had timely effects on caregivers' gerotranscendence recognition and behavioral intention towards aging, and so caregivers working in LTC facilities may require ongoing training in the gerotranscendence educational program to ensure that these positive effects remain strong.

Abstract B08: Meta-analyses of methionine-related polymorphisms and colorectal cancer risk for population health

Introduction/Purpose: The purpose of this meta-analysis is to determine the associations between the methionine related polymorphisms and the risk of developing colorectal cancer (CRC) for population health. CRC accounts for over 9% of all cancer incidences, is the third most common cancer worldwide, and accounts for the third leading cause of cancer related deaths. Studies have been published to support the important roles of methionine synthase (MTR), and methionine synthase reductase (MTRR) as key enzymes involved in DNA synthesis, repair, and methylation. However, the associations between these methionine-related polymorphisms and the risk of CRC have been inconsistent. Previous meta-analyses on these genes had mixed findings, without clear identification of mutation rates per population groups.

Procedure: On-line databases were searched from PubMed (PM) and PM Central databases for meta-analyses by using a combination of key words including methionine synthase or MTR, methionine synthase reductase or MTRR, colorectal or colon or rectal and cancer or carcinoma, and case control studies and meta-analysis. The located papers were cross referenced to find all original studies. For this analysis, 68 studies of human samples published within the last 16 years were located. Following the exclusions of the non-original research and non-case control studies, 34 studies remained. These papers were reviewed and evaluated using the criteria for the quality of studies by two raters. Relative risks (RR) were calculated for increased or decreased risks for CRC.

New Data Findings: Preliminary data analysis included 15377 cases and 22445 controls for MTR2756 in 27 studies with 31 race-ethnic groups; and 11594 cases and 16665 controls for MTRR66 in 20 studies with 22 race-ethnic groups. MTRR66 AA subtype was associated with increased CRC risk for Asian-Japanese group (RR = 1.0824, 95% CI = 1.01 – 1.05, p = 0.0165, 1696 cases and 2355 controls in 4 studies); whereas MTRR66 AG subtype was protective against CRC risk for Asian-Japanese group (RR = 0.9236, 0.86 – 0.99, p = 0.0358, 1696 cases and 2355 controls in 4 studies). MTR2756 GG subtype for the Western countries was protective against CRC approaching statistical significance (RR = 0.9107, 0.81-1.02, p = 0.0997, 13485 cases and 19317 controls in 26 study groups). The mutation rates for MTR2756 for all populations were distributed very closely between Western countries and Asian-Japanese groups (overall GG=3.7% for cases and 4% for controls, AG=30.7% for cases and 30.9% for controls, GG+AG=34.4% for cases and 34.9% for controls). The mutation rates for MTRR66 were greater in western countries than Asian-Japanese group (Western countries GG=29% for cases and 28.9% for controls, AG=48.7% for both cases and controls, GG+AG=77.7% for cases and 77.6% for controls; Asian-Japanese GG=8.6% for cases and 9.2% for controls, AG=41.1% for cases and 44.1% for controls, GG+AG=49.7% for cases and 53.3% for controls).

Conclusion: Different gene mutation rates across populations may be accredited to the differences in racial origin of the populations, the lifestyle, and the pattern of diet in the respective countries. Further studies are needed to evaluate the associations related to epigenetics pathways and gene-environment interactions for cancer prevention.

Citation Format: Carolyn Du, Pamela K. Shiao, Yen-Chun Lin. Meta-analyses of methionine-related polymorphisms and colorectal cancer risk for population health. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr B08.