Outbreaks of severe acute respiratory syndrome (SARS) and coronavirus disease 2019 (COVID-19) have affected populations worldwide. Our literature review summarises the studies reporting psychological ...issues among healthcare staff and infected patients in mainland China, Hong Kong, and Taiwan during these two outbreaks and the potential strategies for addressing these issues. Our review shows that patients and healthcare staff presented similar psychological symptoms, including anxiety, fear, distress, and depression, which may lead to stress-related complications such as insomnia. In patients, these psychological impairments can be contributed to by being quarantined, perceptions of threats to life, and uncertainty about health status. Quarantine is also a factor for distress among healthcare staff, together with their heavy workload, the fear that they and their families would become infected, witnessing their patients' poor and deteriorating conditions, and the requirement to wear protective gear. Strategies that are needed to address these factors include providing counselling services, implementing mindfulness-based therapies and optimism interventions, and providing telecommunication facilities for patients to communicate with their families. Healthcare staff should also be provided with these services, together with appropriate and flexible work shift arrangements and morale boosting. These strategies would improve not only the mental well-being of patients and healthcare staff, but also the self-efficacy and competence of the staff to provide quality healthcare services.
This study was performed to assess whether intubation is more difficult in obese patients and to assess the ability of a new index: the ratio of the neck circumference to thyromental distance ...(NC/TM), to predict difficult intubation in obese patients.
The incidence of difficult tracheal intubation in 123 obese (BMI≥27.5 kg m−2) and 125 non-obese patients was compared. Difficult intubation was determined using the intubation difficulty scale (IDS≥5). The NC/TM ratio was calculated and its ability to predict difficult intubation in obese patients was compared with that of established predictors including high BMI, the Mallampati score, the Wilson score, NC, width of mouth opening, sternomental distance, TM, and a previous history of difficult intubation.
Difficult intubation was more frequent in obese patients than in non-obese patients (13.8% vs 4.8%; P=0.016). Multivariate analysis revealed that the Mallampati score, the Wilson score, and NC/TM independently predicted difficult intubation in obese patients. Among these three indices, NC/TM showed the highest sensitivity and a negative predictive value, and largest area under the curve on an ROC curve.
Difficult intubation was more common in obese patients and the NC/TM was a better method for predicting difficult intubation than other established indices.
Small studies suggest that low-dose dopamine or low-dose nesiritide may enhance decongestion and preserve renal function in patients with acute heart failure and renal dysfunction; however, neither ...strategy has been rigorously tested.
To test the 2 independent hypotheses that, compared with placebo, addition of low-dose dopamine (2 μg/kg/min) or low-dose nesiritide (0.005 μg/kg/min without bolus) to diuretic therapy will enhance decongestion and preserve renal function in patients with acute heart failure and renal dysfunction.
Multicenter, double-blind, placebo-controlled clinical trial (Renal Optimization Strategies Evaluation ROSE) of 360 hospitalized patients with acute heart failure and renal dysfunction (estimated glomerular filtration rate of 15-60 mL/min/1.73 m2), randomized within 24 hours of admission. Enrollment occurred from September 2010 to March 2013 across 26 sites in North America.
Participants were randomized in an open, 1:1 allocation ratio to the dopamine or nesiritide strategy. Within each strategy, participants were randomized in a double-blind, 2:1 ratio to active treatment or placebo. The dopamine (n = 122) and nesiritide (n = 119) groups were independently compared with the pooled placebo group (n = 119).
Coprimary end points included 72-hour cumulative urine volume (decongestion end point) and the change in serum cystatin C from enrollment to 72 hours (renal function end point).
Compared with placebo, low-dose dopamine had no significant effect on 72-hour cumulative urine volume (dopamine, 8524 mL; 95% CI, 7917-9131 vs placebo, 8296 mL; 95% CI, 7762-8830 ; difference, 229 mL; 95% CI, -714 to 1171 mL; P = .59) or on the change in cystatin C level (dopamine, 0.12 mg/L; 95% CI, 0.06-0.18 vs placebo, 0.11 mg/L; 95% CI, 0.06-0.16; difference, 0.01; 95% CI, -0.08 to 0.10; P = .72). Similarly, low-dose nesiritide had no significant effect on 72-hour cumulative urine volume (nesiritide, 8574 mL; 95% CI, 8014-9134 vs placebo, 8296 mL; 95% CI, 7762-8830; difference, 279 mL; 95% CI, -618 to 1176 mL; P = .49) or on the change in cystatin C level (nesiritide, 0.07 mg/L; 95% CI, 0.01-0.13 vs placebo, 0.11 mg/L; 95% CI, 0.06-0.16; difference, -0.04; 95% CI, -0.13 to 0.05; P = .36). Compared with placebo, there was no effect of low-dose dopamine or nesiritide on secondary end points reflective of decongestion, renal function, or clinical outcomes.
In participants with acute heart failure and renal dysfunction, neither low-dose dopamine nor low-dose nesiritide enhanced decongestion or improved renal function when added to diuretic therapy.
clinicaltrials.gov Identifier: NCT01132846.
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A magnetized inductively coupled plasma ion beam etcher (MICP-IBE) was designed by employing electromagnets around the etcher (IBE). A magnetic field can be set up such that the magnitude of the ...magnetic flux density on the screen grid increases or decreases with the radial distance from the screen grid center. Four different types of magnetic field conditions were considered. The plasma densities and electron temperatures were measured as functions of radial distance from the screen grid center under each condition. In addition, ion flux was measured with respect to radial distance from the substrate center using ion energy analyzer (IEA), after which the uniformity characteristics of the ion flux in the substrate were investigated. The dry etching characteristics of CoFeB, a typical alloy being used in the magnetic memory device, were investigated. The uniformity characteristics of the ion flux and the etch rate can be improved with the proper design of magnetic field conditions; however, the improvement was confirmed to be limited. In this respect, a new screen and acceleration grid were designed that have different grid hole densities with radial distance from the grid center (hereafter referred to as the proposed grid). Using the proposed grid, the ion flux and etch rate of CoFeB were measured with respect to radial distance from the substrate center, to see if the radial etch rate uniformity can be improved further. The CoFeB etch rate non-uniformity in the proposed grid (11.65%) was lower than that for the conventional grid (17.5%).
Recently, a different type of microsatellite instability (MSI) instability designated 'elevated microsatellite alterations at selected tetranucleotide repeats' (EMAST) has been reported in several ...neoplasms, but its clinical implications remain unclear. We aimed to determine the relationships among EMAST, MSI and clinicopathologic characteristics, including oncologic outcomes, in colorectal cancer (CRC).
We evaluated 100 sporadic CRC cases subjected to surgery using five markers (MYCL1, D9S242, D20S85, D8S321, and D20S82) for EMAST and the Bethesda panel for MSI status. Immunohistochemical detection of hMSH3, c-erbB2, EGFR and thymidylate synthase was performed. Clinical characteristics and prognostic relevance were assessed.
We identified 22 EMAST-positive tumors (22.0%) and 32 MSI-high (MSI-H) tumors (32.0%). EMAST was more frequent in colon cancer than rectal cancer (p=0.033), and associated with MSI-H phenotype (p<0.001), low expression of hMSH3 (p=0.004), and overexpression of thymidylate synthase (p=0.006). Among the 38 MSI-L tumors, only one (4.5%) showed EMAST. Long-term oncologic results in terms of overall and disease-free survival were similar between EMAST and non-EMAST tumors.
EMAST is more closely related to MSI-H than MSI-L or MSS status. The clinical and molecular characteristics of EMAST were distinct in terms of tumor location, thymidylate synthase expression, MSI status and hMSH3 expression. Our preliminary findings support the utility of EMAST as a new potential classifier in CRC.
During the International Conference on Deriving Environmental Quality Standards for the Protection of Aquatic Ecosystems held in Hong Kong in December 2011, an expert group, comprising scientists, ...government officials, and consultants from four continents, was formed to discuss the important scientific and regulatory challenges with developing sediment quality guidelines (SQGs). We identified the problems associated with SQG development and made a series of recommendations to ensure that the methods being applied were scientifically defensible and internationally applicable. This document summarizes the key findings from the expert group. To enable evaluation of current SQG derivation and application systems, a feedback mechanism is required to communicate confounding factors and effects in differing environments, while field validation is necessary to gauge the effectiveness of SQG values in sediment quality assessments. International collaboration is instrumental to knowledge exchange and method advancement, as well as promotion of ‘best practices’. Since the paucity of sediment toxicity data poses the largest obstacle to improving current SQGs and deriving new SQGs, a standardized international database should be established as an information resource for sediment toxicity testing and monitoring data. We also identify several areas of scientific research that are needed to improve sediment quality assessment, including determining the importance of dietary exposure in sediment toxicity, mixture toxicity studies, toxicity screening of emerging chemicals, how climate change influence sediments and its biota, and possible use of new toxicity study approaches such as high throughput omic-based toxicity screenings.
Background Atopic disease is a major health problem. Mutations in the filaggrin gene (FLG) confer major susceptibility to eczema and related asthma. Objective We sought to determine the natural ...history and burden of atopic disease conferred by the 2 most common FLG mutations in a large, population-based birth cohort study. Methods We analyzed the effect of the most common null alleles (R501X and 2282del4) on several atopic phenotypes in a cohort of approximately 7000 English children born in 1990-1991. Results FLG null alleles associated strongly with eczema; eczema associated with these mutations presents in early life and is more persistent (hazard ratio for eczema resolution for those with FLG mutations to FLG wild type, 0.67; 95% CI, 0.58-0.77; P = 5 × 10−8 ). FLG mutations conferred a population asthma risk of 1.80 (95% CI, 1.34-2.41; P = .00019); asthma risk was especially high in the context of eczema (odds ratio, 3.16; 95% CI, 2.25-4.43; P = 1.4 × 10−11 ). Strong associations were identified with sensitization to grass, house dust mite, and cat dander and sensitization to multiple allergens (odds ratio, 2.12; 95% CI, 1.03-4.37; P = 5.42 × 10−27 ). Conclusion FLG mutations are strong genetic determinants of eczema, early wheeze, asthma in the context of eczema, and atopic sensitization. They confer risk of a particular trajectory for eczema, with increased duration of disease and greater risk of asthma and multiple allergic sensitizations. FLG alleles help define the risk profile of children with eczema and help define the “eczema plus early wheeze” and “eczema plus asthma” phenotypes.
Abstract
TRPV4 belongs to the ‘Transient Receptor Potential’ (TRP) superfamily. It has been identified to profoundly affect a variety of physiological processes, including nociception, heat sensation ...and inflammation. Unlike other TRP superfamily channels, its role in cancers are unknown until recently when we reported TRPV4 to be required for cancer cell softness that may promote breast cancer cell extravasation and metastasis. Here, we elucidated the molecular mechanisms mediated by TRPV4 in the metastatic breast cancer cells. TRPV4-mediated signaling was demonstrated to involve Ca
2+
-dependent activation of AKT and downregulation of E-cadherin expression, which was abolished upon TRPV4 silencing. Functionally, TRPV4-enhanced breast caner cell transendothelial migration requires AKT activity while a combination of transcriptional and post-translational regulation contributed to the TRPV4-mediated E-cadherin downregulation. Finally, mass spectrometry analysis revealed that TRPV4 is required for the expression of a network of secreted proteins involved in extracellular matrix remodeling. In conclusion, TRPV4 may regulate breast cancer metastasis by regulating cell softness through the Ca
2+
-dependent AKT-E-cadherin signaling axis and regulation of the expression of extracellular proteins.
In this paper, we introduce a new iterative scheme for finding a common element of the set of solutions of an equilibrium problem, the set of common fixed point for a family of infinitely ...nonexpansive mappings and the set of solutions of the variational inequality for
α
-inverse-strongly monotone mappings in a Hilbert space. Under suitable conditions, some strong convergence theorems for approximating a common element of the above three sets are obtained. As applications, at the end of the paper we utilize our results to study the optimization problem and some convergence problem for strictly pseudocontractive mappings. The results presented in the paper extend and improve some recent results of Yao and Yao Y.Y. Yao, J.C. Yao, On modified iterative method for nonexpansive mappings and monotone mappings, Appl. Math. Comput. 186 (2) (2007) 1551–1558, Plubtieng and Punpaeng S. Plubtieng, R. Punpaeng, A new iterative method for equilibrium problems and fixed point problems of nonlinear mappings and monotone mappings, Appl. Math. Comput. (2007) doi:10.1016/j.amc.2007.07.075, S. Takahashi and W. Takahashi S. Takahashi, W. Takahashi, Viscosity approximation methods for Equilibrium problems and fixed point problems in Hilbert spaces, J. Math. Anal. Appl. 331 (2006) 506–515, Su, Shang and Qin Y.F. Su, M.J. Shang, X.L. Qin, An iterative method of solution for equilibrium and optimization problems, Nonlinear Anal. (2007) doi:10.1016/j.na.2007.08.045 and Chang, Cho and Kim S.S. Chang, Y.J. Cho, J.K. Kim, Approximation methods of solutions for equilibrium problem in Hilbert spaces, Dynam. Systems Appl. (in print).
Objective
To compare the effects of the simplified 5‐step and the conventional 7‐Step hand hygiene programme in a cluster randomized controlled trial among students with intellectual disabilities.
...Method
A total of 472 Chinese students with intellectual disabilities were randomized to either simplified 5‐step or conventional 7‐step hand hygiene programme. Assessments included handwashing technique, cleanliness and sick leave days.
Results
Handwashing technique scores (g = 0.25, 95% CI 0.18, 0.32) and hand cleanliness scores (g = 0.33, 95% CI 0.26, 0.4) in intervention group were significantly higher than those scores in control group at 6th month post‐intervention although there were significant increases in the scores within both groups. The mean number of sick leave days decreased between baseline and 10 month in both groups according to descriptive statistics.
Conclusions
It is feasible and effective to adopt the simplified 5‐step intervention as a standardized handwashing technique for the population group with intellectual disabilities.
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