Polo‐like kinases (PLKs) are potent regulators of cell proliferation and cell survival. Polo‐like kinases are potential targets in the treatment of anaplastic thyroid cancer (ATC), a rare but deadly ...disease. The therapeutic effects of volasertib, a PLK inhibitor, was evaluated for the treatment of ATC either alone or in combination with sorafenib. Volasertib decreased cell viability in three ATC cell lines (8505C, 8305C, and KAT18) in a dose‐dependent manner. Volasertib caused ATC cells to accumulate in G2/M phase, activated caspase‐3 activity, and induced apoptosis. Combination therapy using volasertib and sorafenib in ATC cells showed mostly synergistic effects. In vivo studies revealed that combination therapy of volasertib and sorafenib was effective in the treatment of 8505C xenografts. Single‐agent volasertib treatment was sufficient to retard 8305C tumor growth. No substantial morbidity was observed in animals that received either single‐agent or combination treatment. These preclinical findings suggest that volasertib could be an effective drug in treating ATC.
Anaplastic thyroid cancer is a rare but deadly disease. Polo‐like kinases (PLKs) are potent regulators of cell proliferation and cell survival. We found that PLK inhibitor volasertib, either alone and in combination with sorafenib, was effective in the treatment of anaplastic thyroid cancer in vitro and in vivo.
Aims and objectives
This study aims to explore the current state of self‐management behaviours among persons with type 2 diabetes mellitus in the Solomon Islands and to discuss the factors ...influencing these behaviours.
Background
The prevalence of diabetes and diabetes complications is increasing in the Solomon Islands. However, the effective diabetes prevention and care are not provided in the country.
Design
This is a cross‐sectional study.
Methods
A convenience sample of 150 persons with type 2 diabetes mellitus was recruited from a hospital in the Solomon Islands from August 2017–September 2017. Self‐report questionnaires were used to measure the self‐management behaviours, diabetes knowledge and illness perception. In addition, the study adhered to the EQUATOR checklist, STROBE (see Appendix S1).
Results
The overall score for self‐management was 56.9 ± 13.2 and diabetes knowledge and illness perception, as influencing factors of self‐management, earned total scores of 13.3 ± 4.0 and 55.8 ± 12.0, respectively. Stepwise regression analysis identified illness perception, diabetes knowledge and smoking as significant influencing factors, explaining 20.8% of the total variance in self‐management.
Conclusions
The level of diabetes self‐management behaviours demonstrated by persons with type 2 diabetes mellitus in this study was rated as less than ideal. Diabetes knowledge and illness perception were the two main factors influencing patient self‐management in the Solomon Islands.
Relevance to clinical practice
The study addressed the current state of the self‐management behaviours of persons with diabetes and discussed the factors influencing these behaviours. The findings indicated that knowledge and illness perception of diabetes were the two main factors and provided baseline information for policymakers, health planners and healthcare providers highlighting diabetes as an important issue in Solomon Islands.
Hepatitis B virus (HBV)-related liver cirrhosis (HBV-LC) presents a substantial mortality and hepatocellular carcinoma (HCC) risk. While antiviral therapy (AVT) is the standard, complete HBV ...clearance remains elusive and may not reduce the risk of death in patients with decompensated cirrhosis. Silymarin, a centuries-old herbal remedy, has shown promise against HBV infection and as an antifibrosis therapy. This study explores the potential of silymarin combined with AVT to reduce mortality and HCC incidence in patients with HBV-LC. This research, spanning from 2001 to 2019, entailed a multi-institutional retrospective cohort study which included 8447 HBV-LC patients all undergoing AVT. After applying inclusion and exclusion criteria, the study comprised two cohorts: a case cohort receiving silymarin alongside AVT for at least 30 days, and a control cohort on AVT alone. Propensity score matching, based on baseline parameters including HBV-DNA levels, comorbidity, and an important LC medication, namely, non-selective β-blockers, was employed to ensure balanced groups, resulting in 319 patients in each cohort for subsequent analyses. Overall mortality was the primary outcome, with HCC occurrence as a secondary outcome. Among 319 patients in both cohorts, the case cohort exhibited significant improvements in the international normalized ratio (INR), model for end-stage liver disease (MELD) score and the Charlson comorbidity index (CCI) one year after the index date. A competing risk survival analysis demonstrated superior one-year and two-year mortality outcomes in the case cohort. However, no significant impact on one-year and two-year HCC occurrence was observed in either cohort. The combination of silymarin and AVT in HBV-LC patients demonstrated a synergistic effect, leading to decreased overall mortality and an improved comorbidity index. While the incidence of HCC remained unchanged, our results suggested promising potential for further clinical trials investigating the synergistic role of silymarin in the treatment of HBV-LC.
Background: In modern critical care, extracorporeal membrane oxygenation (ECMO) is crucial in the management of severe respiratory and cardiac failure. Nationwide studies of the relationship between ...hospital volume and outcomes of ECMO use are unavailable.Methods and Results: Using Taiwan’s National Health Insurance Research Database, we identified 11,734 adult patients who received ECMO support in 101 hospitals between January 1, 2001, and December 31, 2017. Outcomes included in-hospital mortality, 1-year mortality, and ECMO-related complications. Cox proportional hazards model, locally estimated scatterplot smoothing, and restricted cubic spline regression were used to analyze the volume–outcome relationship. The overall in-hospital mortality rate was 65.5%, and the 1-year mortality rate was 70.6% in this database. The 101 hospitals were divided into 4 groups based on annual volume. The in-hospital and 1-year mortality rates were significantly lower in the high-volume group (annual volume >40) than in the low-volume group (annual volume <10).Conclusions: For critical care, high-volume hospitals have superior short-term and mid-term outcomes. To make the medical system equitable and reasonable, establishing a rapid and efficient nationwide referral system should be considered.
Hepatic encephalopathy (HE) implies high morbidity and mortality. The assessment of covert HE (CHE) i.e. minimal HE (MHE) plus grade 1 HE is often neglected in Taiwan. Therefore, the aim was to ...investigate the potential of the animal naming test (ANT
1
and simplified ANT
1
(S-ANT
1)
) for assessing CHE in Chinese-speaking regions, specifically Taiwan.
A prospective cohort study was conducted, comprising 65 cirrhotic patients and 29 healthy controls (relatives of the patients). Patients were followed up every three months and censored after two years or until death. Hospitalization for overt HE (OHE) and mortality were considered. All subjects underwent ANT
1
, psychometric HE score (PHES), and mini-mental state examination (MMSE). The patients underwent an electroencephalogram (EEG) to detect slowing indicative of MHE. Cut-off values for ANT
1
and S-ANT
1
were assessed by ROC analysis and Youden's index, considering CHE as a reference. The prognostic values for OHE and OHE-free survival were assessed.
Preliminary analysis confirmed that PHES ≤-4 is a good discriminant point for abnormal results. CHE was found in 29 patients: 9 had MHE (PHES ≤ -4 or altered EEG) and 20 had grade 1 HE. ANT
1
and S-ANT
1
were found to have diagnostic values for CHE: AUC = 0.807, 0.786; cut off: 18 and 19, respectively. ANT
1
and S-ANT
1
were found to have prognostic value for OHE, number of hospitalization episodes for OHE, and OHE recurrence-free survival.
ANT
1
shows promise as a tool for CHE detection, quantification, and follow-up in Taiwan and other Chinese-speaking regions.
Key messages
The animal naming test (ANT
1
) is a simple and valid semantic fluency test that can be easily performed in outpatient or bedside settings in one minute and can also be used as a tool for covert hepatic encephalopathy (CHE) detection, quantification, and follow-up in Taiwan, other Chinese-speaking regions, and many other countries.
The diagnostic value of ANT
1
and S-ANT
1
for CHE were found to be significant, with area under the receiver operating characteristic curve (AUROC) values of 0.807 and 0.786 respectively, and cut-off scores of 18 and 19.
ANT
1
and S-ANT
1
have prognostic value for the first breakthrough of overt hepatic encephalopathy (OHE), number of hospitalization episodes for OHE, and OHE recurrence-free survival, independent of the MELD score.
Dengue virus (DENV) infection may be associated with increased risks of major adverse cardiovascular effect (MACE), but a large-scale study evaluating the association between DENV infection and MACEs ...is still lacking.
All laboratory confirmed dengue cases in Taiwan during 2009 and 2015 were included by CDC notifiable database. The self-controlled case-series design was used to evaluate the association between DENV infection and MACE (including acute myocardial infarction AMI, heart failure and stroke). The "risk interval" was defined as the first 7 days after the diagnosis of DENV infection and the "control interval" as 1 year before and 1 year after the risk interval. The incidence rate ratio (IRR) and 95% confidence interval (CI) for MACE were estimated by conditional Poisson regression. Finally, the primary outcome of the incidence of MACEs within one year of dengue was observed in 1,247 patients. The IRR of MACEs was 17.9 (95% CI 15.80-20.37) during the first week after the onset of DENV infection observed from 1,244 eligible patients. IRR were significantly higher for hemorrhagic stroke (10.9, 95% CI 6.80-17.49), ischemic stroke (15.56, 95% CI 12.44-19.47), AMI (13.53, 95% CI 10.13-18.06), and heart failure (27.24, 95% CI 22.67-32.73). No increased IRR was observed after day 14.
The risks for MACEs are significantly higher in the immediate time period after dengue infection. Since dengue infection is potentially preventable by early recognition and vaccination, the dengue-associated MACE should be taken into consideration when making public health management policies.
Aims
This study aimed to explore the effectiveness of gong meditation on nurses' perceived stress and occupational burnout during the COVID‐19 pandemic.
Background
Nurses play an important role in ...hospitals, and they currently encounter additional stress due to the COVID‐19 pandemic.
Design and Methods
In this experimental study, participants were provided intervention with seven sections of gong meditation, and each session lasted for approximately 50–60 min. Data were collected from July 2020 to February 2021. Eighty nurses were randomly assigned to the experimental or control group, and 79 completed all the processes of our protocol. Generalized estimating equations (GEE) were used in data analysis.
Results
Compared with the control group, the experimental group experienced significant improvements in stress and occupational burnout.
Conclusions
Gong meditation can effectively alleviate stress and occupational burnout among nurses during the COVID‐19 pandemic.
Implications for nursing management
Gong meditation can be provided by hospital managers to all nurses to reduce their stress, occupational burnout and subsequent mental health problems. Additionally, we suggest that gong meditation can be used as an effective intervention for individuals in other occupational fields, as it is accessible and inexpensive intervention.
Background
Herpes zoster (HZ), which is caused by reactivation of the latent varicella zoster virus, was not listed as a side effect of any vaccines until the introduction of coronavirus disease 2019 ...(COVID‐19) vaccine. This study used a nationwide population database to examine whether the HZ risk is increased after receiving the influenza vaccination.
Methods
This population‐based retrospective self‐controlled case series evaluated the association between influenza vaccine exposure and HZ risk. Data were collected from Taiwan's National Health Insurance Research Database between 2015 and 2017. Patients with HZ diagnosed within 6 months before and after receiving the influenza vaccination were included. After receiving the influenza vaccine, the first 15 and 30 days were defined as risk intervals, while the other periods were defined as control intervals. Poisson regression was used to compare the incidence rate ratio (IRR) for HZ during the risk interval vs. the control interval.
Results
In total, 13,728 patients were diagnosed with HZ before and after receiving the influenza vaccine. The IRR for days 1–15 was significantly higher (IRR = 1.11; 95% confidence interval CI, 1.02–1.20), but insignificant for days 1–30 (IRR = 1.04; 95% CI, 0.98–1.10). In a subgroup analysis, the IRRs were significantly higher in participants, including 50–64 years old (1.16; 95% CI, 1.02–1.33), males (1.14; 95% CI, 1.01–1.28), and healthier individuals (i.e., no history of cancer or autoimmune diseases).
Conclusions
There was a slight increase in risk of HZ in people receiving influenza vaccine in the first 1–15 days after vaccination.
The prevalence of low vitamin D status in the elderly population of subtropical area and the potential risk/protective factors have not been addressed. This cross-sectional questionnaire-based study, ...which collected demographic/anthropometric data and information on diet habit and sun exposure, recruited 170 subjects with mean age 70.9±5.6 in rural areas of southern Taiwan. Serum 25-OH vitamin D, calcium, and intact parathyroid hormone were also measured. Using cut-off level of 30 ng/mL, subjects were divided into low (n = 95) and normal (n = 75) serum vitamin D groups. The results demonstrated a low vitamin D status in 30.6% of men and 57.7% of women. Dietary vitamin D intake was another factor associated with vitamin D status (p = 0.02). Logistic regression identified inadequate intake of vitamin D-rich food as the only risk factor for low vitamin D status in men (OR = 4.55, p = 0.01), whereas inadequate sun exposure was the only predictable risk with dose-response relationship in women (low vs. high sun exposure, OR = 6.84, p = 0.018; moderate vs. high sun exposure, OR = 6.67, p = 0.005). In conclusion, low vitamin D status was common in the elderly of subtropical rural areas. Low sun exposure and inadequate dietary vitamin D consumption were associated with a low vitamin D status in females and males, respectively.
Bronchiectasis is a chronic infectious respiratory disease with diverse causes and ethnic or geographic differences. However, few large-scale studies of its etiology have been conducted in Asia. This ...study aimed to determine the etiology and clinical features of bronchiectasis in Taiwan.
This longitudinal cohort study investigated the etiology and clinical features of newly diagnosed non-cystic fibrosis bronchiectasis patients from January 2002 to December 2016. The clinical, functional and microbiological data of patients were retrieved from the Chang Gung Research Database, which includes seven medical facilities throughout Taiwan. The index date was the date of the first bronchiectasis diagnosis. Known diseases that were diagnosed before the index date were regarded as etiologies of bronchiectasis.
The cohort comprised 15,729 adult patients with bronchiectasis. Idiopathic (32%) was the most common cause, followed by post-pneumonia (24%). Other causes included post-tuberculosis (12%), chronic obstructive pulmonary disease (14%), asthma (10%), gastroesophageal reflux disease (2%) and rheumatic diseases (2%). At diagnosis, 8487 patients had sputum culture. Pseudomonas aeruginosa (5.3%) was the most common bacteria, followed by non-tuberculosis mycobacteria (3.6%), Haemophilus influenzae (3.4%) and Klebsiella pneumoniae (3.1%), but 6155 (72.1%) had negative sputum cultures. Patients with post-tuberculosis had a higher sputum isolation rate of non-tuberculosis mycobacteria than P. aeruginosa. Patients with post-tuberculosis and post-pneumonia bronchiectasis had a higher frequency of chronic lung infection than other groups (p < 0.05). Clinical characteristics, such as gender, lung function, comorbidities and microbiology, were significantly different between idiopathic and known etiologies.
Idiopathic, post-infection and tuberculosis constitute major bronchiectasis etiologies in Taiwan. Clinical characteristics and sputum microbiology were distinct among separate etiology phenotypes.
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