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Background & Problems: Fetal heartbeat (FHB) monitoring is used to monitor the condition of a fetus in the uterus and estimate the expected time of delivery. It is crucial to accurately and comprehensively monitor fetal heart beats in high-risk pregnancies. However, invalid alarms frequently occur in clinical environments, easily promoting alarm fatigue among nurses and causing anxiety and distrust in the laboring women and their families. Health professionals may ignore valid alarms due to alarm fatigue and miss the opportunity to save a fetus' life. A survey in our hospital identified invalid alarm rates for fetal heart beats as high as 65.1%, with causes including a lack of standard operating procedures for FHB monitoring in high-risk pregnancies and incomplete health education., Purpose: This project was developed to reduce the rate of invalid alarms in FHB monitoring in high-risk pregnancies to less than 42.8%., Resolutions: According to patient safety references for medical equipment management, our team established FHB monitoring standards and procedures for high-risk pregnancies. We edited FHB monitoring nursing guidance leaflets and multimedia health education videos. Nurses distributed the health education leaflets and explained the purpose and precautions during labor to expectant mothers at hospital admission. We invited nurses to share the dilemmas of caring for high-risk pregnancy experiences with nurses and obstetricians. Obstetricians and nurses proposed joint solutions for monitoring to improve the feasibility of comprehensive FHB monitoring and reduce the rate of invalid alarms., Results: The invalid alarm rate associated with FHB monitoring in high-risk pregnancies was reduced from 65.1% to 21.3%. In addition, the integrity of FHB monitoring was increased from 41.7% to 100%., Conclusions: This project effectively reduced the invalid alarm rate for delivery room nurse FHB monitoring in high-risk pregnancies and improved the integrity of this monitoring procedure. Adopting this approach has the potential of reducing anxiety and distrust in women in labor and their families, thereby enhancing the quality of care provided to these women experiencing high-risk pregnancies.

Objectives: To explore the effect of acupuncture and moxibustion on intestinal flora in the rats with diarrhea-predominant irritable bowel syndrome (IBS-D) based on 16S rDNA technique., Methods: Ten rats were randomized from 58 SPF-grade male SD rats to be the blank group. The remained 48 rats were prepared to be IBS-D models by the modified method of acetic acid enema combined with binding tail-clip stress. Forty successfully-modeled rats were randomly divided into a model group, an acupuncture group, a moxibustion group and a western medication group, with 10 rats in each one. In the acupuncture group, the needle was inserted at bilateral "Zusanli" (ST 36) and remained for 15 min in each rat. In the moxibustion group, the suspending moxibustion was delivered at bilateral "Zusanli" (ST 36) for 15 min. The rats in the western medication group were given pinaverium bromide suspension (10 mL/kg) by intragastric administration. The above interventions were performed once daily for consecutive 14 days. The body mass and the score of fecal trait were compared before and after modeling, as well as after intervention in each group. Fecal water content, diarrhea index and colon transit time (CTT) were measured after modeling and intervention in the rats of each group separately. After intervention, the colonic morphology of rats in each group was observed, and using 16S rDNA technique, the intestinal flora was detected., Results: After modeling, compared with the blank group, the body mass and CTT were reduced ( P <0.01); fecal trait scores, fecal water contents and diarrhea index increased ( P <0.01) in the other 4 groups. After intervention, the body mass and CTT of the rats decreased ( P <0.01), and fecal trait score, fecal water content and diarrhea index increased ( P <0.01) in the model group compared with those in the blank group. In the acupuncture group, the moxibustion group and the western medication group, when compared with the model group, the body mass and CTT were elevated ( P< 0.01), while fecal trait scores, fecal water contents and diarrhea index declined ( P <0.01). Compared with the western medication group, fecal water content decreased in the acupuncture group and the moxibustion group ( P< 0.05), while CTT increased in the acupuncture group ( P <0.01), the body mass increased and fecal trait score was dropped in the moxibustion group ( P <0.05). The colonic mucosa structure was clear and complete, and there was no obvious inflammatory cell infiltration in the blank group. The mild interstitial edema of intestinal mucosa was presented with the infiltration of few inflammatory cells in the model group. There was the infiltration of few inflammatory cells in the mucosa of the acupuncture group, the moxibustion group and the western medication group. Compared with the blank group, the indexes of Richness, Chao1, ACE and Shannon decreased in the model group ( P <0.05). Indexes of Richness, Chao1 and ACE increased in the acupuncture group and the moxibustion group ( P <0.05), and the Richness index in the western medication group increased ( P< 0.05) when compared with those in the model group. The relative abundance of Bacteroidetes , Proteobacteria and Prevotella increased ( P <0.05), and that of Firmicutes and Muribaculaceae decreased ( P <0.05) in the model group compared with those in the blank group. When compared with the model group, the relative abundance of Bacteroidetes , Proteobacteria and Prevotella was reduced ( P <0.05), while that of Firmicutes and Muribaculaceae increased ( P <0.05) in the acupuncture group, the moxibustion group and the western medication group; and that of Actinobacteria and Bifidobacterium increased in the acupuncture group and the moxibustion group ( P <0.05). Compared with the blank group, the relative abundance of lipopolysaccharide (LPS) biosynthesis was elevated ( P <0.05), and that of folate biosynthesis, lipoic acid metabolism, zeatin biosynthesis, ubiquinone and other terpenoid quinone biosynthesis decreased ( P <0.05) in the model group. The relative abundance of LPS biosynthesis was dropped ( P <0.05), and that of folate biosynthesis, lipoic acid metabolism, zeatin biosynthesis, ubiquinone and other terpenoid quinone biosynthesis increased ( P <0.05) in the acupuncture group, the moxibustion group and the western medication group compared with those of the model group., Conclusions: Either acupuncture or moxibustion can relieve the symptoms of IBS-D and protect intestinal mucosa, which may be associated with regulating the structure of intestinal flora and promoting nutrient metabolism and biosynthesis.

Background & Problems: The community spread of SARS-CoV-2 occurred during the COVID-19 pandemic in May 2021 in Taiwan. Due to the large number of COVID-19 patients, demand for healthcare capacity had also increased. In response to the massive influx of patients with COVID-19 in our hospital, a designated COVID-19 ward was established. In addition, the oncology ward was also quickly transformed into a designated COVID-19 ward that shared staff and work schedules with the originally designed COVID-19 ward during the pandemic period. The process of setting up the ward, training personnel, and providing independent care to COVID-19 patients and the period of professional cooperation with medical staff from the infectious disease ward caused great burden and pressure on nurses., Purpose: The objective of this study was to reduce the work-related stress index from 20.2 to 15., Resolution: Cross-training and in-service courses were implemented to assist the oncology nurses to learn nursing care for patients with COVID-19. Five solutions were discussed and implemented in a timely manner. The interventions included the unifying the logistical flows between wards, optimizing ward environments, providing education and training on COVID-19, launching a new communication platform to facilitate discussions and gather various opinions, and implementing flexible scheduling., Results: The stress index score declined from 20.2 to 8.2 on the stress and anxiety to viral epidemics-9 scale., Conclusions: The findings of this study may be referenced to assist nurses and nursing managers when making preparations to transform oncology wards into designed COVID-19 wards.

Objective: To observe the effect of acupuncture of "Yinlingquan"(SP9) and "Sanyinjiao"(SP6) on expression of phosphatidylinositol-3 kinase/protein kinase B/mammalian target protein of rapamycin (PI3K/Akt/mTOR) signaling in adjuvant arthritis (AA) rats, so as to explore its mechanism underlying improvement of AA., Methods: Forty-eight male Wistar rats were randomly divided into normal control, AA model, acupuncture and medication (tripterygium wilfordii) groups, with 12 rats in each group. The AA model was established by putting the rats in a windy, cold and wet environment for 12 h, once every day for 21 days and injection of Freund's complete adjuvant (CFA) into the sole of the right hindlimb on the 21 st day. Manual acupuncture stimulation was applied at SP9 and SP6 for 30 min/time, once a day for 21 days. Rats of the medication group received gavage of tripterygium wilfordii tablets solution (8 mg/kg), once a day for 21 days, and those of the normal control group and model group received gavage of the same amount of normal saline, once a day for 21 days. The degree of joint swelling and arthritis index (AI) were detected 1 day before modeling, 3 days after modeling, and 21 days after the treatment. Twenty-four hours after the last treatment, the contents of serum cytokines interleukin (IL)-17, IL-6 and tumor necrosis factor (TNF)-α were detected by enzyme-linked immunosorbent assay (ELISA); and changes of synovial ultrastructure were observed under electron microscope. Western blot was used to detect the expression levels of PI3K, Akt, phosphorylated protein kinase B (p-Akt), phosphorylated mammalian rapamycin target protein (p-mTOR), mTOR, microtubule associated protein 1 light chain 3B (LC3-Ⅱ) and mammalian atg6 homologous protein (Beclin-1) in the synovial membrane tissue., Results: Compared with the normal control group, the joint swel-ling degree and AI, contents of serum TNF-α, IL-6 and IL-17, and the expression levels of PI3K, Akt, p-Akt, mTOR and p-mTOR in the synovium were increased in the model group ( P <0.05), while the expression levels of LC3-Ⅱ and Beclin-1 proteins in the synovium were significantly decreased ( P <0.05). Compared with the model group, the joint swelling degree and AI, contents of serum TNF-α, IL-6 and IL-17, and the expression levels of PI3K, Akt, p-Akt, mTOR and p-mTOR were significantly decreased in the acupuncture and medication groups ( P <0.05), while the expresion levels of LC3-Ⅱ and Beclin-1 proteins were significantly increased （ P <0.05）. Comparison between the two treatment groups showed that the therapeutic effects of acupuncture were obviously weaker than those of medication in down-regulating TNF-α and IL-6, Akt, p-Akt and mTOR levels ( P <0.05) and in up-regulating Beclin-1 expression ( P <0.05). Outcomes of electron microscope displayed widened nuclear membrane space, some fractured mitochondrial cristae with vacuoles, expanded rough endoplasmic reticulum, reduction of autophagosomes in the cytoplasm and ruptured synovial cell membrane in the model group, and increase of autophagosomes, deformed organelles in the acupuncture and medication groups., Conclusion: Acupuncture can relieve the inflammatory reactions and joint synovial injury of the affected joint in AA rats which may be associated with its effects in inhibiting PI3K/Akt/mTOR signaling and increasing the auto-phagy level of synovial cells.

Background & Problems: The return-to-treatment rate is an important indicator of treatment outcome and care effectiveness in cancer patients. The return-to-treatment rates for patients at National Taiwan University Hospital (NTUH) in 2011 and 2012 were 38.5% and 33.3%, respectively. In order to improve the quality of care that is provided to patients, we reviewed NTUH's current clinical case management protocols for handling patients who refused treatment and then identified and resolved the potential problems in these protocols., Purpose: To raise the return-to-treatment rate above 45% by 2013., Resolution: We developed four new interventions to improve the return-to-treatment rate. Firstly, we assembled a quality care team that monitored the rates of patient return to treatment on a monthly basis and reminded case managers to follow up with patients regularly. Secondly, we introduced new protocols for case managers that facilitated the ongoing analysis of the reasons that patients elect not to return to treatment. Thirdly, we delivered regular education programs for case managers addressing good quality and quantity care for cancer patients. Finally, we developed an interdisciplinary liaison care program for patients., Results: After implementing these four interventions, the return-to-treatment rate improved to 48% in 2013., Conclusions: This improvement project demonstrated that integrating an interdisciplinary team, assembling a quality care team, implementing new protocols to help cancer patients who refuse to commence / continue treatment, providing regular education to clinical case managers, and enacting an interdisciplinary care program were all helpful to improving the effectiveness of cancer care services and the return-to-treatment rate of cancer patients.

This article describes the experience of the author in providing nursing care to a lung cancer patient with brain metastasis who was unable to care for herself. The period of care ran from July 26th to August 7th, 2012. The focus of the article is on the problems of disease adaptation and the coping strategies of the patient and her primary caregivers. The author used the Family Resiliency Model to collect information via physical examination, observation, and interviews. Five major nursing problems were identified in this case: risk of aspiration, self-care deficits, adjustment disorder, caregiver role strain, and family coping ineffectiveness. Based on these problems, the author constructed an individualized care plan to: 1) improve the self-care ability of the patient, 2) enhance the skills of the primary caregiver, 3) recruit the timely assistance of other family members, 4) and reduce the burden of the primary caregiver. The primary goal of this care plan was to promote the quality of life of the patient and her family.

Objective: To study the effect and potential mechanism of expression of c-jun N-terminal kinase (JNK) signal pathway on neuron autophagy after diffuse brain injury (DBI)., Methods: Male Sprague Dawley rats (n = 216) were randomly divided into four groups: DBI group (n = 54), SP600125 intervene group (n = 54), DMSO group (n = 54) and sham operation group (n = 54). DBI rat model was established according to the description of Marmarou DBI. At different time points (1, 6, 12, 24, 48 and 72 h) after operation, the histopathologic changes of neurons in cortex were observed by HE staining method; The expression of p-JNK, p-P53, DRAM and Beclin-1 were detected by Western blot and immunohistochemistry., Results: The results showed that under light microscope degenerated and necrotic neurons were observed to be scattered in cortex at 6 h after operation in DBI group, but these changes were low in SP600125 intervene group. Compared with SP600125 intervene group, the expression of p-JNK in DBI group were enhanced obviously at 6, 12 and 24 h (F = 17.902, P < 0.05); the expression of p-P53 in DBI group were enhanced obviously at 12, 24, 48 and 72 h (F = 7.107, P < 0.05); the expression of DRAM in DBI group were enhanced obviously at 6, 12, 24, 48 and 72 h (F = 15.455, P < 0.05); the expression of Beclin-1 in DBI group were enhanced obviously at 6, 12, 24, 48 and 72 h (F = 11.517, P < 0.05). Compared with DBI group, the expression of p-JNK, p-P53, DRAM and Beclin-1 in DMSO group were similar at 1, 6, 12, 24, 48 and 72 h (F = 1.509, P > 0.05)., Conclusions: The present results indicate that SP600125 can dramatically improve trauma brain injury from autophagy after DBI and the molecular mechanism is related to the modulation of JNK signal pathway following DBI, while it measures the neuron autophagy by means of intervening JNK signal pathway.

In order to investigate the role of non-adrenergic non-cholinergic nerves in regulating mechanical and electrical activity of gastric circular smooth muscle, the effects of ATP and its analogues on gastric motility and electrical activities were observed in guinea-pig. In organ bath system, isometric force of the circular smooth muscle of guinea-pig gastric antrum was measured. Electrical activity of the muscle was recorded by using intracellular microelectrode. Electrical and mechanical activities were recorded by chart recorder. ATP and 2-MeSATP potentiated the mechanical activity but did not affect electrical activity in gastric circular smooth muscle. ATP and 2-MeSATP-induced contraction was effectively blocked by nonselective P2y-purinoceptor antagonist, reactive-blue-2 and suramin, but ATP-induced contraction was not blocked by alpha,beta-MeATP-induced desensitization of P2x-purinoceptors. However, alpha,beta-MeATP, P2x-purinoceptor agonist, attenuated slow waves with membrane hyperpolarization and inhibited contraction. The relaxation by beta,gamma-MeATP was blocked by alpha,beta-MeATP-induced desensitization of P2x-purinoceptors. ATP-induced contraction was blocked by external calcium-free, but not by nicardipine, a L-type calcium channel blocker. Indomethacin, a nonselective cyclooxygenase inhibitor, did not block ATP-induced contraction. The results suggest that: (1) ATP- and analogues-induced contraction is mediated by P2y-purinoceptor, whereas alpha,beta-MeATP-induced relaxation by P2x-purinoceptor in guinea-pig gastric antral circular smooth muscle. (2) ATP-induced contraction is dependent on extracellular calcium, but Ca2+ entry is not mediated by L-type calcium channel. (3) Prostaglandins are not involved in ATP- and analogue-induced contraction of gastric circular smooth muscle in guinea-pigs, and alpha,beta-MeATP-induced relaxation is related to membrane hyperpolarization.

Relapsing polychondritis (RP) is a rare disease of unknown etiology, characterized by episodic and progressive chondritis, ocular and audiovestibular involvement, and occasional cardiovascular abnormalities. The inflammation typically involves the cartilage of the ears, nose, trachea, larynx, ribs, joints, and Eustachian tubes. The major clinical features include auricular chondritis, arthritis, nasal chondritis, ocular inflammation, chondritis of the respiratory tract, audiovestibular damage, and cardiovascular disorders. RP occurs predominantly in Caucasians and is uncommon in Oriental patients. Two cases of RP have previously been reported in Taiwan. We report one Taiwanese patient who was diagnosed with RP according to the criteria proposed by Damiani and Levine. The patient has bilateral auricular chondritis, episcleritis, and uveitis. Successful treatment was accomplished with systemic corticosteroid and topical corticosteroid eye drops. At an outpatient visit one year and ten months after discharge, there was no evidence of recurrence.

Teratomas are the most common congenital tumors, but teratomas of the nasopharynx are rare and seen almost exclusively in infants, usually in neonates. An unusual case of a neonate with respiratory distress is presented and a nasopharyngeal mass protruding into the oral cavity. After successful removal of the mass, pathological examination revealed a mature teratoma. The management and differential diagnosis are discussed, accompanied by a review of the literature.