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This study aims to describe the relationship between physical activity, suboptimal health status based on traditional Chinese medicine, and psychological health in older people in Taiwan. A total of 4,497 older individuals were selected from the Taiwan Biobank Research Database. Suboptimal health status was assessed using a body constitution questionnaire to measure yang deficiency, yin deficiency, and stasis. The results showed that older adults involved in physical activity had a lower likelihood of yang/yin deficiency and stasis constitutions than physically inactive people. Participants with yang deficiency or stasis constitutions had a higher likelihood of poor psychological health, whereas those with yin deficiency had a greater likelihood of depression. People involved in physical activity had a lower likelihood of depression than physically inactive people. Compared with male older adults, females had a lower percentage of physical activity habits, poorer body constitutions, and poorer psychological health. [ABSTRACT FROM AUTHOR]

This study aims to elucidate the relationship between intestinal obstruction and carnitine deficiency in neonates and infants. We retrospectively reviewed medical records of 330 neonates and infants, younger than six months, who underwent surgery for intestinal obstruction at our institute from January 2009 to April 2022. The analysis focused on clinical symptoms, related signs, complications, and etiology of the intestinal obstruction. Tandem mass spectrometry (MS/MS) or urine organic acid analysis was conducted for 47 patients, revealing carnitine deficiency in 16 patients. The incidence of carnitine deficiency was 34.0% in the suspicious group and 4.8% overall, significantly higher than in the general population in Taiwan. Notably, patients with carnitine deficiency experienced prolonged ileus, with a mean fasting duration of 41.7 days (range 7.8–65.5 days), compared to 10.8 days (range 8.2–13.4 days) in patients without carnitine deficiency. Carnitine replacement therapy was administered to twelve patients at dosages ranging from 32 to 90 mg/kg/day. One patient exhibited a drug allergy with skin rashes. Our findings suggest that carnitine deficiency should be considered in cases of neonatal and infant intestinal obstruction. Replacement therapy is straightforward and can be prognostically beneficial for some patients. Therefore, we recommend generalizing MS/MS and urine organic acid analysis, particularly for patients with prolonged ileus. [ABSTRACT FROM AUTHOR]

Background. The link between organizational culture, organizational trust, job satisfaction, and team-based practice among nurse practitioners (NPs) has not been examined simultaneously. Aim. To identify the effects of organizational culture, organizational trust, and other factors on NPs such as job satisfaction and team-based practice. Methods. We used a cross-sectional design with a national sample. Data were collected using an online survey of 1,100 NPs working in acute care settings. The survey included demographic and working characteristics, the Organizational Culture Scale, the Organizational Trust Scale, the Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS), and the NP-physician relations (NP-PR) subscale of the Nurse Practitioner Primary Care Organizational Climate (NP-PCOCQ). Multiple regression analysis with a stepwise selection method explored potential factors that influence job satisfaction and team-based practice. Results. A learning environment, psychological safety, senior leadership support, commitment to the organization, and the organizational culture and trust were positively associated with higher job satisfaction, which accounted for 49.2% of the variance in NPs' job satisfaction. Organizational trust, commitment to the organization, and learning environment promoted better team-based practice significantly. Also, NPs working a fixed shift pattern showed higher levels of team-based practice. These factors accounted for 23.66% of variances in team-based practice. Conclusion. Organizational culture and organizational trust affect the job satisfaction and team-based practice of NPs in acute care practices. Implications for Nursing Management. Acute care hospitals are encouraged to develop policies to enhance a learning environment, a supportive organizational culture, and trust in NPs' practice. [ABSTRACT FROM AUTHOR]

Objective: Iron accumulation is associated with osteoporosis. This study aims to explore the effect of chronic iron accumulation induced by hepcidin1 deficiency on aging osteoporosis. Methods: Iron accumulation in hepcidin1 knockout aging mice was assessed by atomic absorption spectroscopy and Perl's staining. Bone microarchitecture was observed using Micro-CT. Hepcidin, ferritin, oxidative stress, and markers of bone turnover in serum were detected by enzyme-linked immunosorbent assay. Bone formation and resorption markers were measured by real-time quantitative PCR. Cell aging was induced by D-galactose treatment. CCK-8, flow cytometry, EdU assays, and Alizarin red staining were performed to reveal the role of hepcidin1 knockout in cell model. Iron Colorimetric Assay Kit and western blot were applied to detect iron and ferritin levels in cells, respectively. Results: In hepcidin1-knockout mice, the ferritin and iron contents in liver and tibia were significantly increased. Iron accumulation induced by hepcidin1 knockout caused a phenotype of low bone mass and deteriorated bone microarchitecture. Osteogenic marker was decreased and osteoclast marker was increased in mice, accompanied by increased oxidative stress level. The mRNA expression levels of osteoclast differentiation markers (RANKL, Mmp9, OPG, Trap, and CTSK) were up-regulated, while bone formation markers (OCN, ALP, Runx2, SP7, and Col-1) were down-regulated in model group, compared to wild type mice. In vitro, hepcidin1 knockdown inhibited proliferation and osteogenic differentiation, while promoted apoptosis, with increased levels of iron and ferritin. Conclusion: Iron accumulation induced by hepcidin1 deficiency aggravates the progression of aging osteoporosis via inhibiting osteogenesis and promoting osteoclast genesis. [ABSTRACT FROM AUTHOR]

Simple Summary: We proposed a deep learning algorithm to detect lymph nodes and classify them in the head and neck region on computed tomography. We further analyzed the inference result from the model and found that the size of the lymph nodes may be a characteristic for the model to classify them. This finding is consistent with current clinical aspects. We will deploy the model in clinical practice and hope to assist clinicians in finding out the lesions more correctly and efficiently. Background: Head and neck cancer is highly prevalent in Taiwan. Its treatment mainly relies on clinical staging, usually diagnosed from images. A major part of the diagnosis is whether lymph nodes are involved in the tumor. We present an algorithm for analyzing clinical images that integrates a deep learning model with image processing and attempt to analyze the features it uses to classify lymph nodes. Methods: We retrospectively collected pretreatment computed tomography images and surgery pathological reports for 271 patients diagnosed with, and subsequently treated for, naïve oral cavity, oropharynx, hypopharynx, and larynx cancer between 2008 and 2018. We chose a 3D UNet model trained for semantic segmentation, which was evaluated for inference in a test dataset of 29 patients. Results: We annotated 2527 lymph nodes. The detection rate of all lymph nodes was 80%, and Dice score was 0.71. The model has a better detection rate at larger lymph nodes. For those identified lymph nodes, we found a trend where the shorter the short axis, the more negative the lymph nodes. This is consistent with clinical observations. Conclusions: The model showed a convincible lymph node detection on clinical images. We will evaluate and further improve the model in collaboration with clinical physicians. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the outcomes of thrombectomy with/without iliac vein stenting for young and transiently provoked DVT patients with iliac vein stenosis. Methods: This is a retrospective analysis of a prospectively collected multicenter database. Acute, transiently provoked DVT patients between 18 and 45 years old with iliac vein stenosis were included. All patients underwent thrombectomy. Outcomes including the Villalta score, the VEINES-QOL score, and adverse events were evaluated. Results: The data of 522 patients were collected of whom 75 were included, 58 underwent thrombectomy alone (nonstenting group) and 17 underwent thrombectomy and stenting (stenting group). Within 6 months, the Villalta score of patients in stenting group is lower than that of patients in nonstenting group (6 mo: 0.73 ± 0.77 vs. 1.41 ± 0.56, p =.0004), and the VEINES-QOL score of stenting group is higher than that of nonstenting group (6 mo: 89.00 ± 2.94 vs. 87.47 ± 3.72, p =.2141). At the following follow-ups, the Villalta score (12 mo: 0.56 ± 0.49 vs. 0.60 ± 0.58, p =.8266) and VEINES-QOL score (12 mo: 88.36 ± 2.29 vs. 88.31 ± 3.36, p =.9604) between the two groups are similar. Conclusion: The stenting group had better efficacy within 6 months after intervention, while there was no significant difference in the symptom, signs, and quality of life between two groups after 6 months within a 2-year follow-up. Trial registration: This study was registered in the Chinese Clinical Trial Registry (Registration Number: ChiCTR2200056073). [ABSTRACT FROM AUTHOR]

In recent years, advance care planning (ACP) promotion in Taiwan has expanded beyond clinical practice to the broader population. This study aims to investigate people's attitudes toward ACP and to identify factors influencing their signing of advance directives (ADs) and appointment of health care agents (HCAs). Methods: We identified 2337 ACP participants from consultation records between 2019 and 2020. The relationships among the participants' characteristics, AD completion, and HCA appointment were investigated. Results: Of 2337 cases, 94.1% completed ADs and 87.8% were appointed HCAs. Welfare entitlement (OR = 0.47, p < 0.001), the place ACP progressed (OR = 0.08, p < 0.001), the participation of second-degree relatives (OR = 2.50, p < 0.001), and the intention of not being a family burden (OR = 1.65, p = 0.010) were significantly correlated with AD completion. The probability of appointing HCAs was higher in participants with family caregiving experience (OR = 1.42, p < 0.05), who were single (OR = 1.49, p < 0.05), and who expected a good death with dignity (OR = 1.65, p < 0.01). Conclusions: Our research shows that adopting ACP discussion in Taiwan is feasible, which encourages ACP conversation and facilitates AD completion. Implications: Male and younger adults may need extra encouragement to discuss ACP matters with their families. Limitations: due to sampling restrictions, our data were chosen from an urban district to ensure the integrity of the results. Furthermore, interview data could be collected in future research to supplement the quantitative results. [ABSTRACT FROM AUTHOR]

Background: In Taiwan, the National Health Insurance Administration initiated the integrated home‐based medical care (iHBMC) program in 2016 to improve accessibility to health care for homebound patients. This study aimed to describe the characteristics of older people receiving iHBMC services in Taiwan as well as the relationship between patient characteristics and survival. Methods: All older adults registered in the iHBMC application dataset were enrolled between March 1, 2016, and December 31, 2018. Data on social determinants of health (income level, residential area), functional status, consciousness status, nasogastric tube or urinary catheter placement, and major diseases were retrieved from the database. Data on the frequency of multidisciplinary team members' visits were collected. The survival rate was investigated using the Kaplan–Meier method. A Cox proportional hazards univariate regression was conducted to analyze factors influencing survival rates. Results: A total of 41,079 patients aged ≥65 years were enrolled in iHBMC services. The results showed that the one‐year survival rates were 72.1%, 67.4%, and 14.7% in the home‐based primary care (HBPC), home‐based primary care plus (HBPC‐Plus), and home‐based palliative care (HBPalC), respectively. Nearly two‐thirds of the HBPC‐Plus patients underwent nasogastric tube placement. The Cox proportional hazards univariate regression analysis showed that a low urbanization level, a low income level, a low functional status, and an impaired consciousness status were significant predictors of poor survival after adjustment for confounding variables. Conclusions: Older adults receiving iHBMC services had a high mortality rate. The high rate of feeding tube use indicated that education and support for both clinical practitioners and family caregivers regarding careful hand feeding are warranted. There was a relationship between low income levels and poor survival in rural areas. Further research on whether social care could impact prognosis should be considered. [ABSTRACT FROM AUTHOR]

Purpose: To investigate nurse practitioners' (NPs) experience of job strain in acute care settings, and to examine the factors that may affect job strain in that context. Design: Descriptive design using a national survey was employed. Methods: A total of 1396 NPs completed online surveys that recorded demographic characteristics and included a Job Content Questionnaire (JCQ), a Condition for Work Effectiveness Questionnaire (CWEQ), and the Dempster Practice Behavior Scale (DPBS). Multiple logistic regressions were conducted to explore the factors associated with job strain types. Findings: NPs were classified into job strain categories of passive (24.4%), active (31.4%), low (19.2%), or high (24.9%). The passive job strain type was associated with overtime hours, organizational empowerment, and autonomy. The active job type was associated with higher organizational empowerment and autonomy. The high‐strain and low‐strain job types were both associated with overtime hours and autonomy. Conclusion: Nearly 25% of acute care NPs are in a high job strain type. Organizational empowerment and autonomy were two major factors associated with the passive and active job strain types. Overtime hours and autonomy were both associated with the high‐strain and low‐strain job types. Clinical relevance: Supportive hospital/nursing leadership should acknowledge the impact of NP practice as they can contribute to the operational efficacy of their organization. Hospital administrators should provide a supportive practice environment by empowering NPs, enhancing autonomy, and addressing working conditions for NPs to decrease the odds of having a passive or high‐strain job type in practice. [ABSTRACT FROM AUTHOR]

Background: Palliative family conference (PFC) was included in the reimbursement of National Health Insurance to promote palliative care in Taiwan in 2012. Objectives: This study aimed to evaluate the impact of PFC on death in intensive care unit (ICU) and receiving cardiopulmonary resuscitation (CPR) within three days before death. Design: This is a cross-sectional study. Subjects: All patients who died in a public hospital and were admitted to ICU within 30 days before death, from 2013 to 2018, were included. Measurements: The medical records were analyzed to identify information on causes of death, receiving PFC, receiving palliative care consultation, death in ICU, and receiving CPR within three days before death. Multivariate logistic regression was used to assess the independent effects of receiving PFC on the risk of death in ICU and receiving CPR within three days before death. Results: For patients who died and those who did not die in ICU, the proportion of receiving PFC was 45.8% (1818/3973) and 55.0% (808/1468), respectively. For patients who received and those who did not receive CPR within three days before death, the proportion of receiving PFC was 23.9% (140/585) and 51.2% (2486/4856), respectively. PFC was associated with a reduced risk of death in ICU (adjusted odds ratio [AOR]: 0.842; 95% confidence interval [CI]: 0.717–0.988) and a reduced risk of receiving CPR within three days before death (AOR: 0.361; 95% CI: 0.286–0.456). Conclusion: PFC reduces the risk of receiving nonbeneficial aggressive intervention and may improve the quality of end-of-life care. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to determine the main factors that affect nurse practitioners' (NPs) job satisfaction, especially the relationship between organisational commitment and leadership styles in acute care practices. Background: There is little known about the influence of organisational commitment and leadership on NPs' job satisfaction within acute care hospitals. Methods: A cross‐sectional design with a national online survey enrolled 1205 NPs from the Taiwan Association of Nurse Practitioners. A multiple regression model was applied to identify potential variables that associated with job satisfaction. Results: Organisational commitment (mean = 59.47), job satisfaction (mean = 173.47) and leadership style (mean ranged from 13.29 to 28) were at a moderate level. Organisational commitment, leadership style, patient load and NP advancement levels explained 63% of the variance in NPs' job satisfaction. Conclusions: Organisational commitment and leadership styles, such as idealized influence and individual consideration, are major factors that impact NPs' job satisfaction. Implications for Nursing Management: Health care organisations should develop policies targeting organisational commitment and managers' leadership styles to improve NPs' job satisfaction. [ABSTRACT FROM AUTHOR]

Headache, both before and after injury, has been associated with worse outcome following mild traumatic brain injury (MTBI). This study examined whether three MTBI patient groups – no headache (reported no pre-/post-injury headache), pre-injury headache (reported pre-injury headache, nearly all of whom also reported post-injury headache), and post-traumatic headache only (denied pre-injury headache and reported post-injury headache) – differed in acute-to-subacute outcomes. Cross-sectional observational study. Patients within 21 days of a MTBI (n = 291) completed neuropsychological tests and questionnaires evaluating depression, anxiety, and post-concussion symptoms. Neuropsychological test performances did not differ between headache groups. Participants with pre-injury headache and participants with post-traumatic headache only reported greater change in self-reported physical and cognitive symptoms than participants with no headache. Participants with pre-injury headache reported worse post-injury anxiety symptoms than participants with post-traumatic headache only. The pre-injury headache and post-traumatic headache only groups did not meaningfully differ in outcome within 21 days of MTBI, but they had worse physical and cognitive symptoms than participants with no headache. Future research should assess whether differences in outcome emerge further from injury and whether specific headache subtypes are differentially associated with outcome. [ABSTRACT FROM AUTHOR]

Background: Nurse practitioners (NPs) play an important role in addressing growing health care needs. Among NPs, organizational empowerment is positively associated with overall practice outcomes. Therefore, efforts to promote organizational empowerment in practice are necessary to increase job satisfaction among NPs as well as decrease the stress and intention to leave. Purpose: This study investigated the relationships of organizational empowerment and practice outcomes of job satisfaction, work stress, and intention to leave in acute care practices. Methodological orientation: This study was conducted as a cross-sectional design with a national survey of 946 acute care NPs. Questionnaires contained demographic and practice characteristics, Misener Nurse Practitioner Job Satisfaction Scale, Condition for Work Effectiveness Questionnaire II, and the work stress VAS scale. Hierarchical Linear Model (HLM) was used to investigate individual NP-level or organization-level effects on job satisfaction. The factors associated with job satisfaction were examined by stepwise multiple regression. Results: The organizational empowerment was low, work stress was moderately high, and job satisfaction was between slightly unsatisfied and slightly satisfied. The HLM results indicated that organization-level effects did not affect the job satisfaction of NPs. Nurse practitioners with greater formal power, resources, and informal power had higher job satisfaction. Conversely, NPs with an intention to leave and a higher level of stress showed lower job satisfaction. Conclusions: Organizational empowerment, intention to leave, and stress affect job satisfaction of acute care NPs in Taiwan. Implications for practic: To enhance the job satisfaction of NPs, health care administrators should empower NPs by providing access to opportunity, support, information, and resources in the health care delivery system. [ABSTRACT FROM AUTHOR]

High fibre intake is associated with reduced mortality risk in both general and chronic kidney disease populations. However, in dialysis patients, such data are limited. Therefore, the association between dietary fibre intake (DFI) and the risk of all-cause and CVD mortality was examined in this study. A total of 1044 maintenance haemodialysis (MHD) patients from eight outpatient dialysis centres in China were included in this study. Data on DFI were collected using 24-h dietary recalls for 3 d in a week and were normalised to actual dry weight. The study outcomes included all-cause and CVD mortality. Over a median of 46 months of follow-up, 354 deaths were recorded, of which 210 (59 %) were due to CVD. On assessing DFI as tertiles, the CVD mortality risk was significantly lower in patients in tertiles 2–3 (≥0·13 g/kg per d; hazard ratio (HR) 0·71; 95 % CI 0·51, 0·97) compared with those in tertile 1 (<0·13 g/kg per d). A similar but non-significant trend was found for the association between DFI (tertiles 2–3 v. tertile 1; HR 0·83; 95 % CI 0·64, 1·07) and all-cause mortality. In summary, higher DFI was associated with lower CVD mortality risk among Chinese MHD patients. This study emphasises the significance of DFI in MHD patients and provides information that is critical for the improvement of dietary guidelines for dialysis patients. [ABSTRACT FROM AUTHOR]

Background: The purpose of this retrospective study was to evaluate the clinical efficacy of mineralized collagen (MC) versus anorganic bovine bone (Bio-Oss) for immediate implant placement in esthetic area. Methods: Medical records of Department of Oral and Maxillofacial Surgery of Shandong Provincial Hospital were screened for patients who had been treated with immediate implant implantation in the esthetic area using either MC (Allgens®, Beijing Allgens Medical Science and Technology Co., Ltd., China) or Bio-Oss (Bio-Oss®, Geistlich Biomaterials, Wolhusen, Switzerland), between January 2018 and December 2019. All patients fulfilling the in-/exclusion criteria and following followed for a minimum period of 1 year after surgery were enrolled into the presented study. Implant survival rate, radiographic, esthetic and patient satisfactory evaluations were performed. Results: Altogether, 70 patients were included in the study; a total of 80 implants were inserted. All implants had good initial stability. The survival rate of implants was 100% at 1-year follow-up. The differences in horizontal and vertical bone loss between the MC group (0.72 ± 0.26 mm, 1.62 ± 0.84 mm) and the Bio-Oss group (0.70 ± 0.52 mm, 1.57 ± 0.88 mm) were no significant difference statistically no significant 6 months after permanent restoration. Similar results occurred at 12 months after permanent restoration functional loaded. Clinical acceptability defined by pink esthetic score (PES) ≥ 6 (6.07 ± 1.62 vs. 6.13 ± 1.41) was not significantly different between groups. Patient satisfaction estimated by visual analog scale (VAS) was similar (8.56 ± 1.12 vs. 8.27 ± 1.44), and the difference was no significant difference between the two groups. Conclusions: The biomimetic MC showed a similar behaviour as Bio-Oss not only in its dimensional tissues changes but also in clinical acceptability and patient satisfaction. Within the limitations of this study, these cases show that MC could be considered as an alternative bone graft in IIP [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the central mechanism underlying the putative beneficial effects of electroacupuncture (EA) on learning and memory ability of rats with ischemic stroke-induced cognitive deficits by resting-state functional magnetic resonance imaging (fMRI). Methods: A rat model of middle cerebral artery occlusion (MCAO)-induced cognitive deficit (MICD) was established. Rats were randomly assigned into a sham-operated control group (SC group, n = 12), untreated MICD model group (MICD group, n = 12), and MICD group receiving EA treatment at GV20 and GV24 (MICD + EA group, n = 12). Results: Compared to the MICD group, rats in the MICD + EA group receiving EA at GV20 and GV24 exhibited significantly shortened escape latency times and crossed the position of the platform a significantly increased number of times during the Morris water maze test on the 14th day after EA, which suggested EA could significantly improve spatial learning and memory ability. Furthermore, compared to the MICD group, functional connectivity of the left retrosplenial cortex (RSC) with the left hippocampus, left RSC, right RSC, left cingulate gyrus, right cingulate gyrus, right tegmentum of midbrain, and right visual cortex was increased in the MICD + EA group; the MICD group showed decreased functional connectivity of the left RSC with the left hippocampus, right hippocampus, left RSC, right RSC, right amygdaloid body, left visual cortex, and right visual cortex. Conclusion: These findings suggest that EA at GV20 and GV24 might improve the learning and memory ability of MICD rats by increasing the functional connectivity between the RSC and hippocampus, cingulate gyrus and midbrain, which is encouraging for the potential treatment for cognitive impairment secondary to ischemia stroke. [ABSTRACT FROM AUTHOR]

Objective: To identify distinct subgroups of patients newly diagnosed with lung cancer (LC) over time and to explore the predictors of distinct trajectories of symptom and fatigue distress in LC patients. Methods: A total of 120 patients newly diagnosed with LC were recruited in this longitudinal prospective study. Our survey investigated patients' symptoms in 6 months. Latent growth curve analysis (LGCA) was conducted to identify patients with distinct trajectories of symptom and fatigue distress. The characteristics of the patients among groups were compared for statistical differences by the chi‐square test or ANOVA. Results: The results of LGCA revealed that the linear three‐trajectory model had the best model fit for symptom and fatigue distress. Patients' symptom and fatigue distress improved with time, except for patients with increasing trajectories. Patients' trajectories of symptom and fatigue distress were affected by pain, lower functional status, total symptom score and depression. Moreover, patients with increasing trajectories of symptom and fatigue distress experienced more pain, physiological symptoms and depression from 1 to 6 months. Conclusions: Pain and functional status were the major factors that deteriorated the recovery of trajectory in symptom distress and fatigue distress among patients with increasing trajectories. [ABSTRACT FROM AUTHOR]

Background: Evaluating the need for palliative care and predicting its mortality play important roles in the emergency department. Aim: We developed a screening model for predicting 1-year mortality. Design: A retrospective cohort study was conducted to identify risk factors associated with 1-year mortality. Our risk scores based on these significant risk factors were then developed. Its predictive validity performance was evaluated using area under receiving operating characteristic analysis and leave-one-out cross-validation. Setting and participants: Patients aged 15 years or older were enrolled from June 2015 to May 2016 in the emergency department. Results: We identified five independent risk factors, each of which was assigned a number of points proportional to its estimated regression coefficient: age (0.05 points per year), qSOFA ⩾ 2 (1), Cancer (4), Eastern Cooperative Oncology Group Performance Status score ⩾ 2 (2), and Do-Not- R esuscitate status (3). The sensitivity, specificity, positive predictive value, and negative predictive value of our screening tool given the cutoff larger than 3 points were 0.99 (0.98–0.99), 0.31 (0.29–0.32), 0.26 (0.24–0.27), and 0.99 (0.98–1.00), respectively. Those with screening scores larger than 9 points corresponding to 64.0% (60.0–67.9%) of 1-year mortality were prioritized for consultation and communication. The area under the receiving operating characteristic curves for the point system was 0.84 (0.83–0.85) for the cross-validation model. Conclusions: A-qCPR risk scores provide a good screening tool for assessing patient prognosis. Routine screening for end-of-life using this tool plays an important role in early and efficient physician-patient communications regarding hospice and palliative needs in the emergency department. [ABSTRACT FROM AUTHOR]

Background. Traditional Chinese medicine (TCM) appears to be the common therapy in middle-aged women. The constitution serves as a guide for TCM treatment. However, little is known about the constitution and related factors in middle-aged women. The objectives of this study were to describe the yang-deficiency, yin-deficiency, and stasis constitutions in middle-aged women. Demographic and health factors related to yang deficiency, yin deficiency, and stasis were also examined. Methods. A total of 1,000 women aged 40–65 years were selected from 2009 through 2018 using random sampling from the Taiwan Biobank Research Database in Taiwan. Yang-deficiency, yin-deficiency, and stasis were assessed using the body constitution questionnaire. Multiple logistic regression analysis was used to identify factors associated with constitution in deficiency or stasis. Results. The proportions of middle-aged women who had the constitution in yang-deficiency, yin-deficiency, and stasis were 29.7%, 21.7%, and 17.7%, respectively. The result of binary logistic regression showed that current menstruation, abnormal spirometry, and education level were predictive factors of yang deficiency. Women with younger age, abnormal spirometry, or a vegetarian diet had a significantly associated yin deficiency. Younger age, abnormal spirometry, and coffee habit were predictors of stasis. Conclusions. Middle-aged women in Taiwan with abnormal spirometry had a higher risk for deficiency or stasis constitutions, especially for those younger than 56 years. Healthcare providers should learn patients' constitutions and provide appropriate advice, referring them to safe providers of their desired method. [ABSTRACT FROM AUTHOR]

Background: Patients with diffuse large B‐cell lymphoma (DLBCL) with concurrent hepatitis B surface antigen (HBsAg)‐positive hepatitis B virus (HBV) infection have distinct clinical features. Nevertheless, the prognostic value of HBsAg in DLBCL in the rituximab era remains unclear. Materials and Methods: We conducted a retrospective cohort study to investigate the clinical relevance of HBsAg in immunocompetent patients with DLBCL treated with homogeneous rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone between 2002 and 2016. Results: Among 416 analyzed patients, 98 (23.6%) were HBsAg positive. HBsAg positivity was associated with a younger age and more advanced stage at diagnosis, more frequent hepatic impairment during perichemotherapy, and a trend of higher National Comprehensive Cancer Network‐International Prognostic Index (NCCN‐IPI) score at diagnosis. Compared with the HBsAg‐negative patients, the HBsAg‐positive patients had a lower overall response rate (76.5% vs. 85.5%, p =.043), poorer 5‐year overall survival (OS) rate (57.2% vs. 73.5%, p <.001), and shorter 5‐year progression‐free survival (PFS) rate (47.2% vs. 60.7%, p =.013). Multivariate analyses showed that HBsAg positivity was an independent unfavorable prognostic indicator for OS and PFS. A scoring system incorporating HBsAg positivity, the NCCN‐IPI score, and serum albumin levels proved to be useful for stratifying prognostically relevant subgroups of patients with DLBCL. Conclusion: This study demonstrated that HBV infection is uniquely relevant to DLBCL. HBsAg might serve as a novel biomarker to improve clinical risk stratification of patients with DLBCL in areas with high prevalence of HBV infection. Further research investigating the etiopathogenesis of HBV infection in DLBCL is imperative. Implications for Practice: A considerable disparity exists regarding the prognostic relevance of hepatitis B surface antigen (HBsAg)‐positive hepatitis B virus (HBV) infection in patients with diffuse large B‐cell lymphoma (DLBCL). In this large, retrospective cohort study from an area with high prevalence of HBV infection, the authors demonstrated that HBsAg was an independent unfavorable factor significantly associated with survival, highlighting its potential as a novel prognostic indicator to improve the risk stratification of patients with DLBCL in the rituximab era. Hepatitis B virus infection remains a major public health problem in endemic areas. This article reports a new scoring system for risk stratification for patients with diffuse large B‐cell lymphoma in endemic areas for HBV infection. [ABSTRACT FROM AUTHOR]

This study describes the fertility intention and explores factors related to fertility intention in reproductive-age women with breast cancer in Taiwan. In this cross-sectional study, women of childbearing age who had been diagnosed with breast cancer completed a face-to-face survey that included demographic, disease, and symptom-related data, and social support and fertility intention information. The mean fertility intention score among the 223 participants was "medium" (M ± SD = 41.18 ± 12.62). Higher symptom severity, especially for distress, was related to lower fertility intention. Instrumental support from families and friends was positively associated with fertility intention score. Younger women had better fertility intention scores than older women. The Sobel test showed that age mediated menopause and fertility intention. The findings offer the evidence of the needs to control symptoms and provide sufficient instrumental support regarding fertility after completing chemotherapy. [ABSTRACT FROM AUTHOR]

Shenqi Fuzheng Injection (SFI) is a traditional Chinese medicine injection with anticancer properties and is mainly composed of ginseng and astragalus. Its efficacy has been confirmed in clinical trials, but the mechanism remains unclear. We investigated the effect of SFI on vascular endothelial growth factor (VEGF) gene expression in hepatocellular carcinoma (HCC) cells and identified its possible mechanism of synergistic effects when combined with the chemotherapeutic drug interferon (IFN-) α. An MTT assay was used to measure the inhibition effects of low-dose IFN-α (6000 IU) with or without SFI (0.5 g/L) on the HCC cell line MHCC97. VEGF-silenced MHCC97L-mir200 cell lines were prepared using lentiviral vectors and evaluated by real-time PCR to determine the inhibition effect. We examined MHCC97L-mir200 and MHCC97L cells by MTT assay, using IFN-α alone or in combination with SFI. The inhibition ratio of IFN-α (6000 IU) was -29.5%, while that for IFN-α (6000 IU) + SFI (0.5 g/L) was 17.0%, which was significantly higher than that for the IFN-α group (P < 0.01). The VEGF gene was silenced successfully in MHCC97-L cells. After interference of VEGF, the inhibition by SFI and IFN-α in MHCC97L-mir200 did not differ from that in MHCC97-L cells (P > 0.05). SFI can reduce the expression of VEGF in HCC, which can increase the efficacy of IFN-α, providing a theoretical basis for clinical application. [ABSTRACT FROM AUTHOR]

In this study we examine whether there is healthy immigrant effect among women immigrated to Taiwan through transnational marriage. A sample of immigrant women (N = 246) with original nativity of Southeast Asian countries and Taiwanese-born women sample (N = 201) was recruited from December 2008 to December 2009. Their depressive symptoms, acculturative stresses and family functioning were assessed by a series of questionnaires. Immigrant women had lower depressive scores than their native-born counterparts when other potential confounders were controlled for in the multiple regression model. Our findings suggest that the healthy immigrant effect exists among immigrant women in Taiwan. Although such effect may due to immigrant women is a highly selective population with hardy mental characteristics, it is crucial to improve immigrant women's mental health by helping them to enhance the ability of expressing emotions between family members as well as by mitigating socioeconomic inequality of cross-cultural immigrant families. [ABSTRACT FROM AUTHOR]

Daphnauranins A ( 1 ) and B ( 2 ), two sesquiterpenoids were isolated from the roots of Daphne aurantiaca Diels. One is an unprecedented 5/7 oxacycloheptane ring system, the other is a sesquiterpene-lignan complex. Their structures were elucidated by comprehensive spectroscopic methods including MS and NMR. Their absolute configurations were further confirmed by the quantum ECD calculations. Daphnauranins A and B showed anti-insect activities against male fruit fly with anti-feeding rate up to 46.2 ± 7.1 and 44.7 ± 5.4% at 1 mM, respectively. [ABSTRACT FROM AUTHOR]

The study examined the differences in nursing student empathy, caring behavior and competence between the experimental and control groups before and after educational intervention and to predict the factors affecting their core competencies. Educating nursing students in empathy and caring behaviors before entering clinical practice is challenging. We used a two-group pretest and post-test quasi-experimental design. First-year nursing students from medical schools in Taiwan participated in our study. Data were collected between March and May 2022. The learning method used with the intervention group was role-playing with videos and guided reflection. The control group was exposed to traditional curriculum. Empathy, caring behavior and competence were measured using the Jefferson Scale of Empathy- Healthcare Providers, the Caring Behaviors Scale and the Nursing Student Competence Scale. A total of 72 participants (40 in the experimental group and 32 in the control group) were included in the final statistical analysis. The response rate was 92%. Statistically significant differences in nursing student empathy, caring behavior and competence were observed between the experimental and control groups (p <.05). The η2 effect levels were 0.083, 0.223 and 0.270. Higher caring behavior scores were significantly associated with higher nursing student competence scores (β = 0.81, 95% CI:0.66–0.97). Education based on video role-play and guided reflection improved empathy, caring behavior and nursing competence in first-year nursing students. [ABSTRACT FROM AUTHOR]

Osteosarcoma is an aggressive bone cancer arising from primitive transformed cells of mesenchymal origin to form malignant osteoid. Phyllanthus urinaria P. urinaria is a widely used folk medicine in cancer treatment, however the mechanism of P. urinaria inhibited human osteosarcoma is unclear. The present study was aimed at investigating the antitumoral effects of an aqueous P. urinaria on human osteosarcoma in vivo and the related underlying mechanisms, mainly focusing on mitochondrial dynamic dysfunction. Our results showed that oral administration of P. urinaria to mice led to significant inhibition of tumor development without substantial changes to body weight or major organs. Histological examinations with H&E, Giemsa, and Masson trichrome stains confirmed inhibition of tumor growth by the P. urinaria treatment. Immunohistochemical staining of proliferation markers antigen KI-67 (Ki67) and proliferating cell nuclear antigen (PCNA), as well as a terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay demonstrated a decrease of tumor proliferation and an increase of apoptosis, which was associated with the modulation of B-cell lymphoma 2 (Bcl-2) family activating the caspase cascade in the P. urinaria-treated mice. The neovascularization marker cluster of differentiation 31 (CD31) was inhibited in P. urinaria-treated xenografts, implicating the potential anti-angiogenic effect of P. urinaria. P. urinaria treatment resulted in a significant decrease in the mitochondrial fusion proteins, including mitofusin 1/2 (Mfn1/2) and optic atrophy type 1 (Opa1), as well as an increase in the fission protein dynamin-related protein 1 (Drp1). The results of this study suggest mitochondrial dysfunction is associated with dynamic change that is involved in the apoptosis and anti-angiogenesis elicited by P. urinaria. [ABSTRACT FROM AUTHOR]

Objectives: The study aim was to compare the long-term effect of Western medicine and combined treatment with Traditional Chinese Medicine (TCM) and Western medicine on the prognosis (survival rate, symptom distress, physical function, and quality of life) of patients with lung cancer. Design: Longitudinal study. Setting/Location: Two medical centers, one each in Northern and Southern Taiwan. Patients: Patients newly diagnosed with lung cancer and treated with Western medicine ( n = 54) or TCM plus Western medicine ( n = 30). Outcome measures : Symptom distress, physical function, and quality of life were measured by using the Symptom Distress Scale, Eastern Cooperative Oncology Group-Performance Status Rating, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ-C30 and EORTC QLQ-LC13), respectively. Data on these measures were collected at baseline (before treatment) and 1, 3, 6, and 12 months after starting treatment. Survival was estimated by Kaplan-Meier curves. Group differences in outcomes were analyzed by generalized estimating equations. Results: Treatment groups did not differ significantly at baseline for demographic information; disease severity; symptom distress; or EORTC QLQ-C30 and QLQ-LC13 scores, except for pain and dyspnea. After adjustment for these baseline effects, the combined-treatment group had better physical function and role function than the Western medicine group at 6 months ( p < 0.05). The combined treatment group had better cumulative survival, but this difference did not reach significance. Conclusions: To more precisely estimate the long-term effectiveness of combined treatment on the prognosis of patients with lung cancer, future studies should standardize the number of TCM visits; increase the number of participants by continuous recruitment; and ask patients to complete daily logs with single-item measures of outcomes, such as symptom distress, quality of life, and physical function. Similar studies are suggested in patients with different cancers to develop a collaborative model using Western medicine and TCM. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance Allergic rhinitis has long been a worldwide health problem with a global growth trend. The use of traditional Chinese medicines alone or integrated Chinese–Western medicines for its treatment is quite common in Taiwan. Respiratory diseases account for the majority of outpatient traditional Chinese medicine treatment, while allergic rhinitis accounts for the majority of respiratory diseases. We hereby conduct a comparative analysis between traditional Chinese medicine treatments and western medicine treatments for allergic rhinitis in Taiwan. The results of the analysis on the prescription difference of traditional Chinese medicine and western medicine treatments would be helpful to clinical guide and health policy decision making of ethnopharmacological therapy. Materials and methods Patients diagnosed as allergic rhinitis with diagnostic code 470–478 (ICD-9-CM) were selected as subjects from 2009–2010 National Health Insurance Research Database based on the claim data from the nationwide National Health Insurance in Taiwan. This retrospective study used Chi-Square test to test the effects of gender and age on visit of traditional Chinese medicine, western medicine, and integrated Chinese–Western medicine treatments. Results A total of 45,804 patients diagnosed as allergic rhinitis with ICD-9-CM 470–478 were identified from 2009–2010 NHIRD. There were 36,874 subjects for western medicine treatment alone, 5829 subjects for traditional Chinese medicine treatment alone, and 3101 subjects for integrated Chinese–Western medicine treatment. Female patients were more than male in three treatments. 0–9 years children had the highest visit frequency in western medicine and integrated Chinese–Western medicine groups, while 10–19 years young-age rank the highest in traditional Chinese medicine group. The Chi-square test of independence showed that the effects of gender and age on visit of three treatments were significant. Conclusions The prescription drugs of western medicine treatment alone were almost for relieving the symptoms of allergic rhinitis. That leads to the little difference between 2009 and 2010. The same phenomenon occurs in integrated Chinese–Western medicine. However, the prescription drugs of traditional Chinese medicine treatment vary considerably. Multiple-composition medicine been replaced by single-composition medicine implied that syndrome differentiation and treatment were used and the synergistic effects of multiple-composition medicine were no longer suitable for the most patients of 2010. [ABSTRACT FROM AUTHOR]

Davallia bilabiata ( D. bilabiata) is also called GuSuiBu in Taiwan and is used as a substitute for Drynaria fortunei J. Sm. It is often used for trauma and bone repair. The inhibitory effect of D. bilabiata on inflammatory activity has not been reported. In the present study, we aimed to study the mechanism of anti-inflammation of D. bilabiata on the adhesion of leukocytes to vascular endothelial cells. The results showed that D. bilabiata, at concentrations without cytotoxic effect, inhibited the adhesion of monocytes (THP-1) to the TNF-α-stimulated human umbilical vascular endothelial cells (HUVECs). D. bilabiata suppressed the expression of the adhesion molecules ICAM, VCAM, and E-selectin at both the mRNA and protein level. In addition, both of the TNF-α-induced mRNA and protein expression of chemokines including fractalkine/CX3CL1, MCP-1 and RANTES as well as the level of secreted soluble fractalkine were decreased by D. bilabiata. We also verified that D. bilabiata inhibited the TNF-α-induced nuclear translocation of NF-κB through the inhibitory process on the TNF-α-activated phosphorylation of IKKα, IKKβ, IκB and NF-κB. All together, we concluded that the D. bilabiata affected the canonical pathway of TNF-α-induced NF-κB activation and down-regulated cell adhesion molecules and chemokine expression through inhibition of the NF-κB/IκBα/IKK signaling pathway. These findings strongly indicated that D. bilabiata might be a promising alternative/adjunct treatment for inflammatory diseases, such as rheumatoid arthritis and osteoarthritis. [ABSTRACT FROM AUTHOR]

Eight tetranortriterpenoids (1–8) and two sesquiterpenoids (9 and 10) including two new compounds, cineracipadesin G (1) and 1β-hydroperoxy-6α-hydroxy-eudesm-4(15)-ene (9), were isolated from the EtOAc extract of branches of Cipadessa cinerascens. The structures of two new compounds were elucidated by 1D and 2D NMR and MS spectroscopic analyses. The anti-feedant activity of two tetranortriterpenoids (1 and 7) was tested and obvious anti-feedant effects were detected. [ABSTRACT FROM AUTHOR]

This study examined the moderating effect of family functioning on the relationship between perceived discrimination and depressive symptoms in immigrant women. A total of 239 immigrant women were selected from four administrative regions in Central Taiwan. Questionnaires concerning perceived discrimination, family functioning (including family cohesion and family adaptability), depressive symptoms, and demographic characteristics were completed by either women themselves ( N = 120) or their husbands ( N = 119). The moderating effect of family functioning on the relationship between perceived discrimination and depression symptoms was analyzed using multiple regression analysis. Findings showed that a higher level of perceived discrimination among immigrant women is associated with more severe depressive symptoms. Family functioning serves as a moderator between the relationship of perceived discrimination and depressive symptoms, but the moderating effect of family adaptability was evident only in data reported by immigrant women. The results indicate that perceived discrimination has negative mental health implications, and also point to the importance of family functioning for depression. Findings suggest that providers should consider addressing immigrant women's mental health needs through declining their psychosocial distress at multiple ecological levels. [ABSTRACT FROM AUTHOR]

Abstract: Three tigliane-type diterpenoids named excoecafolins A–C and two daphnane-type diterpenoids named excoecafolins D and E, together with 13 known compounds, were isolated from the EtOAc extract of Excoecaria acerifolia Didr. Their structures were elucidated through the analysis of the spectroscopic data. The anti-HIV-1 activity evaluation of five of these compounds showed that four possessed moderate anti-HIV-1 activities with EC50 0.258, 0.036, 0.046, and 0.978 ?M, SI >1,836.9, 431.1, 298.7, and >503.7, respectively. Additionally, the chemotaxonomic issue of the affinity correlation between Thymelaeceae and Euphorbiaceae is discussed based on the isolates. [Copyright &y& Elsevier]

Abstract: Five new diterpenoids named excocarinols A–E (1–5) including three pimaranes, one cleistanthane, and one nor-beyerane, together with nine known compounds, were isolated from the EtOAc extract of the Chinese ethnodrug Gua-jing-ban (Excoecaria acerifolia Didr.). Their structures were elucidated by the analysis of spectroscopic data including 1D, 2D NMR and HR-MS. The anti-HIV-1 bioassay on the diterpenoids showed that excocarinol A (1) exhibited moderate anti-HIV-1 activity with EC50 5.58?M and SI (Selection Index) over 112.71. [Copyright &y& Elsevier]

Twelve lanostane triterpenoids (1–12) including a new one 16α,26-dihydroxylanosta-8,24-dien-3-one (1) were isolated from the fruiting bodies of Ganoderma hainanense. The structure of the new compound was elucidated by 1D and 2D NMR and MS spectroscopic analyses. All isolates were evaluated for their cytotoxicities against human tumor cell lines K-562, SMMC-7721, and SGC-7901 and five compounds (1, 2, 5,7, and 9) showed definite cytotoxicities against K-562 cell line. Meanwhile, compounds 2, 5,7, and 9 exhibited cytotoxic activities against SMMC-7721 and SGC-7901 cell lines. [ABSTRACT FROM AUTHOR]

Primary objectives: To evaluate irritability in patients with mild traumatic brain injury (mTBI) and moderate-to-severe traumatic brain injury (msTBI), respectively. Research design: A prospective study was conducted at a level I trauma centre. Methods and procedures: A total of 160 participants, which included 80 healthy subjects and 80 patients with TBI, were recruited. Irritability was assessed by the National Taiwan University Irritability Scale and other cognitive functions, which included memory, executive function and information processing, were also evaluated. Main outcomes and results: The results showed post-injury self-reported irritability in patients with mTBI and family-reported irritability in patients with msTBI were significantly higher than irritability reported by healthy participants. Irritability was significantly associated with information processing ability in patients with mTBI, but it was not associated with any cognitive functions in patients with msTBI. Conclusions: Irritability was found to be prominent after TBI. Divergent causes of irritability seemed apparent in patients with mTBI and msTBI. Irritability after mTBI appeared might be related to the cognitive functions disrupted after the injury, whereas irritability after msTBI appeared to result directly from the brain lesions involved. [ABSTRACT FROM AUTHOR]

Three new isopimarane diterpenoids named excoecarins F–H (1–3) were isolated from the EtOAc extract of the Chinese ethnodrug Gua-jing-ban (Excoecaria acerifolia Didr.). Their structures were elucidated by the analysis of spectroscopic data including 1D, 2D NMR and HR-MS. The anti-HIV-1 bioactivity test of 1 and 2 showed weak activity. [ABSTRACT FROM AUTHOR]

Three new lanostanoid triterpenes, 3β,7β,15β-trihydroxy-11,23-dioxo-lanost-8,16-dien-26-oic acid (1), 3β,7β,15β-trihydroxy-11,23-dioxo-lanost-8,16-dien-26-oic acid methyl ester (2), and 3β,15β-dihydroxy-7,11,23-trioxo-lanost-8,16-dien-26-oic acid methyl ester (3) were isolated from the EtOAc extract of the fruiting bodies ofGanoderma tropicum. Their structures were elucidated on the basis of 1D and 2D NMR spectroscopy as well as MS. The bioassay of inhibitory activity against acetylcholinesterase (AChE) of these isolates was evaluated and compound2exhibited definite inhibitory activity against AChE. [ABSTRACT FROM PUBLISHER]

Primary objectives: To evaluate irritability following traumatic brain injury. Research design: A prospective study was conducted at a level I trauma centre. Methods and procedures: One hundred and forty-four participants, which included 80 healthy subjects and 64 patients suffering from TBI, were recruited. Irritability was assessed by the National Taiwan University Irritability Scale (NTUIS) from patients themselves and their families. Main outcomes and results: the results showed 14.8% of patients and 29.4% of their families reported patients' problems of irritability. Meanwhile, both self-reported and family-reported irritability post-injury were significantly higher than those reported by the healthy subjects. When evaluating two sub-components of irritability, respectively, both family- and self-reported post-injury annoyance were significantly higher than the pre-injury one, while the self-reported post-injury verbal aggression was not. Conclusions: TBI patients have remarkable problems of irritability after injuries. Specifically, the results showed that annoyance might be the main characteristic of irritability in TBI patients and patients themselves might be unaware of their verbal aggression post-injury. Hence, it is merited to pay more attention to the annoyance of the patients with TBI and to the reports from significant caregivers when evaluating TBI patients' irritability in clinical settings. [ABSTRACT FROM AUTHOR]

Background: The use of complementary and alternative medicine (CAM) continues to increase in Taiwan. This study examined the use of CAM and beliefs about CAM as expressed by patients with traumatic brain injury (TBI) in Taiwan. Methods: TBI patients and their accompanying relatives were interviewed by using a structured questionnaire at an outpatient clinic in a medical center in northern Taiwan. Results: A total of 101 patients with TBI participated in the study. Sixty-four (63%) patients had used at least oneform of CAM after sustaining TBI. CAM users had used an average of 2.72 forms of CAM after sustaining TBI. The most frequently used CAM category was traditional Chinese medicine (37; 57.8%), followed by folk and religious therapies (30; 46.9%), and dietary supplements (30; 46.9%). The majority of the patients (45; 70.3%) did not report CAM use because they felt it was unnecessary to do so. Patients who used CAM had a significantly stronger positive belief in CAM than those who did not (t = −2.72; P = .008). After using CAM, most of the patients (54; 85%) perceived moderate satisfaction (2.89 ± 0.44), according to a 4-point Likert scale. Conclusion: Although the use of CAM is common for TBI patients receiving conventional medical health care in Taiwan, most patients did not inform health care personnel about their CAM use. TBI patients perceive combined use of CAM and conventional medicine as beneficial for their overall health. [ABSTRACT FROM AUTHOR]

Objective: This study aims to explore the predictive value of demographic and clinical factors in changes in quality of life (QoL) in liver cancer (LC) patients over time. Methods: We performed a prospective cohort study in 128 patients who had 4 time point data newly diagnosed with LC at two hospitals in Taiwan. Different functional QoL was measured by QLQ‐C30. Specific characteristics were predictors for distinct functional QoL, estimated by a generalised estimating equation (GEE). Results: Patients who received liver resection or radiofrequency ablation therapy (RFA) versus transarterial chemoembolisation (TACE) or transcatheter arterial embolisation (TAE) experienced a decrease in physical function from baseline to 1 month. In addition, patients who underwent liver resection versus RFA experienced a significant recovery in cognitive functioning from baseline to 6 months. Patients with advanced stage compared to those in early stage had a reduction in physical functioning from baseline to 1 month. The alcohol intake, hepatitis C infection and the job also affected the changes in physical and cognitive functioning. Conclusion: Healthcare professionals should pay attention to changes after treatment in the short term; additionally, they need to provide health education to modifiable factors such as alcohol intake attributed to the deterioration in QoL. [ABSTRACT FROM AUTHOR]

Background: Metastatic breast cancer (MBC) patients with low expression of human epidermal growth factor 2 (HER2) have been proven to benefit from HER2 targeted therapy. We aimed to determine how HER2-low status affected survival and metastatic risk as well as how it affected pathological complete response (pCR) in neoadjuvant chemotherapy (NAC) patients. Methods: According to the results of immunohistochemistry (IHC) and in situ hybridization (ISH) testing, 321 female patients were sorted into HER2-low (IHC 1+/2+ with ISH negative) and HER2-zero (IHC 0) groups using propensity score matching (PSM). Overall survival (OS), disease-free survival (DFS), and distant disease-free survival (DDFS) were compared for both groups, while pCR was only analyzed for NAC patients. Results: In total, 97 patients in each group after PSM were included. We discovered that pCR was not associated with HER2 expression status in 45 patients who underwent NAC. Five-year OS in the HER2-low group was significantly higher (98.99%) than in the HER2-zero group (95.87%, P =.044); however, this difference was not reflected in the 5-year DFS (90.61 vs 90.52%, P =.868) and 5-year DDFS (93.67 vs 91.53%, P =.757). Meanwhile, multivariate analysis revealed that HER2-low expression could indicate better OS (P =.047, hazard ratios [HRs] = 16.121, 95% confidence interval [CI] = 1.035-251.046), but it had no prognostic value for DFS or DDFS. Conclusion: When compared with HER2-zero expression, HER2-low expression was not connected to pCR and could not modify metastasis risk in female patients with early-stage breast cancer (BC), but it may prolong patient survival. [ABSTRACT FROM AUTHOR]

Six new dimeric 2-(2-phenylethyl)chromones (1 – 6) were successfully isolated from the ethanol extract of agarwood of Aquilaria filaria from Philippines under HPLC-MS guidance. Compounds 1 – 6 are all dimers formed by linking 5,6,7,8-tetrahydro-2-(2-phenylethyl)chromone and flindersia 2-(2-phenylethyl)chromone via a single ether bond, and the linkage site (C5-O-C8′′) of compound 2 is extremely rare. A variety of spectroscopic methods were used to ascertain their structures, including extensive 1D and 2D NMR spectroscopic analysis, HRESIMS, and comparison with literature. The in vitro tyrosinase inhibitory and anti-inflammatory activities of each isolate were assessed. Among these compounds, compound 2 had a tyrosinase inhibition effect with an IC 50 value of 27.71 ± 2.60 μM, and compound 4 exhibited moderate inhibition of nitric oxide production in lipopolysaccharide-stimulated RAW264.7 cells with an IC 50 value of 35.40 ± 1.04 μM. [Display omitted] • Six new 2-(2-phenethyl)chromone dimers were isolated from agarwood of Aquilaria filaria. • Compound 2 had tyrosinase inhibition effect with an IC 50 value of 27.71 ± 2.60 μM. • Compound 4 exhibited anti-inflammatory activity with an IC 50 value of 35.40 ± 1.04 μM. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance There is a decided lack of in-depth studies to evaluate the effectiveness of Chinese Herbal Medicine (CHM) as an adjuvant therapy on the incidence of chronic hepatitis in patients with colon cancer. Aim of the study The aim of this study is to assess whether CHM treatment decreased the incidence of chronic hepatitis in colon cancer patients who received conventional Western medical treatment. Materials and methods A Taiwanese nationwide population-based study of colon cancer patients receiving Western medicine treatment in conjunction with CHM treatment, using data provided by the National Health Insurance (NHI) Research Database, was conducted. A total of 61676 patients were diagnosed with colon cancer in Taiwan within the defined study period, from 1997 to 2010. After randomly equal matching for age, sex, excluding patients younger than 18 years of age, chronic hepatitis before colon cancer diagnosis date, receiving acupuncture and/or moxibustion and taking CHM for less than 30 days, data from 155 patients were analyzed. Hazard ratios of incidence rate of chronic hepatitis were used to determine the influence of CHM and the therapeutic potential of herbal products in treating patients with colon cancer. Results CHM used for patients with colon cancer exhibited significantly decreased incidence rates of chronic hepatitis [hazard ratio (HR)=0.53; 95% confidence interval (CI):0.38–0.74], with multivariate adjustment, compared to those without CHM use. The protective effect of CHM treatment with statistical significance across the stratification of age, gender, co-morbidity and treatment modality was noted. The cumulative incidence of chronic hepatitis was also reduced in patients with colon cancer receiving CHM treatment during a five-year period. In this study, we provide the ten most used single herbs and herbal formulas that were prescribed for patients with colon cancer; moreover, we identify the eight single herbs and five formulas used in CHM treatment which significantly decreased incidence of chronic hepatitis among colon cancer patients. Conclusions This nationwide retrospective cohort study determined that therapy using CHM as an adjuvant modality may have a significant impact on liver protection in patients with colon cancer. [ABSTRACT FROM AUTHOR]

Background: Little is known regarding the factors that affect the team-based practice of nurse practitioners (NPs). Examining the relationships between these factors and team-based practice may provide important insights into the strength of the NP practice. Purpose: This study was designed to examine the effects of practice autonomy and leadership style on the team-based practice of acute care NPs working in hospitals. Methods: A cross-sectional, national survey design was conducted to examine the autonomy, leadership, and team-based practice of NPs. One thousand three hundred ninety-one NPs completed the questionnaire, which included demographic and practice variables, the Dempster Practice Behavior Scale, the Multifactor Leadership Questionnaire, and the NP–physician relations subscale of the Nurse Practitioner Primary Care Organizational Climate Questionnaire. The hierarchical linear model was used to differentiate between the NP-level and organization-level effects on team-based practice. Multiple regression was applied to explore the factors associated with team-based practice. Results: The hierarchical linear model results identified no organization-level effect on team-based practice. Moreover, the results of the regression model found that NPs with greater autonomy in actualization, empowerment and readiness, and idealized influence leadership style enhanced the performance of the doctor of medicine–NP team-based practice. The final model explained 39% of the variance in doctor of medicine–NP team-based practice. Autonomy in actualization and empowerment were identified as the two most important predictors. Conclusions/Implications for Practice: The practice autonomy and leadership style of NPs influence the efficiency of team-based practice in Taiwan. To improve the team-based practice of NPs, healthcare administrators must support the practice autonomy of NPs. [ABSTRACT FROM AUTHOR]

Background: Nurse practitioners (NPs) in Taiwan have practiced mainly in acute care hospitals since 2006. Although organizational support and level of support have been associated with the successful integration of NP roles and effective practice outcomes, organizational support in the context of NPs in inpatient settings is an area that has been rarely explored in the literature. Purpose: The purpose of this study was to investigate the relationship between organizational support and the practice outcomes of job satisfaction, care effectiveness, and intention to leave in NPs. Methods: A national survey of 512 NPs was conducted that included a demographic characteristics datasheet, the Nurse Practitioner Primary Care Organizational Climate Questionnaire, the Misener Nurse Practitioner Job Satisfaction Scale, and the Nurse Practitioner Care Effectiveness Scale. Multiple regression analysis was applied to explore the specific factors associated with job satisfaction. The statistical significance level was set at.05 with a two-tailed test. All statistical analyses were conducted using SPSS Statistics Version 22.0 software. Results: More than half of the participants were found to be dissatisfied with their hospital managers (54.8%) and with each dimension of organizational support. Overall, 82.1% of the participants were satisfied with their current practice. A multiple regression analysis showed that the participants who perceived higher levels of organizational support in the workplace (β =.53, p <.001), expressed satisfaction with working with their managers (β =.25, p <.001), or perceived better care outcomes (β =.10, p <.001) reported higher job satisfaction. In addition, the participants who expressed intention to leave within 1 year (β = −.09, p <.001) and those with higher patient loads (β = −.09, p <.001) reported lower job satisfaction. Organizational support was found to explain 50% of the variance in job satisfaction. Conclusions/Implications for Practice: The results of this study highlight organizational support as the most important factor affecting job satisfaction in NPs. Therefore, administrators work to promote organizational support and improve the work environment to enhance the job satisfaction, increase the clinical practice retention, and improve the care outcomes of NPs. [ABSTRACT FROM AUTHOR]