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Abstract Background The increasing trend of patients with mental health conditions seeking emergency care is a global phenomenon. Numerous studies have emphasized the importance of emergency physicians' ability to recognize and manage psychiatric emergencies, both for patient well-being and societal safety nets. With the growing demand for emergency care related to mental health conditions, it is crucial to assess whether emergency physicians possess sufficient confidence and capabilities to adapt to these changes. Against this backdrop, our study aimed to explore the factors influencing emergency physicians' management of acute psychiatric emergencies and to critically evaluate whether current training programs adequately align with societal expectations for psychiatric emergency care. Methods A cross-sectional survey, disseminated online by the Taiwan Society of Emergency Medicine, targeted 936 attending physicians and 449 residents in 43 Resident Review Committee approved training hospitals in winter 2021. The questionnaire covered participant demographics, skill requirements, and confidence in managing acute psychiatric patients independently. Statistical analyses included descriptive statistics, chi-square tests, medians (IQRs), and Wilcoxon rank-sum tests. Results Out of 229 participants, 63.8% were attending physicians, and 81.7% were affiliated with medical centers. Psychiatrists led 69.9% of emergency psychiatric training curricula, and 66.8% reported that their clinical psychiatric training outcomes were assessed by psychiatrists. Clinical seniority, training hospital level, and the average number of patients with an acute psychiatric presentation seen in a daily shift influenced physicians' self-reported confidence in managing acute psychiatric patients independently. Medical center training improved capability in managing psychiatric emergencies in the elderly, while encountering a higher average number of patients with an acute psychiatric presentation seen in a daily EM shift was associated with better performance, especially in managing specific populations. Conclusions Our nationwide study highlights how clinical seniority, training hospital level, and patient volume per shift influence emergency physicians' confidence in managing acute psychiatric patients. However, there remains room for improvement, particularly in addressing the needs of specific patient populations. These findings underscore the importance of refining training curricula to bridge these gaps and enhance the quality of psychiatric emergency patient care.

Bacterial infections and antibiotic resistance pose significant public health challenges globally. Natural products serve as valuable sources for discovering antimicrobial agents. Rhododendron simsii Planch, a folk medicine, is traditionally used to treat various inflammatory diseases. In this study, we investigated the antibacterial metabolites derived from R. simsii Planch. Rhodosimsiin A (1), bearing a 1,5-seco-1,6 and 3,6-epoxy grayanane diterpene skeleton, representing a novel 5/6/7/6/5 pentacyclic ring system, and 3β,16α-dihydroxy-6β-ethoxy-14β-acetoxy-grayan-1(5)-ene-10-one (4), which represents the first example of the degradation of C-20 and carbonylation in C-10 diterpenoid, together with two new grayanane diterpenes (2−3), three new triterpenes (13−15), and known analogs (5−12, 16−30), were isolated from the leaves of R. simsii Planch by using the bioassay-guided method. Their structures were elucidated by comprehensive spectroscopic analyses, and absolute configurations were established by single-crystal X-ray diffraction and calculated ECD spectra. Compounds 14, 15, 18, 20, 27, 28, and 30 exhibited potent antibacterial activity with an MIC50 of 1.4–24.3 μg/mL against Staphylococcus aureus. The findings of this research indicate that secondary metabolites derived from R. simsii Planch are promising natural antimicrobial candidates.

Abstract Background A well-known anesthetic, lidocaine is the most widely used local anesthetic. Local anesthetic systemic toxicity (LAST) is a life-threatening event with common and prominent presentations of central nervous system (CNS) toxicity and cardiovascular toxicity. The most frequent and prominent early warning signs and symptoms of LAST are central nervous system symptoms. While rare, cases quadriparesis after the administration of lidocaine has been reported. Case presentation In this paper, we report a very rare case of quadriparesis after local anesthesia administration for vocal cord cyst-removal surgery, which dramatically improved after treatment. LAST can occur during various routes of lidocaine administration, such as local spray. A possible mechanism of our case could be the local diffusion of lidocaine to the spinal cord, which caused the symptoms to mimic anterior cord syndrome. Conclusions Our case presented a favorable outcome following the administration of intravenous lipid emulsion (ILE) for non-over dose local anesthetic drug induced spinal cord inhibition symptoms. These findings highlight the need for further research on the use of ILE to reverse LAST and other adverse effects of local anesthetics.

Pig farmers in Taiwan tend to overdose copper (Cu) and zinc (Zn) in animal feeds to ensure pig health. The application of Cu- or Zn-rich livestock compost to fields can result in high Cu/Zn residues in surface soil and violate limitations for zinc and copper in land applications. This study aims to extract Cu and Zn from sludge using organic acid or H2O2/organic acids. The livestock bio-sludge was dried and treated with different concentrations of acetic acid (1N, 2N, and 4N). The acid-extracted sludge was then treated with or without adding H2O2 during different periods (4, 24, and 48 h) to investigate the efficiency of acid extraction of Cu and Zn. The supernatant of the acid-extracted product was separated from the residues through centrifugation. Experimental results showed that the treatment set of dried bio-sludge with 2% H2O2 significantly promoted the removal efficiency of Cu and Zn from the bio-sludge (p < 0.01). The best removal efficiency of Cu and Zn from the bio-sludge was 40% and 70%, respectively, using 4N acetic acid in the 48 h group. The study shows a green method for extracting Cu and Zn from livestock sludge, enhancing the sustainability of intensive livestock farming.

Cancer cell dysregulations result in the abnormal regulation of cellular metabolic pathways. By simulating this metabolic reprogramming using constraint‐based modeling approaches, oncogenes can be predicted, and this knowledge can be used in prognosis and treatment. We introduced a trilevel optimization problem describing metabolic reprogramming for inferring oncogenes. First, this study used RNA‐Seq expression data of lung adenocarcinoma (LUAD) and lung squamous cell carcinoma (LUSC) samples and their healthy counterparts to reconstruct tissue‐specific genome‐scale metabolic models and subsequently build the flux distribution pattern that provided a measure for the oncogene inference optimization problem for determining tumorigenesis. The platform detected 45 genes for LUAD and 84 genes for LUSC that lead to tumorigenesis. A high level of differentially expressed genes was not an essential factor for determining tumorigenesis. The platform indicated that pyruvate kinase (PKM), a well‐known oncogene with a low level of differential gene expression in LUAD and LUSC, had the highest fitness among the predicted oncogenes based on computation. By contrast, pyruvate kinase L/R (PKLR), an isozyme of PKM, had a high level of differential gene expression in both cancers. Phosphatidylserine synthase 1 (PTDSS1), an oncogene in LUAD, was inferred to have a low level of differential gene expression, and overexpression could significantly reduce survival probability. According to the factor analysis, PTDSS1 characteristics were close to those of the template, but they were unobvious in LUSC. Angiotensin‐converting enzyme 2 (ACE2) has recently garnered widespread interest as the SARS‐CoV‐2 virus receptor. Moreover, we determined that ACE2 is an oncogene of LUSC but not of LUAD. The platform developed in this study can identify oncogenes with low levels of differential expression and be used to identify potential therapeutic targets for cancer treatment.

In nature, wind often occurs simultaneously with rainfall, causing nutrient loss in soil and water on slopes. However, the influence of different rainfall intensities combined with different wind directions on soil erosion and nutrient loss remains unclear. This study utilized wind‐driven rainfall laboratory flume experiments to analyse the influence of different wind directions (windward, leeward and crosswind) and rainfall intensities (30, 60 and 90 mm h−1) with constant wind speed (5 m s−1) on slope runoff, sediment yield and the associated losses of different forms of N (NH4+, NO3−) and P (PO43−‐P). The response of soil erosion, N and P loss to rainfall changes with different wind directions. When the rainfall intensity was constant, runoff, sediment yield and sediment‐associated total nitrogen (TN) and total phosphorus (TP) losses on slopes showed a trend of leeward > crosswind > windless > windward, whereas runoff‐associated TN and TP losses showed a trend of windward > crosswind > windless > leeward. Runoff, sediment yield and sediment‐associated TN and TP losses on leeward slopes were 1.09–1.17, 1.25–1.44, 1.33–1.62, and 1.40–1.66 times than windless slopes. Moreover, with constant wind direction, the runoff, sediment yield and associated N and P losses increased significantly with increasing rainfall intensity. When the rainfall intensity increased from 30 to 60 and 90 mm h−1, the runoff, sediment yield and associated TN and TP losses increased 2.02–2.28, 3.65–5.35, 3.96–34.39 and 4.28–8.45 times, respectively. The effects of rainfall on soil erosion and nutrient loss were significantly greater than those of wind. The loss of different forms of N and P associated with runoff and sediment was consistent with that of TN and TP losses. However, with an increase in rainfall intensity, the growth rates of runoff, sediment yield and associated N and P losses exhibited a gradually weakening trend for all wind directions. An increase in rainfall intensity enhanced the vertical vector force of wind‐driven rainfall, which increasingly decreased the angle between the rain incidence and the normal line of the horizon; therefore, the direction of the rain erosion force gradually approached that of windless conditions. [ABSTRACT FROM AUTHOR]