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Background. Older people with life-limiting conditions often have dysphagia. The Department of Medicine and Rehabilitation of Tung Wah East Hospital initiated a careful hand feeding (CHF) programme for patients with feeding problems. We aimed to evaluate the effectiveness of the CHF programme as well as the completeness and appropriateness of CHF discussions with in-patients. Methods. This retrospective observational study was conducted from May 2021 to October 2022. All patients who had CHF were recruited. Demographic data, feeding information, follow-up survey records, and data regarding subsequent readmission or death were retrieved. The primary outcome was 6-month survival. Secondary outcomes were hospital readmission, change from CHF to tube feeding, and support from healthcare staff. Results. A total of 94 patients (36 women and 58 men) aged 49 to 100 (mean, 85) years were included. Of these, 46% had advanced dementia as the principal diagnosis. Overall, 48% of patients died during the index admission; 39% of discharged patients were readmitted within 1 month. Moreover, 2% and 41% of patients died within 1 and 6 months, respectively. Among discharged patients, 80% followed dietary recommendations, whereas the remaining patients added foods they liked. Common feeding problems were refusal to open the mouth and occasional choking. Conclusions. Structured management protocols and training can facilitate CHF implementation. Communication with the family is important, as is documentation of the communication process. Telephone follow-up ensures continuous support from the hospital to community settings. Future enhancements include dietitian recommendations for soft meal choices and recipes. [ABSTRACT FROM AUTHOR]

Background/Aims: Changes in cell-to-cell communication have been linked to several secondary complications of diabetes, but the mechanism by which connexins affect disease progression in the kidney is poorly understood. This study examines a role for glucose-evoked changes in the beta1 isoform of transforming growth factor (TGFβ1), on connexin expression, gap-junction mediated intercellular communication (GJIC) and hemi-channel ATP release from tubular epithelial cells of the proximal renal nephron. Methods: Biopsy material from patients with and without diabetic nephropathy was stained for connexin-26 (CX26) and connexin-43 (CX43). Changes in expression were corroborated by immunoblot analysis in human primary proximal tubule epithelial cells (hPTECs) and model epithelial cells from human renal proximal tubules (HK2) cultured in either low glucose (5mmol/L) ± TGFβ1 (2-10ng/ml) or high glucose (25mmol/L) for 48h or 7days. Secretion of the cytokine was determined by ELISA. Paired whole cell patch clamp recordings were used to measure junctional conductance in control versus TGFβ1 treated (10ng/ml) HK2 cells, with carboxyfluorescein uptake and ATP-biosensing assessing hemi-channel function. A downstream role for ATP in mediating the effects of TGF-β1 on connexin mediated cell communication was assessed by incubating cells with ATPγS (1-100µM) or TGF-β1 +/- apyrase (5 Units/ml). Implications of ATP release were measured through immunoblot analysis of interleukin 6 (IL-6) and fibronectin expression. Results: Biopsy material from patients with diabetic nephropathy exhibited increased tubular expression of CX26 and CX43 (P<0.01, n=10), data corroborated in HK2 and hPTEC cells cultured in TGFβ1 (10ng/ml) for 7days (P<0.001, n=3). High glucose significantly increased TGFβ1 secretion from tubular epithelial cells (P<0.001, n=3). The cytokine (10ng/ml) reduced junctional conductance between HK2 cells from 4.5±1.3nS in control to 1.15±0.9nS following 48h TGFβ1 and to 0.42±0.2nS after 7days TGFβ1 incubation (P<0.05, n=5). Acute (48h) and chronic (7day) challenge with TGFβ1 produced a carbenoxolone (200µM)-sensitive increase in carboxyfluorescein loading, matched by an increase in ATP release from 0.29±0.06μM in control to 1.99±0.47μM after 48hr incubation with TGFβ1 (10ng/ml; P<0.05, n=3). TGF-β1 (2-10ng/ml) and ATPγs (1-100µM) increased expression of IL-6 (P<0.001 n=3) and fibronectin (P<0.01 n=3). The effect of TGF-β1 on IL-6 and fibronectin expression was partially blunted when preincubated with apyrase (n=3). Conclusion: These data suggest that chronic exposure to glucose-evoked TGFβ1 induce an increase in CX26 and CX43 expression, consistent with changes observed in tubular epithelia from patients with diabetic nephropathy. Despite increased connexin expression, direct GJIC communication decreases, whilst hemichannel expression/function and paracrine release of ATP increases, changes that trigger increased levels of expression of interleukin 6 and fibronectin. Linked to inflammation and fibrosis, local increases in purinergic signals may exacerbate disease progression and highlight connexin mediated cell communication as a future therapeutic target for diabetic nephropathy. [ABSTRACT FROM AUTHOR]

Using the superheating method [Luo et al., Phys. Rev. B68, 134206 (2003)], we deployed classical molecular dynamics (MD) simulation to compute solid-liquid interfacial tension of silicon. We performed isobaric-isothermal MD simulation on two silicon models, the Stillinger-Weber [Phys. Rev. B31, 5262 (1985)] and Tersoff-89 [Phys. Rev. B38, 5565 (1989)], and applied heating rates of 1×1011 and 5×1011 K/s to the system. The calculated average value of solid-liquid surface tension of silicon is 0.413 J/m2, which is in good agreement with the measured values (0.34–0.40 J/m2). [ABSTRACT FROM AUTHOR]

Background: Health-related quality of life (HRQoL) and health preference of patients with diabetes mellitus (DM) are essential in health economic evaluations but data on Chinese population is rare. This study aims to evaluate HRQoL and health preference of diabetic patients with different diabetic complications in Chinese population.Methods: A cross-sectional study was conducted in 1275 patients with DM, including 518 subjects with various DM-related complications. HRQoL and health preference were estimated using SF-12 and SF-6D questionnaires, respectively. Disease status of DM and complications were identified from documented clinical diagnosis. Multivariable regression was used to investigate the effects of specific complications on HRQoL and health preference, adjusting for socio-demographic and clinical parameters.Results: The presence of any diabetic complication was associated with lower physical component summary (-3.81 points, P < 0.01), and end-stage renal disease (ESRD) showed greatest reduction (-7.05 points, P < 0.01). Mental component summary and mental health (MH) scores were not decreased in any of the diabetic complications. The health preference score for diabetic subjects without complications was 0.882 (95% CI, 0.778 to 0.989). The reductions of health preference score were significant for stroke (-0.042, 95% CI -0.072 to -0.012), ESRD (-0.055, 95% CI -0.093 to -0.017), and sight-threatening diabetic retinopathy (STDR) (-0.043, 95% CI -0.075 to -0.010), while heart disease had an insignificant reduction (-0.017, 95% CI -0.042 to 0.008).Conclusions: The presence of any of the four major diabetic complications (heart disease, stroke, ESRD and STDR) was associated with lower HRQoL and health preference scores. Findings of this study facilitated the cost-effectiveness studies of alternative management strategies for prevention of diabetic complications in Chinese population. [ABSTRACT FROM AUTHOR]

Objectives. Prolactin (PRL) is a lactation-inducing hormone with immunomodulatory properties and is found at elevated levels in the serum of patients with RA and other rheumatic diseases. The PRL receptor (PRLR) has been shown to be expressed by macrophages in atherosclerotic plaques. The aim of this study was to examine PRLR expression by synovial macrophages and its role in the regulation of macrophage activation. Methods. Serum monomeric 23kDa PRL levels were measured in 119 RA patients using a fluoroimmuno-metric assay. PRLR expression was assessed in synovial tissue of 91 RA, 15 PsA and 8 OA patients by immunohistochemistry and digital image analysis. Double IF was used to identify PRLR-expressing cells. The effects of PRL on monocyte-derived macrophage gene expression were examined by quantitative real-time PCR and ELISA. Results. Serum PRL levels were similar in female and male RA patients. Median (interquartile range) PRLR expression was significantly higher (P < 0.05) in RA and PsA synovial tissue compared with OA. PRLR colocalized with synovial CD68+ macrophages and von Willebrand factor+ endothelial cells. In vitro, PRLR was prominently expressed in IFN-γ-and IL-10-polarized macrophages compared with other polarizing conditions. PRL by itself had negligible effects on macrophage gene expression, but cooperated with CD40L and TNF to increase expression of pro-inflammatory genes including IL-6, IL-8 and IL-12β. Conclusions. Synovial PRLR expression is enhanced in patients with inflammatory arthritis compared with OA, and PRL cooperates with other pro-inflammatory stimuli to activate macrophages. These results identify PRL and PRLR as potential new therapeutic targets in inflammatory arthritis. [ABSTRACT FROM AUTHOR]

Background: Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients' ability to participate in self-management. Purpose: To examine the effects of the empowerment intervention on stroke patients' selfefficacy, self-management behavior, and functional recovery. Methods: This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups. Results: A total of 210 (CG =105, IG =105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P,0.05), apart from medication adherence (P.0.05). Those in IG had significantly better functional recovery (Barthel, all P,0.05; Lawton, all P,0.001), compared to CG. The overall dropout rate was 16.7%. Conclusion: Patient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes mellitus and diabetic nephropathy (DN) are prevalent and costly to manage. DN is the leading cause of end-stage kidney disease. Conventional therapy blocking the renin-angiotensin system has only achieved limited effect in preserving renal function. Recent observational data show that the use of Chinese medicine (CM), a major form of traditional medicine used extensively in Asia, could reduce the risk of end-stage kidney disease. However, existing clinical practice guidelines are weakly evidence-based and the effect of CM remains unclear. This trial explores the effect of an existing integrative Chinese-Western medicine protocol for the management of DN. Objective: To optimise parameters and assess the feasibility for a subsequent phase III randomised controlled trial through preliminary evaluation on the effect of an adjuvant semi-individualised CM treatment protocol on patients with type 2 diabetes with stages 2-3 chronic kidney disease and macroalbuminuria. Methods and analysis: This is an assessor-blind, add-on, randomised, controlled, parallel, multicentre, open-label pilot pragmatic clinical trial. 148 patients diagnosed with DN will be recruited and randomised 1:1 to a 48-week additional semi-individualised CM treatment programme or standard medical care. Primary end points are the changes in estimated glomerular filtration rate and spot urine albumin-tocreatinine ratio between baseline and treatment end point. Secondary end points include fasting blood glucose, glycated haemoglobin, brain natriuretic peptide, fasting insulin, C peptide, fibroblast growth factor 23, urinary monocyte chemotactic protein-1, cystatin C, nephrin, transforming growth factor-β1 and vascular endothelial growth factor. Adverse events are monitored through self-completed questionnaire and clinical visits. Outcomes will be analysed by regression models. Enrolment started in July 2015. [ABSTRACT FROM AUTHOR]

Diabetic nephropathy (DN) is a severe micro vascular complication accompanying diabetes mellitus that affects millions of people worldwide. End stage renal disease occurs in nearly half of all DN patients, resulting in large medical costs and lost productivity. The course of DN progression is complicated, and effective and safe therapeutic strategies are desired. While the complex nature of DN renders medicines with a single therapeutic target less efficacious, Chinese medicine, with its holistic view targeting the whole system of the patient, has exhibited efficacy for DN management. This review aims to describe the experimental evidence for Chinese medicines in DN management, with an emphasis on the underlying mechanisms, and to discuss the combined use of herbs and drugs in DN treatment. [ABSTRACT FROM AUTHOR]

Aquaporin 5 (AQP5), a water channel protein, is highly expressed in non-small cell lung cancer (NSCLC) tissues compared with adjacent normal tissues. AQP5 expression in lung cancer tissues is associated with a poor prognosis. The present study aimed to analyze the expression of AQP5 and investigate its role in primary and lymph node metastatic NSCLCs. An immunohistochemical labeled streptavidin-biotin method was used to determine the expression of AQP5 in 94 cases of NSCLC primary carcinoma, which included 51 cases accompanied by lymph node metastasis. The results revealed that the expression of AQP5 was significantly higher in adenocarcinomas compared with squamous cell carcinomas (P=0.002). In addition, the percentage of AQP5 expression in the primary carcinomas with lymph node metastasis was significantly higher compared with those without lymph node metastasis (P=0.024). However, no statistically significant difference in the percentage of AQP5 expression was observed between the metastatic and the primary carcinomas (P=0.377). The expression of AQP5 exhibited a correlation with the tumor-node-metastasis staging of NSCLC (P=0.027). The percentage of AQP5 expression in stage III and IV tumors was higher than that in stage I and II tumors. In addition, AQP5 expression was correlated with the survival rate of NSCLC patients (P=0.051). In conclusion, the results of the present study provide evidence for the AQP5-facilitated incidence, progression and metastasis of NSCLC. Therefore, AQP5 may be used as a potential target to investigate the incidence, progression and metastasis of NSCLC. [ABSTRACT FROM AUTHOR]

Objective: Anxiety disorders (ANDI) commonly occur in patients with Parkinson's disease (PD) but their socio-demographic and clinical correlates have not yet been unequivocally determined. This study aimed to assess the frequency of ANDI and their correlates in Chinese PD patients. Methods: A cohort of 133 patients of PD were recruited from three neurology outpatient clinics. Participants' neurological, cognitive, and psychiatric status was assessed using standardized rating instruments. ANDI were diagnosed by qualified psychiatrists using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders—4th Edition (SCID-DSM IV). Results: Thirty-six patients (27.1%) were diagnosed with some types of ANDI; Generalized Anxiety Disorder, Agoraphobia, and Social Phobia were the commonest subtypes of ANDI in PD (n = 11, 8.3%, in each of the three subtypes). Nine patients had more than one subtype of ANDI. In multivariate logistic regression, younger age of onset of PD [odds ratio (OR) =2.654, 95% confident intervals (CI) = 1.120-6.289, p = 0.027), Geriatric Depression Scale score (OR = 1.179, 95% CI = 1.056-1.316, p = 0.003) and muscle cramps (≥ 1/week) (OR = 2.605, 95% CI = 1.098-6.184, p = 0.030) were independent correlates of ANDI. Conclusions: ANDI are common in Chinese PD patients. Younger age of onset of PD, severity of depressive symptoms, and muscle cramps may be independent correlates of ANDI suggesting that anxiety in PD has multifactorial origin. [ABSTRACT FROM AUTHOR]

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A method involving solid-phase extraction (SPE) and reversed-phase liquid chromatography–mass spectrometry (LC–MS) has been developed for determination, in groundwater, of nitrobenzoic acids associated with 2,4,6-trinitrotoluene production. Pre-concentration on a co-polymer-based SPE cartridge enabled quantitative extraction of the analytes from water. Investigation of negative ion electrospray and atmospheric-pressure chemical ionization mass spectrometry indicated the sensitivity of APCI was more than twice that of ESI. An 15N-labeled internal standard was used to achieve more accurate quantitation and mass assignment. Recovery was better than 80% when 10 mL water was extracted with the SPE cartridge. Combination of SPE with LC–MS analysis resulted in method detection limits of less than 5 μg L−1. The method has been used for analysis of groundwater samples collected from a site of a former ammunition plant. Contamination with nitrobenzoic acids was determined at μg L−1 levels. [ABSTRACT FROM AUTHOR]

A gas chromatography/ion trap mass spectrometry method was used for the trace analysis of atrazine and its deethylated degradation product deethylatrazine in environmental water and sediment samples. The isotope dilution technique was applied for the quantitative analysis of atrazine at parts-per-trillion levels. Water samples were pre-concentrated by solid-phase extraction using a C 18 cartridge while the sediment samples were extracted by sonication with methanol. The concentrated extracts were analysed by a GC/ion trap MS operated in the MS/MS method. The extraction recoveries for the analytes were better than 83% when 1&ThickSpace;L of water or 10&ThickSpace;g of sediment was analysed. The method detection limits were 0.75&ThickSpace;ng/L and 0.13&ThickSpace;ng/g for atrazine and deethylatrazine detected in water and sediment, respectively. The precisions of the method represented by the relative standard deviation were in the range of 3.2–16.1%. The method was successfully applied to analyse surface water and sediment samples collected from Beijing Guanting reservoir. Trace levels of atrazine at 35.9–217.3&ThickSpace;ng/L and 2.4–8.4&ThickSpace;ng/g were detected in the water and sediment samples, respectively. The levels of deethylatrazine were five to 20 times lower that those of atrazine. [ABSTRACT FROM AUTHOR]

A reversed-phase LC–MS method with quadrupole-time of flight (QTOF) detection has been developed for the determination of four dinitro-toluenesulfonic acids and two amino-nitro-toluenesulfonic acids in groundwater. The analytes were separated by HPLC with 0.1% (v/v) formic acid as mobile phase modifier compatible with mass spectrometric detection. QTOF-MS analysis with negative ion electrospray ionization afforded good selectivity and sensitivity for analysis of the dinitro- and amino-nitro-toluenesulfonic acids. Structure elucidation and confirmation were accomplished by tandem mass spectrometry. Characteristic ions resulting from the loss of NO, NO2, and SO2 from the [M-H]- ions were detected. An intense fragment ion at m/z 80 representing the [SO3]- ion was detected for all dinitro- and amino-nitro-toluenesulfonic acids. Solid-phase extraction using a co-polymer cartridge was developed for preconcentration of the analytes from water. Good recovery (>85%) was achieved when 0.1% formic acid was added into the water samples before extraction. Method detection limits ranged from 10 to 76 ng L-1 for the targeted compounds when 10 mL water was analyzed. Groundwater samples collected from wells close to a former ammunition plant in Stadtallendorf, Germany, were analyzed for the dinitro- and amino-nitro-toluenesulfonic acids. [ABSTRACT FROM AUTHOR]

A reversed-phase HPLC method was developed for analyzing sinigrin and gluconasturtiin in six vegetable and two Chinese herb samples. A gradient program and mobile phases using methanol and 0.05% trifluoroacetic acid containing 20 mM ammonium acetate allowed sufficient retention and separation of the glucosinolates in the sample extracts. Quadrupole time-of-flight tandem mass spectrometry in negative ion electrospray ionization was used to analyze the fractions collected from the HPLC elution to confirm the identification of the glucosinolates. The levels of sinigrin and gluconasturtiin in the vegetables and Chinese herbs were determined by using an external calibration method. Concentrations of gluconasturtiin in the Chinese herbs were more than 15 times higher than those of sinigrin. Detection limits were 18 nmol g-1 for sinigrin and 4 nmol g-1 for gluconasturtiin when 50 g of fresh vegetable was analyzed. [ABSTRACT FROM AUTHOR]

The charge line (CL) method had been used in the past to represent the periodic charges in Monte Carlo simulations of ions in a cylindrical pore. In this method, there exists a possible singularity when the edge of the image line overlaps with an ion in the central cylinder. This singularity is more problematic for molecular dynamics when the force is evaluated. Molecular dynamics simulations with the CL method have not been reported in the literature. By replacing the first section of the image charge line with an image point, we show that the CL method can be improved and be applicable in the molecular dynamics simulation of electrolytes in a cylindrical geometry. The modified method is demonstrated to be effective by simulations of a high packing primitive model electrolyte, representing the state of a molten salt. [ABSTRACT FROM AUTHOR]

The objective of this paper is to report on the vocational outcomes of individuals with psychiatric disabilities participating in a supported competitive employment (SCE) program. A total of 458 subjects enrolled in the present SCE program which was developed on the basis of the Supported Employment Model developed by Wehman [23] and the principles of the Individual Placement and Support (IPS) developed by Becker and Drake [5]. Of the 458 subjects, 308 (67.3%) obtained competitive employment. The mean job tenure was 134 days. The mean salary was $4,740 for full-time jobs and was $2,321 for part-time jobs. The majority of subjects (59.4%) could sustain their job placement for more than 30 days, 74 (24.0%) subjects could work for more than six months, and 38 (12.3%) could maintain the job for more than one year. Subjects who became employed were compared to those who did not gain employment on a variety of demographic variables. Significant differences were found between two groups in terms of sex and source of referral. The rate of employment in the current study was slightly higher, but the job retention rate was lower than in earlier studies. Recommendations for future research on evaluation of the effectiveness of SCE program are suggested. [ABSTRACT FROM AUTHOR]

We assessed the relationship between the hemodynamic changes and shock intensity in transvenous atrial defibrillation for chronic AF. The correlation between the clinical profile and atrial DFT and the factors predicting maintenance of SR after successful defibrillation were also investigated. Atrial defibrillation using entirely transvenoas leads has been investigated as an alternative means of managing patients with AF. However, the hemodynamic consequence of this technique and the clinical factors predicting defibrillation efficacy have not been evaluated. Thirty-seven patients with chronic AF (4 weeks to 60 months) underwent transvenoas atrial defibrillation. Defibrillation was performed by delivering R wave synchronized, biphasic (3/3 ms) shocks with step-up voltages (20-400 V) between defibrillation catheters in the anterolateral right atrium and the distal coronary sinus. Clinical profile of the patients, the DFT. arterial blood pressure, and RH interval during defibrillation and the 6-month recurrence rate were determined. SR was restored in 33 (89%) of 37 patients and the DFT was 3.7 ± 1.4 J (317 ± 58 V). Transvenous atrial defibrillation resulted in a mild reduction in blood pressure (6 ± 10 mmHg), but substantial prolongation of longest postshock RR intervals (507 ± 546 ms). which were significantly related to the shock intensity (r = 0.5, P < 0.001). There was no ventricular proarrhythmia. The patients' age. body weight, duration of AF, left atrial diameter, and ejection fraction were not related to the success of defibrillation, not the 6-month maintenance rate of SR (39%). However, the patients' age was related to DFT. Apart from transient reduction in blood pressure and shock related pauses that may require backup pacing, transvenous biatrial defibrillation was a highly effective and well-tolerated technique. The absence of clinical determinant for successful defibrillation suggests that restoring SR by transvenous atrial defibrillation could be attempted in most patients with chronic AF. [ABSTRACT FROM AUTHOR]

Enhancement-mode Si3N4/AIGaN/GaN metal-insulator-semiconductor HFETs (MISHFETs) with a 1-µm gate footprint are demonstrated by combining CF4 plasma treatment technique and a two-step Si3N4 deposition process. The threshold voltage has been shifted from -4 [for depletion-mode HFET] to 2 V using the techniques. A 15-nm Si3N4 layer is inserted under the metal gate to provide additional isolation between the gate Schottky contact and AIGaN surface, which can lead to reduced gate leakage current and higher gate turn-on voltage. The two-step Si3N4 deposition process is developed to reduce the gate coupling capacitances in the source and drain access region, while assuring the plasma-treated gate region being fully covered by the gate electrode. The forward turn-on gate bias of the MISHFETs is as large as 7 V, at which a maximum current density of 420 mA/mm is obtained. The small-signal RF measurements show that the current gain cutoff frequency (fT) and power gain cutoff frequency (fmax) are 13.3 and 23.3 GHz, respectively. [ABSTRACT FROM AUTHOR]