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Yeon-Hwan Park,1,2 Sun-Hee Moon,3 Ji-Yeon Ha,1 Min-Hye Lee1 1College of Nursing, Seoul National University, 2The Research Institute of Nursing Science, Seoul National University, Seoul, 3Department of Nursing, College of Health and Welfare and Education, Gwangju University, Gwangju, South Korea Background and aims: Little is known about whether a self-management program for nursing-home residents (NHR) with cognitive impairment is likely to have an impact on the care of this growing population. This study aimed to evaluate the effects of the health-coaching self-management program for NHR (HCSMP-NHR) on 1) self-efficacy and goal attainment scaling (GAS), 2) health status and quality of life (QoL) among older people, including those with cognitive impairment, in Korean nursing homes.Methods: This was a cluster-randomized controlled trial. Participants in the intervention group (n=43, mean age =80.91±7.65 years) received the HCSMP-NHR intervention, composed of group health education and individual coaching, for 8 weeks. Conventional care was provided to the conventional group (n=47, mean age =80.19±7.53 years) during the same period. The effects of the HCSMP-NHR were measured three times: at baseline, week 9, and week 20.Results: The intervention group showed better results for self-efficacy (P=0.007), health distress (P=0.007), depression (P

Yeon-Hwan Park,1,2 Hwal Lan Bang,2,3 Ga Hye Kim,1 Ji Yeon Ha1 1College of Nursing, Seoul National University, Seoul, Korea; 2The Research Institute of Nursing Science, Seoul National University, Seoul, Korea; 3Department of Nursing Science, College of Industry, Sangmyung University, Cheonan, Korea Purpose: To explore facilitators and barriers to self-management from the viewpoint of staff taking care of nursing home (NH) residents with chronic diseases in South Korea. Patients and methods: A qualitative content analysis was done using the focus group interview method. A total of 23 health-care professionals (16 registered nurses and 7 social workers) were interviewed from three urban NHs, each with more than 100 beds. Results: Five facilitators were identified: grouping the residents; the resident’s awareness of his/her current health status; the willingness of residents to engage in self-management; residence in the facility; and support from the staff. Additionally, seven barriers were identified: deterioration of the resident’s health; the dependency expectations of the resident; hesitation in asking for help; difference in expectations between the staff and the resident’s family; insufficient staffing and time; lack of standardized guidelines; and conservative tendencies of the staff due to rigid policies. Conclusion: The findings of this study can help health-care professionals recognize the factors that influence self-management and provide direction for registered nurses and other health professionals involved in supporting self-management programs for NH residents. Keywords: self-management, aged, focus groups, long-term care

Alzheimer's disease (AD) poses a major societal challenge, yet no definitive cure exists. Noninvasive brain stimulation methods, such as transcranial magnetic stimulation and transcranial direct current stimulation, have shown promise in alleviating cognitive symptoms associated with neurodegenerative disorders. This study investigated the effects of 40Hz vibrotactile stimulation on AD-related cellular responses using SH-SY5Y neuroblastoma cells, primary human brain pericytes, and BV2 microglia. SH-SY5Y cells and brain pericytes treated with oligomeric beta-amyloid (Aβ) underwent 40Hz vibrational stimulation for varying durations. Cell viability was determined via the CCK-8 assay, while intracellular calcium levels in pericytes were assessed. Protein expression was measured using western blotting, and gene expression was quantified via a real-time quantitative polymerase chain reaction. Detailed vibrational parameters were employed to ensure precise stimulation. Notably, 40Hz vibrotactile stimulation improved cell viability in Aβ-exposed SH-SY5Y cells, reduced intracellular calcium ion (Ca2+) levels in Aβ-treated pericytes, activated autophagy, and mitigated tau hyperphosphorylation in SH-SY5Y cells. Additionally, it exhibited anti-neuroinflammatory properties in BV2 microglia. These findings highlight the potential of 40Hz vibrotactile stimulation as a therapeutic strategy for AD., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2024. Published by Elsevier Inc.)

Objectives: The role of extracellular vesicles (EVs), also known as outer membrane vesicles (OMVs), secreted by oral bacteria in the progression of head and neck squamous cell carcinomas (HNSCCs), is largely unexplored. This study aimed to investigate the influence of bacterial EVs, specifically those derived from Aggregatibacter actinomycetemcomitans (Aa), on the progression of HNSCC., Materials and Methods: FaDu and UMSCC1 cell lines were treated with Aa-derived EVs, and oncogenic activities were assessed. Comprehensive cellular and RNA-sequencing transcriptome analyses were conducted to assess the impact of these EVs on cell cycle progression and gene expression., Results: Our findings reveal that Aa-derived EVs accelerate cell cycle progression through the S and G2 phases and enhance invasion in HNSCC cell lines. RNA-sequencing analysis showed that Aa-derived EVs exert a more significant effect on general transcript expression than on microRNA profiles, except for miR-146a, which is recognized as a key factor in both carcinogenesis and immune modulation., Conclusions: Bacterial EVs, particularly from periodontal pathogens like Aa, are significant modulators within the oral cancer environment, potentially affecting cellular behavior and gene expression profiles. This study highlights the complex relationship between periodontal health and oral carcinogenesis, emphasizing the significant role of bacterial EVs in HNSCC progression., (© 2024 John Wiley & Sons Ltd.)

Background: Dissociative symptoms are often conceptualized as a response to childhood trauma. However, most previous studies did not consider dissociation as a multidimensional phenomenon and only focused on English-speaking samples., Objectives: To establish the cross-cultural validity of dissociation and examine the relationship of childhood trauma with different specific dissociative symptoms across two different samples., Participants and Setting: Data from two surveys were analyzed (N = 781 Chinese-speaking adults and N = 468 English-speaking adults)., Methods: Participants completed the Childhood Trauma Subsection of the Brief Betrayal Trauma Survey and the Multiscale Dissociation Inventory (MDI) in their respective languages. We first established the measurement invariance of the MDI across the samples. Then, we examined the correlations between childhood trauma and different dimensions of dissociation., Results: The six-factor structure of MDI achieved configural, metric and scalar invariance across the samples. In both samples, childhood trauma was significantly correlated with all facets of dissociation (rs = 0.227 to 0.450, p < .001), after controlling for age and gender. While depersonalization (r = 0.450) had the strongest correlation with childhood trauma in the Chinese-speaking sample, memory disturbance (r = 0.333) had the strongest correlation with childhood trauma in the English-speaking sample., Conclusions: Dissociation is a valid, multidimensional construct associated with childhood trauma across cultures. Yet, social and cultural factors might influence this relationship. Further studies on the complex relationship between childhood trauma and different specific dissociative symptoms, as well as possible moderators, are needed., Competing Interests: Declaration of competing interest The authors have no relevant financial or non-financial interests to disclose., (Copyright © 2024. Published by Elsevier Ltd.)

There is an ongoing debate regarding whether ICD-11 complex PTSD and DSM-5 borderline personality disorder (BPD) are the same syndrome. Little is known about the extent to which these two conditions overlap and whether they exhibit distinct clinical correlates in Asian cultures. This study examined the co-occurrence of ICD-11 complex PTSD and DSM-5 BPD in a sample of treatment seekers in Hong Kong (N = 220). Participants completed validated self-report measures which assessed if they met the respective diagnostic criteria. In this sample, 30.9 % met the ICD-11 criteria for complex PTSD only, 10.0 % met the DSM-5 criteria for BPD only, and 28.2 % met the criteria for both conditions. Complex PTSD symptoms were most strongly associated with depressive symptoms (β =.347, p <.001) and trauma-related maladaptive beliefs (β =.337, p <.001), while BPD symptoms were most strongly associated with dissociative symptoms (β =.281, p <.001). This study is the first to show that ICD-11 complex PTSD and DSM-5 BPD commonly co-occurred but were not the same construct in the Asian context, and their symptoms were associated with different sets of demographic and clinical factors. Future editions of DSM and ICD should not merge the two conditions into a single diagnosis., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Health disparities among ethnic minority and migrant women can lead to adverse maternal and neonatal outcomes. This study explores the maternity care experiences of South Asian women in Hong Kong, providing insights for woman-centred and culturally responsive care in the East Asia., Objective: To understand South Asian women's views and experiences regarding maternity care services in Hong Kong., Methods: A qualitative descriptive study was conducted with 20 English-speaking South Asian women who had used maternity care services in Hong Kong within the past 5 years. Data were analysed by thematic analysis., Findings: Four themes were identified: 1) Comparing maternity care services in their home country versus Hong Kong; birth location, mode of birth and care. 2) Navigating Hong Kong maternal medical care system; including private public dual care and learning information from other South Asians. 3) The discrepancy in perception of optimum care; including a preferring for assistance with daily tasks, epidural anaesthesia, doctor-led care, and priority to infants' health. 4) The impact of the COVID-19 pandemic on maternity care experiences, including the cancellation of translation services and limited visiting hours., Discussion: South Asian appreciate Hong Kong's public maternity services due to its perceived greater cost-effectiveness. The major incongruence between expectations and services provided being women-staff communication., Conclusion: The quality of healthcare in Hong Kong is appreciated. Individualized care should be offered to cater to diverse needs. Improvements in staff attitude and provision of detailed information should help alleviate feelings of differential treatment., Competing Interests: Declaration of Competing Interest No conflict of interest has been declared by the authors., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The advent of immunomodulatory therapies and their ever-expanding number of treatment indications necessitates the understanding of their associated complications. Neutropenic fever serves as an example of these complications often encountered in clinical practice. Although neutropenic fever can result from virtually any pathogen, episodes of the syndrome secondary to tick-borne illness remain relatively undocumented in the scientific literature. In the case presented, a 77-year-old female with a pertinent past medical history of smoldering IgG multiple myeloma on active immunosuppressive therapy presented with a first-time episode of neutropenic fever likely secondary to tick-borne illness. Through this report, attention is drawn to an additional source pathogen for neutropenic fever and its management, thus expanding upon clinician understanding of this all-too-common complication of immunosuppression., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Thor et al.)

Intimate partner violence (IPV) during pregnancy emerges as a compelling and urgent concern within the domain of public health, casting a long shadow over a substantial cohort of women. Its pernicious consequences extend beyond the individual, enveloping the well-being of both the mother and the fetus, giving rise to an elevated risk of preterm birth, low birth weight, fetal harm, and maternal psychological distress, including depression, anxiety, post-traumatic stress disorder, and, tragically, maternal mortality. Despite the prevalence of IPV being comparable to other conditions like gestational diabetes and preeclampsia, a universal screening protocol for IPV remains absent globally. We reviewed the clinical guidelines and practices concerning IPV screening, painstakingly scrutinizing their contextual nuances across diverse nations. Our study unveils multifaceted challenges of implementing universal screening. These hurdles encompass impediments to victim awareness and disclosure, limitations in healthcare providers' knowledge and training, and the formidable structural barriers entrenched within healthcare systems. Concurrently, we delve into the potential biomarkers intricately entwined with IPV. These promising markers encompass inflammatory indicators, epigenetic and genetic influences, and a diverse array of chemical compounds and proteins. Lastly, we discussed various criteria for universal screening including (1) valid and reliable screening tool; (2) target population as pregnant women; (3) scientific evidence of screening programme; and (4) integration of education, testing, clinical services, and programme management to minimise the challenges, which are paramount. With the advancement of digital technology and various biomarkers identification, screening and detecting IPV in clinical settings can be conducted systemically. A systems-level interventions with academia-community-indutrial partnerships can help connect pregnant women to desire support services to avoid adverse maternal and child health outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The extent to which complex post-traumatic stress disorder (C-PTSD) can be conceptualized as a dissociative disorder remains an ongoing debate. This study investigated the prevalence and correlates of dissociative symptoms in people with C-PTSD. We analyzed baseline data from an international randomized controlled trial. A total of 165 intervention seekers who met the ICD-11 criteria for C-PTSD completed standardized self-report measures of trauma, C-PTSD symptoms, dissociative symptoms, depressive symptoms, and work and social impairments. In this sample, only 42.3 % of participants exhibited clinically significant dissociative symptoms. Dissociative symptoms had a unique association with depressive symptoms and work and social impairments in our participants with C-PTSD, even after controlling for trauma exposure and C-PTSD symptoms. The data does not support the theory that C-PTSD is a dissociative disorder. However, the findings highlight the importance of recognizing dissociation in people with C-PTSD., Competing Interests: Declaration of competing interest The authors declare there is no conflict of interests., (Copyright © 2024. Published by Elsevier B.V.)

Background: Obstructive sleep apnea (OSA) is linked to various health complications, including erectile dysfunction (ED), which is more prevalent in individuals with OSA. This study explored ED in Korean OSA patients and assessed the impact of continuous positive airway pressure (CPAP) therapy on ED., Methods: A total of 87 male patients with OSA from four different sleep centers underwent physical measurements and completed sleep and mental health (MH) questionnaires, including the Korean version of the International index of erectile function (IIEF), before and three months after initiating CPAP therapy., Results: After three months of CPAP therapy, the patients demonstrated a significant improvement in ED as measured on the IIEF. However, the study found no significant correlation between the duration of CPAP use and the improvement in IIEF score. It did identify the SF36 quality of life assessment as a significant factor influencing ED improvement after CPAP., Conclusions: ED is a prevalent issue that escalates with age and is associated with OSA. CPAP therapy has shown potential in alleviating ED symptoms, particularly in those with underlying psychological conditions, although further research is required to confirm these findings and understand the underlying mechanisms.

The primary hepatic leiomyosarcoma is a rare malignant tumor arising from the smooth muscle cells in the hepatic vessels, bile ducts, and ligamentum teres. It is considered a subtype of hepatic sarcomas. We report awkward 18 F-FDG PET-CT findings of a primary hepatic leiomyosarcoma masquerading as a benign hepatic tumor, which were confirmed by histopathological and immunohistochemical examinations in a 78-year-old woman.

Purpose: Finasteride and dutasteride are used to treat benign prostatic hyperplasia (BPH) and reduce the risk of developing prostate cancer. Finasteride blocks only the type 2 form of 5-alpha-reductase, whereas dutasteride blocks both type 1 and 2 forms of the enzyme. Previous studies suggest the possibility that dutasteride may be superior to finasteride in preventing prostate cancer. We directly compared the effects of finasteride and dutasteride on the risk of prostate cancer in patients with BPH using a pooled analysis of 15 real-world databases., Materials and Methods: We conducted a multicenter, cohort study of new-users of finasteride and dutasteride. We include patients who were prescribed 5 mg finasteride or dutasteride for the first time to treat BPH and had at least 180 days of prescription. We excluded patients with a history of prostate cancer or a prostate-specific antigen level ≥ 4 ng/mL before the study drug prescription. Cox regression analysis was performed to examine the hazard ratio (HR) for prostate cancer after propensity score (PS) matching., Results: A total of 8,284 patients of new-users of finasteride and 8,670 patients of new-users of dutasteride were included across the 15 databases. In the overall population, compared to dutasteride, finasteride was associated with a lower risk of prostate cancer in both on-treatment and intent-to-treat time-at-risk periods. After 1:1 PS matching, 4,897 patients using finasteride and 4,897 patients using dutasteride were enrolled in the present study. No significant differences were observed for risk of prostate cancer between finasteride and dutasteride both on-treatment (HR=0.66, 95% confidence interval [CI]: 0.44-1.00; p=0.051) and intent-to-treat time-at-risk periods (HR=0.87, 95% CI: 0.67-1.14; p=0.310)., Conclusions: Using real-world databases, the present study demonstrated that dutasteride was not associated with a lower risk of prostate cancer than finasteride in patients with BPH., Competing Interests: The authors have nothing to disclose., (Copyright © 2024 Korean Society for Sexual Medicine and Andrology.)

ABSTRACT Background: Trauma can give rise to mental health problems and emotional and interpersonal difficulties, which in turn can perpetuate the cycle of trauma and adversity for future generations. However, little is known about the prevalence and potential effects of trauma and trauma-related mental health problems among parents. Objective: The primary goal of this study was to examine childhood and adulthood trauma and trauma-related symptoms among mothers of children aged between 6 and 18. We also conducted exploratory analyses of their potential relationship with children's emotional and behavioural problems. Method: A total of 817 mothers living with a child aged between 6 and 18 in Taiwan completed standardized self-report assessments of trauma exposure, trauma-related symptoms, and children's emotional and behavioural problems. A subsample ( n  = 256) also provided follow-up data after six months. Results: Most surveyed mothers reported at least one childhood traumatic event (74.79%) and one adulthood traumatic event (78.70%); 4.4% met the ICD-11 criteria for PTSD, and 12.1% for complex PTSD; 11.4% reported clinically significant dissociative symptoms. Mothers' complex PTSD and dissociative symptoms were cross-sectionally correlated with children's emotional and behavioural problem (rs = .186 to .239, p  < .001). After controlling for possible confounding variables and baseline scores, mothers' childhood non-betrayal trauma reported at baseline was found to be a predictor of children's emotional and behavioural problems reported at follow up. Conclusion: This study is the first to provide data regarding childhood and adulthood trauma and trauma-related disorders, including ICD-11 complex PTSD, among mothers in the community. It calls for more studies to understand the potential effects of intergenerational trauma.

Purpose: This study aimed to analyze the efficacy of psychosocial interventions for improving pregnancy rates in infertile women undergoing in vitro fertilization (IVF) treatment through a systematic review and meta-analysis., Methods: Twelve studies were included in the meta-analysis. To estimate the effect size, a meta-analysis of the studies was performed using RevMan 5.3. The possibility of publication bias was evaluated using funnel plots and Egger's method., Results: A statistically significant effect size (standardized mean difference [SMD] = 1.39; 95% confidence interval [CI] = 1.11-1.71; p  = 0.004; I 2 = 19%) was found for the 12 studies that investigated the effects of psychosocial interventions on clinical pregnancy rates. The psychosocial interventions that had a significant effect on pregnancy rates were mind-body interventions (SMD = 1.37; 95% CI = 1.01-1.85; p  = 0.040; I 2 = 0%) and cognitive behavioral therapy (SMD = 2.19; 95% CI = 1.17-4.13; p  = 0.010)., Conclusions: The results suggest that psychosocial interventions affect pregnancy rates. Moreover, they indicate that mind-body interventions and cognitive behavioral therapy are beneficial for improving the pregnancy outcome in infertile women undergoing IVF.

Gram-negative bacteria derived extracellular vesicles (EVs), also known as outer membrane vesicles, have attracted significant attention due to their pathogenic roles in various inflammatory diseases. We recently demonstrated that EVs secreted by the periodontopathogen Aggregatibacter actinomycetemcomitans (Aa) can cross the blood-brain barrier (BBB) and that their extracellular RNA cargo can promote the secretion of proinflammatory cytokines, such as IL-6 and TNF-α, in the brain. To gain more insight into the relationship between periodontal disease (PD) and neuroinflammatory diseases, we investigated the effect of Aa EVs in a mouse model of ligature-induced PD. When EVs were administered through intragingival injection or EV-soaked gel, proinflammatory cytokines were strongly induced in the brains of PD mice. The use of TLR (Toll-like receptor)-reporter cell lines and MyD88 knockout mice confirmed that the increased release of cytokines was triggered by Aa EVs via TLR4 and TLR8 signaling pathways and their downstream MyD88 pathway. Furthermore, the injection of EVs through the epidermis and gingiva resulted in the direct retrograde transfer of Aa EVs from axon terminals to the cell bodies of trigeminal ganglion (TG) neurons and the subsequent activation of TG neurons. We also found that the Aa EVs changed the action potential of TG neurons. These findings suggest that EVs derived from periodontopathogens such as Aa might be involved in pathogenic pathways for neuroinflammatory diseases, neuropathic pain, and other systemic inflammatory symptoms as a comorbidity of periodontitis., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ha et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Bisphosphonates (BP), a commonly used medication for various bone diseases, have been known to have severe complications such as bisphosphonate-related osteonecrosis of the jaw (BRONJ). Failure of dental implants has also been found in patients with medication-related osteonecrosis of the jaw (MRONJ). In this study, we analyzed the necrotic bone tissues and the surface of the failed implants removed from the jaw in patients treated with BPs and antiresorptive agents., Results: Chronic inflammatory cells with collagen and fibrous tissues and bone sequestrum were shown at 5.0 × , 10.0 × , 20.0 × , and 40.0 × magnified histologic sections in the bone and fibrotic scar tissues removed from patients with MRONJ due to osteonecrosis. Hardened bone tissues with microcracked bony resorbed lacunae were observed in SEM. Unlike the previously published comparative data where immune cells, such as dendritic cells, were found in the failed implant surface, these immune cells were not identified in the BRONJ-related peri-implantitis tissues through the TEM investigations. Furthermore, EDS revealed that in addition to the main titanium element, gold, carbon, oxygen, calcium, phosphorus, silicon, and sulfur elements were found., Conclusion: Hardened bone tissues with microcracked bony resorbed lacunae were observed in the SEM findings, which were considered as the main characteristic of the osteonecrosis of the jaw. Immune cells, such as dendritic cells were not identified in the TEM. EDS showed that in addition to the main titanium element, gold, carbon, oxygen, calcium, phosphorus, and silicon elements were found. Furthermore, it was revealed that sulfur was found, which was considered to be one of the complicated causes of implant failure in patients with BRONJ., (© 2023. Korean Association of Maxillofacial Plastic and Reconstructive Surgeons.)

Purpose: Several previous studies and case reports have reported ethanol-induced symptoms in patients receiving anticancer drugs containing ethanol. Most docetaxel formulations contain ethanol as a solvent. However, there are insufficient data on ethanol-induced symptoms when docetaxel-containing ethanol is administered. The primary purpose of this study was to investigate the frequency and pattern of ethanol-induced symptoms during and after docetaxel administration. The secondary purpose was to explore the risk factors for ethanol-induced symptoms., Materials and Methods: This was a prospective, multicenter, observational study. The participants filled out ethanol-induced symptom questionnaire on the day of chemotherapy and the following day., Results: Data from 451 patients were analyzed. The overall occurrence rate of ethanol-induced symptoms was 44.3% (200/451 patients). The occurrence rate of facial flushing was highest at 19.7% (89/451 patients), followed by nausea in 18.2% (82/451 patients), and dizziness in 17.5% (79/451 patients). Although infrequent, unsteady walking and impaired balance occurred in 4.2% and 3.3% of patients, respectively. Female sex, presence of underlying disease, younger age, docetaxel dose, and docetaxel-containing ethanol amount were significantly associated with the occurrence of ethanol-induced symptoms., Conclusion: The occurrence of ethanol-induced symptoms was not low in patients receiving docetaxel-containing ethanol. Physicians need to pay more attention to the occurrence of ethanol-induced symptoms and prescribe ethanol-free or low-ethanol-containing formulations to high-risk patients.

Purpose: Sarcopenia is a poor prognostic factor in cancer patients, and exercise is one of the treatments to improve sarcopenia. However, there is currently insufficient evidence on whether exercise can improve sarcopenia in patients with advanced cancers. This study examined the feasibility of exercise in advanced gastrointestinal (GI) cancer patients treated with palliative chemotherapy., Methods: Between 2020 and 2021, 30 patients were enrolled in a resistance and aerobic exercise program for six weeks. The exercise intervention program (EIP) consisted of low, moderate, and high intensity levels. Patients were asked to select the intensity level according to their ability. The primary endpoint was the feasibility of the EIP measured by compliance during the six weeks. A compliance of over 50% was considered acceptable. The secondary endpoints were changes in weight and muscle mass, safety, quality of life (QoL) and overall survival (OS)., Results: The median age of the study's participants was 60 (30-77). The total compliance to the EIP was 63.3% (19/30 patients). Sixteen (53.3%) patients had a compliance of over 80%. The attrition rate was 30.0% (9/30). The mean exercise time was 41.4 min, and the aerobic exercise was 92.3% and the resistant exercise was 73.7%, and both exercise was 66.5%. Most patients performed the moderate intensity level exercises at home or near their home. The mean skeletal muscle index (SMI) was 43.5 cm 2 /m 2 pre-chemotherapy and 42.2 cm 2 /m 2 after six weeks of chemotherapy, with a decrease of -1.2 ± 2.8 cm 2 /m 2 (-3.0%) (p = 0.030). In the poor compliance group, the mean SMI decrease was -2.8 ± 3.0 cm 2 /m 2 which was significantly different (p = 0.033); however, in the good compliance group, the mean SMI decrease was -0.5 ± 2.5 cm 2 /m 2 which was maintained over the six weeks (p = 0.337). The good compliance group had a significantly longer median OS compared with the poor compliance group (25.3 months vs. 7.9 months, HR = 0.306, 95% CI = 0.120-0.784, p = 0.014). The QoL showed a better score for insomnia (p = 0.042). There were no serious adverse events., Conclusions: The EIP during palliative chemotherapy in advanced GI cancer patients showed good compliance. In the good compliance group, muscle mass and physical functions were maintained for six weeks. The EIP was safe, and the QoL was maintained. Based on this study, further research in exercise intervention in advanced cancer patients is needed., Clinical Trial Registration: The clinical trial registration number is KCT 0005615 (CRIS, https://cris.nih.go.kr/cris/en/ ); registration date, 23rd Nov 2020., (© 2023. The Author(s).)

Although therapeutic immunoglobulin G (IgG) antibodies that regulate the activity of immune checkpoints bring innovation to the field of immuno-oncology, they are still limited in their efficiency to infiltrate the tumor microenvironment due to their large molecular size (150 kDa) and the necessity of additional engineering works to ablate effector functions for antibodies targeting immune cells. To address these issues, the human PD-1 (hPD-1) ectodomain, a small protein moiety of 14-17 kDa, has been considered as a therapeutic agent. Here, we used bacterial display-based high-throughput directed evolution to successfully isolate glycan-controlled (aglycosylated or only single- N -linked glycosylated) human PD-1 variants exhibiting over 1000-fold increased hPD-L1 binding affinity compared to that of wild-type hPD-1. The resulting hPD-1 variants, aglycosylated JYQ12 and JYQ12-2 with a single- N -linked glycan chain, showed exceptionally high binding affinity to hPD-L1 and very high affinity to both hPD-L2 and mPD-L1. Moreover, the JYQ12-2 efficiently potentiated the proliferation of human T cells. hPD-1 variants with significantly improved binding affinities for hPD-1 ligands could be used as effective therapeutics or diagnostics that can be differentiated from large-sized IgG antibody-based molecules.

Background: Interstitial cystitis (IC) is a chronic and intractable disease that can severely deteriorate patients' quality of life. Recently, stem cell therapy has been introduced as a promising alternative treatment for IC in animal models. We aimed to verify the efficacy and safety of the human perirenal adipose tissue-derived stromal vascular fraction (SVF) in an IC rat model., Methods: From eight-week-old female rats, an IC rat model was established by subcutaneous injection of 200 μg of uroplakin3A. The SVF was injected into the bladder submucosal layer of IC rats, and pain scale analysis, awakening cytometry, and histological and gene analyses of the bladder were performed. For the in vivo safety analysis, genomic DNA purification and histological analysis were also performed to check tumorigenicity and thrombus formation., Results: The mean pain scores in the SVF 20 μl group were significantly lower on days 7 and 14 than those in the control group, and bladder intercontraction intervals were significantly improved in the SVF groups in a dose-dependent manner. Regeneration of the bladder epithelium, basement membrane, and lamina propria was observed in the SVF group. In the SVF groups, however, bladder fibrosis and the expression of inflammatory markers were not significantly improved compared to those in the control group., Conclusion: This study demonstrated that a perirenal adipose tissue-derived SVF is a promising alternative for the management of IC in terms of improving bladder pain and overactivity., (© 2023. The Author(s).)

Aim: The first scoping review is to map and synthesize the stressors, problems and coping strategies surrounding the health issues of migrant domestic workers., Design: Scoping review using Arksey and O'Malley's five-stage framework., Methods: Ten electronic databases were systematically searched by keywords for literature published between January 1995 and December 2019. Data were extracted into tables and collated and summarized into themes for presentation., Results: Twenty-seven reports were included in the final review. Analysis revealed that stressors to health included abuse, poor health service accessibility, ongoing financial hardship despite demanding working conditions and social isolation. Physical and mental health problems were identified for which migrant domestic workers largely depended on social networks and religion to cope with stressors and health problems. Training para-professional peer leaders of migrant domestic workers by community nurses and including them in interprofessional teams is a possible way for nurses to promote their health and well-being., (© 2022 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Cognitive interventions that can be operated using mobile gadgets could facilitate the maintenance and improvement in the cognitive function of the community-dwelling elderly. The aims of this study was to estimate influences for mobile-based cognitive interventions in the community-dwelling elderly. A systematic literature search were conducted using various databases such as the Cochrane Library, PubMed, the Excerpta Medica Database, and Cumulative Index to Nursing and Allied Health Literature. Published articles up to August 2021 were searched without period limit. Integrated and analyzed RCTs' results that identified the effects of mobile-based cognitive interventions on the cognitive function of community-dwelling older adults with normal cognitive function. A meta-analysis was performed by RevMan 5.3 version. The methodological quality was assessed by the Cochrane Collaboration risk of bias tool. Registered with PROSPERO, the registration number is CRD42021268788. Overall, 6 randomized controlled trials identified from 400 articles were included in meta-analysis. The mobile-based cognitive interventions were found to have a significant effect on the short-term memory [standardized mean difference(SMD)= 0.22; 95% confidence interval (CI)=0.13,0.32; p<.001; I²=0%], working memory (SMD=0.70; 95% CI=0.02,1.37; p=.040; I²=81%), reasoning (SMD=0.27; 95% CI=0.11,0.42; p<.001; I²=25%), and executive function (SMD=0.62; 95% CI=0.09,1.16; p=.020; I²=0%). Finally, Egger's regression test and a funnel plot were conducted to examine publication bias; however, there was no significant bias. The mobile-based cognitive interventions had significantly affirmative effect on the older adults' executive function, reasoning, short-term memory, and working memory. Such programs may be employed as a supportive or an alternative method for improving their cognitive functions., Competing Interests: Declaration of Competing Interests The authors declare that they have no competing interests., (Copyright © 2022. Published by Elsevier B.V.)

Objectives: To explore associations of screen time (total, mobile gaming) with sleep problems in Chinese young adults., Methods: This was a 4-week daily morning (completion rate = 82.1%, 909/1107) and evening (completion rate = 92.4%, 1061/1148) assessment study in 41 university students (22 female, mean age = 22.3 [SD 4.2] years). Short sleep duration < 7 h, difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, and any of these three insomnia symptoms were self-reported in the morning. Mobile gaming time was self-reported in the evening, whilst total screen time was objectively tracked. Bayesian multilevel mixed-effects modeling disaggregated between- and within-person associations., Results: Between person, longer mobile gaming time predicted short sleep duration (adjusted odds ratio [AOR] = 1.90, 95% CI 1.39, 2.69), any insomnia symptoms (AOR = 1.59, 95% CI 1.20, 2.11), difficulty initiating sleep (AOR = 3.05, 95% CI 1.51, 6.24), and difficulty maintaining sleep (AOR = 2.19, 95% CI 1.18, 3.74). Short sleep duration (adjusted b = 0.99, 95% CI 0.05, 1.95), any insomnia symptoms (adjusted b = 1.19, 95% CI 0.24, 1.94), and difficulty initiating sleep (adjusted b = 1.72, 95% CI 0.11, 3.19) reversely increased mobile gaming time. Within person, any insomnia symptoms (adjusted b = 0.17, 95% CI 0.04, 0.31) and early morning awakening (adjusted b = 0.28, 95% CI 0.08, 0.48) increased next-day mobile gaming time. Total screen time was not associated with sleep problems both between and within person., Conclusions: Bidirectional between-person associations of mobile gaming time with short sleep duration and insomnia symptoms informed multiple-health-behavior-change interventions. Unidirectional within-person associations of insomnia symptoms with next-day mobile gaming time informed just-in-time adaptive interventions addressing daily variations in insomnia symptoms. [250/250 word limits]., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

We examined the impact of COVID-19 pandemic on the emergency department length of stay (EDLOS) and clinical outcomes of patients with severe pneumonia admitted to the intensive care unit (ICU) through the emergency department (ED). This single-center retrospective observational study included adult patients with pneumonia admitted to the ICU through the ED between January and December 2019 (pre-pandemic) and between March 2020 and February 2021 (during-pandemic). We compared and analyzed the EDLOS by dividing it into pre-, mid-, and post-EDLOS and in-hospital mortality of patients with pneumonia admitted to the ICU according to the time of ED visits before and during the COVID-19 pandemic. Risk factors for in-hospital mortality according to the time of ED visits were analyzed using multiple logistic regression analysis. In total, 227 patients (73 patients pre-pandemic and 154 patients during the pandemic) with pneumonia admitted to the ICU through the ED were analyzed. During the COVID-19 pandemic, pre-, mid-, and post-EDLOS increased (P < .05), and the in-hospital mortality rate increased by 10.4%; however, this was not significant (P = .155). Multivariate logistic regression analysis revealed post-EDLOS (ED waiting time after making ICU admission decision) as an independent risk factor for in-hospital mortality of patients with pneumonia admitted to the ICU, pre-pandemic (odds ratio [OR] = 2.282, 95% confidence interval [CI]: 1.367-3.807, P = .002) and during the pandemic (OR = 1.126, 95% CI: 1.002-1.266, P = .047). Mid-EDLOS (ED time to assess, care, and ICU admission decision) was an independent risk factor for in-hospital mortality of patients with pneumonia admitted to the ICU during the COVID-19 pandemic (OR = 1.835, 95% CI: 1.089-3.092, P = .023). During the pandemic of emerging respiratory infectious diseases, to reduce in-hospital mortality of severe pneumonia patients, it is necessary to shorten the ED waiting time for admission by increasing the number of isolation ICU beds. It is also necessary to accelerate the assessment and care process in the ED, and make prompt decisions regarding admission to the ICU., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

The management of chronic wounds in the elderly such as pressure injury (also known as bedsore or pressure ulcer) is increasingly important in an ageing population. Accurate classification of the stage of pressure injury is important for wound care planning. Nonetheless, the expertise required for staging is often not available in a residential care home setting. Artificial-intelligence (AI)-based computer vision techniques have opened up opportunities to harness the inbuilt camera in modern smartphones to support pressure injury staging by nursing home carers. In this paper, we summarise the recent development of smartphone or tablet-based applications for wound assessment. Furthermore, we present a new smartphone application (app) to perform real-time detection and staging classification of pressure injury wounds using a deep learning-based object detection system, YOLOv4. Based on our validation set of 144 photos, our app obtained an overall prediction accuracy of 63.2%. The per-class prediction specificity is generally high (85.1%-100%), but have variable sensitivity: 73.3% (stage 1 vs. others), 37% (stage 2 vs. others), 76.7 (stage 3 vs. others), 70% (stage 4 vs. others), and 55.6% (unstageable vs. others). Using another independent test set, 8 out of 10 images were predicted correctly by the YOLOv4 model. When deployed in a real-life setting with two different ambient brightness levels with three different Android phone models, the prediction accuracy of the 10 test images ranges from 80 to 90%, which highlight the importance of evaluation of mobile health (mHealth) application in a simulated real-life setting. This study details the development and evaluation process and demonstrates the feasibility of applying such a real-time staging app in wound care management., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Lau, Yu, Yip, Luk, Wai, Sit, Wong and Ho.)

Extracellular vesicles (EVs), which are nanosized membranous particles secreted from both prokaryotic and eukaryotic cells, can deliver various biological molecules, such as nucleic acids, proteins, and lipids, into recipient cells. However, contrary to what is known about eukaryotic EVs, whether bacterial EVs (bEVs) can be used as transporters for bioactive molecules is becoming a hot area of research. In this study, we electroporated enhanced green fluorescent protein (EGFP) genes and precursor microRNA of Cel-miR-39 (pre-Cel-miR-39) from isolated bEVs of Escherichia coli and Lactobacillus reuteri . The EGFP plasmid, synthetic EGFP RNA, and pre-Cel-miR-39 were successfully delivered into the murine microglial BV2 cells via bEVs. PCR and confocal microscopy analysis confirmed the transfer of the EGFP plasmid and RNA. The bEV-delivered exogenous pre-Cel-miR-39 was further processed into the mature form of Cel-miR-39; its incorporation into Ago2-a major component of the RNA-induced silencing complex-was assessed using RNA-immunoprecipitation-PCR. Taken together, bEVs can be used as vehicles to deliver genetic materials and for novel biotechnological applications, such as gene transfer and mRNA vaccines.

Background: Engaging students in interprofessional education for higher order thinking and collaborative problem-solving skills is challenging. This study reports the development of Virtual ER, a serious game played on a virtual platform, and how it can be an innovative way for delivering interprofessional education to medical and nursing undergraduates., Objective: We report the development of a serious online game, Virtual ER, and evaluate its effect on teamwork enhancement and clinical competence. We also explore if Virtual ER can be an effective pedagogical tool to engage medical and nursing students with different learning styles., Methods: Virtual ER is a custom-made, learning outcome-driven, case-based web app. We developed a game performance scoring system with specific mechanisms to enhance serious gaming elements. Sixty-two students were recruited from our medical and nursing programs. They played the games in teams of 4 or 5, followed by an instructor-led debriefing for concept consolidation. Teamwork attitudes, as measured by the Human Factors Attitude Survey, were compared before and after the game. Learning style was measured with a modified Honey and Mumford learning style questionnaire., Results: Students were satisfied with Virtual ER (mean satisfaction score 5.44, SD 0.95, of a possible 7). Overall, Virtual ER enhanced teamwork attitude by 3.02 points (95% CI 1.15-4.88, P=.002). Students with higher scores as activists (estimate 9.09, 95% CI 5.17-13.02, P<.001) and pragmatists (estimate 5.69, 95% CI 1.18-10.20, P=.01) had a significantly higher degree of teamwork attitude enhancement, while students with higher scores as theorists and reflectors did not demonstrate significant changes. However, there was no difference in game performance scores between students with different learning styles., Conclusions: There was considerable teamwork enhancement after playing Virtual ER for interprofessional education, in particular for students who had activist or pragmatist learning styles. Serious online games have potential in interprofessional education for the development of 21st century life skills. Our findings also suggest that Virtual ER for interprofessional education delivery could be expanded locally and globally., (©Janet Yuen-Ha Wong, Joanna Ko, Sujin Nam, Tyrone Kwok, Sheila Lam, Jessica Cheuk, Maggie Chan, Veronica Lam, Gordon T C Wong, Zoe L H Ng, Abraham Ka-Chung Wai. Originally published in JMIR Serious Games (https://games.jmir.org), 14.07.2022.)

Purpose: This study evaluated the diagnostic performance of contrast-enhanced voiding ultrasonography (CeVUS) for detecting intrarenal reflux (IRR) and the correlation between CeVUS-detected IRR sites and photon defect sites in acute 99mTc-dimercaptosuccinic acid (DMSA) renal scans in pediatric patients., Methods: Fifty-four kidneys from 27 patients (20 males and seven females; mean age, 5.6±4.1 months) who underwent CeVUS and acute DMSA renal scans for recurrent urinary tract infection (UTIs) or pyelonephritis were included. Pediatric experts compared the results of CeVUS with acute DMSA renal scans., Results: Thirteen renal units (13/54, 24.1%) in 10 patients (nine males and one female; mean age, 6.3±3.7 months; age range, 0 to 13 months) showed vesicoureteral reflux and eight renal units (8/54, 14.8%) demonstrated IRR on CeVUS. Ten renal units in eight patients (six males and two females; mean age, 6.9±1.4 months; age range, 2 to 13 months) showed 19 photon defects on acute DMSA renal scans. Fifty-two renal units (96.3%) showed concordant results, and two renal units (3.7%) showed discordant results between CeVUS and acute DMSA renal scans. IRR accounted for 15/19 (78.9%) photon defects in eight renal units of seven patients using CeVUS. In a per-renal-unit analysis, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CeVUS were 80%, 100%, 100%, 95.7%, and 96.3%, respectively., Conclusion: CeVUS showed good performance in detecting IRR, and the IRR sites detected by CeVUS closely correlated with photon defect sites in acute DMSA scans. CeVUS may play an important role in managing patients with recurrent UTIs or pyelonephritis with reduced radiation exposure.

Objective: To develop and evaluate a deep learning-based artificial intelligence (AI) model for detecting skull fractures on plain radiographs in children., Materials and Methods: This retrospective multi-center study consisted of a development dataset acquired from two hospitals (n = 149 and 264) and an external test set (n = 95) from a third hospital. Datasets included children with head trauma who underwent both skull radiography and cranial computed tomography (CT). The development dataset was split into training, tuning, and internal test sets in a ratio of 7:1:2. The reference standard for skull fracture was cranial CT. Two radiology residents, a pediatric radiologist, and two emergency physicians participated in a two-session observer study on an external test set with and without AI assistance. We obtained the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity along with their 95% confidence intervals (CIs)., Results: The AI model showed an AUROC of 0.922 (95% CI, 0.842-0.969) in the internal test set and 0.870 (95% CI, 0.785-0.930) in the external test set. The model had a sensitivity of 81.1% (95% CI, 64.8%-92.0%) and specificity of 91.3% (95% CI, 79.2%-97.6%) for the internal test set and 78.9% (95% CI, 54.4%-93.9%) and 88.2% (95% CI, 78.7%-94.4%), respectively, for the external test set. With the model's assistance, significant AUROC improvement was observed in radiology residents (pooled results) and emergency physicians (pooled results) with the difference from reading without AI assistance of 0.094 (95% CI, 0.020-0.168; p = 0.012) and 0.069 (95% CI, 0.002-0.136; p = 0.043), respectively, but not in the pediatric radiologist with the difference of 0.008 (95% CI, -0.074-0.090; p = 0.850)., Conclusion: A deep learning-based AI model improved the performance of inexperienced radiologists and emergency physicians in diagnosing pediatric skull fractures on plain radiographs., Competing Interests: Young Hun Choi and Jung-Eun Cheon who is on the editorial board of the Korean Journal of Radiology was not involved in the editorial evaluation or decision to publish this article. All remaining authors have declared no conflicts of interest., (Copyright © 2022 The Korean Society of Radiology.)

Objectives: To evaluate the detection rate of clinically significant prostate cancer (csPCa) in Magnetic resonance imaging and ultrasonography (MRI/US) fusion biopsy in patients with biopsy-naïve men for varying prostate-specific antigen (PSA) levels. Since MRI can efficiently detect csPCa compared to standard transrectal ultrasound (TRUS) guided biopsy; however, the optimal PSA threshold for its use is unclear., Materials and Methods: We retrospectively reviewed those who underwent MRI/US-fusion and standard biopsy from January 2016 to June 2018. Patients were divided into three groups: PSA <4, 4-10, >10 ng/mL. Propensity scoring was performed to balance the characteristics of the different biopsy groups, and the detection rate of csPCa was compared., Results: Data from a total of 670 males were included in the analysis (standard TRUS, n  = 333; MRI/US fusion, n  = 337). Prior to matching, patients who received MRI/US-fusion biopsy had lower prostate volume. Propensity score matching balanced this characteristic and generated a cohort comprising 195 patients from each group. In the matched cohort, patients with PSA 4-10 ng/mL had a significantly increased risk of csPCa by MRI/US-fusion vs. standard biopsy (35.0% vs. 26.6%, P  = 0.033). However, patients with PSA <4 ng/mL had csPCa found by MRI/US-fusion versus standard biopsy (12.0% vs. 16.0%, P  = 0.342), whereas, patients with PSA >10 ng/mL had csPCa found by MRI/US-fusion versus standard biopsy (78.0% vs. 80.0%, P  = 0.596). In multivariate logistic analysis among patients with PSA 4-10 ng/mL, MRI/US-fusion biopsy (odds ratio: 2.46, 95% confidence interval = 1.31-4.60, P  = 0.005) were significantly associated with a detection of csPCa., Conclusions: Detection of csPCa by MRI/US-fusion biopsy is more efficient in patients with biopsy-naïve men with PSA 4-10 ng/mL. However, standard TRUS biopsy may identify csPCa in patients with PSA <4 ng/mL and ≥10 ng/mL, emphasizing the importance of performing a standard biopsy in conjunction with MRI/US-fusion biopsy in such populations., Competing Interests: There is no conflict of interest., (© 2022 Asian Pacific Prostate Society. Publishing services by Elsevier B.V.)

Depression among childless middle-aged and elderly people is a serious social problem in Korea. However, few studies examine the influence of life satisfaction on the depression of spouses as actors and partners. Hence, this study analyzes the influence of life satisfaction (a positive factor childless married couples may have) on depression. This cross-sectional study employed data on couples to analyze the effect of life satisfaction on the depression of childless married couples as actors and partners via the actor-partner interdependence model. The Korea Longitudinal Study of Aging was employed to investigate life satisfaction and depression among 207 childless middle-aged and elderly couples. Regarding actor effects, wives' (β = -0.285, p = 0.004) and husbands' (β = -0.403, p < 0.001) life satisfaction significantly affected individual depression. Regarding partner effects, husbands' life satisfaction (β = -0.255, p = 0.011) significantly affected wives' depression, and the wives' life satisfaction (β = -0.375, p < 0.001) significantly affected husbands' depression. A childless actor's life satisfaction affected own and partner's depression. Thus, spouses should work together to improve their life satisfaction, thereby improving their depression.

Limited studies exist on women's mild traumatic brain injury received from episode of intimate partner violence. This study aims to identify the occurrence of intimate partner violence-related mild traumatic brain injury in Chinese women admitted to emergency units; and examine the physical, mental, and cognitive functioning of abused women with mild traumatic brain injury related to violent episodes. Eighty-six Chinese abused women presenting at emergency units in four major local hospitals in Hong Kong between January 2014 and December 2016 were recruited. They were admitted for the treatment of intimate partner violence-related physical injuries and were screened for traumatic brain injury by the emergency unit nurses at triage. Participants were assessed for traumatic brain injury based on the definition from US Center for Disease Control and Prevention, post-concussion physical symptoms, anxiety and depression, health-related quality of life, and cognitive functioning. Structured multiphase regression was used to examine the impact of intimate partner violence-related mild traumatic brain injury on physical, mental, and cognitive functioning of participants. We found that 24.4% of participants had intimate partner violence-related mild traumatic brain injury. There were significantly more severe post-concussion physical symptoms in abused women with intimate partner violence-related mild traumatic brain injury than those without mild traumatic brain injury (estimate = 18.7, 95% CI = 10.9 to 26.6, p < 0.001). The Mental Component Summary was also significantly associated with intimate partner violence-related mild traumatic brain injury (estimate = -7.9, 95% CI = -13.8 to -2.1, p = 0.009). Regarding cognitive functioning, the mean total test scores indicated that both groups were cognitively abnormal and there was no significant impact from mild traumatic brain injury. This study provides evidence on the impact of mild traumatic brain injury and implications in screening for mild traumatic brain injury and early intervention for improving quality of life in abused women., (© 2020 John Wiley & Sons Ltd.)

Aims and Objectives: This study aimed to evaluate the effect of a virtual simulation education programme with debriefing in undergraduate nursing students. Perceived clinical competence and learning needs of students in a simulation environment were also measured., Background: Evidence showed virtual simulation education programmes provided better knowledge acquisition. However, these studies to date did not incorporate virtual simulation in the combination of a debriefing model in nursing students., Design: A one-group pre-test and post-test design., Methods: 188 final year undergraduate nursing students participated in the study. Linear mixed model analysis was conducted to evaluate the effect of the programme., Results: Students have perceived a significant improvement in clinical competence and nursing process. Self-efficacy has also boosted. Communication and critical thinking were applied better in the traditional clinical environment., Conclusion: Perceived clinical competence of Chinese nursing students has significant improvements by using virtual simulation combining a debriefing model during the COVID-19 period. Virtual simulation met students' learning needs. Future studies should include a control group for comparison and long-term measurement., Relevance to Clinical Practice: The study provided an innovative clinical learning pedagogy to serve as a potential alternative with traditional clinical practicum during the COVID-19 period as this is substantially limited., (© 2021 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Introduction: Health information about COVID-19 has been circulating in social networking sites, including unproven claims that smoking and alcohol drinking could protect against COVID-19. We examined if exposure to such claims was associated with changes in tobacco and alcohol consumption., Methods: We conducted a population-based, landline and mobile phone survey of 1501 randomly sampled adults aged 18 years or older (47.5% male) in Hong Kong in April 2020. Respondents reported if they had ever seen claims that 'smoking/alcohol drinking can protect against COVID-19' from popular social networking platforms. Current tobacco and alcohol users reported if they had increased or reduced their consumption since the outbreak. Prevalence data were weighted by sex, age and education of the general adult population., Results: 19.0% (95% CI 16.8% to 21.4%) of all respondents reported having seen claims that 'smoking/alcohol drinking can protect against COVID-19' from social networking sites. Multinomial logistic regression showed that exposure to the claims was significantly associated with increased tobacco use (OR 2.37, 95% CI 1.08 to 5.20) in current tobacco users (N=280) and increased alcohol use (OR 4.16, 95% CI 2.00 to 8.67) in current drinkers (N=722), adjusting for sex, age, education level, alcohol/tobacco use status, home isolation, anxiety and depressive symptoms, and survey method., Conclusion: Our results first showed that exposure to health misinformation that smoking/alcohol drinking can protect against COVID-19 was associated with self-reported increases in tobacco and alcohol consumption in Chinese during the pandemic., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Young mothers face considerable challenges that can affect their mental health, with anxiety being one of the most common mental health problems observed in this population. Furthermore, pregnancy is one of the risk factors for intimate partner violence (IPV). There is thus an urgent need to explore the IPV risk faced by young mothers and its association with their mental health, anxiety in particular. The study aimed to investigate the correlation between IPV victimization and anxiety in young mothers, as well as the protective effects of social support and resilience. A total of 79 young Chinese mothers aged 16 to 25 were recruited from a special service project for young parents in Hong Kong. Just more than half (50.6%) were found to have experienced psychological aggression by their current partner, with 26.6% and 13.9%, respectively, having experienced physical assault and sexual abuse. Roughly a quarter (25.3%) perceived themselves to suffer from moderate or severe generalized anxiety disorder. Logistic regression further showed the young mothers who had experienced physical assault and/or sexual abuse by their current partners to be at least six times likelier to have moderate or severe anxiety disorder (adjusted odds ratio [aOR] = 4.51, p < .05) than those who had experienced no such violence. Young mothers with less perceived social support (aOR = 0.77, p < .01), a lower secondary level of education or below (aOR = 12.99, p < .05), and in receipt of social security assistance (aOR = 5.69, p < .05) were also likelier to have moderate or severe anxiety disorder. The results indicate the importance of social support during the critical period of young motherhood. Health care professionals need to remain alert to the impacts of IPV victimization and the risk of anxiety in young mothers with a low level of education and/or receiving financial support.

This study aimed to evaluate a deep learning model for generating synthetic contrast-enhanced CT (sCECT) from non-contrast chest CT (NCCT). A deep learning model was applied to generate sCECT from NCCT. We collected three separate data sets, the development set (n = 25) for model training and tuning, test set 1 (n = 25) for technical evaluation, and test set 2 (n = 12) for clinical utility evaluation. In test set 1, image similarity metrics were calculated. In test set 2, the lesion contrast-to-noise ratio of the mediastinal lymph nodes was measured, and an observer study was conducted to compare lesion conspicuity. Comparisons were performed using the paired t-test or Wilcoxon signed-rank test. In test set 1, sCECT showed a lower mean absolute error (41.72 vs 48.74; P < .001), higher peak signal-to-noise ratio (17.44 vs 15.97; P < .001), higher multiscale structural similarity index measurement (0.84 vs 0.81; P < .001), and lower learned perceptual image patch similarity metric (0.14 vs 0.15; P < .001) than NCCT. In test set 2, the contrast-to-noise ratio of the mediastinal lymph nodes was higher in the sCECT group than in the NCCT group (6.15 ± 5.18 vs 0.74 ± 0.69; P < .001). The observer study showed for all reviewers higher lesion conspicuity in NCCT with sCECT than in NCCT alone (P ≤ .001). Synthetic CECT generated from NCCT improves the depiction of mediastinal lymph nodes., (© 2021. The Author(s).)

The change in the crystallinity of Ce-Ti oxide nanocatalysts with different water contents was investigated in terms of the local atomic structure and the surface atomic concentration. The crystallization of TiO₂, which was induced by the hydrolysis of the Ti precursor, was observed in the catalyst synthesized via a liquid phase reaction employing a mixture of ethanol and distilled water as the solvent. The hydrolysis reaction of the Ti precursor was impeded in the solvent mixture of ethanol and anhydrous ethanol. CeO₂ nanocrystallization occurred due to the suppression of the TiO₂ crystal growth. Low crystallinity of the catalyst synthesized in a single anhydrous ethanol solvent was observed through the broadened X-ray diffraction (XRD) peak and the diffused ring pattern in transmission electron microscopic (TEM) images. In addition, the Ce-O and Ce-Ce bond lengths of the catalyst synthesized using the single solvent decreased beyond those of the catalysts synthesized in the mixed solvent, indicating the amorphization of the catalyst. It was also verified that the inhibition of the precursor crystallization during the synthesis led to the enhanced dispersion of the nanocatalyst, compared to the stoichiometry of the surface atomic concentration.

Intimate partner violence (IPV) is largely recognized to have a cyclical pattern and violence escalation in terms of frequency and intensity over time. However, there is a lack of systematic investigation of the profiles of victims and quantification of the patterns of injury of the victims associated with the first time versus repeated violence episodes. This study aimed to fill this knowledge gap by medical chart review of 878 victims in a 5-year period from 2010 to 2014 in Accident and Emergency Department (AED) of two public general hospitals in Hong Kong. The differences in injury patterns between the first IPV episode (FE) and recurrent IPV episodes (REs) experienced by male and female victims in heterosexual relationship were evaluated. The results indicated the violence escalation occurred in recurrent IPV in both genders. In female victims, there was significant increase in the number of injury locations (mean [ M ] = 2.0 vs. 2.2, p < .05), number of causes of injury ( M = 1.7 vs. 2.2, p < .001) and police escort (15.2% vs. 22.1%, p < .05) in RE compared to FE. In male victims, however, only the increase in the number of causes of injury was significant ( M = 1.6 vs. 2.1, p < .05) in RE compared to FE. In summary, our results highlight the escalation in the severity of harm of IPV victims in heterosexual relationship, and the gender differences in severity aggression and injury and help-seeking behavior change in recurrent IPV. Preventive measures are indicated to intervene the IPV occurrence and recurrence with rising morbidity and a potential of mortality.

Intimate partner violence (IPV) exists in various forms including physical, psychological, sexual, and economic. Although abundant literature documented the association between physical, psychological, or sexual violence with the associated mental well-being outcomes on survivors, the literature on economic violence, and its consequences were insufficient. In the past, most of the literature captured economic abuse within the scope of psychological abuse. However, different from psychological abuse, survivors of economic abuse may directly suffer from deteriorating economic well-being. Therefore, there is a need to explicitly investigate economic abuse. This paper aims to critically appraise and summarize the instruments of economic abuse and the associated mental well-being outcomes on women. This study highlights the lack of vigorous study in the area and also an underreporting of the negative impact of economic abuse. The implications and future research directions are discussed., (© Copyright 2021 Springer Publishing Company, LLC.)

Purpose: The tumor-infiltrating lymphocytes (TILs) expression in breast cancer is a positive prognostic marker for certain breast cancer subtypes. We evaluated the efficacy of dual anti-human epidermal growth factor receptor 2 (HER2) blockade in HER2-positive breast cancer and hypothesized that high TILs tumors are associated with better outcomes., Methods: A total of 176 patients who were treated with neoadjuvant docetaxel, carboplatin, trastuzumab, and pertuzumab (TCHP) between December 2015 and December 2018 were reviewed. They were grouped based on a cut-off value of the stromal TILs grade (≤ 20% TILs, > 20% TILs)., Results: In total, 107 patients (60.8%) achieved pathological complete response (pCR). Hormone receptor (HR)-negativity ( p = 0.001) and a high TILs grade ( p = 0.022) were independent predictors of pCR. Among the HR-negative patients, high TILs tumors were significantly associated with pCR ( p = 0.035)., Conclusion: HR status and the TILs grade are significantly correlated with pCR in dual anti-HER2 neoadjuvant therapy. The evaluation of the TILs at baseline may be beneficial for predicting pCR in HER2-positive breast cancer., Competing Interests: Dr. Kim SB has received research funding from Novartis, Sanofi-Aventis, Kyowa-Kirin Inc., and DongKook Pharm Co. and has participated as a consultant in advisory boards of Novartis, AstraZeneca, Lilly, Dae Hwa Pharmaceutical Co. Ltd, ISU Abxis, and Daiichi-Sankyo. Dr. Jung KH has participated as a consultant in advisory boards of Roche, AstraZeneca, Novartis, Takeda, and MSD., (© 2021 Korean Breast Cancer Society.)

Background: Although vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the most desired solution to end the coronavirus disease (COVID-19) pandemic, there are growing concerns that vaccine hesitancy would undermine its potential. We examined the intention to receive vaccination against SARS-CoV-2 and the associated factors in a representative sample of Chinese adults in Hong Kong., Methods: We did a dual-frame (landline and mobile) cross-sectional survey of a random sample of 1501 Hong Kong residents aged 18 years or older (53.6% females) in April 2020. We collected data on the intention to receive SARS-CoV-2 vaccine when it becomes available (yes/ no/ undecided), knowledge and perceptions of COVID-19, smoking, alcohol drinking, and sociodemographic factors. Prevalence estimates were weighted by the sex, age, and education of the general population of Hong Kong., Results: Overall, 45.3% (95% CI: 42.3-48.4%) of the participants had intentions to vaccinate against SARS-CoV-2 when it becomes available, 29.2% (26.5-32.1%) were undecided, and 25.5% (22.9-28.2%) had no intention. The most common reason for vaccine hesitancy (undecided or no intention) was safety concerns (56.5%). Multivariable partial proportional odds model showed higher vaccine hesitancy in males, younger adults, those with no chronic disease, current smokers, and non-alcohol drinkers. After adjusting for sociodemographic and other factors, inadequate knowledge of SARS-CoV-2 transmission (adjusted ORs ranged from 1.27 to 2.63; P < 0.05) and lower perceived danger of COVID-19 (adjusted ORs ranged from 1.62 to 2.47; P < 0.001) were significantly associated with vaccine hesitancy., Conclusions: In a representative sample of Chinese adults in Hong Kong, only 45.3% of the participants intended to vaccinate against SARS-CoV-2 when available. Vaccine hesitancy was associated with inadequate knowledge about SARS-CoV-2 transmission and lower perceived danger of COVID-19, which needed to be addressed to improve vaccination uptake., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Lumbar spinal stenosis (LSS) can cause various neurological symptoms and reduce the daily activity of patients. Many studies have shown that free physical activities and exercise can improve bone mineral density (BMD) in patients with osteoporosis. However, the effect of LSS on BMD has not been reported. The purpose of this study was to investigate the effects of LSS on BMD in patients treated with ibandronate for newly diagnosed osteoporosis., Methods: Group 1 included 83 patients treated for osteoporosis alone, and group 2 included 76 patients treated for both osteoporosis and symptomatic LSS. We confirmed four BMD values presented as T-score at initial, and 1-, 2-, and 3-year follow-ups. Mean BMD and annual changes of BMD for three years were compared between the two groups. Correlations between initial BMD and total change of BMD, and related factors for continuous BMD improvement for three years were also evaluated., Results: Mean annual BMDs were significantly higher in group 1 compared than in group 2 (-3.39 vs. -3.58 at 1-year; -3.27 vs. -3.49 at 2-year; -3.13 vs. -3.45 at 3-year; all p < 0.05). Annual change of BMD at 1-year follow-up (0.32 vs. 0.21, p = 0.036) and total change of BMD for three years (0.57 vs. 0.35, p = 0.002) were significantly higher in group 1. Group 1 had a strong negative correlation (r = -0.511, P = 0.000) between initial BMD and total change of BMD, whereas group 2 showed a weak negative correlation (r = -0.247, p = 0.032). In multivariate analysis, symptomatic LSS was the only independent risk factor for continuous BMD improvement (Odds ratio = 0.316, p = 0.001)., Conclusions: Symptomatic LSS may interfere with BMD improvement in the treatment of osteoporosis with ibandronate. Active treatment for LSS with more potent treatment for osteoporosis should be taken to increase BMD for patients with osteoporosis and LSS.

Purpose: This study was to systematically review randomized controlled trials and conduct a meta analysis. The results of randomized controlled trials were integrated and analyzed to assess the effects of mind-body programs on anxiety, depression, quality of life, and pregnancy rate in infertile women., Methods: Using electronic databases (i.e., Research Information Sharing Service, Korean Studies Information Service System, Korean Medical Database, National Digital Science Library, Cochrane Library, PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and PsycARTICLES), 10 of 2,259 studies were included for meta-analysis. To estimate the effect size, a meta-analysis of the studies was performed using RevMan 5.3., Results: The mind-body program was effective in relieving anxiety [standardized mean difference (SMD) = -3.44; 95% confidence interval (CI) = -5.94, -0.95; p = .007; I 2 = 69%] and depression (SMD = -5.79; 95% CI = -10.36, -1.22; p = .010; I 2 = 86%). Furthermore, it was effective in enhancing the quality of life (SMD = 7.40; 95% CI = 2.92, 11.88; p = .001; I 2 = 53%) and pregnancy rate (SMD = 2.06; 95% CI = 1.08, 3.95; p = .030; I 2 = 73%). The mind-body program was found to relieve anxiety and depression in infertile women and improve their quality of life, thereby positively affecting the pregnancy rate., Conclusion: The mind-body program was found to relieve anxiety and depression in infertile women and improve their quality of life, thereby positively affecting the pregnancy rate. The mind-body program needs to be considered to a wider audience for positive effects on emotions and pregnancy outcomes of infertile women., Competing Interests: Conflict of interest The authors declared no conflict of interest., (Copyright © 2021. Published by Elsevier B.V.)

Background: eHealth literacy can potentially facilitate web-based information seeking and taking informed measures., Objective: This study aimed to evaluate socioeconomic disparities in eHealth literacy and seeking of web-based information on COVID-19, and their associations with COVID-19 preventive behaviors., Methods: The COVID-19 Health Information Survey (CoVHIns), using telephonic (n=500) and web-based surveys (n=1001), was conducted among adults in Hong Kong in April 2020. The Chinese eHealth literacy scale (eHEALS; score range 8-40) was used to measure eHealth literacy. COVID-19 preventive behaviors included wearing surgical masks, wearing fabric masks, washing hands, social distancing, and adding water or bleach to the household drainage system. Adjusted beta coefficients and the slope indices of inequality for the eHEALS score by socioeconomic status, adjusted odds ratios (aORs) for seeking of web-based information on COVID-19 by socioeconomic status, and aORs for the high adherence to preventive behaviors by the eHEALS score and seeking of web-based information on COVID-19 were calculated., Results: The mean eHEALS score was 26.10 (SD 7.70). Age was inversely associated with the eHEALS score, but education and personal income were positively associated with the eHEALS score and seeking of web-based information on COVID-19 (for all, P for trend<.05). Participants who sought web-based information on COVID-19 showed high adherence to the practice of wearing surgical masks (aOR 1.56, 95% CI 1.15-2.13), washing hands (aOR 1.33, 95% CI 1.05-1.71), social distancing (aOR 1.48, 95% CI 1.14-1.93), and adding water or bleach to the household drainage system (aOR 1.67, 95% CI 1.28-2.18). Those with the highest eHEALS score displayed high adherence to the practice of wearing surgical masks (aOR 3.84, 95% CI 1.63-9.05), washing hands (aOR 4.14, 95% CI 2.46-6.96), social distancing (aOR 2.25, 95% CI 1.39-3.65), and adding water or bleach to the household drainage system (aOR 1.94, 95% CI 1.19-3.16), compared to those with the lowest eHEALS score., Conclusions: Chinese adults with a higher socioeconomic status had higher eHealth literacy and sought more web-based information on COVID-19; both these factors were associated with a high adherence to the guidelines for preventive behaviors during the COVID-19 pandemic., (©Ziqiu Guo, Sheng Zhi Zhao, Ningyuan Guo, Yongda Wu, Xue Weng, Janet Yuen-Ha Wong, Tai Hing Lam, Man Ping Wang. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 14.04.2021.)

Background: In the setting of multiple trauma, radiation exposure is considered a relevant issue because patients may require repeated imaging to evaluate injuries in different body parts. Recently, spectral shaping of the X-ray beam has been shown to be beneficial in reducing radiation exposure. We investigated the clinical feasibility of a tin-filtered 100 kV protocol for the diagnostic use, compared to routine dedicated maxillofacial CT at 120 kVp in patients with craniofacial trauma; we assessed the image quality, radiation dose, and interobserver agreement., Methods: We retrospectively evaluated 100 consecutive patients who underwent dedicated maxillofacial CT for craniofacial trauma. Fifty patients were examined with a tin-filtered 100 kV protocol performed using a third-generation dual source CT. The other 50 patients were examined with a standard protocol on a different scanner. Two readers independently evaluated image quality subjectively and objectively, and the interobserver agreement was also assessed. CT dose index volume (CTDI vol ) and dose-length product (DLP) were recorded to compare radiation exposure. A quality-control phantom was also scanned to prospectively assess the impact of tin filtration., Results: All CT scans showed diagnostic image quality for evaluating craniofacial fractures. The tin-filtered 100 kV protocol showed sufficient-to-good image quality for diagnostic use; however, overall image quality and anatomic delineation from the tin-filtered 100 kV protocol were significantly lower than from the standard protocol. Interobserver agreement was moderate to almost perfect (k=0.56-0.85). Image noises in the air, eye globe, and retrobulbar fat were comparable between the two protocols (P>0.05), whereas both signal-to-noise ratio and contrast-to-noise ratio in the eye globe and retrobulbar fat showed a significant difference (P<0.05). The tin-filtered 100 kV protocol showed a significant reduction in radiation dose compared to the standard protocol: CTDI vol , 3.33 vs. 30.5 mGy (P<0.001); and DLP, 70.70 vs. 669.43 mGy*cm (P<0.001). The phantom study also demonstrated a lower radiation dose for the tin-filter 100 kV protocol compared to the standard protocol., Conclusions: Dedicated maxillofacial CT using spectral shaping with tin filtration can allow a significant reduction in radiation dose while maintaining sufficient diagnostic image quality, when compared to the standard protocol., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/qims-20-800). The authors have no conflicts of interest to declare., (2021 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Background: Sexual health concerns among young adults worldwide help to motivate preventative practices against sexually transmitted infections. To foster better sexual health, sexual health literacy must be enhanced. Little research has been conducted on the impact of gender power dynamics on sexual health, such as sexual coercion, even though the prevalence of sexual coercion remains high in China., Objective: This study describes the development and systematic evaluation of a web-based sexual health literacy intervention called "Smart Girlfriend" for female Chinese university students., Methods: A multicenter randomized controlled trial was conducted with 781 female university students at 5 universities with dormitories in Hong Kong. Inclusion criteria were used to select unmarried, female, Chinese university students who were ≥18 years old and had not received a sexual health intervention in the past 12 months. Participants were randomly assigned to 2 groups: one group received an interactive web-based sexual health literacy intervention and the other group received a single webpage of online information about condom use. The intervention content was based on the Health Belief Model and the Continuum of Conflict and Control theory. The primary outcome was self-reported consistency of condom use with every partner at 3-month and 6-month follow-up assessments, analyzed using zero/one inflated beta (ZOIB) regression. The secondary outcome was an appraisal of the knowledge, attitudes, norms, and self-efficacy of condom use using the 25-item Multidimensional Condom Attitudes Scale (MCAS). The intention to treat was applied in analyses., Results: Of 1503 individuals that were screened, 781 (52%) were randomized into 2 groups. The retention rates at the 3-month and 6-month follow-ups were 92% and 91%, respectively. Most participants were born locally (536/746, 72%), and 18% (134/746) self-reported as a sexual minority. ZOIB results regarding the consistency of condom use were not significant [model 1: odds ratio (OR) 2.25 with a 95% credible interval (CrI) of 0.84-6.36; model 2: OR 8.03 (95% CrI 0.22-330.31); model 3: OR 1.21 (95% CrI 0.78-1.86)]. Consistency in the intervention group was 5% higher (95% CI -1.90 to 11.63) than the control group at the 3-month follow-up, and 1% higher (95% CI -5.81 to 8·02) at the 6-month follow-up. MCAS scores at the 3-month follow-up were significantly higher in the intervention group (mean 122.51, SD 15.97) than the control group (mean 119.86, SD 15.85; P=.02)., Conclusions: An interactive web-based sexual health literacy program did not significantly increase the consistency of condom use compared to a single webpage of condom use information; however, it did temporarily improve knowledge, attitudes, norms, and self-efficacy regarding condom use. Future revisions of this intervention should be personalized and delivered with a proactive approach., Trial Registration: ClinicalTrials.gov NCT03695679; https://clinicaltrials.gov/ct2/show/NCT03695679., (©Janet Yuen-Ha Wong, Wen Zhang, Yongda Wu, Edmond Pui Hang Choi, Herman Hay Ming Lo, Wendy Wong, Jasmine Hin Man Chio, Hau Lin Cherry Tam, Fei Wan Ngai, Marie Tarrant, Man Ping Wang, Hextan Yuen-Sheung Ngan, Daniel Yee-Tak Fong. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 12.03.2021.)