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This study explores how parents experienced the surgical decision-making process for their child with a congenital heart disease (CHD). Purposive sampling was used in this qualitative descriptive study at a medical center in Northern Taiwan. Twelve parents whose children had cardiac corrective surgery participated in one-to-one in-depth interviews. The interview content subsequently was transcribed verbatim and analyzed by content analysis. Five themes, with 2 to 3 subthemes, were identified: 1) accumulating medical knowledge in a short time, 2) trusting the medical teams but parents needing clear communication, 3) feeling pervasive uncertainty, 4) using self-talk to calm down, and 5) looking for positive energy from various sources. For the parents of these children with CHD, participating in surgical decision-making can be a difficult and stressful experience. When explaining the disease and treatment procedures, it is important for medical professionals to make sure of the individual parent's information needs, to use plain language and encourage parents to ask questions. Although the surgery is imperative and inevitable, understanding the parents' worries and providing adequate support can help them reduce feelings of uncertainty during the decision-making and surgical processes. • Parents enrich their knowledge from the websites of professional and parent groups. • Surgeons should make sure of the parent's information needs, use plain language and encourage them to ask questions. • Nurses can play an important role in providing adequate preparation and support to reduce the parents' worries and feelings of uncertainty. [ABSTRACT FROM AUTHOR]

Fucoidan is a fucose-rich polysaccharide that has gained attention for its various anticancer properties. However, the effect and underlying mechanism of fucoidan on triple-negative breast cancer (TNBC) are still unknown. Herein, we investigated the anticancer potential of fucoidan from Laminaria japonica. We found that fucoidan showed modest antiproliferative activity against TNBC cells, while it effectively reduced migratory and invasive capacities. Mechanistically, fucoidan suppressed activation of MAPK and PI3K followed by inhibition of AP-1 and NF-κB signaling in TNBC. Additionally, fucoidan downregulated expressions of proangiogenic factors in TNBC cells, and fucoidan blocked tumor-elicited tube formation by human umbilical vascular endothelial cells (HUVECs). We also observed that fucoidan blocked tumor adhesion and invasion towards HUVECs. Surprisingly, fucoidan robustly suppressed tube formation on HUVECs. Moreover, fucoidan inhibited in vivo angiogenesis and micrometastasis in a transgenic zebrafish model. Together, L. japonica fucoidan exhibits potent antitumor effects by its attenuation of invasiveness and proangiogenesis in TNBC. • Fucoidan from Laminaria japonica exerts antitumor effects. • Fucoidan suppresses proangiogenesis and micrometastasis in TNBC. • Fucoidan blocks MAPK and PI3K signaling in TNBC. [ABSTRACT FROM AUTHOR]

Abstract Aims To generate a descriptive theory framework regarding the experiences of the cultural competencies among clinical nurses in Taiwan. Background With the advances in, and the easy accessibility to health care services, frontline nurses require a higher cultural competence to perceive and satisfy the needs of the culturally diverse patients. Methods A qualitative approach using a grounded theory was applied. There were 30 nurses recruited by purposive sampling. Results 'Unprepared when encountering different cultures' was the core theme for describing and guiding the process of examining the nurses' experiences with a cultural competence. 'Awareness of value differences' was identified as the antecedent condition. The nurses revealed that they have had difficulty implementing their nursing work and seeking resources that represented situations in which interactive behavioral characteristics appeared to improve their cultural competencies. The nurses managing different cultural situations ultimately learned to tolerate the different cultures and to give patients culturally appropriate care, which thereby enhanced the care quality. Conclusions This study highlights the multiple layers of cultural competence experienced by the nurses and the understanding of cultural diversity among patients and caregivers. These results will assist the healthcare providers by offering references for clinical healthcare based on the patients' subjectively different cultural perspectives. Medical organizations should design an in-service educational program/instructions concerning culture to help strengthen the nursing specialists' relevant cultural competencies, to meet the individual patients' cultural care needs, and thereby boost the clinical care quality. Highlights • The findings of this study provided great of information regarding to the experiences of cultural competencies among nurses. • The ability accepting the multicultural background of patients should be prioritized as taking caring various ethnic groups. • It is crucial to offer continuing education related to health issue with diverse cultural backgrounds to clinical nurses. [ABSTRACT FROM AUTHOR]

Introduction Nurses are often the first responders to in-hospital cardiac emergencies. A positive attitude towards cardiopulmonary resuscitation with defibrillation may contribute to early cardiopulmonary resuscitation and rapid defibrillation, which are associated with enhanced long-term survival. The aim of this study was to translate and adapt the 31-item attitudes towards cardiopulmonary resuscitation with defibrillation and the national resuscitation guidelines (ACPRD) instrument into Chinese and to evaluate its psychometric properties in a sample of Taiwanese hospital nurses. Methods The ACPRD instrument was translated into Chinese using professional translation services. Content validity index based on five experts to refine the translated instrument. The final instrument was applied to a sample of 290 female nurses, recruited from a regional hospital in southern Taiwan, to assess its internal consistency, factor structure, and discriminative validity. Results The Chinese ACPRD instrument showed good internal consistency (Cronbach’s alpha = 0.87). Seven factors emerged from the factor analysis. The instrument showed good discriminative validity and were able to differentiate the attitudes of nurses with more experience of defibrillation or cardiopulmonary resuscitation from those with less experience. Nurses working in emergency ward or intensive care unit also showed significantly higher overall scores compared to those working in other units. Conclusion The Chinese ACPRD demonstrated adequate content validity, internal consistency, sensible factor structure, and good discriminative validity. Among Chinese-speaking nurses, it may be used as a tool for assessing the effectiveness of educational programs that aim to improve their confidence in performing cardiopulmonary resuscitation with defibrillation. [ABSTRACT FROM AUTHOR]

Although medical professionals possess a positive attitude toward SDM, they lack of a complete understanding of conceptual shared decision making (SDM). Therefore, a related knowledge base must be constructed to enhance service education. We aimed to examine the effectiveness of an educational program with situational simulation video on nurses' SDM attitude. A randomized controlled trial with single-blind study design was conducted, and permuted block randomization was employed. Participants were randomly assigned to an experimental group (n = 50) or control group (n = 50). Only the experimental group received education programs within 2 weeks, with the first covering the basic concept of SDM and the second comprising situation simulation teaching. In both groups, data were collected prior to intervention as baseline, immediately after intervention to evaluate its immediate effects, and 2 months after intervention to test the delay effect. A generalized estimating equation, subgroup analysis and descriptive statistics were used to analyse data. A significant main effect over time was discovered. Nevertheless, no significant group-time interaction was noted between the two groups after a 2-month interval. Subgroup analysis reveals that the SDM attitude scores in both the experimental and control groups increase for within group. The improvement of SDM attitude score in the experiment group was better than control group at follow test. The findings of this study might provide a reference for health care providers when designing service education courses to improve the execution strategies of SDM and thus the quality of care provided. • Simulation teaching provides a reference for health care providers when designing service education. • The cultural competence on nurses should be prioritized as taking caring various ethnic groups. • Nurses' positive SDM attitude and thus the quality of care provided [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore the effectiveness of an essential oil massage on the sleep quality of the critical care nurses. A randomized controlled trial with single blind was conducted. A total of 112 critical care nurses were recruited. Participants were randomly allocated to either the experimental or control group. Only the experimental group received four sessions consisting of a lavender essential oil massage. The results of this study revealed that the overall subjective sleep quality and objective sleep parameters did not reach a significant difference between the two groups before and after the intervention, but a progressive the subjective sleep quality score reduction was observed in the experimental group. The findings of this study might provide information to critical care nurses who are under high pressure to find the optional alternative way of managing their self-sleep health by employing safe and convenient alternatives through aromatherapy. • Aromatherapy has a certain degree of effect on improving the subjective sleep quality of nurses in critical care units. • Participants receiving lavender aromatherapy revealed that the use of sleep pills was decreased. • Critical care nurses might educate themselves on the concept of self-care on aromatherapy to decrease high pressure. [ABSTRACT FROM AUTHOR]

The cultural competence education programme for health professionals aimed to ensure that all people receive effective health care, particularly those from culturally diverse backgrounds. The purpose of this study was to investigate the effect of a cultural competence educational course on nurses' self-assessment of their cultural competence. A single-blind, randomised control trial design was employed. Eligible nurses were recruited from a northern Taiwan medical centre with 2089 beds. A permuted block of four was used to randomly assign participants to the experimental (n = 47) and control groups (n = 50). The educational course comprised four units and was conducted once weekly for four weeks, with each session lasting 3 h. A significant group-time interaction was identified regarding self-learning cultural ability, verifying the education intervention's effect on self-learning cultural ability after a two-month intervention. In addition, a significant main effect over time was discovered for total cultural competence; there was no significant interaction effect. The study provided evidence that an educational programme effectively improved cultural competence in clinical nurses. The results provide a reference for health care providers to design in-service cultural competence education for improving quality of care. • Cultural competence in healthcare services caters to the patients' cultural needs. • Cultural competence is not an innate characteristic; it requires education. • Continuing education is crucial to foster cultural competence among nurses. [ABSTRACT FROM AUTHOR]

Multitarget agents simultaneously trigger molecules in functionally complementary pathways, and are therefore considered to have potential in effectively treating Alzheimer's disease (AD), which has a complex pathogenetic mechanism. In this study, the HDAC inhibitor core is incorporated into the acetylcholine esterase (ACE) inhibitor acridine–derived moiety and resulted in compounds that exhibited higher class IIa HDAC (4, 5, 7, and 9)- and class IIb HDAC6-inhibiting activity when compared to the pan-HDAC inhibitor SAHA in clinical practice. One of these compounds, 11b, displayed greater selectivity toward HDAC6 than other isoform enzymes. In contrast, the activity of compound 6a was selective toward class IIa HDAC and HDAC6. These two compounds exhibited strong activity against Aβ-aggregation as well as significantly disrupted Aβ-oligomer. Additionally, 11b and 6a strongly inhibited AChE. These experimental findings demonstrate that compounds 11b and 6a are HDAC-Aβ-aggregation-AChE inhibitors. Notably, they can enhance neurite outgrowth, but with no significant neurotoxicity. Further biological evaluation revealed the various cellular effects of multitarget compounds 11b and 6a , which have the potential to treat AD. Image 1 • Novel acridine-containing histone deacetylase inhibitors have been developed. • Structure-activity relationship of the resulting compounds has been established. • Several compounds are identified as multiple HDAC-Aβ-aggregation-AChE inhibitors. • Compounds 11b and 6a enhance neurite outgrowth without significant neurotoxicity. • Compound 11b can permeate blood-brain barrier. [ABSTRACT FROM AUTHOR]

A series of C6-substituted N -hydroxy-2-quinolineacrylamides (3 – 15), with four types of bridging groups have been synthesized. Most of these compounds exhibit antiproliferative activity against A549 and HCT116 cells and Western blot analysis revealed that they are able to inhibit HDAC. Measurement of the HDAC isoform activity of ether-containing compounds showed that compound 9 has distinct HDAC6 selectivity, more than 300-fold over other isoforms. This paper describes the development of 6-aryloxy- N -hydroxy-2-quinolineacrylamides as potential HDAC6 inhibitors. [ABSTRACT FROM AUTHOR]

Novel dual inhibitors of histone deacetylase (HDAC) and heat-shock protein 90 (HSP90) are synthesized and evaluated. These compounds are endowed with potent HDAC and HSP90 inhibitory activities with IC 50 values in nanomolar range with Compound 20 (HDAC IC 50 = 194 nM; HSP90α IC 50 = 153 nM) and compound 26 (HDAC IC 50 = 360 nM; HSP90α IC 50 = 77 nM) displaying most potent HDAC and HSP90α inhibitory activities. Both of these compounds induce HSP70 expression and down regulate HSP90 client proteins which play important roles in the regulation of survival and invasiveness in cancer cells. In addition, compounds 20 and 26 induce acetylation of α-tubulin and histone H3. Significantly, compounds 20 and 26 could effectively reduce programmed death-ligand 1 (PD-L1) expression in IFN-γ treated lung H1975 cells in a dose dependent manner. These findings suggest that dual inhibition of HDAC and HSP90 that can modulate immunosuppressive ability of tumor area may provide a better therapeutic strategy for cancer treatment in the future. Image 1 • N -alkyl-hydroxybenzoyl anilide hydroxamates show potent dual inhibition of HDAC and HSP90a. • Lead compounds 20 and 26 induce HSP70 expression and down regulate HSP90 client proteins. • Compounds 20 and 26 displayed their HDAC inhibitory effects due to increased acetylated α-tubulin and histone H3 levels. • Compounds 20 and 26 could effectively reduce programmed death-ligand 1 (PD-L1) expression in IFN-γ treated lung H1975 cells. [ABSTRACT FROM AUTHOR]

Colon cancer is one of the most lethal cancers worldwide even with the significant progress made in screening techniques and therapeutic agents. Genetic mutations in tumors complicated the treatments, and the survival rate remains low for patients at late or metastatic stages. KRAS gene mutation which leads to failure of the EGFR targeted therapies stands for an example of the challenges in clinical sites. Therefore, development of novel agents for colon cancer treatment is in need. Natural and synthetic coumarin derivatives have been suggested with various biological activities with pharmacologic potential including anti-cancer capacity. Here in this study, five coumarin derivatives, include trifluoromethyl-, dimethoxy-, and/or nitro-substitutions at different positions, were synthesized. Their cancer inhibition potential was investigated in various cancer cell lines. Our data demonstrated that one nitro-coumarin derivate, 5,7-Dimethoxy-4-methyl-6-nitro-chromen-2-one, exhibits cytotoxicity specifically towards colon cancer cells under competitive EC 50. Our results showed that this compound can effectively suppress colon cancer cells harboring either wild type or mutant KRAS genes, and that it could inhibit short-term proliferation, long term proliferation, and migration capacities of cancer cells. Finally, we demonstrated that this coumarin derivate facilitates cancer cell death through activation of apoptosis pathway. Our results suggest that this coumarin derivate is a promising lead drug worth further investigation and development for future cancer treatment. • Coumarin derivatives were synthesized and examined in different human cancer cells. • A novel compound exhibited cytotoxicity specifically towards colon cancer cells. • It can inhibit short-term and long-term cancer cell proliferation. • It can suppress migration capacity of colon cancer cells. • It can facilitate cancer cell death through activation of apoptosis pathway. [ABSTRACT FROM AUTHOR]

Abstract We report structure-activity relationships of 1-arylsulfonyl indoline based benzamides. The benzamide (9) exhibits striking tubulin inhibition with an IC 50 value of 1.1 μM, better than that of combretastain A-4 (3), and substantial antiproliferative activity against a variety of cancer cells, including MDR-positive cell lines with an IC 50 value of 49 nM (KB), 79 nM (A549), 63 nM (MKN45), 64 nM (KB-VIN10), 43 nM (KB-S15), and 46 nM (KB-7D). Dual inhibitory potential of compound 9 was found as it demonstrated significant inhibitory potential against HDAC1, 2 and 6 in comparison to MS-275 (6). Some key interactions of 9 with the amino acid residues of the active site of tubulin and with amino acid residues of HDAC 1 isoform have been figured out by molecular modeling. Compound 9 also demonstrated significant in vivo efficacy in the human non-small cell lung cancer A549 xenograft model as well as B-cell lymphoma BJAB xenograft tumor model. Graphical abstract Image 1 Highlights • A series of 1-Arylsulfonyl Indoline-Benzamides has been synthesized. • Compound 9 remarkably suppressed the growth of cancer cell lines. • The benzamide 9 displayed striking tubulin inhibition. • Compound 9 exhibited significant inhibitory potential against HDAC 1, 2 and 6. • Compound 9 also demonstrated significant in vivo efficacy. [ABSTRACT FROM AUTHOR]

Microtubule-targeting agents (MTA) have enjoyed significant clinical success for decades. However, several mechanisms may cause inactivation of such drugs, leading to acquired resistance in patients treated with them. Therefore, drugs containing a stilbene-like skeleton and possessing dual inhibitory activity may provide a new and differentiated treatment for patients to overcome challenging acquired resistance. A new compound (16c) displays promising anticancer activity with GI 50 of 22 ± 2 and 12 ± 0.1 nM in vincristine-resistant nasopharyngeal (KB-Vin) cancer cells and etoposide-resistant nasopharyngeal (KB-7D) cancer cells and is better than vincristine, etoposide, ABT-751, and MS-275. A mechanistic study revealed that 16c interferes with the cell cycle distribution and induces cell cycle arrest at the G2/M phase and severe mitotic spindle defects followed by apoptosis. In addition, it produces much more significant cytotoxicity than vincristine and etoposide in the corresponding resistant cells, indicating that it may be a promising candidate to overcome drug resistance in cancer cells. Compound 16c also displays inhibitory activity against HDAC 1 and HDAC 2 with IC 50 values of 1.07 μM, and 1.47 μM, respectively. These findings may lead to a new type of structural motif for future development of drugs that could overcome acquired resistance to MTAs. Image 1 • N-phenyl-4-(2-phenylsulfonamido)-benzamides act as Microtubule-targeting agents. • 16c displays promising anticancer activity against resistant cancer cells. • 16c induces cell cycle arrest at the G2/M phase. • 16c significantly inhibits microtubule polymerization. • 16c exhibited inhibitory potential against HDAC 1, 2 and 3. [ABSTRACT FROM AUTHOR]

This study reports the synthesis of a series of 2-aroylisoindoline hydroxamic acids employing N-benzyl, long alkyl chain and acrylamide units as diverse linkers. In-vitro studies led to the identification of N-benzyl linker-bearing compound (10) and long chain linker-containing compound (17) as dual selective HDAC6/HSP90 inhibitors. Compound 17 displays potent inhibition of HDAC6 isoform (IC 50 = 4.3 nM) and HSP90a inhibition (IC 50 = 46.8 nM) along with substantial cell growth inhibitory effects with GI 50 = 0.76 μM (lung A549) and GI 50 = 0.52 μM (lung EGFR resistant H1975). Compound 10 displays potent antiproliferative activity against lung A549 (GI 50 = 0.37 μM) and lung H1975 cell lines (GI 50 = 0.13 μM) mediated through selective HDAC6 inhibition (IC 50 = 33.3 nM) and HSP90 inhibition (IC 50 = 66 nM). In addition, compound 17 also modulated the expression of signatory biomarkers associated with HDAC6 and HSP90 inhibition. In the in vivo efficacy evaluation in human H1975 xenografts, 17 induced slightly remarkable suppression of tumor growth both in monotherapy as well as the combination therapy with afatinib (20 mg/kg). Moreover, compound 17 could effectively reduce programmed death-ligand 1 (PD-L1) expression in IFN-γ treated lung H1975 cells in a dose dependent manner suggesting that dual inhibition of HDAC6 and HSP90 can modulate immunosuppressive ability of tumor area. Compound 17 downregulated PD-L1 expression in INF-γ treated H1975 lung cancer cells. Compound 17 in combination with afatinib enhanced antitumor efficacy. Image 1 • 1-Aroylisoindoline-hydroxamic acids as dual HDAC6/HSP90 inhibitors have been synthesized. • Compound 17 displays potent inhibition of HDAC6 isoform and HSP90a inhibition. • Compound 17 induced suppression of tumor growth in human H1975 xenografts. • Compound 17 downregulated PD-L1 expression in INF-γ treated H1975 lung cancer cells. • Compound 17 in combination with T cell immunotherapy might be worth investigating for treatment of cancer. [ABSTRACT FROM AUTHOR]

A series of thiochromeno[2,3- c ]quinolin-12-one derivatives with various substitutions were synthesized and evaluated as topoisomerase (Topo) inhibitors. Six (8 , 10 , 12 , 14 , 19 , and 26) of 23 compounds showed strong inhibitory activities against Topo-mediated DNA relaxation and proliferation of five human cell lines including breast (MDA-MB-231, MDA-MB-468 and MCF7), colorectal (HCT116) and non-small cell lung (H1299) cancers. Among these, compounds 14 and 26 exhibited full inhibitory activities against Topo I at 3 μM and Topo IIα at 1 μM. Cancer cells treated with 26 accumulated DNA damage and were arrested at the G 2 /M phase. With time, cells proceeded to apoptosis, as revealed by increased amounts of cells with fragmented DNA and cleavage of caspase-8 and -9. In contrast, normal breast epithelial cells showed low sensitivity to 26. Taken together, our study identifies 26 as a potent Topo dual-inhibitor with low toxicity to normal cells, and elucidates that the terminal amino group of N -2-aminoethylamino or N -3-aminopropylamino at the 6th position and 8,10-di-halogen substituents on thiochromeno[2,3- c ]quinolin-12-one are critical for the Topo-inhibiting and cancer-killing activities. Image 1 • Six compounds identified as dual Topo inhibitors. • 26 exhibits the highest toxicity in five cancer cell lines but is less toxic in normal breast epithelial cells. • 26 traps Topo I and IIα on chromatin and suppresses their activities. • 26 triggers DNA damage, cell-cycle arrest at the G 2 /M phase, followed by apoptosis. [ABSTRACT FROM AUTHOR]

A series of 10,11-dihydro-5H-dibenzo [b,f]azepine hydroxamates (4–15) were synthesized, behaving as histone deacetylase inhibitors, and examined for their influence on vascular cognitive impairment (VCI), which correlated with dementia. The results revealed that (E)-3-(4-(((3-(3-chloro-10,11-dihydro-5 H -dibenzo [b,f]azepin-5-yl)propyl)amino)methyl)phenyl)-N-hydroxy-acrylamide (13) increases cerebral blood flow (CBF), attenuates cognitive impairment, and improves hippocampal atrophy in in vivo study. It is also able to increase the level of histone acetylation (H3K14 or H4K5) in the cortex and hippocampus of chronic cerebral hypoperfusion (CCH) mice; as a result, it could be a potential HDAC inhibitor for the treatment of vascular cognitive impairment. Image 1 • A series of 10,11-dihydro-5H-dibenzo [b,f]azepine hydroxamates has been synthesized. • The synthesized adducts were evaluated for their effects on vascular cognitive impairment. • Compound 13 increases cerebral blood flow (CBF), attenuates cognitive impairment, and improves hippocampal atrophy. • Compound 13 also increases the level of histone acetylation (H3K14 or H4K5). • Compound 13 could emerge as a potential HDAC inhibitor for the treatment of vascular cognitive impairment. [ABSTRACT FROM AUTHOR]