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Our study investigates the influence of career facilitators and barriers on nurses' improvement of their professional capabilities and their professional turnover intention.Reducing nurses' professional turnover intention could help alleviate the global nursing shortage. Nevertheless, little research has addressed how career facilitators and barriers, nurses' improvement of their professional capabilities and professional turnover intention are related, indicating a gap.This study used a cross-sectional design.We surveyed 502 out of 2,660 full-time nurses who worked for a medical centre in Taiwan between January-March 2018. Our items were adapted from Cunningham et al. and Teng et al. and had adequate reliability and validity. Structural equation modelling was used to test the study hypotheses.Human capital, social capital, and discrimination were positively related to intention to improve professional capabilities. Moreover, intention to improve professional capabilities was positively related to action to improve professional capabilities, which was negatively related to professional turnover intention.Most of the career facilitators and even barriers, boost the improvement of professional capabilities and are useful for retaining nurses in the nursing profession.Findings of this study should have an impact on nursing managers by offering them means to retain nurses, for example, enhancing human capital and social capital among nurses to reduce their turnover intention.目的: 我们的研究探讨了职业促进因素和障碍对护士专业能力提升和职业转换意愿的影响。 背景: 降低护士的职业转换意愿有助于缓解全球护士短缺问题。然而,很少有研究探讨职业促进因素与障碍、护士专业能力的提高与职业转换意愿之间的关系,这说明存在差距。 设计: 本研究使用了横向设计。 方法: 我们调查了2018年1月至3月期间在台湾一家医疗中心工作的2660名全职护士中的502人。我们的项目由Cunningham等人和Teng等人的研究改编而成,具有足够的信度和效度。结构方程模型用于验证研究假设。 结果: 人力资本、社会资本、歧视与提升专业能力的意愿呈正相关。提高专业能力的意愿与提高专业能力的行动呈正相关,与专业离职意愿呈负相关。 结论: 大多数的职业促进因素乃至障碍都促进了专业能力的提高,有利于在护理专业留住护士。 影响: 本研究的结果应该通过为他们提供留住护士的手段(如提高护士的人力资本和社会资本)来对护理管理者产生影响,以降低护士的离职意愿。.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted through respiratory droplets, aerosols and close contact. Cross infections occur because viruses spread rapidly among humans. Nineteen percent (19%) of the infected patients developed severe pneumonia and acute respiratory distress syndrome (ARDS). Hypoxemia usually occurs and patients may require oxygen therapy or mechanical ventilation (MV) support. In this article, recently published clinical experience and observational studies were reviewed. Corresponding respiratory therapy regarding different stages of infection is proposed. Infection control principles and respiratory strategies including oxygen therapy, non-invasive respiratory support (NIRS), intubation evaluation, equipment preparation, ventilator settings, special maneuvers comprise of the prone position (PP), recruitment maneuver (RM), extracorporeal membrane oxygenation (ECMO), weaning and extubation are summarized. Respiratory equipment and device disinfection recommendations are worked up. We expect this review article could be used as a reference by health care workers in patient care while minimizing the risk of environmental contamination.

Tumor-infiltrating dendritic cells (TIDCs) are mostly immature and immunosuppressive, usually mediating immune inhibition. The utilization of cytosine-guanine oligodeoxynucleotides (CpG ODNs) to stimulate the activation of TIDCs has been demonstrated to be effective for improving antitumor immunity. However, a series of biological barriers has limited the efficacy of previous nanocarriers for delivering CpG to TIDCs. Herein, we developed a dual-sensitive dendrimer cluster-based nanoadjuvant for delivering CpG ODNs into TIDCs. We show that the tumor acidity triggers the rapid release of CpG conjugated polyamidoamine (PAMAM) dendrimers from the nanoadjuvant, thus facilitating its perfusion deep into tumors and phagocytosis by TIDCs. Thereafter, the reductive condition of the endolysosomes led to the subsequent release of CpG, which promotes the DCs activation and enhances antitumor immunotherapies. Programmable delivery of immune adjuvant efficiently overcomes the barriers for targeted delivery to TIDCs and provides a promising strategy for improving cancer immunotherapy.

Background: The purpose of this meta-analysis was to compare the effectiveness and safety of cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures. Methods: We searched PUBMED, EMBASE, Cochrane Library, and Google Scholar from their inception to February 2016. All RCTs comparing cemented with uncemented hemiarthroplasty for displaced femoral neck fractures were eligible. The participants who underwent primary hemiarthroplasty for unilateral femoral neck fracture were older than 55 and the mean age of more than 75 years old. For the trials before 2006 used old designed prostheses, so we excluded trails before 2006 which used old designed prostheses. Outcomes of interest include postoperative hip function, Harris hip score (HHS), mortality, reoperation rate, complications, operation time, intraoperative blood loss. Two reviewers independently evaluated the included studies and extracted data into RevMan. Quality Assessments were classified by agreement of 2 authors based on the Cochrane tool. Results: Seven trials were eligible. Postoperative hip function at 12 months cemented hemiarthroplasty was better than that in uncemented hemiarthroplasty (OR = 0.52, 95% CI, 0.31–0.88; P = .01). Postoperative fractures rates in cemented hemiarthroplasty were lower than that in uncemented hemiarthroplasty (OR = 0.09, 95% CI, 0.02–0.38; P = .001). Also, the interoperative fracture rates in cemented hemiarthroplasty were lower than that in uncemented hemiarthroplasty (OR = 0.29, 95% CI, 0.13–0.68; P = .004). Shorter operation time was achieved in uncemented hemiarthroplasty than that in cemented hemiarthroplasty (WMD = 8.22 min, 95% CI, 5.57–10.86 min; P

This study aimed to investigate the therapeutic responses of lung cancer mice models with adenocarcinoma HCC827 (gefitinib sensitive) and HCC827R (gefitinib resistant) to the epidermal growth factor receptor-tyrosine kinase inhibitor erlotinib alone and in combination with the anti-angiogenesis agent bevacizumab using dynamic contrast enhanced (DCE) and diffusion-weighted MRI. In the HCC827 model, temporal changes in DCE-MRI derived parameters (Ktrans, kep, and iAUC90) and apparent diffusion coefficient (ADC) were significantly correlated with tumor size. Ktrans and iAUC90 significantly decreased at week 2 in the groups receiving erlotinib alone and in combination with bevacizumab, whereas kep decreased at week 1 and 2 in both treatment groups. In addition, there was a significant difference in iAUC90 between the treatment groups at week 1. Compared to the control group of HCC827, there was a significant reduction in microvessel density and increased tumor apoptosis in the two treatment group. ADC value increased in the erlotinib alone group at week 1 and week 2, and in the erlotinib combined with bevacizumab group at week 2. Enlarged areas of central tumor necrosis were associated with a higher ADC value. However, progressive enlargement of the tumors but no significant differences in DCE parameters or ADC were noted in the HCC827R model. These results showed that both erlotinib alone and in combination with bevacizumab could effectively inhibit tumor growth in the gefitinib-sensitive lung cancer mice model, and that this was associated with decreased vascular perfusion, increased ADC percentage, decreased microvessel density, and increased tumor apoptosis with a two-week treatment cycle.

Anesthetic techniques can contribute to reduction of anesthesia-controlled time to improve operating room (OR) efficiency. However, little is known about the difference in anesthesia-controlled time between propofol-based total IV anesthesia (TIVA) and desflurane anesthesia (DES) techniques for ophthalmic surgery under general anesthesia.We performed a retrospective analysis using hospital databases to compare the anesthesia-controlled times of ophthalmic surgery patients receiving either TIVA via target-controlled infusion with propofol/fentanyl or desflurane/fentanyl-based anesthesia between January 2010 and December 2011. The various time intervals (surgical time, incision to surgical completion and application of dressings; anesthesia time, start of anesthesia to extubation; extubation time, surgery complete and dressings applied to extubation; time in OR, arrival in the OR to departure from the OR; postanesthetic care unit (PACU) stay time, arrival in the PACU to discharge from the PACU to the general ward; and total surgical suite time, arrival in the OR to discharge from the PACU to the general ward) that comprise a patient's hospital stay and the incidence of postoperative nausea and vomiting were compared between the 2 anesthetic techniques.We included data from 1405 patients, with 595 patients receiving TIVA and 810 receiving DES. The extubation time was faster (TIVA-DES = -1.85 minutes, 99.2% confidence interval [CI], -2.47 to -1.23 minutes) and the PACU stay time was shorter (TIVA-DES = -3.62 minutes, 99.2% CI, -6.97 to -0.10 minutes) in the TIVA group than in the DES group. However, there was no significant difference in total surgical suite time between groups (TIVA-DES = -5.03 minutes, 99.2% CI, -11.75 to 1.69 minutes). We performed the random-effects analyses while stratifying for procedure and showed that the extubation time in the TIVA group was faster by 14% (99.2% CI, 9% to 19%, P0.0001) relative to the DES group, and the PACU stay time was faster by 5% (99.2% CI, 1% to 10%, P = 0.002). Significantly fewer patients suffered postoperative nausea and vomiting and required rescue therapy in the TIVA group than in the DES group (11.3% vs 32.2%, risk difference 21.0%, 95% CI, 16.9% to 25.1%, P0.001 and 23.9% vs 54.0%, risk difference 30.1%, 95% CI, 18.3% to 42.0%, P = 0.002, respectively).In our hospital, the use of TIVA reduced the mean time to extubation by at least 9% and PACU stay time by more than 1% when compared with the use of DES anesthesia for ophthalmic surgery.

Background Angiogenesis is a hallmark of cancer and plays a critical role in lung cancer progression, which involves interactions between cancer cells, endothelial cells and the surrounding microenvironment. However, the gene expression profiles and the changes in the biological phenotype of vascular endothelial cells after interactions with lung cancer cells remain unclear. Methods An indirect transwell co-culture system was used to survey the interaction between human umbilical vein endothelial cells (HUVECs) and human lung adenocarcinoma CL1-5 cells, as well as to investigate the morphological and molecular changes of HUVECs. The differentially expressed genes (DEGs) in HUVECs after co-culture with cancer cells were identified by microarray. Moreover, a publicly available microarray dataset of 293 non-small-cell lung cancer (NSCLC) patients was employed to evaluate the prognostic power of the gene signatures derived from HUVECs. Results The interaction between HUVECs and lung cancer cells changes the morphology of HUVECs, causing them to have a mesenchymal-like morphology and alter their cytoskeleton organization. Furthermore, after co-culture with lung cancer cells, HUVECs showed increased cell motility and microvessel tube formation ability and a decreased apoptotic percentage. Transcriptomic profiling of HUVECs revealed that many survival-, apoptosis- and angiogenesis-related genes were differentially expressed after interactions with lung cancer cells. Further investigations showed that the PI3K/Akt signalling pathway and COX-2 are involved in endothelial tube formation under the stimulation of lung cancer cells. Moreover, Rac-1 activation might promote endothelial cell motility through the increased formation of lamellipodia and filopodia. The inhibitors of PI3K and COX-2 could reverse the increased tube formation and induce the apoptosis of HUVECs. In addition, the gene signatures derived from the DEGs in HUVECs could predict overall survival and disease-free survival in NSCLC patients and serve as an independent prognostic factor. Conclusions In this study, we found that cancer cells can promote endothelial cell tube formation and survival, at least in part, through the PI3K/Akt signalling pathway and thus change the microenvironment to benefit tumour growth. The gene signatures from HUVECs are associated with the clinical outcome of NSCLC patients. Electronic supplementary material The online version of this article (doi:10.1186/s13046-017-0495-3) contains supplementary material, which is available to authorized users.

Chemotherapy is an important postsurgery adjuvant therapy in the treatment of breast cancer. However, because of the individual genotype differences of patients, the drug efficacy differs from person to person, even when the same chemotherapy drug is administered. The purpose of this research was to probe the gene expression profiles to predict the efficacy of 5-fluorouracil (5-FU), the common drug used in chemotherapy for various type of cancers, in Taiwanese breast cancer patients. Microarray analysis was conducted on the cancer cell line ZR-75-1 with and without 5-FU stimulation to identify the differentially expressed genes. The significant overexpressed gene groups were selected after bioinformatics software analysis to explore the molecular mechanism of 5-FU. Six strains of breast cancer cell line purchased from American Type Culture Collection were used to analyze the expression profiles of the above target gene groups. IL18, CCL28, CXCL2, SOD1, HRAS, FDXR, and CHI3L1 genes were significantly differentially expressed in 5-FU responder and nonresponder cell lines. The selected gene groups were validated with 20 strains of breast cancer primary cultures established previously in our laboratory. The experimental results demonstrated that FAM46A, IL18, CCL28, TNF, CXCL2, PLEKHA8, HRAS, FDXR, and CHI3L1 genes showed statistically significant differential expression between primary breast cancer culture cells that respond and nonrespond to 5-FU. Six genes, IL18, CCL28, CXCL2, HRAS, FDXR, and CHI3L1, showed significant differential expression pattern in both American Type Culture Collection and primary breast cancer cultured cells. The findings of this study may serve as basis for predicting the effectiveness of 5-FU on breast cancer.

Dengue virus (DEN), the pathogen behind dengue hemorrhagic fever, remains a public health problem in Asia and South America. In this study, monoclonal antibodies (MAbs) against DEN serotype 1 (DEN-1) were generated by fusing NSI/1-Ag4-1 mouse myeloma cells with lymphocytes from BALB/c mice immunized with DEN-1. Twelve MAbs were found to react specifically to the DENs by enzyme-linked immunosorbent assay, immunofluorescence analysis, and immunoblotting analysis. Five MAbs, namely, DA4-7, DA6-7, DA9-5, DA10-2, and DA11-13, were found to react with envelope proteins of DEN-1. Two serotype-specific MAbs of DEN-1, DA6-7 and DA11-13, were further shown to neutralize DEN-1 infection by a plaque reduction neutralization test. The neutralizing epitopes of these MAbs were further identified from a random peptide library displayed on phage. Immunopositive phage clones reacted specifically with these MAbs and did not react with normal mouse serum. Epitope-based peptide antigens were proved able to detect antibodies in serum samples collected from DEN-1-infected patients but not in those taken from DEN-2-infected patients or healthy controls. We believe that these MAbs and neutralizing epitopes will provide information that will lead to the development of DEN-1 serotype-specific diagnostic reagents and vaccines.

Tissue-engineering approaches for treating degenerative intervertebral discs aim to regenerate intervertebral disc tissues in order to retard or even reverse the degenerative process. This study was designed to investigate the feasibility of the glutaraldehyde crosslinked gelatin/chondroitin-6-sulfate copolymer scaffold to serve as a bioactive scaffold for culturing human nucleus pulposus (NP) cells in vitro with preservation of the cell viability, cell proliferation, and production of important extracellular matrix, including glycoaminoglycans (GAG) and Type II collagen. Each experimental sample was seeded with 1 × 106 human NP cells, and then the cell–scaffold hybrids were cultured in vitro for 6 or 12 weeks. SEM showed a highly porous structure with an average pore size of 100 μm in the copolymer scaffold. Immediately after cell seeding, SEM showed that the seeded cells penetrated deeply and distributed evenly in the copolymer scaffold. Water-soluble tetrazolium salt-1 (WST-1) assay showed good viability and active proliferation of cultured human NP cells in the copolymer scaffolds up to 12 weeks. The cell–scaffold hybrids contained significantly higher levels of sulfated GAG than the control samples (41.29 μg vs 6.04 μg per scaffold). Immunohistochemical study showed Type II collagen fibrils on the surface of scaffold substrate after 6 weeks of cultivation. More abundant deposition of Type II collagen could be detected after 12 weeks. The results achieved in this study indicate that the gelatin/chondroitin-6-sulfate copolymer scaffold is a promising bioactive scaffold for regeneration of nucleus pulposus tissue. © 2005 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2005

Humans produce exhaled breath particles (EBPs) during various breath activities, such as normal breathing, coughing, talking, and sneezing. Airborne transmission risk exists when EBPs have attached pathogens. Until recently, few investigations had evaluated the size and concentration distributions of EBPs from mechanically ventilated patients with different ventilation mode settings. This study thus broke new ground by not only evaluating the size concentration distributions of EBPs in mechanically ventilated patients, but also investigating the relationship between EBP level and positive expiratory end airway pressure (PEEP), tidal volume, and pneumonia. This investigation recruited mechanically ventilated patients, with and without pneumonia, aged 20 years old and above, from the respiratory intensive care unit of a medical center. Concentration distributions of EBPs from mechanically ventilated patients were analyzed with an optical particle analyzer. This study finds that EBP concentrations from mechanically ventilated patients during normal breathing were in the range 0.47–2,554.04 particles/breath (0.001–4.644 particles/mL). EBP concentrations did not differ significantly between the volume control and pressure control modes of the ventilation settings in the mechanically ventilated patients. The patient EBPs were sized below 5 µm, and 80% of them ranged from 0.3 to 1.0 µm. The EBPs concentrations in patients with high PEEP (> 5 cmH2O) clearly exceeded those in patients with low PEEP (≤ 5 cmH2O). Additionally, a significant negative association existed between pneumonia duration and EBPs concentration. However, tidal volume was not related to EBPs concentration.

Acute urinary retention in children is rare. There are a variety of causes about the disease. We report a case of a 7-year-old girl with acute urinary retention and hematuria. Pelvic sonogram revealed an isoechoic mass in the urinary bladder that appeared as a lobulated filling defect over the bladder neck on intravenous urography and computed tomography studies. The surgical specimen from cystoscopic examination showed reactive changes on pathologic analysis. Cytomegalovirus was isolated from urine culture. The girl recovered after supportive treatment.

We conducted a randomized, open-label, controlled, multicenter study to compare sulbactam/cefoperazone with cefotaxime in terms of efficacy and safety for the treatment of hospitalized patients with moderate-to-severe bacterial infections. More than two-thirds of the pathogens recovered from these patients produced beta-lactamase. Two hundred-seven (88.1%) of the 235 patients enrolled completed the study and were included in the efficacy and safety evaluations. One hundred-three patients received sulbactam/cefoperazone (2-4 g/d) administered in evenly divided doses every 12 hours by a 30-minute intravenous drip; 104 patients received cefotaxime (6-12 g/d) administered in evenly divided doses every 6 or 8 hours by a 30-minute intravenous drip. The overall efficacy rates (i.e., cure or markedly improved) were 95% for the sulbactam/cefoperazone group and 90% for the cefotaxime group (P = .186), whereas the bacterial eradication rates were 85% for the sulbactam/cefoperazone group and 81% for the cefotaxime group (P = .467). Both drug regimens were well tolerated. Sulbactam/cefoperazone is effective and safe for the treatment of moderate-to-severe bacterial infections caused mainly by beta-lactamase-producing organisms.

To analyze and evaluate the efficacy and safety of tacrolimus and low-dose steroids in the treatment of steroid-resistant nephrotic syndrome in children.Twenty-one children with steroid-resistant nephrotic syndrome enrolled from October 2008 to July 2010 into this retrospective longitudinal study received oral tacrolimus treatment, 0.1 to 0.15 mg/kg per day and once every 12 hours, and prednisone 0.2 to 0.75 mg/kg per day simultaneously. During the treatment, the plasma concentration of tacrolimus, urine volume, urine, serum creatinine and liver function were regularly monitored.After 1 to 3 months treatment, 14 cases showed complete remission and 7 cases had partial remission. Sixteen patients received renal biopsy, of whom 6 revealed minimal change nephropathy with complete remission in 3 cases, 3 cases had partial remission;4 cases revealed focal segmental glomerulosclerosis with 2 complete remission and 2 partial remission; other 5 children with IgM nephropathy and 1 mesangial proliferative glomerulonephritis achieved complete remission. Within treatment period, 6 patients presented transient adverse reactions, without altering the principle treatment strategy, but only taking the symptomatic treatment. During follow-up, 1 case was lost to follow-up and the remaining 20 cases were followed up from 2 months to 21 months. In 4 patients the disease relapsed within 1st-year follow-up, while at 2nd-year follow-up, 4 cases had (6 times) recurrence.Tacrolimus showed a reliable effect in children with steroid-resistant nephrotic syndrome. Less adverse reactions were seen, and most of them could be tolerated. Nevertheless, the patients had a higher relapse rate after 1 to 2 years treatment. Therefore, the long-term effects of tacrolimus for steroid-resistant nephrotic syndrome remains to be further evaluated.

The expressions of different vascular endothelial growth factor (VEGF) isoforms are associated with the degree of tumor invasiveness and the patient's prognosis in human cancers. We hypothesized that different VEGF isoforms can exert different effects on the functional and structural characteristics of tumor angiogenesis. We used dynamic contrast-enhanced MRI (DCE-MRI) and steady-state contrast-enhanced MRI (SSCE-MRI) to evaluate in vivo vascular functions (e.g., perfusion and permeability) and structural characteristics (e.g., vascular size and vessel density) of the tumor angiogenesis induced by different VEGF isoforms (VEGF121, VEGF165, and VEGF189) in a murine xenograft model of human lung cancer. Tumors overexpressing VEGF189 were larger than those overexpressing the other two VEGF isoforms. The K(trans) map obtained from DCE-MRI revealed that the perfusion and permeability functions of tumor microvessels was highest in both the rim and core regions of VEGF189-overexpressing tumors (p

To investigate the contribution of magnetic resonance imaging (MRI) to the diagnosis of fetal cystic lung lesions found on routine prenatal ultrasound (US).Experienced radiologists retrospectively reviewed 34 fetal MRI studies performed in 20 fetuses (from 20 to 35 gestational weeks; including 14 repeat studies 10 weeks after the initial MRI), focusing on shape, signal characteristics, feeding artery, volume change, and location of the cystic lesions. Diagnoses were confirmed after birth by postnatal multidetector computed tomography (MDCT) and/or surgery.Bronchopulmonary sequestration (BPS) in the second trimester appeared as a well-defined, homogeneous, hyperintense mass (pure BPS) in eight cases or as a lobulated, inhomogeneous hyperintense mass (BPS mixed with congenital cystic adenomatoid malformation (CCAM)) in three cases. The feeding artery was visible in all 11 cases in the initial MRI, and regression of the mass was seen in 7 cases. As the mass regressed in the third trimester, the signal intensity decreased, becoming inhomogeneous, and the margins became lobulated. The mean initial ratio of the volume of the BPS lesion to the ipsilateral lung in lesions with partial regression was 82%; the mean initial ratio in lesions with nearly complete regression was 61%. CCAM (6) cases also appeared as a hyperintense lobulated mass, and as the lesions regressed, they decreased in size and signal intensity. As with BPS, the larger the lesion on initial MRI, the less likely it was to regress completely. Congenital lobar fluid overload in three cases appeared as a hyperintense, homogeneous lobe with stretched hilar vessels.Prenatal MRI is useful as a diagnostic tool complementary to US for evaluating fetal cystic lung lesions. Smaller lung lesions (60%) may regress completely.

Epidermal growth factor receptor (EGFR)-directed tyrosine kinase inhibitors (TKIs) have been established as a treatment option in patients with advanced non-small cell lung cancer (NSCLC). Clinically, PCR and RFLP are commonly used to evaluate the efficacy of TKIs, and these methods require cancer tissues to proceed. In the event a peripheral blood test is able to replace current evaluation methods, a greater clinical application advantage may be achieved. Therefore, in this study, we selected 30 EGFR pathway-related genes and constructed activated EGFR chips to identify overexpression of EGFR pathway-related genes from the peripheral blood of 72 NSCLC patients and 100 normal subjects. According to ROC curve analysis, the best chip interpretation cutoff value was 11 genes. Correlation analysis showed high significance among EGFR mutations, overexpression and the overexpression of EGFR pathway-related genes (p

The purpose of this study was to prospectively evaluate the accuracy of MDCT for the characterization of occult lower gastrointestinal bleeding in infants and children.MDCT examinations were prospectively performed on 27 patients (2l boys, six girls; age range, 2 months-18 years). Patients with known causes of lower gastrointestinal bleeding were excluded from the study. Nonionic contrast medium was administered in an amount based on body weight. Images were obtained with a 16-MDCT scanner. For the arterial phase the section thickness was 1 mm; beam pitch, 1; and reconstruction interval, 0.7 mm. The scans were examined for abnormal vessels and extravasation of contrast medium. Two radiologists independently reviewed the images. The sensitivity, specificity, and diagnostic accuracy of MDCT were assessed with the pathologic findings or the final diagnosis as the reference standard.Twenty of 27 patients had abnormal MDCT findings: arteriovenous malformation in 17 patients and Meckel's diverticulum in three patients. Contrast extravasation was identified in four patients. Surgery was performed on 13 of the 27 patients, and the diagnosis was otherwise confirmed in two additional patients. In these 15 cases, the sensitivity, specificity, and diagnostic accuracy of MDCT were 82%, 50%, and 74%. The interobserver difference was not significant (McNemar exact test, p = 0.063).MDCT can be used to identify the location and source of lower gastrointestinal bleeding in infants and children.

In 2008, the National Comprehensive Cancer Network suggested conducting a KRAS mutations test in metastatic colorectal cancer (mCRC) patients prior to administering therapy that uses anti-epidermal growth factor receptor (EGFR) monoclonal antibody. However, tests of KRAS mutations have been limited when traditional molecular techniques, such as polymerase chain reaction (PCR) combined direct sequencing, are used to obtain and analyze patients’ cancer tissues. If the primary tumor or metastatic tissues of patients with mCRC is unavailable, then such analysis will not be feasible. Our laboratory has successfully established a colorimetric membrane array analysis platform that could detect activating KRAS mutations from the peripheral blood of patients with various malignancies. The current research aims to improve the above-mentioned technique not only by using chemiluminescence detection to replace color development, but also to add scores weighted according to the relevance of each gene to activating KRAS mutations. Our results show that the described weighted chemiluminescent membrane array (WCHMA) can detect circulating tumor cells (CTCs) harboring activating KRAS mutations in the peripheral blood in CRC. The sensitivity, specificity, and accuracy were 90.2, 94.9, and 93.5%, respectively, and the detection limitation was three colon tumor cells per millimeter of blood. The current study would significantly improve the detection sensitivity and accuracy over that of our previously designed membrane array method. These findings also highlight the need to prompt further prospective studies on more cases of CRC to further establish the clinical relevance of activating KRAS mutation detection from peripheral blood in anti-EGFR-based chemotherapy that uses activating KRAS detection chips and the WCHMA analysis method.

Most reports regarding unplanned extubation (UE) are case-control studies with matching age and disease severity. To avoid diminishing differences in matched factors, this study with only matching duration of mechanical ventilation aimed to re-examine the risk factors and the factors governing outcomes of UE in intensive care units (ICUs). This case-control study was conducted on 1,775 subjects intubated for mechanical ventilation. Thirty-seven (2.1%) subjects with UE were identified, and 156 non-UE subjects were randomly selected as the control group. Demographic data, acute Physiological and Chronic Health Evaluation II (APACHE II) scores, and outcomes of UE were compared between the two groups. Logistic regression analysis was used to identify the risk factors of UE. Milder disease, younger age, and higher Glasgow Coma Scale (GCS) scores with more frequently being physically restrained (all p

Early detection is the hallmark of successful cancer treatment. Evidence is accumulating that primary cancers begin shedding neoplastic cells in the circulation at an early stage. To date, a high-sensitivity and high-throughput method for the detection of circulating tumor cells (CTCs) is deficient. In this study, we have developed a high-sensitivity colorimetric membrane-array method to detect CTCs in the peripheral blood of colorectal cancer (CRC) patients as a potential diagnostic tool. Previously, we identified a set of 18 oligonucleotide clones, significantly overexpressed in CRC, which were synthesized and applied to a nylon membrane. Digoxigenin (DIG)-labeled cDNA were amplified by reverse transcriptase-polymerase chain reaction (RT-PCR) from the peripheral blood of 88 Taiwanese CRC patients and 50 healthy subjects, and were then hybridized to the membrane-array. Hybridization signals were detected by color development. Meanwhile, blood samples were analyzed by real-time quantitative PCR (Q-PCR). Subsequently, both methods were compared regarding their correlation, sensitivity and specificity in the detection of CTCs by statistics. The results of membrane-arrays were demonstrated to be closely related to that of Q-PCR (P

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by anti-nuclear autoantibodies that cause damage to multiple organs and tissues. Intrinsic defects have been demonstrated in the lymphoid and myeloid cellular compartments, including T cells. Lupus susceptibility is mediated through the interplay of a large number of genes, most of which are still unidentified. Most of the genetic studies in both human patients and mouse models have addressed lupus susceptibility as a whole. More recently however, more attention has been paid to the inheritance of specific lupus-associated phenotypes. In this review, we summarized our results obtained with the Sle1 locus in the NZM2410 mouse model, which mediates the generation of anti-histone autoreactive T cells. Sle1, which is constituted of multiple genes, is the only known genomic region that is sufficient for the generation of autoreactive T cells. The identification of the corresponding genes will constitute a landmark for our understanding of the mechanisms of autoimmunity. Our results are discussed in the context of candidate genes and the role of T cells in systemic autoimmunity.

The objective of this study was mainly to develop and evaluate a membrane array-based method simultaneously detecting the expression levels of a multiple mRNA marker panel in the peripheral blood for used in complementary breast cancer diagnosis. The mRNA markers employed included cytokeratin 19 (CK-19), carcinoembryonic antigen (CEA), c-Met, Her2/neu, and mammaglobin (hMAM). The specimens of peripheral blood were collected from 80 healthy women and 102 female patients with breast cancer. The expression levels of molecular markers were evaluated by real-time Q-PCR and membrane array. Data obtained from real-time Q-PCR and membrane array were subjected to linear regression analysis, revealing that there was a high degree of correlation between the results of these two methods (r=0.979, P

To evaluate the clinical application of lung function analysis in diagnosis of children respiratory diseases.Respiratory function was evaluated with portable lung function detector in 6 261 children with respiratory diseases. FEV1, FVC and PEFR were measured in 268 children with cough variant asthma (CVA) and 147 children with asthma (AS), and the results were self-compared during follow-up.There were no significant differences in above parameters between children with cough variant asthma and those with asthma (P0.05). Lung functions of asthma children were improved evidently by administration of glycocorticoid inhalator (P0.001).Lung function detection is essential for diagnosis of asthma and it can be used as a reliable index for therapeutic effect of asthma children.

Previously, we identified human papillomavirus type 16 (HPV-16) E5 as a tumor rejection antigen that can induce cytotoxic T lymphocytes (CTLs) to protect against tumor growth (D. W. Liu et al., J. Virol.74:9083-9089, 2000). In the present study, we further mapped the CTL epitope of E5 protein by analyzing E5-specific CD8+gamma interferon-positive (IFN-γ+) double-positive cells in C57BL/6 mice with flow cytometry. The results showed the region spanning amino acids 25 to 33 (VCLLIRPLL) contained the potential Db-restricted CTL epitope. Subsequently, to determine whether peptide E5 25-33-based vaccination could induce E5-specific CTL activity, syngeneic animals received E5 25-33 emulsified with either CpG oligodeoxynucleotide (CpG ODN 1826) or Freund's adjuvant, and the growth of the tumors was monitored. The results showed that although both adjuvants induced E5-specific CD8+IFN-γ+T cells and eradicated E5-containing tumor growth, CpG ODN was found to stimulate stronger CTL response than Freund's adjuvant. We also compared the immune response of the effector/memory/recall phase induced by E5 25-33 peptide or by E5 protein that was synthesized in vivo by adenovirus-based E5 gene delivery. E5 25-33 peptide plus CpG ODN was shown to be a superior vaccine compared to the adenovirus-based E5 gene. Interestingly, their chronological patterns of immune response were similar, suggesting that E5 25-33 is a major CTL peptide of E5 protein.

Our previous studies have shown that the cell proliferation rate, mRNA levels of p450scc, p450c17, and 3betaHSD, and secretion of cortisol were significantly increased in human adrenocortical cells stably transfected with mutated K-ras expression plasmid "pK568MRSV" after being inducted with IPTG. In addition, the increased level was a time-dependent manner. However, the levels of p450, p450scc, p450c17, 3betaHSD, cortisol, and cell proliferation rate were inhibited by a MEK phospholation inhibitor, PD098059. The above results prove that mutated K-ras oncogene is able to regulate tumorigenesis and steroidogenesis through a Ras-RAF-MEK-MAPK signal transduction pathway. The aim of this study was to investigate regulated factors in this pathway and also examine whether the other signal transduction pathways or other moles involved in tumorigenesis or steroidogenesis. In the first year, we analyzed gene profiles of mutant K-ras-transfected adrenocortical cells by DNA microarray to determine the gene expression related to cell cycle, signal transduction, apoptosis, tumorigenesis, steroidogenesis, and other expressed sequence tag. After being affected by the K-ras mutant, gene expression was significantly increased in some upregulated genes. Human zinc-finger protein 22 increased by 28.5 times, Osteopontin increased by 5.8 times, LIM domain Kinase 2 (LIMK2) increased by 3.3 times, Homo sapiens dual-specificity tyrosine-(Y)-phosphorylation regulated Kinase 2 (DYRK2) increased by 2.2 times, and human syntaxin 3 increased by two times. On the other hand, significant decreases in gene expression were also observed in some downregulated genes. Retinoblastoma binding protein 1 (RBBP1) decreased by four times, Homo sapiens craniofacial development protein 1 (CFDP1) decreased by 2.4 times, DAP Kinase-related apoptosis-inducing protein Kinase 1 (DRAK1) decreased by 2.3 times, SKI-interacting protein (SKIP) decreased by 2.2 times, and human poly(A)-Binding protein (PABP) decreased by 2.1 times. In all significant differentially expressed genes, preliminary analysis by bioinformatics revealed that after induced K-ras mutant expression by isopropyl thiogalctoside (IPTG), the downregulation of RBBP1 gene was most correlated to cell proliferation. RBBP1 can bind with RB/E2F to form a mSIN3-HDAC complex, which induces cell cycle arrest in the G1/G0 stage by repressing transcription of E2F-regulated genes. The result of a Northern blot showed that RBBP1 were inhibited after an induction of IPTG for 36 h. Another Northern blot analysis proved that mRNA levels of cyclin D1 and c-myc increased in proportion to K-ras expression. Finally, Western blot was carried out, and the results showed that phosphorylated pRB also increased. Taken together, we infer that the mutant K-ras oncogene promoted the cells to proceed to the G1/S stage by the inhibiting the formation of RB/RBBP1-dependent repressor complex from binding with the SIN3-HDAC complex, which resulted in the acetylation of histone to active transcription of E2F-regulated genes. However, the roles of the other differentially expressed genes involved in cell proliferation, cell morphologic change, tumorigenesis, or steroidogenesis still need further investigation.