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Shared decision making is a patient-centered clinical decision-making process that allows healthcare workers to share the existing empirical medical outcomes with patients before making critical decisions. This study aims to explore a project in a medical center of developing a mobile SDM in Taiwan. Chi Mei Medical Center developed the mobile SDM platform and conducted a survey of evaluation from healthcare workers. A three-tier platform that based on cloud infrastructure with seven functionalities was developed. The survey revealed that healthcare workers with sufficient SDM knowledge have an antecedent effect on the three perceptive factors of acceptance of mobile SDM. Resistance to change and perceived ease of use show significant effect on behavioral intention. We provided a comprehensive architecture of mobile SDM and observed the implementation in a medical center. The majority of healthcare workers expressed their acceptancem; however, resistance to change still present. It is, therefore, necessary to be eliminated by continuously promoting activities that highlight the advantages of the Mobile SDM platform. In clinical practice, we validated that the mobile SDM provides patients and their families with an easy way to express their concerns to healthcare workers improving significantly their relationship with each other.

PurposeThe unfolded protein response (UPR) is triggered when the protein folding capacity of the endoplasmic reticulum (ER) is overwhelmed and misfolded proteins accumulate in the ER, a condition referred to as ER stress. IRE1α is an ER-resident protein that plays major roles in orchestrating the UPR. Several lines of evidence implicate the UPR and its transducers in neurodegenerative diseases, including retinitis pigmentosa (RP), a group of inherited diseases that cause progressive dysfunction and loss of rod and cone photoreceptors. This study evaluated the contribution of IRE1α to photoreceptor development, homeostasis, and degeneration.MethodsWe used a conditional gene targeting strategy to selectively inactivate Ire1α in mouse rod photoreceptors. We used a combination of optical coherence tomography (OCT) imaging, histology, and electroretinography (ERG) to assess longitudinally the effect of IRE1α deficiency in retinal development and function. Furthermore, we evaluated the IRE1α-deficient retina responses to tunicamycin-induced ER stress and in the context of RP caused by the rhodopsin mutation RhoP23H.ResultsOCT imaging, histology, and ERG analyses did not reveal abnormalities in IRE1α-deficient retinas up to 3 months old. However, by 6 months of age, the Ire1α mutant animals showed reduced outer nuclear layer thickness and deficits in retinal function. Furthermore, conditional inactivation of Ire1α in rod photoreceptors accelerated retinal degeneration caused by the RhoP23H mutation.ConclusionsThese data suggest that IRE1α is dispensable for photoreceptor development but important for photoreceptor homeostasis in aging retinas and for protecting against ER stress-mediated photoreceptor degeneration.

Neurofibromatosis type 2 (NF2) is an autosomal dominant disorder characterized by the development of multiple tumors in the central nervous system, most notably schwannomas, and meningiomas. Mutational inactivation of the NF2 gene encoding the protein Merlin is found in most sporadic and inherited schwannomas, but the molecular mechanisms underlying neoplastic changes in schwannoma cells remain unclear. We report here that Nf2-deficient cells display elevated expression levels of key enzymes involved in lipogenesis and that this upregulation is caused by increased activity of Torc1. Inhibition or knockdown of fatty acid synthase (FASN), the enzyme that catalyzes the formation of palmitic acid from malonyl-CoA, drove NF2-deficient cells into apoptosis. Treatment of NF2-mutant cells with agents that inhibit the production of malonyl-CoA reduced their sensitivity to FASN inhibitors. Collectively, these results suggest that the altered lipid metabolism found in NF2-mutant cells renders them sensitive to elevated levels of malonyl-CoA, as occurs following blockade of FASN, suggesting new targeted strategies in the treatment of NF2-deficient tumors. Cancer Res; 77(18); 5026–38. ©2017 AACR.

Supplemental files describing metabolic alterations in NF2-deficient cells, supplementary materials and methods, and supportive data regarding the effects of FASN inhibitors or knockdown on various metabolic processes in WT and NF2-deficient cells.

Purpose: The role of cholesterol biosynthesis in hedgehog pathway activity and progression of hedgehog pathway medulloblastoma (Hh-MB) were examined in vivo. Statins, commonly used cholesterol-lowering agents, were utilized to validate cholesterol biosynthesis as a therapeutic target for Hh-MB.Experimental Design: Bioinformatic analysis was performed to evaluate the association between cholesterol biosynthesis with hedgehog group medulloblastoma in human biospecimens. Alterations in hedgehog signaling were evaluated in medulloblastoma cells after inhibition of cholesterol biosynthesis. The progression of endogenous medulloblastoma in mice was examined after genetic blockage of cholesterol biosynthesis in tumor cells. Statins alone, or in combination with vismodegib (an FDA-approved Smoothened antagonist), were utilized to inhibit medulloblastoma growth in vivo.Results: Cholesterol biosynthesis was markedly enhanced in Hh-MB from both humans and mice. Inhibition of cholesterol biosynthesis dramatically decreased Hh pathway activity and reduced proliferation of medulloblastoma cells. Statins effectively inhibited medulloblastoma growth in vivo and functioned synergistically in combination with vismodegib.Conclusions: Cholesterol biosynthesis is required for Smoothened activity in the hedgehog pathway, and it is indispensable for the growth of Hh-MB. Targeting cholesterol biosynthesis represents a promising strategy for treatment of Hh-MB. Clin Cancer Res; 24(6); 1375–88. ©2018 AACR.

Cholesterol availability influences proliferation of Ptch1+/- MB proliferation cells

Gene sets and pathways with selective enrichment among MB subtypes

Cirrhosis refers to irreversible liver damage where healthy tissue is replaced by scar tissue, resulting in impaired liver function. There is no cure and current treatments only prevent further liver damage; thus, novel therapeutic options are urgently needed. Here, we report a new approach that enables the formation of self-assembled 3D spheroids of adipose-derived stem cells (ADSCs) and murine hepatocytes (AML12) via reconstituted collagen fibers. Compared with the spheroids formed in the commercially available EZSHERE dish, the collagen fiber-based ADSC/hepatocyte spheroids offer a notable benefit in structure formation and paracrine factor secretion. To test the regenerative capability of the collagen fiber-based 3D ADSC/hepatocyte spheroids, a rat model of thioacetamide (TAA)-induced liver cirrhosis was employed. The transplantation of the collagen fiber-based 3D ADSC/hepatocyte spheroids show an improvement in liver function and ameliorates pathological liver cirrhosis in TAA-treated rats. In summary, our data show collagen fiber-based self-assembled 3D ADSC/hepatocyte spheroids to possess the excellent regenerative capacity in response to TAA-induced liver injury, promising an alternative therapeutic strategy for liver cirrhosis.

Po-An Su,1 Mu-Chen Lo,2 Chiao-Ling Wang,2 Ping-Chen Yang,3 Chiao-I Chang,4 Meng-Chuan Huang,4,5 Ming-Kuo Huang,6 Kuang-I Cheng6 1Department of Operation Management, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 2Department of Human Resource, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 4Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 5Department of Nutrition and Dietetics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 6Superintendent Office, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, TaiwanCorrespondence: Meng-Chuan HuangDepartment of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kaohsiung, 80708, TaiwanTel +886 7-3121101 ext. 5341Fax +886 7-3121101 ext. 5345Email mechhu@kmu.edu.twPurpose: This study investigated the association between professional quality of life, working context, and mental health outcomes among hospital personnel in Taiwan during the worldwide upsurge in COVID-19 cases.Patients and Methods: We recruited 503 hospital personnel to whom we administered online questionnaires containing items from the Professional Quality of Life (ProQoL) scale, which covers compassion satisfaction (CS), burnout (BO) and compassion fatigue (CF), the Depression, Anxiety and Stress Scale (DASS-21) and questions on work-related variables. Data were collected from 13 July to 19 August 2020.Results: The participants generally reported moderate CS and BO and low CF. Overall prevalence of mild-to-extremely-severe stress, anxiety and depression was 24.5%, 39.6% and 31.2%, respectively. Multiple logistic regression revealed that moderate-to-high BO and CF correlated with increased risks of mild-to-extremely-severe stress (OR = 4.17 and 2.23, respectively), anxiety (OR = 4.86 and 2.81, respectively) and depression (OR = 5.83 and 3.01, respectively), while moderate-to-high CS correlated with reduced risks of stress (OR = 0.53) and depression (OR = 0.45) only. There were CS and BO differences in groups categorized by marital status and profession. Anxiety increased linearly by seniority < 10, 10– 19 and ≥ 20 years (p for trend < 0.05).Conclusion: In conclusion, the subscales of ProQOL, BO and CF appeared to be associated with increased risks of stress, anxiety and depression among hospital personnel during the COVID-19 epidemic. A long-term contingency program may be needed to adjust work context variables and support emotional well-being of these workers.Keywords: COVID-19, depression, Anxiety and Stress Scale, DASS-21, hospital personnel, professional quality of life, ProQoL

Groundwater is a vital source of fresh water for drinking and agricultural purposes in the region of Hatiya Island, Bangladesh, yet it is subject to contamination by natural and anthropogenic activities. Over time, the contamination has resulted in a variety of negative effects on human health. This research aims to examine groundwater hydrogeochemical characterization and suitability for irrigation and drinking purposes on different indices utilizing a combined geochemical method, multivariate statistical approaches, and geospatial analysis. Results of hydrogeochemical analyses of 15 groundwater samples from the intermediate aquifer (60–90 m depth) represent the order of cations, anions, and metal concentrations as Na+ > Mg2+ > Ca2+ > K+, Cl− > SO42− > HCO3− > NO3−, and Fe > I > Br > Mn > As, respectively. Saltwater intrusion has been determined to be the most important hydrogeochemical process influencing the chemistry of groundwater. Principal component analysis, Pearson’s correlation matrix, and hierarchical cluster analysis indicate that groundwater quality is highly governed by geogenic influences. This information has been evaluated using a drinking water quality index map, which found that six (40%) of the groundwater samples are suitable for human consumption, whereas the other nine (60%) are unfit for drinking. The analysis of irrigation quality parameters revealed that eight (54%) of the groundwater samples are in excellent or good condition for agricultural uses; however, the other seven (46%) samples are unsuitable.

Background Liver-type fatty acid-binding protein (L-FABP) is widely expressed in hepatocytes and plays a role in lipid metabolism. It has been demonstrated to be overexpressed in different types of cancer; however, few studies have investigated the association between L-FABP and breast cancer. The aim of this study was to assess the association between plasma concentrations of L-FABP in breast cancer patients and the expression of L-FABP in breast cancer tissue. Method A total of 196 patients with breast cancer and 57 age-matched control subjects were studied. Plasma L-FABP concentrations were measured using ELISA in both groups. The expression of L-FABP in breast cancer tissue was examined using immunohistochemistry. Result The patients had higher plasma L-FABP levels than the controls (7.6 ng/mL (interquartile range 5.2–12.1) vs. 6.3 ng/mL (interquartile range 5.3–8.5), p = 0.008). Multiple logistic regression analysis showed an independent association between L-FABP and breast cancer, even after adjusting for known biomarkers. Moreover, the rates of pathologic stage T2+T3+T4, clinical stage III, positive HER-2 receptor status, and negative estrogen receptor status were significantly higher in the patients with an L-FABP level greater than the median. Furthermore, the L-FABP level gradually increased with the increasing stage. In addition, L-FABP was detected in the cytoplasm, nuclear, or both cytoplasm and nuclear of all breast cancer tissue examined, not in the normal tissue. Conclusions Plasma L-FABP levels were significantly higher in the patients with breast cancer than in the controls. In addition, L-FABP was expressed in breast cancer tissue, which suggests that L-FABP may be involved in the pathogenesis of breast cancer.

Frugivory evolved multiple times in mammals, including bats. However, the cellular and molecular components driving it remain largely unknown. Here, we used integrative single-cell sequencing on insectivorous and frugivorous bat kidneys and pancreases and identified key cell population, gene expression and regulatory element differences associated with frugivorous adaptation that also relate to human disease, particularly diabetes. We found an increase in collecting duct cells and differentially active genes and regulatory elements involved in fluid and electrolyte balance in the frugivore kidney. In the frugivorous pancreas, we observed an increase in endocrine and a decrease in exocrine cells and differences in genes and regulatory elements involved in insulin regulation. Combined, our work provides novel insights into frugivorous adaptation that also could be leveraged for therapeutic purposes.

Using low-energy electron diffraction and angle-resolved photoemission spectroscopy, we investigated the lattice and electronic structures of the Pb(111) surface upon the adsorption of Au atoms at the low temperature T = 40 K. Unlike earlier results showing the formation of PbAu-alloy layers at room temperature, we found that Au atoms form a ultra-thin superstructure, Au/Pb(111)-3 × 3, on top of the Pb(111) surface. Moreover, three surface-state bands, S1, S2, and S3, are induced within and immediately adjacent to the Pb bulk projected band gap centered at the surface zone boundary $${\overline{\text{M}}}_{Pb(111)}$$ M ¯ P b ( 111 ) at the energies of − 0.02, − 1.05, and − 2.56 eV, respectively. First-principles calculation based on Au/Pb(111)-3 × 3 confirms the measured surface-state bands among which the most interesting are the S1 and S3 surface states. They are derived from surface resonances in Pb(111). Moreover, S1, which disperses across Fermi level, exhibits a large anisotropic Rashba splitting with α of 1.0 and 3.54 eVÅ in the two symmetry directions centered at $${\overline{\text{M}}}_{Pb(111)}$$ M ¯ P b ( 111 ) . The corresponding Rashba splitting of S1 band in Cu/Pb(111)-3 × 3 and Ag/Pb(111)-3 × 3 were calculated for comparison.

Due to the excellent engineering property, aluminum has become an important material for processing industries. As the demand of aluminum increased, a large amount of waste aluminum dross has been generated during the aluminum smelting process. The aluminum dross contained aluminum nitride and would cause odor while being disposed in landfill, making the aluminum dross disposal a tough issue. Therefore, the aluminum dross was mostly stored in the original plants. The objective of this study is to develop an economically-feasible and environmentally-friendly technology to recover aluminum dross.In this study, the original aluminum dross was collected from the secondary smelting aluminum dross factories with 33.6% Al. The aluminum dross was dissolved with 3 M NaOH at 50 °C for 60 min to form NaAl(OH)4 solution. The NaAl(OH)4 was then transformed to aluminum hydroxide by adding H2SO4. Then, the aluminum hydroxide was filtered, washed, and dried. The thermogravimetric analysis and X-ray powder diffraction analysis result show that the main crystal phase of aluminum hydroxide (intermediate product) is boehmite. The aluminum hydroxide powder was calcined at 700 °C for 5 min by an atmospheric-pressure microwave plasma to produce Al2O3. The result show that this process can reduce environmental pollution and recycle aluminum as recoverable form.

Urban nature—such as greenness and parks—can alleviate distress and provide space for safe recreation during the COVID-19 pandemic. However, nature is often less available in low-income populations and communities of colour—the same communities hardest hit by COVID-19. In analyses of two datasets, we quantified inequity in greenness and park proximity across all urbanized areas in the United States and linked greenness and park access to COVID-19 case rates for ZIP codes in 17 states. Areas with majority persons of colour had both higher case rates and less greenness. Furthermore, when controlling for sociodemographic variables, an increase of 0.1 in the Normalized Difference Vegetation Index was associated with a 4.1% decrease in COVID-19 incidence rates (95% confidence interval: 0.9–6.8%). Across the United States, block groups with lower income and majority persons of colour are less green and have fewer parks. Our results demonstrate that the communities most impacted by COVID-19 also have the least nature nearby. Given that urban nature is associated with both human health and biodiversity, these results have far-reaching implications both during and beyond the pandemic. Access to green space has been a critical, and contentious, issue for neighbourhood inequality and health outcomes. This Analysis looks at how the COVID-19 pandemic interacts with availability of nature for urban residents.