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Objective: We conducted a comparison of the diagnostic kit for quantification of hepatitis B virus DNA (PCR-fluorescence probing) and COBAS TaqMan automated nucleic acid extraction and real-time polymerase chain reaction (PCR) amplification systems. We tested their capacity to quantify and diagnose patients with chronic viral hepatitis B with low viral load < 1 x 103 IU/mL, in hope to provide further evidence for promoting the application of COBAS TaqMan as the diagnostic method for such patients., Patients and Methods: Diagnostic kit and COBAS TaqMan system were tested on 100 patients diagnosed with chronic viral hepatitis B in our hospital and with a viral load lower than the detection limit of real-time extraction-quantification kit. These patients included 47 cases with chronic viral HBV, 53 cases of HBV-associated cirrhosis (11 cases were HBV-associated liver cancer with cirrhosis). COBAS TaqMan real-time quantification PCR with a sensitivity of 20 IU/ml was performed to test the reproducibility for the diagnosis result., Results: The COBAS TaqMan real-time system quantified 76 cases out of 100 with a viral load higher than 20 IU/ml (detection rate, 76%). Among these patients, there were 33 cases of chronic viral HBV (without cirrhosis) (detection rate, 70.2%), 43 cases of cirrhosis (detection rate, 81.1%, including 28 cases of compensatory cirrhosis and 15 cases of decompensated cirrhosis), and 11 cases of liver cancer (detection rate, 81.2%)., Conclusions: The COBAS TaqMan system has higher sensitivity than traditional real-time PCR detection kit, especially for HBV-related cirrhosis and liver cancer with low viral load. The limitation of real-time PCR should be taken into account during treatment monitoring and the alternative of COBAS TaqMan system should be promoted in patients with high risk of liver cirrhosis and cancer to avoid delayed diagnosis and improve clinical outcome.

Apoptosis inducing factor (AIF) and cytochrome c (CYC) are two mitochondrial apoptogenic factors. In the present study, the cDNA sequences of AIF (LvAIF) and CYC (LvCYC) were cloned from Pacific white shrimp, Litopenaeus vannamei. The LvAIF was 1664 bp, including a 5'-terminal untranslated region (UTR) of 154 bp, an open reading frame (ORF) of 1323 bp encoding a polypeptide of 440 amino acids (aa) and a 3' UTR of 187 bp. The LvCYC was 582 bp, including a 50 bp 5' UTR, a 315 bp ORF encoding for 104 aa, and a 217 bp 3' UTR. The deduced protein of LvAIF contained a conserved Pyr&#95;redox and AIF&#95;C domain at the N-terminal and the predicted LvCYC included a conservative cytochrome&#95;C domain, respectively. Phylogenetic analysis revealed that LvAIF belonged to AIF1 subfamily and showed a close relationship with AIF1 from vertebrates and LvCYC showed the closest relationship with its counterparts from shrimp Marsupenaeus japonicus. Tissue expression profiles showed that both LvAIF and LvCYC existed in most tissues, with the most predominant expression of LvAIF in intestine, then followed muscle and the weakest expression in gill. The highest expression of LvCYC was detected in muscle, and the weakest expression was in hemocytes. Additionally, after white spot syndrome virus (WSSV) infection, the significant up-regulation of LvAIF, LvCYC and caspase 3 transcripts and the increase of pro-caspase 3 and active-caspase 3 protein were detected at most time points (P < 0.05). However, all of the three genes down-regulated in hemocytes in the early stage after WSSV infection. WSSV proliferation and shrimp mortality showed a time-dependent manner and the production of ROS in hemocytes were significantly increased at 6 and 24 h after infection. Our results showed that the apoptotic genes AIF, CYC and caspase 3 might play crucial roles in hepatopancreas, however, the production of ROS in hemocytes might be important in shrimp defense against WSSV infection., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Advance care planning (ACP) is an emerging issue in the primary care system of Taiwan. Previous studies have attributed benefits to various types of ACP in diverse ranges of healthcare settings and populations. However, few older adults in Taiwan have had the opportunity to discuss ACP or to complete their advance directives. The present article takes the perspective of community health nursing to describe the international development and current status of ACP in the community in Taiwan. Furthermore, the intervention models and available resources of ACP are described. We look forward to healthcare professionals using ACP to assist greater numbers of community older adults, thus enhancing their terminal-stage quality of life.

The pathogenesis of hypertension-related cognitive impairment has not been sufficiently clarified, new molecular targets are needed. p38 MAPK pathway plays an important role in hypertensive target organ damage. Activated p38 MAPK was seen in AD brain tissue. In this study, we found that long-term potentiation (LTP) of hippocampal CA1 was decreased, the density of the dendritic spines on the CA1 pyramidal cells was reduced, the p-p38 protein expression in hippocampus was elevated, and cognitive function was impaired in angiotensin II-dependent hypertensive C57BL/6 mice. In vivo, using a p38 heterozygous knockdown mice (p38(KI/+)) model, we showed that knockdown of p38 MAPK in hippocampus leads to the improvement of cognitive function and hippocampal synaptic plasticity in angiotensin II-dependent p38(KI/+) hypertensive mice. In vitro, LTP was improved in hippocampal slices from C57BL/6 hypertensive mice by treatment with p38MAPK inhibitor SKF86002. Our data demonstrated that p38 MAPK may be a potential therapeutic target for hypertension-related cognitive dysfunction.

Background: Chinese tradition and culture developed from Taoism, Confucianism, and Buddhism and have influenced ethnic Chinese for thousands of years, particularly thoughts on death. Many ethnic Chinese, particularly older people, refrain from discussing death-related concerns, making it difficult to obtain advance directives, including do-not-resuscitate (DNR) directives, signed independently by older people. This study explored the attitudes of older nursing home residents in Taiwan toward signing their own DNR directives., Methods: This study adopted purposive sampling and collected data through in-depth interviews. The data were analysed using qualitative inductive content analysis, and the study location was a nursing home in Eastern Taiwan., Results: A total of 11participants were recruited from a sample of 12 eligible participants. Most of the older residents in this study refused to make decisions independently regarding DNR directives. Content analysis of the interviews revealed four themes concerning refusing to sign DNR directives independently: not going against nature, accepting the results of cause and effect, viewing the family as a decision-making system, and practising self-effacement. Chinese cultural aspects, including Taoist, Buddhist, and Confucian philosophy, affected the autonomy of the older residents, and they relied on others to make decisions for them., Conclusions: Professionals must respect this family-oriented decision-making thinking of older residents because it reflects personal choice. Otherwise, healthcare providers may play a mediating role in coordinating and communicating between older residents and their families regarding EOL-care-related concerns, replacing the traditional practice of holding a family meeting.

Synaptic plasticity is an important mechanism that underlies learning and cognition. Protein phosphorylation by kinases and dephosphorylation by phosphatases play critical roles in the activity-dependent alteration of synaptic plasticity. In this study, we report that Wip1, a protein phosphatase, is essential for long-term potentiation (LTP) and long-term depression (LTD) processes. Wip1-deletion suppresses LTP and enhances LTD in the hippocampus CA1 area. Wip1 deficiency-induced aberrant elevation of CaMKII T286/287 and T305 phosphorylation underlies these dysfunctions. Moreover, we showed that Wip1 modulates CaMKII dephosphorylation. Wip1(-/-) mice exhibit abnormal GluR1 membrane expression, which could be reversed by the application of a CaMKII inhibitor, indicating that Wip1/CaMKII signaling is crucial for synaptic plasticity. Together, our results demonstrate that Wip1 phosphatase plays a vital role in regulating hippocampal synaptic plasticity by modulating the phosphorylation of CaMKII.

The role of sodium channel voltage-gated beta 2 (SCN2B) in brain aging is largely unknown. The present study was therefore designed to determine the role of SCN2B in brain aging by using the senescence-accelerated mice prone 8 (SAMP8), a brain senescence-accelerated animal model, together with the SCN2B transgenic mice. The results showed that SAMP8 exhibited impaired learning and memory functions, assessed by the Morris water maze test, as early as 8 months of age. The messenger RNA (mRNA) and protein expressions of SCN2B were also upregulated in the prefrontal cortex at this age. Treatment with traditional Chinese anti-aging medicine Xueshuangtong (Panax notoginseng saponins, PNS) significantly reversed the SCN2B expressions in the prefrontal cortex, resulting in improved learning and memory. Moreover, SCN2B knockdown transgenic mice were generated and bred to determine the roles of SCN2B in brain senescence. A reduction in the SCN2B level by 60.68% resulted in improvement in the hippocampus-dependent spatial recognition memory and long-term potential (LTP) slope of field excitatory postsynaptic potential (fEPSP), followed by an upregulation of COX5A mRNA levels and downregulation of fibroblast growth factor-2 (FGF-2) mRNA expression. Together, the present findings indicated that SCN2B could play an important role in the aging-related cognitive deterioration, which is associated with the regulations of COX5A and FGF-2. These findings could provide the potential strategy of candidate target to develop antisenescence drugs for the treatment of brain aging.

Two strains of Gram-stain-positive, aerobic, non-motile, irregular coccus-shaped bacteria, designated YIM 2617 T and YIM 2617-2, were isolated from the root of Ocimum basilicum . Phylogenetic analysis on the basis of 16S rRNA gene sequence comparison revealed that the two strains were closely related to Mariniluteicoccus flavus YIM M13146 T (98.1 and 98.0 % similarities, respectively) and formed a robust clade with M. flavus in the neighbour-joining tree. Optimum growth of the strains was observed at 28-32 °C, at pH 7.0-8.0 and in the presence of 0-2 % (w/v) NaCl. The chemotaxonomic profiles of the strains comprised anteiso-C 15 : 0 as the major cellular fatty acid, MK-9(H 4 ) as the predominant menaquinone, alanine, glycine, glutamic acid and ll-diaminopimelic acid as peptidoglycan components, and phosphatidylcholine and diphosphatidylglycerol as the major polar lipids. The G+C contents of the genomic DNA of strains YIM 2617 T and YIM 2617-2 were 66.4 and 66.6 mol%, respectively. DNA-DNA hybridizations of the two strains with M. flavus YIM M13146 T gave mean relatedness values of 47.6 ± 2.0 and 43.2 ± 1.5 %, respectively, while the relatedness value between them was 92.1 ± 2.2 %. On the basis of the data recorded from the present study, strains YIM 2617 T and YIM 2617-2 represent a novel species of the genus Mariniluteicoccus , for which the name Mariniluteicoccus endophyticus sp. nov. is proposed. The type strain is YIM 2617 T ( = KCTC 29482 T  = DSM 28728 T  = JCM 30097 T ).

The current ethical dilemmas met by healthcare professionals were never compared with those 15 years ago when the palliative care system was newly developing in Taiwan. The aim of the study was to investigate the ethical dilemmas met by palliative care physicians and nurses in 2013 and compare the results with the survey in 1998. This cross-sectional study surveyed 213 physicians and nurses recruited from 9 representative palliative care units across Taiwan in 2013. The compared survey in 1998 studied 102 physicians and nurses from the same palliative care units. All participants took a questionnaire to survey the "frequency" and "difficulty" of 20 frequently encountered ethical dilemmas, which were grouped into 4 domains by factor analysis. The "ethical dilemma" scores were calculated and then compared across 15 years by Student's t tests. A general linear model analysis was used to identify significant factors relating to a high average "ethical dilemma" score in each domain. All of the highest-ranking ethical dilemmas in 2013 were related to insufficient resources. Physicians with less clinical experience had a higher average "ethical dilemma" score in clinical management. Physicians with dissatisfaction in providing palliative care were associated a higher average "ethical dilemma" score in communication. Nurses reported higher "ethical dilemma" scores in all items of resource allocation in 2013. Further analysis confirmed that, in 2013, nurses had a higher average "ethical dilemma" score in resource allocation after adjustment for other relating factors. Palliative care nursing staff in Taiwan are more troubled by ethical dilemmas related to insufficient resources than they were 15 years ago. Training of decision making in nurses under the framework of ethical principles and community palliative care programs may improve the problems. To promote the dignity of terminal cancer patients, long-term fundraising plans are recommended for countries in which the palliative care system is in its early stages of development.

Bisphenol A (BPA) is a ubiquitous endocrine disruptor exerting lifelong effects on gene expression in rodent prostate cancer (PCa) models. Here, we aimed to determine whether epigenetic events mediating the action of BPA on human prostaspheres enriched in epithelial stem-like/progenitor cells is linked to PCa. We performed genome-wide transcriptome and methylome analyses to identify changes in prostaspheres treated with BPA (10 nM, 200 nM, and 1000 nM) or estradiol-17β (E2) (0.1 nM) for 7 days and validated changes in expression, methylation, and histone marks in parallel-treated prostaspheres. BPA/E2-treatment altered expression of 91 genes but not the methylation status of 485,000 CpG sites in BPA/E2-treated prostaspheres. A panel of 26 genes was found repressed in all treatment groups. Fifteen of them were small nucleolar RNAs with C/D motif (SNORDs), which are noncoding, small nucleolar RNAs known to regulate ribosomal RNA assembly and function. Ten of the most down-regulated SNORDs were further studied. All 10 were confirmed repressed by BPA, but only 3 ratified as E2-repressed. SNORD suppression showed no correlation with methylation status changes in CpG sites in gene regulatory regions. Instead, BPA-induced gene silencing was found to associate with altered recruitments of H3K9me3, H3K4me3, and H3K27me3 to 5'-regulatory/exonic sequences of 5 SNORDs. Expression of 4 out of these 5 SNORDs (SNORD59A, SNORD82, SNORD116, and SNORD117) was shown to be reduced in PCa compared with adjacent normal tissue. This study reveals a novel and unique action of BPA in disrupting expression of PCa-associated SNORDs and a putative mechanism for reprogramming the prostasphere epigenome via histone modification.

Background: This study aimed to evaluate the impact of diagnosis-related group (DRG) payments on health-care providers' behavior and the potential best course of action to make a profit under a DRG payment mechanism., Methods: This is a natural experiment study with a tertiary hospital-based dataset. Under a consecutive three-period (3 years) or 12-period (12 seasons) design, length of stay, medical cost with detailed items, the percentage of general anesthesia (GA), and the percentage of receiving additional operations were compared. Furthermore, the differences between negative- and positive-profit groups were also examined., Results: There was no difference in the length of stay and total medical cost after the launch of the DRG payment scheme. However, the percentage of additional operations increased significantly. In addition, there were reduced costs of radiological images and medication, a reduced percentage of GA, fewer patients undergoing additional operations, and a higher rate of complications or comorbidities in the "positive-profit group.", Conclusion: The introduction of DRG payment resulted in significantly reduced examination fee, slightly decreased medical costs without significant difference in several detailed items, a reduced number of GA cases without statistical significance, and more patients receiving additional operations. The possible solution to make a profit under the DRG payment scheme is to curtail the costs of radiological images and medication, lower GA percentage, perform fewer additional operations, and correct recording of complications or comorbidities., (Copyright © 2015. Published by Elsevier Taiwan.)

Major advances during the past decade have permitted a clearer understanding of processes that regulate stem cell self-renewal and lineage commitment toward differentiated progeny that populate all tissues. Considerable evidence has also accumulated to indicate that aberrations in the stem and progenitor cell populations can lead to increased cancer risk in specific organs systems. It is long recognized that environmental factors play a major role in cancer etiology, and emerging data suggest that endocrine-disrupting chemicals (EDCs) may contribute to an increased cancer risk. Using the prostate gland as a model system, the present review highlights recent data that find that estrogens and EDCs can reprogram prostate stem and progenitor cell populations, leading to increased cancer susceptibility. We propose that stem cell programming during early development in hormone-regulated tissues may lead to heightened sensitivity to early-life EDC exposures and that aberrant stem cell reprogramming by EDCs may contribute to the developmental basis of adult cancer risk.

Previous investigations suggested that Streptomyces jiujiangensis JXJ 0074(T) can secrete antialgal compounds. In this study, an antialgal compound was isolated from the cultured broth of S. jiujiangensis JXJ 0074(T) by using bioassay methods. Based on spectroscopic data, the active compound was identified as 2'-deoxyadenosine, which exhibited a greater antialgal activity against cyanobacteria than its analogues such as adenosine, guanosine, and 2'-deoxyguanosine. The antialgal activity of 2'-deoxyadenosine increased with the content and time. 2'-Deoxyadenosine severely damaged the vegetative cells of cyanobacteria, causing crumpling, collapse, expanding, perforation, breakage of filamentous cyanobacteria, and decrease of the chlorophyll. However, 2'-deoxyadenosine seemed to have less impact on the morphology of heterocysts of filamentous cyanobacteria. The superoxide dismutase (SOD) activity in the treated cells of M. aeruginosa FACHB-905 initially increased with 31.14 ± 2.00% higher than that of the control after 36 h and then decreased quickly. On the same time, there were rapid increases in superoxide anion radical (O2 (-)) and malondialdehyde (MDA) contents with 315.53 ± 12.81 and 84.72 ± 6.15% higher than these of the controls at 60 h, respectively. The intracellular microcystin-LR (MC-LR) content in the treated cells of M. aeruginosa FACHB-905 increased by 36.34 ± 7.35% 1 day later, followed by a rapid decrease with a rate of 90.50 ± 1.08% 8 days later, while the extracellular MC-LR content showed no significant difference with the control. Five days after adding 15 μg/ml of 2'-deoxyadenosine to the culture of M. aeruginosa FACHB-905, there was no 2'-deoxyadenosine detected by HPLC, suggesting that 2'-deoxyadenosine completely degraded. This study provides a new clue to screen natural-based antialgal compounds from nucleoside analogues.

Seed development is an important process of reproductive development and consists of embryo and endosperm development; both comprise several key processes. To determine and investigate the functions of the dynamic DNA methylome during seed development, we profiled the DNA methylation genome wide in a series of developmental stages of rice (Oryza sativa) embryo and endosperm by methylcytosine immunoprecipitation followed by Illumina sequencing. The results showed that embryo is hypermethylated predominantly around non-transposable element (TE) genes, short DNA-TEs, and short interspersed TEs compared with endosperm, and non-TE genes have the most diverse methylation status across seed development. In addition, lowly expressed genes are significantly enriched in hypermethylated genes, but not vice versa, confirming the crucial role of DNA methylation in suppressing gene transcription. Further analysis revealed the significantly decreased methylation at early developing stages (from 2 to 3 d after pollination), indicating a predominant role of demethylation during early endosperm development and that genes with a consistent negative correlation between DNA methylation change and expression change may be potentially directly regulated by DNA methylation. Interestingly, comparative analysis of the DNA methylation profiles revealed that both rice indica and japonica subspecies showed robust fluctuant profiles of DNA methylation levels in embryo and endosperm across seed development, with the highest methylation level at 6 d after pollination (2 d after pollination of endosperm in japonica as well), indicating that a complex and finely controlled methylation pattern is closely associated with seed development regulation. The systemic characterization of the dynamic DNA methylome in developing rice seeds will help us understand the effects and mechanism of epigenetic regulation in seed development., (© 2015 American Society of Plant Biologists. All Rights Reserved.)

Context: The use of antibiotics is a common ethical dilemma in palliative care, thus identifying the concerns of patients with terminal cancer and respecting their wishes are important in making an ethically justified decision., Objectives: The aim of this study was to understand wishes of patients with terminal cancer and determine influencing factors toward the use of antibiotics., Methods: Two hundred and one patients with terminal cancer, admitted to a palliative care unit in Taiwan, completed a structured questionnaire interview, including demographic characteristics, knowledge and attitudes on antibiotics, the health locus of control, subjective norms, and the wishes to use antibiotics., Results: The most common misconception was "Antibiotics use is helpful to all terminal patients with infection," which only 13.4% respondents disagreed. Of the 201patients, 92 (45.8%) expressed their wishes to use antibiotics even in the very terminal stage, and around one-fourth (26.4%) of patients wished not to use antibiotics, the remaining 27.8% were unclear. The most influential persons were medical professionals. The results of logistic regression analysis that showed familiarity with antibiotics, subjective norms, and the attitude toward burdens of antibiotics were the most significant predicting variables for those wishing to use antibiotics (odds ratio [OR] = 4.133, 95% confidence interval [CI] = 1.012-16.880; OR = 1.890, 95% CI = 1.077-3.317; and OR = 1.255, 95% CI = 1.047-1.503)., Conclusion: This study indicated the responsibility of medical professionals to convey burdens of using antibiotics to patients and family. Otherwise, by enhancing professional training and performing effective communication with patients, we can reach a more appropriate decision in the use of antibiotics., (© The Author(s) 2014.)

Objective: To explore the experiences of lactation suppression (LS) among Taiwanese women who experienced stillbirth after 20-weeks gestation., Design: Qualitative research combining practitioner ethnography and the observ-view method (participant observation and unstructured interviews while caring for participants)., Setting: Participants were recruited from a medical center in central Taiwan between June 2013 and November 2014., Participants: Seven Taiwanese women who had stillbirths., Methods: Data were collected by the observ-view method. Recorded interviews were analyzed by content analysis., Results: Participants described three core experiences: deciding to use LS without careful deliberation; psychological pain is substantially stronger than physical pain; and not regretting their choice regarding method of LS., Conclusion: Physical pain often remains unaddressed because of the greater psychological pain following fetal death. Therefore, LS should be an essential component of follow-up care as part of the discharge plan. Follow-up should be for at least 14 days. More research is needed on nonpharmacological LS to address cultural differences and personal beliefs about methods of LS., (© 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Background: Enabling people to die in their preferred place is important for providing high-quality end-of-life care., Objective: The study objective was to explore patients' preferences regarding the place of end-of-life care and death and to compare these preferences with the perceptions of their family physicians., Methods: This cross-sectional study used stratified random sampling, surveying 400 registered patients and 200 of their family physicians nationwide, with a five-part, structured, self-report questionnaire., Results: Of the selected population, 310 patients (response rate 77.5%) and 169 physicians (response rate 84.5%) responded. Regarding the preferred place for end-of-life care, most of the patients would choose to receive care at home (60.6%) if home care services were available. Additionally, home was the most frequently preferred (66.5%) place of death. The family physicians' survey showed that a higher proportion of physicians selected home as the preferred place for end-of-life care and death (71.6% and 87.2%, respectively). The results of logistic regression analysis showed that patients younger than 50 years of age who believed in Chinese folk religion and who resided in a rural area were more likely to prefer to die at home., Conclusions: The most commonly preferred place for end-of-life care and death is the patient's home. Establishing a community-based palliative care system should be encouraged to allow more individuals to die in their preferred locations. There were discrepancies in the preferred place of end-of-life care and death between the patients' preferences and their family physicians' perceptions. More effective physician-patient communication regarding end-of-life care is needed.

Background: Clinical research nurses (CRNs) play an important role in improving the quality of clinical trials. In Taiwan, the increasing number of clinical trials has increased the number of practicing CRNs. Understanding the role responsibilities of CRNs is necessary to promote professionalism in this nursing category., Purpose: This study investigates the role responsibilities of CRNs in conducting clinical trials / research., Methods: A questionnaire survey was conducted in a medical center in Taipei City, Taiwan. Eighty CRNs that were registered to facilitate and conduct clinical trials at this research site completed the survey., Results: "Subject protection" was the CRN role responsibility most recognized by participants, followed by "research coordination and management", "subject clinical care", and "advanced professional nursing". Higher recognition scores were associated with higher importance scores and lower difficulty scores. Participants with trial training had significantly higher difficulty scores for "subject clinical care" and "research coordination and management" than their peers without this training (p < .05). Participants who had participated in a long-term trial-training course earned higher importance scores for "CRN four-subthemes role responsibilities" (p <.05) and lower difficulty scores for "subject protection", "research coordination and management" (p <.005) than their short-term course peers. "Recognition of overall responsibilities" and "receiving trial training" were the significant predictors of difficulty in performing CRN role responsibilities, explaining 21.9% of the total variance., Conclusions: To further promote CRN as a professional career in Taiwan, the findings of this study recommend identifying the core competences of CRNs and adding CRN-related study materials into the advanced nursing curriculum. Long-term and systematic educational training may help CRNs understand the importance of their role responsibilities, better recognize their professional role, and reflect these responsibilities in clinical practice.

Portable X-ray fluorescence (PXRF) spectrometer as a new type of equipment for quick test has a prominent prospect, but there are also shortcomings of detection range and limition, therefore this paper studied the suitability of PXRF spectrometer in monitoring soil environmental qualities of heavy metals included Cr, Ni, Cu, Zn, Pb, Cd, As and Hg, the aim of this paper is to screen elements which can be detected by this kind of instrument and evaluate the accuracy of test results. The research method is to test heavy metals contaminated soil samples by PXRF spectrometer, evaluate the accuracy of test results of PXRF compared with inductively coupled plasma mass(ICP-MS), then establish linear regression relationship between analysis results of PXRF and ICP-MS method. The results show that, (1) When measuring the soil environmental quality, PXRF spectrometer is appropriate to measure the content of Pb, Zn, Cr and Cu, except Ni, Cd, As and Hg. (2) Compared with the test value of ICP-MS, the test value of Pb and Zn is lower, the test value of Cu is higher, the test value of Cr is too high, all the results of PXRF spectrometer should be linear corrected according to standard analysis method. In conclusion, PXRF spectrometer is suitable for monitoring environmental quality of soil which is polluted by heavy metal such as Pb, Zn, Cr and Cu, it is an analysis means with characteristics of simple and rapid, accurate and reliable. The innovation of this article is that reasonable avoiding the shortcomings of PXRF spectrometer as using the instrument to monitor soil environmental quality, at last improved the application value of test results.

Objective: To explore clinical efficacy of double Endobutto reconstituting coracoclavicular ligament combined with repairing acromioclavicular ligament in stage I in treating acromioclavicular dislocation with Rockwood type III - V ., Methods: From January 2010 to September 2013, 56 patients with Rockwood type III - V acromioclavicular dislocation were treated by operation, including 20 males and 36 femlaes, aged from 32 to 52 years old with an average of 38.5 years old. Twenty-five patients were on the left side and 31 cases on the right side. The time from injury to operation was from 3 to 14 days, averaged 7 days. All patients were diagnosed as acromioclavicular dislocation with Rockwood type III - V, and double Endobutto were used to reconstituting coracoclavicular ligament, line metal anchors were applied for repairing acromioclavicular ligament. Postoperative complications were observed, Karlsson and Constant-Murley evaluation standard were used to evaluate clinical effects., Results: All patients were followed up from 8 to 24 months with average of 11 months. According to Karlsson evaluation standard at 6 months after operation,42 cases were grade A, 13 were grade B and 1 was grade C. Constant-Murley score were improved from (42.80±5.43) before operation to (91.75±4.27) at 6 months after operation. All items at 6 months after operation were better than that of preoperative items. Forty-eight patients got excellent results, 7 were moderate and only 1 with bad result. No shoulder joint adhesion, screw loosening or breakage were occurred during following up., Conclusion: Double Endobutto reconstituting coracoclavicular ligament combined with repairing acromioclavicular ligament in stage I for the treatment of acromioclavicular dislocation with Rockwood type III - V could obtain early staisfied clinical effects, and benefit for early recovery of shoulder joint function.

Background and Purpose: At the early stage of Alzheimer's disease (AD), the accumulation of β-amyloid (Aβ) oligomers disturbs intracellular Ca(2+) homeostasis and disrupts synaptic plasticity of brain neurons. Prevention of Aβ-induced synaptic failure remains an unsolved problem for the treatment of AD. Here, the effects of 2-aminoethoxydiphenyl borate (2-APB), a non-specific, but moderately potent Ca(2+) channel inhibitor, on Aβ-induced deficit of synaptic long-term potentiation (LTP) and the underlying molecular mechanisms were explored., Experimental Approach: We used hippocampal slices and primary cultures of hippocampal neurons from C57BL/6 mice. Methods applied in our study included electrophysiological recording, membrane protein extraction, Western blot assay and Ca(2+) imaging., Key Results: 2-APB at 10 μM effectively reversed suppression by oligomeric Aβ1-42 (500 nM) of LTP in hippocampal slices. 2-APB also restored phosphorylation and trafficking of the glutamate receptor subunit GluA1 in Aβ-treated hippocampal slices, supporting its protective action on synaptic function. Aβ-mediated abnormal neuronal [Ca(2+) ]i elevation and hyperactivation of the mitochondrial apoptotic proteins BAX, caspase-3, and glycogen synthase kinase-3β, were blocked by 2-APB pretreatment. Moreover, the defict in long term potentiation deficit in hippocampal slices from APPswe /PS1ΔE 9 gene mutant mice was rescued by 2-APB at 10 μM., Conclusions and Implication: These data demonstrate that 2-APB is a potentially useful chemical to protect synaptic plasticity against neurotoxic effects of Aβ in AD., (© 2014 The British Pharmacological Society.)

Providing patient-centered care from preventive medicine to end-of-life care in order to improve care quality and reduce medical cost is important for accountable care. Physicians in the accountable care organizations (ACOs) are suitable for participating in supportive end-of-life care especially when facing issues in truth telling and treatment strategy. This study aimed to investigate patients' attitudes toward truth telling and treatment preferences in end-of-life care and compare patients' attitudes with their ACOs physicians' perceptions.This nationwide study applied snowball sampling to survey physicians in physician-led ACOs and their contracted patients by questionnaire from August 2010 to July 2011 in Taiwan. The main outcome measures were beliefs about palliative care, attitudes toward truth telling, and treatment preferences.The data of 314 patients (effective response rate = 88.7%) and 177 physicians (88.5%) were analyzed. Regarding truth telling about disease prognosis, 94.3% of patients preferred to be fully informed, whereas only 80% of their physicians had that perception (P < 0.001). Significant differences were also found in attitudes toward truth telling even when encountering terminal disease status (98.1% vs 85.3%). Regarding treatment preferences in terminal illness, nearly 90% of patients preferred supportive care, but only 15.8% of physicians reported that their patients had this preference (P < 0.001).Significant discrepancies exist between patients' preferences and physicians' perceptions toward truth telling and treatment strategies in end-of-life care. It is important to enhance physician-patient communication about end-of-life care preferences in order to achieve the goal of ACOs. Continuing education on communication about end-of-life care during physicians' professional development would be helpful in the reform strategies of establishing accountable care around the world.

The numbers of people who suffer from age-related and chronic diseases have been increased worldwide. This has lead to an increased emphasis in the medical community on end of life care. This paper references the processes followed overseas in developing palliative care education programs as well as the domestic experiences promoting the hospitalization, home care, and "share care" models of palliative care. Particular emphasis is given to considerations of cultural diversity in palliative care. The aim of this paper is to elaborate on the prevalent clinical end-of-life care issues that are faced in Taiwan, to cultivate core capabilities in end-of-life care, to elicit the current status and development of formal nursing education, and to promote continuing education in palliative care. Kern formulated a six-step approach to curriculum development in education and the details has been discussed . Finally, this paper reflects on the current bottlenecks, challenges, and expectations related to palliative care curriculum development in order to help medical professionals further put humanistic and social care into practice, increase ethical reflection in end of life care and nursing competency, and encourage the creation of localized textbooks / multimedia e-teaching materials. The fostering of "patient-centered, family unit and the social-cultural contexture" for palliative care professionals and the ability to respond to the needs of terminal patients and patients with chronic diseases are critical to increasing the quality of Taiwan healthcare.

Objective: To observe the curative effect of acupoint-injection and intramuscular-injection of Bacillus Calmette-Guerin (BCG) Polysaccharide Nucleic Acid for bronchial asthma., Methods: Sixty patients with bronchial asthma were equally randomized into acupoint-injection group and intramuscular-injection group. For patients of the acupoint-injection group, 2 mL of BCG was injected into bilateral Feishu (BL 13, 1 mL for one side) once per day in the first 15 days, and once every other day in the rest 2.5 months except weekends. Intramuscular-injection was conducted at the lateral sites of the left or right buttock, 2 mL/time for each site, and the injection frequency was the same to that of the acupoint-injection. The therapeutic effect was assessed according to the standards of Guide Principles for Clinical Research of New Chinese Herbal Drugs (2002) and Asthma Group of Breathing Diseases of China Medical Association (2008). Changes of FEV 1 (forced expiratory volume in the first second)/FVC (forced vital capacity) and PEF% (peak expiratory flow) were detected using a pulmonary function detector. Serum IgA, IgM, IgG and IgE contents were assayed by using an autonomic biochemical analyzer., Results: After 3 months' treatment, the scores of patients' symptoms and signs and serum IgE and IgG levels were significantly decreased in both muscular-injection and acupoint-injection groups (P<0.01), while asthma controlled test (ACT) scores FEV 1/FVC% and PEF% values were considerably increased in both groups compared to pre-treatment in the same one group (P<0.01). The effects of acupoint-injection were markedly superior to those of the intramuscular-injection in reducing clinical symptom-sign score, and serum IgE content, and in up-regulating ACT score, FEV 1/FVC% and PEF% levels (P<0.05, P<0.01). There were no significant differences in serum IgG, IgA and IgM levels between the two groups 3 months following the treatment (P>0.05)., Conclusion: Acupoint-injection of BCG polysaccharide nucleic acid can effectively improve bronchial asthma patients' clinical symptoms and sings and pulmonary function, which may be closely associated with its function in down-regulating serum IgE and IgG levels.

Acute liver rejection is one of the most severe complications that may affect the liver transplantation procedure. Thus, one of the most important focal points in the field of liver transplantation research is to discover a non-invasive or less-invasive method of diagnosing and predicting cases of acute liver rejection. In the present study, 59 tissue samples, including blood and liver tissues, were collected from patients who underwent liver transplantation between March 2005 and November 2009. The patients were divided into acute rejection and no rejection groups, the latter of which was further divided into normal and abnormal liver function groups. The samples were assayed by enzyme-linked immunosorbent assay and immunohistochemistry methods. The results were analyzed and a receiver operating characteristic (ROC) curve was plotted. The area under the ROC curve and the sensitivity and specificity of the cut-off point were analyzed statistically. The results indicated that the expression level of human leukocyte antigen-G (HLA-G) in the serum and liver samples in the acute rejection group was markedly lower than that in the no rejection group (P<0.001 and P=0.004, respectively). Furthermore, in the no rejection group, no statistically significant difference was identified in the level of HLA-G between patients with normal or abnormal liver function (P=0.0593). The area under the ROC curve was 0.805. When 2.41 U/ml HLA-G was considered as the cut-off point for the diagnosis of acute liver rejection, the sensitivity and specificity were 72.7 and 83.8%, respectively. In conclusion, in the present study, a high expression of the HLA-G was shown to correlate with a reduced occurrence of acute liver rejection. HLA-G may thus be an effective factor for the diagnosis and prediction of acute liver rejection.

We explored caregivers' experiences and needs when providing hospice home care to their terminally ill elderly patients with cancer in Taiwan for 1 year. A total of 44 caregivers were interviewed using a semistructured interview once monthly during hospice home care visits until the patients' deaths. Content analysis of the interviews revealed 5 themes, hoping for a cure, experiencing fluctuating emotions, accepting the patient's dying, regarding the patient's death as a good death, and needing emotional support and information. Caregivers in hospice home care who experienced difficulties tended to seek emotional support and information throughout the entire caregiving process. With a greater understanding of caregivers' experiences and needs, nurses can alleviate caregivers' negative emotional reactions by actively attending to their needs during this process., (© The Author(s) 2013.)

Multi-modal imaging based on multifunctional nanoparticles provides deep, non-invasive and highly sensitive imaging and is a promising alternative approach that can improve the sensitivity of early cancer diagnosis. In this study, two nanoparticles, TbPO4:Ce(3+) and TbPO4:Ce(3+)@TbPO4:Gd(3+), were synthesized via the citric-acid-mediated hydrothermal route, and then systematically characterized by means of microstructure, photoluminescence, magnetic resonance imaging (MRI), biocompatibility, and bioimaging. The results of energy dispersive X-ray spectroscopy (EDS) and electron energy loss spectroscopy (EELS) line scans indicated that TbPO4:Gd(3+) nanoshells about 5 nm in thickness were successfully coated on the TbPO4:Ce(3+) nanocores. X-ray diffraction (XRD) and Fourier transforms of high-resolution transmission electron microscopy (TEM) images indicated that the core-shell nanocomposites had a single crystal structure. The photoluminescence of the TbPO4:Ce(3+)@TbPO4:Gd(3+) and TbPO4:Ce(3+) nanoparticles was greatly intensified by 200 times and 100 times, respectively, compared with pure TbPO4 nanoparticles. In vitro cytotoxicity tests based on the methyl thiazolyl tetrazolium (MTT) assay demonstrated that the monodispersed nanoparticles of TbPO4:Ce(3+)@TbPO4:Gd(3+) had low toxicity. The intracellular luminescence of the nanoparticles after being internalized by HeLa cells was also observed using confocal fluorescence microscopes. MRI showed that the nanoshells of Gd-doped TbPO4 possessed a longitudinal relaxivity of 4.067 s(-1) mM(-1), which is comparable to that of the commercial MRI contrast Gd-TDPA. As a result, the core-shell structured TbPO4:Ce(3+)@TbPO4:Gd(3+) nanoparticles can potentially serve as multifunctional nanoprobes for both optical biolabels and MRI contrast agents.

Purpose: Hospice shared care (HSC) is a new care model that has been adopted to treat inpatient advanced cancer patients in Taiwan since 2005. Our aim was to assess the effect of HSC on medical expenditure and the likelihood of intensive medical utilization by advanced cancer patients., Methods: This is a nationwide retrospective study. HSC was defined as using "Hospice palliative care (HPC) teams to provide consultation and service to advanced cancer patients admitted in the nonhospice care ward." There were 120,481 deaths due to cancer between 2006 and 2008 in Taiwan. Patients receiving HSC were matched by propensity score to patients receiving usual care. Of the 120,481 cancer deaths, 12,137 paired subjects were matched. Medical expenditures for 1 year before death were assessed between groups using a database from the Bureau of National Health Insurance. Paired t and McNemar's tests were applied for comparing the medical expenditure and intensive medical utilization before death between paired groups., Results: Compared to the non-HSC group, subjects receiving HSC had a lower average medical expenditure per person (US$3,939 vs. US$4,664; p<0.001). The HSC group had an adjusted net savings of US$557 (13.3%; p<0.001) in inpatient medical expenditure per person compared with the non-HSC group. Subjects that received different types of HPC had 15.4-44.9% less average medical expenditure per person and significantly lower likelihood of intensive medical utilization than those that did not receive HPC., Conclusions: HSC is associated with significant medical expenditure savings and reduced likelihood of intensive medical utilization. All types of HPC are associated with medical expenditure savings.

Objective: to describe the aspects of infant sleep perceived as problematic by first-time Taiwanese mothers and to discover how mothers cope in response to infant sleep concerns., Design: a qualitative approach was used for data collection., Setting: in-depth interviews were conducted and audio-taped at mothers' homes., Participants: 12 first-time mothers within three months post partum., Measurement and Findings: content analysis was performed to identify patterns, similarities, and differences in the individual and collective interview data. The major themes describing maternal coping experiences were 'self-help' and 'seek-help.' Self-help coping efforts included reception and acceptance of suggestions as well as changing behaviour to allow mothers to feel capable of adapting to infant sleep patterns or problems. Seek-help was a later stage of coping for mothers when they actively utilised formal and informal sources of help to identify and manage infant sleep problems. The majority of mothers sought informal help sources from family members, friends, or online information. Mothers who suspected their infant of suffering from sleep problems either delayed seeking medical advice or did not actively consult a health care provider., Conclusions and Implications for Practice: nurses and health care providers who work in antenatal, postnatal, and paediatric clinics should actively educate and provide information about infant sleep patterns and sleep management options to first-time mothers and discuss maternal coping strategies., (© 2013 Elsevier Ltd. All rights reserved.)

A sensitive analytical method based on packed-fiber solid-phase extraction and high performance liquid chromatography-tandem mass spectrometry (PF SPE-HPLC-MS/MS) has been developed for determination of three synthetic stilbenes in milk. The stilbenes are extracted with acetonitrile, using sodium chloride, and purified with PF SPE using a cartridge containing electrospun polystyrene nanofibers. Parameters affecting the efficiency of PF SPE, such as pH and amount of salt, were optimized. Under optimal conditions, the limits of detection and quantification were 5-13pg/g and 15-37pg/g, respectively. Absolute recoveries varied between 60% and 85% at three different levels. The method was successfully applied for the determination of estrogenic stilbenes in a total of 69 milk samples. The method is sensitive and cost-effective in stilbene detection, and has potential in quality control of dairy products., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Previous studies in rodent models have shown that early-life exposure to bisphenol A (BPA) reprograms the prostate and enhances its susceptibility to hormonal carcinogenesis with aging. To determine whether the human prostate is similarly sensitive to BPA, the current study used human prostate epithelial stem-like cells cultured from prostates of young, disease-free donors. Similar to estradiol-17β (E2), BPA increased stem-progenitor cell self-renewal and expression of stem-related genes in a dose-dependent manner. Further, 10 nM BPA and E2 possessed equimolar membrane-initiated signaling with robust induction of p-Akt and p-Erk at 15 minutes. To assess in vivo carcinogenicity, human prostate stem-progenitor cells combined with rat mesenchyme were grown as renal grafts in nude mice, forming normal human prostate epithelium at 1 month. Developmental BPA exposure was achieved through oral administration of 100 or 250 μg BPA/kg body weight to hosts for 2 weeks after grafting, producing free BPA levels of 0.39 and 1.35 ng/mL serum, respectively. Carcinogenesis was driven by testosterone plus E2 treatment for 2 to 4 months to model rising E2 levels in aging men. The incidence of high-grade prostate intraepithelial neoplasia and adenocarcinoma markedly increased from 13% in oil-fed controls to 33% to 36% in grafts exposed in vivo to BPA (P < .05). Continuous developmental BPA exposure through in vitro (200 nM) plus in vivo (250 μg/kg body weight) treatments increased high-grade prostate intraepithelial neoplasia/cancer incidence to 45% (P < .01). Together, the present findings demonstrate that human prostate stem-progenitor cells are direct BPA targets and that developmental exposure to BPA at low doses increases hormone-dependent cancer risk in the human prostate epithelium.

Background: The hospital-based palliative care team model has been implemented in most Western countries, but this model is new in Taiwan and there is little research to evaluate its outcomes., Objectives: The purpose of this study was to evaluate the effects of the hospital-based palliative care team on the care for cancer patients., Design: The design was a quasi-experimental study with a pretest-posttest design., Setting: A medical center, National Taiwan University Hospital in Taipei, Taiwan., Participants: Cancer patients were excluded after the hospital-based palliative care team visited if they were unable to give informed consent, were not well enough to finish the baseline assessment, were likely to die within 24h or would be discharged within 24h, or could not communicate in Mandarin or Taiwanese. A sample of 60 patients who consulted the hospital-based palliative care team was recruited., Methods: Patients recruited to the study were divided to receive the usual care only (control group, n=30) or the usual care plus visits from the hospital-based palliative care team (intervention group, n=30). Data were collected using questionnaires including the Symptom Distress Scale, Hospital Anxiety and Depression Scale, Spiritual Well-Being Scale, and Social Support Scale at the initial assessment and one week later., Results: Comparison between groups revealed that the degree change for edema, fatigue, dry mouth, abdominal distention, and spiritual well-being in the intervention group showed significant improvement compared to the control group (p<0.05). However, there was no difference between groups on measures of anxiety, depression and feeling of social support. Within group analysis showed patients' pain score, dyspnea, and dysphagia improved in both groups (p<0.05). In addition, the average degree of constipation and insomnia in the control group declined from baseline (p<0.05), while the degree of edema, fatigue, dry mouth, appetite loss, abdominal distention, and dizziness decreased significantly in the intervention group (p<0.05)., Conclusion: The findings indicated the hospital-based palliative care team can improve the care for patients in relation to symptom management and spiritual well-being. The hospital-based palliative care team is a good care model for patients and worth implementing in clinical practice in Taiwan. The results also provide a general understanding about how the hospital-based palliative care team works in Taiwanese culture., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Multifractal spectrum analysis of dynamic contrast enhanced (DCE) breast MR images was used to establish a new quantitative analysis method for solid tumor blood perfusion and to explore its applicability in evaluating efficacy of breast cancer chemotherapy. Five randomly selected patients suffering from newly diagnosed malignant breast nodule lesions were enrolled in this study, and four of them were treated with neoadjuvant chemotherapy. Their DCE breast MR images were collected before and after treatment. Chemotherapeutic efficacy was analyzed using international response evaluation criteria for solid tumors (RECIST). Sandbox method for statistical number density was employed to measure and calculate multifractal spectra of DCE breast MR images with spatiotemporal characteristics. Multifractal spectral data of malignant lesions before and after chemotherapy were compared. Multifractal spectra of malignant lesions show an asymmetric bell-shape. Chemotherapy efficacy was assessed to be partial remission (PR) for three patients and their multifractal spectral width significantly increased after chemotherapy while to be stable disease (SD) for other patient and of her changed slightly. Multifractal spectral width correlates with blood-supply condition of tumor lesion before and after chemotherapy, providing a potential suitable characteristic parameter for evaluating chemotherapeutic efficacy quantitatively.

Aims and Objectives: To explore the essence of the illness experiences of middle-aged men with oral cancer., Background: Having oral cancer creates great challenges in the lives of middle-aged men and their families. Understanding patients' experiences provides a sound basis for patient-centred and individualised care. Research is limited regarding the illness experience of middle-aged men with oral cancer with regard to facing both the invasion of disease and the responsibilities of middle age., Design: A phenomenology approach was used., Methods: Nine men diagnosed with oral cancer within one year were recruited during 2009 and 2010. Data were collected through individual in-depth interviews and analysed using Colaizzi's phenomenological analysis procedures., Results: The following five themes emerged from the patterns of categorised interview data: the psychological journey in facing oral cancer, the question of how patients can control their disease as well as the sequelae of cancer treatment, the continuous disturbance and turmoil resulting from the disease, the appreciation of the support from family and friends, and the ability to learn to actively face the future., Conclusions: Patients with oral cancer experienced tremendous physical, psychosocial and financial challenges. Although burdened with multiple stressors, these middle-aged men were able to learn from their experiences and exhibit positive growth in life., Relevance to Clinical Practice: Patients with oral cancer have to constantly adjust to the impact of their disease. The study results may serve as a reference for improving clinical practice and the quality of care among patients with oral cancer. Cancer care is multidimensional and holistic. Healthcare professionals should develop a set of plans by which patients receive complete medical care and support, as well as assistance from professionals and family members, as their treatment progresses to help patients face the challenges of cancer., (© 2013 John Wiley & Sons Ltd.)

The brain of a human neonate is more vulnerable to hypoglycemia than that of pediatric and adult patients. Repetitive and profound hypoglycemia during the neonatal period (RPHN) causes brain damage and leads to severe neurologic sequelae. Ex vivo high-resolution (1)H nuclear magnetic resonance (NMR) spectroscopy was carried out in the present study to detect metabolite alterations in newborn and adolescent rats and investigate the effects of RPHN on their occipital cortex and hippocampus. Results showed that RPHN induces significant changes in a number of cerebral metabolites, and such changes are region-specific. Among the 16 metabolites detected by ex vivo (1)H NMR, RPHN significantly increased the levels of creatine, glutamate, glutamine, γ-aminobutyric acid, and aspartate, as well as other metabolites, including succine, taurine, and myo-inositol, in the occipital cortex of neonatal rats compared with the control. By contrast, changes in these neurochemicals were not significant in the hippocampus of neonatal rats. When the rats had developed into adolescence, the changes above were maintained and the levels of other metabolites, including lactate, N-acetyl aspartate, alanine, choline, glycine, acetate, and ascorbate, increased in the occipital cortex. By contrast, most of these metabolites were reduced in the hippocampus. These metabolic changes suggest that complementary mechanisms exist between these two brain areas. RPHN appears to affect occipital cortex and hippocampal activities, neurotransmitter transition, energy metabolism, and other metabolic equilibria in newborn rats; these effects are further aggravated when the newborn rats develop into adolescence. Changes in the metabolism of neurotransmitter system may be an adaptive measure of the central nervous system in response to RPHN.

Many tumors are stiffer than their surrounding tissue. This increase in stiffness has been attributed, in part, to a Rho-dependent elevation of myosin II light chain phosphorylation. To characterize this mechanism further, we studied myosin light chain kinase (MLCK), the main enzyme that phosphorylates myosin II light chains. We anticipated that increases in MLCK expression and activity would contribute to the increased stiffness of cancer cells. However, we find that MLCK mRNA and protein levels are substantially less in cancer cells and tissues than in normal cells. Consistent with this observation, cancer cells contract 3D collagen matrices much more slowly than normal cells. Interestingly, inhibiting MLCK or Rho kinase did not affect the 3D gel contractions while blebbistatin partially and cytochalasin D maximally inhibited contractions. Live cell imaging of cells in collagen gels showed that cytochalasin D inhibited filopodia-like projections that formed between cells while a MLCK inhibitor had no effect on these projections. These data suggest that myosin II phosphorylation is dispensable in regulating the mechanical properties of tumors.

Background: Antibiotic administration is frequent in terminal patients with cancer, yet the effects on survival are still under debate., Objective: The aim of this study was to examine the status of infection and the benefit/burden of antibiotic administration on the survival of terminal patients with cancer with infection., Design: A prospective observational study., Setting/subjects: We studied 799 patients with terminal cancer who were admitted to a palliative care unit in Taiwan between January 2008 and the end of April 2010. Survival was calculated from the first day of admission to the day of death in the palliative care unit or under home care., Measurements: A specially designed assessment tool was used daily to evaluate clinical conditions. Afterwards, it was analyzed at different time points in a weekly team meeting. Multivariate Cox proportional hazard analyses were used to examine the benefit/burden of antibiotic administration on survival., Results: Four hundred fifty-five patients were diagnosed as having at least one episode of infection after first admission. A total of 295 of the 378 (78.0%) with infection received antibiotic treatment upon admission. Multivariate Cox proportional hazard analyses showed that antibiotic administration was related to improved survival for patients who were still alive 1 week after admission (hazard ratio: 0.66, 95% confidence interfal [CI]: 0.46-0.95). However, antibiotics would be a hazard to patients' survival if used in the time 2 days prior to death (hazard ratio: 1.54, 95% CI: 1.22-1.94)., Conclusions: The results suggest that with good communication between patients, families, and medical staff, withdrawal of antibiotics should be considered if signs of death appear, in order to avoid unnecessary risks. The possible benefit of prolonged survival should be in line with the goal of care, and also take into account preparing the patient for a dignified death.

The strain effect on the ferroelectric and magnetoelectric coupling in multiferroic tunnel junction (MFTJ) Co/BaTiO3/Co has been investigated systematically by using first-principles calculations within density functional theory. It is found that both in-plane compressive strain and uniaxial tensile strain lead to the enhancement of ferroelectric polarization stability and intensity of magnetoelectric coupling in the MFTJ. There is a transition from the paraelectric phase to the ferroelectric phase for the BaTiO3 layer in MFTJ when the loaded in-plane compressive strain increases up to -2.8% and the corresponding average ferroelectric polarization is about 0.13 C m(-2). Meanwhile, the calculated surface magnetoelectric coefficients increase with increasing in-plane compressive strain. Similar phenomena have been also observed in the case of uniaxial tensile strain implemented in MFTJ. The results suggest that the ferroelectric polarization and magnetoelectric coupling in multiferroic tunnel junctions can be controlled by strain and we expect that this study can provide a theoretical basis for the design of spintronic devices.

Objective: The aim of the study was to explore the relationships between truth telling, patients' psycho-spiritual state and do not resuscitate consent., Methods: Cancer patients who had consulted with hospice care at the National Taiwan University Hospital in Taipei were approached. Patients excluded from the study included those who were unable to give informed consent, not well enough to complete the questionnaire survey, would be discharged within 24 h or who could not communicate in Chinese or Taiwanese. The 90 patients recruited for the study were grouped according to their awareness of their terminal prognosis ('aware' or 'unaware'). A structured questionnaire was used for data collection, including questions on uncertainty, the Hospital Anxiety and Depression Scale and the Spiritual Well-being Scale., Results: Truth telling reduced cancer patients' uncertainty (P = 0.023) and anxiety (P = 0.005), and did not affect their state of spiritual well-being (P = 0.868). Before hospice referral, patients aware of their prognosis were more likely to sign the do not resuscitate consent (P = 0.040). In the aware group, 28% signed the do not resuscitate themselves, whereas in the unaware group, only 5% signed the do not resuscitate themselves (P = 0.031). The median time between signing the do not resuscitate and death was 29 days in the aware group and 16 days in the unaware group. Data revealed that 82% of the aware group died having given their do not resuscitate consent and did not receive a vasopressor or intubation, whereas only 52% of the unaware group died in this manner., Conclusions: Truth telling can reduce cancer patients' uncertainty and anxiety. Patients aware of their prognosis tended to sign the do not resuscitate consent willingly and had more dignified and peaceful deaths.

The study was carried out to investigate the immunomodulation mechanism of carboxymethylpachymaran (CMP). Chicken splenic lymphocytes were cultured in medium alone or with CMP at the final concentration of 50mg/L, 100mg/L, 200mg/L or 400mg/L in vitro for 4h, 8h, 12h or 24h, respectively. The supernatants at different culture periods were analyzed for changes in levels of 6-keto-prostaglandin F1α (6-keto-PGF1α), thromboxane B2 (TXB2) and nitric oxide (NO). The cells were collected to determine contents of oxidized glutathione (GSSG), reduced glutathione (GSH), cyclic AMP (cAMP) and cyclic GMP (cGMP). The results showed that CMP increase the values of NO, 6-keto-PGF1α, TXB2, and the ratio of 6-keto-PGF1α to TXB2 in supernatants. The contents of intracellular GSH, cAMP, cGMP and the ratio of cAMP to cGMP were increased in the cells treated with CMP. The results suggested that CMP enhanced immune functions by increasing the contents of GSH and by regulating arachidonic acid signal transduction systems in chicken splenic lymphocytes. The signal pathway of NO-cGMP plays an important role in CMP-induced activation of chicken splenic lymphocytes., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Objective: Community physicians have a vital role in delivering palliative care, yet their willingness and factors that influence its provision have rarely been explored. Our aims were to identify the willingness of community physicians to provide palliative care for patients with terminal cancer and to investigate the factors that influence their willingness to provide such care., Methods: Through a structured questionnaire, this nationwide study surveyed 708 community physicians who were potential pilots to provide palliative care. Four hundred and ten valid questionnaires (58.0%) were retrieved and analysed., Results: The majority of respondents expressed a willingness (92.4%) to provide palliative care if they encountered patients with terminal cancer. However, they would limit their services to consultation (83.4%) and referral (86.8%), and were less likely to see patients and prescribe medicine (62.0%), to provide phone follow-ups (45.6%), to provide home visits (42.2%) or to offer bereavement care for the family (35.1%). The results of stepwise logistic regression analysis for the willingness to provide home visits showed that 'less perception of barriers', 'family medicine specialist' and 'older than 50 years' significantly predicted higher willingness, while 'female' predicted lower willingness. There was no significant association between the willingness and the knowledge score., Conclusions: Community physicians' beliefs and experience in palliative care rather than their knowledge influence their willingness to provide palliative care for patients with terminal cancer. Only through active participation in the real-world clinical setting and active health policy administration can community physicians overcome obstacles to providing palliative care.

Background: Compassion is the key value of humanities perspective. Little is known, however, concerning the impact of enhancing compassion on ethical decision making in end-of-life care., Methods: A total of 251 preclinical medical students were enrolled in a palliative care training course. A structured self-report questionnaire was administered before and after training., Results: Experience with caring for patients with terminal cancer was positively related to improvement in the decision of "truth telling is helpful to a good death." In addition, improvement in the perception of "compassionate care" was correlated with higher improvement in the decision of "discharge planning and home care.", Conclusion: Compassion-focused training program can be helpful to improve medical students' competence in making more appropriate ethical decisions in end-of-life care.

Nurses are expected to care for grieving women and families suffering from perinatal loss. However, these losses can also significantly impact upon the emotional state of nurses. Failure to adjust may endanger the affected nurse's health and render him or her unable or unwilling to provide continuous quality care. There has been little prior research addressing the effect of patient perinatal loss on nurses tasked with providing nursing care. This paper focuses on internal perceptions and external stresses to explore the impact of this traumatic experience on nurses and related coping strategies. We found that nurses experience a grieving process similar to those directly suffering from perinatal loss. Nurses feel sadness, incompetence, and helplessness but dare not cry in order to protect their professional image. They may also worry about the potential legal risks of verbalizing or otherwise expressing their feelings. Strategies frequently used to adjust to the emotional strain include limiting his or her commitment to the patient, seeking emotional escape, and talking to colleagues. Therefore, it is important to develop institute- or hospital-based emotional support networks and training programs and evidence-based nursing care standards for this important issue. This paper also suggests future policies, nursing strategies and further research directions.

Objectives: This study had two purposes: (1) To explore the mediating effects of substance use-as indicated by alcohol consumption, cigarette smoking, and betel-nut chewing-on the relationship between socioeconomic status (SES) and metabolic syndrome; and (2) to examine the way gender moderates any mediating effects of substance use., Design and Sample: Secondary analyses were conducted on a cross-sectional national dataset. The data from 3,107 males and 3,081 females of Taiwanese were analyzed., Measures: The prevalence of metabolic syndrome, education level, occupation, age, body weight, body height, and behaviors were collected., Results: In male subjects, SES had no direct effect on metabolic syndrome; however, cigarette smoking and betel-nut chewing, but not alcohol consumption, were found to have mediating effects on SES and metabolic syndrome. In females, SES was found to have a direct effect on metabolic syndrome; however, substance use had no mediating effects on the relationship between SES and metabolic syndrome. These differences, in males and females indicated that the mediating effect of substance use on the relationship between SES and metabolic syndrome is moderated by gender., Conclusions: Our study suggests that health care providers may need to provide gender-specific health promotion programs to prevent metabolic syndrome., (© 2012 Wiley Periodicals, Inc.)

For drug candidates, a plasma protein binding (PPB) more than 90% is more meaningful and deserves further investigation in development. In the study, a high-performance liquid chromatography method employing column containing immobilized human serum albumin (HSA) to screen in vitro PPB of leading compounds was established and successfully applied to tested compounds. Good correlation (a coefficient correlation of 0.96) was attained between the reciprocal values (X) of experimentally obtained retention time of reference compounds eluted through HSA column and the reported PPB values (Y) with a correlation equation of Y = 92.03 - 97.01X. The method was successfully applied to six test compounds, and the result was confirmed by the conventional ultrafiltration technique, and both yielded equal results. However, due to the particular protein immobilized to column, the method cannot be applied for all compounds and should be exploited judiciously based on the value of the logarithmic measure of the acid dissociation constant (pKa) as per the requirement. If α1-acid glycoprotein and other plasma proteins could be immobilized like HSA with their actual ratio in plasma to column simultaneously, the result attained using immobilized column may be more accurate, and the method could be applied to more compounds without pKa limitation.

Objective: To investigate the expression of CK19 in HBV-related hepatocellular carcinoma (HCC) tissues in patients with low serum AFP concentration and the relationship between them and the recurrence and prognosis of HCC after R0 radical hepatectomy., Methods: The expressions of CK19 and Ki67 in HCC tissues of 235 cases were examined using tissue microarray and two-step methods of PV-6000 immunohistochemistry. The expression of CK19 mRNA in 20 frozen HCC specimens was examined by RT-PCR. The correlation between gene expressions and tumor recurrence and prognosis was analyzed., Results: Among the 235 HBV-related HCC patients after R0 radical hepatectomy, the median disease-free survival (DFS) was 31.2 months in the patients with serum AFP < 400 µg/L and 13.8 months in the patients with serum AFP ≥ 400 µg/L (P = 0.041), the overall survival (OS) was 84.0 and 58.6 months in the two subgroups (P = 0.125), and the tumor recurrence within one year was in 43 cases (27%) and 37 cases (49.3%), respectively, (P = 0.001). The DFS was 11.6 months in the CK19-positive cases and 27.0 months in the CK19-negative cases (P > 0.05). The OS was significantly lower in the CK19-positive cases than that in the CK19-negative cases (P = 0.023). Both DFS and OS in the CK19-positive cases with AFP < 400 µg/L were significantly lower than those in the CK19-negative cases with AFP < 400 µg/L (both P < 0.05). The CK19 expression was significantly correlated with histological differentiation (P = 0.023), number of tumor foci (P = 0.044), vascular tumor embolism (P = 0.005), regional lymph node metastasis (P = 0.023), and 1-year recurrence (P = 0.006). Among the patients with AFP < 400 µg/L, the 1-year recurrence was 53% in the CK19-positive cases and 23% in the CK19-negative cases (P < 0.001), the median DFS was 11.3 months in CK19-positive cases and 34.0 months in CK19-negative cases (P = 0.010), and the median OS was 19.5 months in the CK19-positive cases, significantly lower than 84.0 months in the CK19-negative cases (P = 0.001). Cox regression analysis showed that CK19-positive expression was an independent factor affecting early HCC recurrence and prognosis., Conclusion: In HBV-related HCC patients after radical hepatectomy with AFP < 400 µg/L, positive expression of CK19 indicates a higher proliferation and invasiveness of HCC, and is an important factor of early recurrence and poor prognosis.

Studying the spectral property of salinized soil is an important work, for it is the base of monitoring soil salinization by remote sense. To investigate the spectral property of salinized soil and the relationship between the soil salinity and the hyperspectral data, the field soil samples were collected in the region of Northeast China and then reflectance spectra were measured. The partial least squares regression (PLSR) model was established based on the statistical analysis of the soil salinity content and the reflectance of hyperspectra. The feasibility of soil salinity prediction by hyperspectra was decided by analyzed calibration model and independent validation. Models accuracy was also analyzed, which was established in the conditions of different treatment methods and different re-sampling intervals. The results showed that it was feasible to predict soil salinity content based on measured reflectance spectrum. The results also revealed that it was necessary to smooth measured hyperspectra for spectral prediction accuracy to be improved significantly after smoothing. The best model was established based on smoothed and log(l/x) transformed hyperspectra with high determination coefficients (R2) of 0.6677 and RPD = 1.61, which showed that this math transformation could eliminate noise effectively and so as to improve the prediction accuracy. The largest re-sampling interval is 8 nm that could meet the accuracy of the soil salinity prediction. Therefore, it provided scientific reference of monitoring soil salinization by remote sensing from satellite platform.

Background: Achieving a good death is the ultimate goal of palliative medicine. Yet, very few studies have investigated factors affecting improvement in quality of dying. We therefore conducted a study to evaluate these factors in terminally ill Taiwanese cancer patients treated in a multidisciplinary palliative care unit., Methods: We included data from terminally ill patients with cancer admitted to the Hospice and Palliative Care Unit in the National Taiwan University Hospital from 2000 to 2009. Quality of dying was assessed by patients' multidisciplinary team at admission and after death using the Good Death Scale and the Audit Scale. We used multivariable regression to assess the association between patient factors, including gender, age, diagnosis, days of hospitalization, calendar year of admission, Good Death score at admission, and process of care scores for physical care, physician-assessed autonomy, emotional support, communication, continuity of life, and physician-reported rate of closure, with the quality of dying., Results: Multivariate regression analysis identified lower Good Death score at admission, lower age 40-65 years, longer unit length of stay (>7 days), higher physician-assessed autonomy, better physician-assessed emotional support, and better physician-reported rate of closure as positively related (all p<0.0001) with improvement in good death scores., Conclusion: In this study in a Taiwanese palliative care unit; we found that late referral to the unit and low physician-assessed autonomy were key factors negatively affecting quality of dying. Earlier truth-tellling and end-of-life care discussions between physicians and patients might improve the quality of dying in this population.