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A postal survey was sent to anaesthetic trainees in Hong Kong and Victoria, Australia to compare work-related stress levels. Demographic data were collected. Anaesthetist-specific stressors, Maslach Burnout Inventory and Global Job Satisfaction scores were used for psychological testing. The response rates from Hong Kong and Melbourne were 64 of 133 (48.1%) and 108 of 196 (55.1%), respectively. Victorian respondents were older with greater family commitments, but more advanced in fulfilling training requirements. Hong Kong respondents, being faced with both the challenge of dual College requirements, exhibited consistently higher indices of stress (P < 0.001) and less job satisfaction (P < 0.001). Common occupational stressors related to dealing with critically ill patients and medicolegal concerns. Higher stress scores observed in Hong Kong trainees related to service provision and a perceived lack of resources. Despite the complex nature of stress, its antecedents and manifestations, an inverse relationship between emotional exhaustion and job satisfaction was evident in correlation analysis (P < 0.001). This survey suggests that stress was present in some trainees in both areas. Hong Kong trainees may benefit from local development to address mental wellbeing as being important to fulfil this highly competitive training program. [ABSTRACT FROM AUTHOR]

Introduction: Cisplatin is one of the most effective chemotherapeutic drugs used in oral cancer treatment, but systemic administration has side effects. The purpose of this study was to evaluate the effect of iontophoresis on the enhancement of cisplatin release from cisplatin-encapsulated chitosan nanoparticles., Methods: The effect of different mass ratios of chitosan to tripolyphosphate (TPP) (5:1, 10:1, 15:1, 20:1) on the encapsulation efficiency of cisplatin was investigated. Uptake of cisplatin-encapsulated chitosan by cells was observed using a confocal laser scanning microscope. The cell viability at different cisplatin concentrations was examined using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Three iontophoresis methods, namely constant-current chronopotentiometry (CCCP), cyclic chronopotentiometry (CCP), and differential pulse voltammetry (DPV), were used to enhance cisplatin release from cisplatin-encapsulated chitosan nanoparticles. In addition, mouse oral squamous cell carcinoma cell lines were implanted into the mouse oral mucosa to induce oral cancer. The effects of enhanced cisplatin release by CCCP, CCP, and DPV on tumor suppression in mice were evaluated. Tumors and lymph nodes were isolated for hematoxylin-eosin staining and immunohistochemistry staining including Ki-67 and pan CK after sacrifice. Inductively coupled plasma mass spectrometry was conducted to quantify the platinum content within the tumors., Results: The results showed that nanoparticles with a mass ratio of 15:1 exhibited the highest cisplatin encapsulation efficiency (approximately 15.6%) and longest continued release (up to 35 days) in phosphate buffered saline with a release rate of 100%. Cellular uptake results suggested that chitosan nanoparticles were delivered to the cytoplasm via endocytosis. The results of the MTT assay revealed that the survival rate of cells decreased as the cisplatin concentration increased. The CCP (1 mA, on:off = 1 s: 1 s) and DPV (0-0.06 V) groups were the most effective in inhibiting tumor growth, and both groups exhibited the lowest percentage of Ki-67 positive and pan CK positive., Conclusion: This study is the first to investigate and determine the efficacy of DPV in enhancing in vivo drug release from nanoparticles for the treatment of cancer in animals. The results suggest that the CCP and DPV methods have the potential to be combined with surgery for oral cancer treatment., Competing Interests: The authors declare that they have no conflicts of interest., (© 2024 Chen et al.)

Purpose: The innate immune response, particularly the reaction of polymorphonuclear neutrophils (PMNs), is crucial in shaping the outcomes of chronic inflammation, fibrosis, or osseointegration following biomaterial implantation. Peri-implantitis or peri-mucositis, inflammatory conditions linked to dental implants, pose a significant threat to implant success. We developed a single-cell analysis approach using a murine model to assess the immune response to implant materials, offering a practical screening tool for potential dental implants., Methods: We performed bioinformatics analysis and established a peri-implant inflammation model by inserting two titanium implants into the maxillary region, to examine the immune response., Results: Bioinformatics analysis revealed that titanium implants triggered a host immune response, primarily mediated by PMNs. In the in vivo experiments, we observed a rapid PMN-mediated response, with increased infiltration around the implants and on the implant surface by day 3. Remarkably, PMN attachment to the implants persisted for 7 days, resembling the immune profiles seen in human implant-mediated inflammation., Conclusions: Our findings indicate that persistent attachment of the short-living PMNs to titanium implants can serve as an indicator or traits of peri-implant inflammation. Therefore, analyzing gingival tissue at the single-cell level could be a useful tool for evaluating the biocompatibility of candidate dental implants.

Cystathionine γ-lyase (CSE) is a major enzyme that produces hydrogen sulfide (H 2 S). Herein, we report how CSE plays a previously unknown role in regulating the antioxidant effects of the mitochondria in human umbilical vein endothelial cells by releasing H 2 S nearby under stress conditions. We found that H 2 S partially promoted angiogenesis in the endothelial cells through the AKT/nuclear factor erythroid 2-related factor 2 (AKT/NRF2) signaling pathway. H 2 S improved mitochondrial function by altering the expressions of the mitofusin2 and dynamin-1-like mitochondrial fission proteins to inhibit oxidative stress and enhance NRF2 nuclear translocation. CSE is located only in the cytoplasm and not in the mitochondria, but it is transported to the vicinity of the mitochondria to produce H 2 S, which plays an antioxidant role in human umbilical vein endothelial cells under stress. The CSE mutant (with mutated CSE activity center: CSE D187A ) partially decreased the effects on promoting angiogenesis, resisting oxidative stress, and entering the mitochondria. These results show that CSE translocation is a unique mechanism that promotes H 2 S production inside the mitochondria under stress stimulation. Therefore, the CSE mutant site (CSE D187A ) may be a potential target for drug therapy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Xiao, Chen, Yan, Zheng, Qiu, Lin, Zong, Chang, Yu Chang, Wu and Hou.)

Aim: Increasing evidence has proposed that mitochondrial abnormalities may be an important factor contributing to the development of heart failure with preserved ejection fraction (HFpEF). Hydrogen sulfide (H 2 S) has been suggested to play a pivotal role in regulating mitochondrial function. Therefore, the present study was designed to explore the protective effect of H 2 S on mitochondrial dysfunction in a multifactorial mouse model of HFpEF., Methods: Wild type, 8-week-old, male C57BL/6J mice or cardiomyocyte specific-Cse (Cystathionine γ-lyase, a major H 2 S-producing enzyme) knockout mice (CSE cko ) were given high-fat diet (HFD) and l-NAME (an inhibitor of constitutive nitric oxide synthases) or standardized chow. After 4 weeks, mice were randomly administered with NaHS (a conventional H 2 S donor), ZLN005 (a potent transcriptional activator of PGC-1α) or vehicle. After additional 4 weeks, echocardiogram and mitochondrial function were evaluated. Expression of PGC-1α, NRF1 and TFAM in cardiomyocytes was assayed by Western blot., Results: Challenging with HFD and l-NAME in mice not only caused HFpEF but also inhibited the production of endogenous H 2 S in a time-dependent manner. Meanwhile the expression of PGC-1α and mitochondrial function in cardiomyocytes were impaired. Supplementation with NaHS not only upregulated the expression of PGC-1α, NRF1 and TFAM in cardiomyocytes but also restored mitochondrial function and ultrastructure, conferring an obvious improvement in cardiac diastolic function. In contrast, cardiac deletion of CSE gene aggravated the inhibition of PGC-1α-NRF1-TFAM pathway, mitochondrial abnormalities and diastolic dysfunction. The deleterious effect observed in CSE cko HFpEF mice was partially counteracted by pre-treatment with ZLN005 or supplementation with NaHS., Conclusion: Our findings have demonstrated that H 2 S ameliorates left ventricular diastolic dysfunction by restoring mitochondrial abnormalities via upregulating PGC-1α and its downstream targets NRF1 and TFAM, suggesting the therapeutic potential of H 2 S supplementation in multifactorial HFpEF., Competing Interests: Declaration of competing interest The authors declares that there is no conflict of interest regarding the publication of this article., (Copyright © 2023. Published by Elsevier Inc.)

Objectives: Titanium implants are regarded as a promising treatment modality for replacing missing teeth. Osteointegration and antibacterial properties are both desirable characteristics for titanium dental implants. The aim of this study was to create zinc (Zn)-, strontium (Sr)-, and magnesium (Mg)-multidoped hydroxyapatite (HAp) porous coatings, including HAp, Zn-doped HAp, and Zn-Sr-Mg-doped HAp, on titanium discs and implants using the vapor-induced pore-forming atmospheric plasma spraying (VIPF-APS) technique., Methods: The mRNA and protein levels of osteogenesis-associated genes such as collagen type I alpha 1 chain (COL1A1), decorin (DCN), osteoprotegerin (TNFRSF11B), and osteopontin (SPP1) were examined in human embryonic palatal mesenchymal cells. The antibacterial effects against periodontal bacteria, including Porphyromonas gingivalis and Prevotella nigrescens , were investigated. In addition, a rat animal model was used to evaluate new bone formation via histologic examination and micro-computed tomography (CT)., Results: The ZnSrMg-HAp group was the most effective at inducing mRNA and protein expression of TNFRSF11B and SPP1 after 7 days of incubation, and TNFRSF11B and DCN after 11 days of incubation. In addition, both the ZnSrMg-HAp and Zn-HAp groups were effective against P. gingivalis and P. nigrescens . Furthermore, according to both in vitro studies and histologic findings, the ZnSrMg-HAp group exhibited the most prominent osteogenesis and concentrated bone growth along implant threads., Significance: A porous ZnSrMg-HAp coating using VIPF-APS could serve as a novel technique for coating titanium implant surfaces and preventing further bacterial infection.

Background: Available evidence suggests that cognitive impairment (CI), which leads to deficits in episodic memory, executive functions, visual attention, and language, is associated with difficulties in the capacity to perform activities of daily living. Hence any forecast of the future prevalence of functional disability should account for the likely impact of cognitive impairment on the onset of functional disability. Thus, this research aims to address this gap in literature by projecting the number of older adults in China with functional disability and cognitive impairment while accounting for the impact of cognitive impairment on the onset of functional disability., Methods: We developed and validated a dynamic multi-state population model which simulates the population of China and tracks the transition of Chinese older adults (65 years and older) from 2010 to 2060, to and from six health states-(i) active older adults without cognitive impairment, (ii) active older adults with cognitive impairment, (iii) older adults with 1 to 2 ADL limitations, (iv) older adults with cognitive impairment and 1 to 2 ADL limitations, (v) older adults with 3 or more ADL limitations, and (vi) older adults with cognitive impairment and 3 or more ADL limitations., Results: From 2015 to 2060, the number of older adults 65 years and older in China is projected to increase, of which the number with impairment (herein referred to as individuals with cognitive impairment and/or activity of daily living limitations) is projected to increase more than fourfold from 17·9 million (17·8-18·0) million in 2015 to 96·2 (95·3-97·1) million by 2060. Among the older adults with impairment, those with ADL limitations only is projected to increase from 3·7 million (3·6-3·7 million) in 2015 to 23·9 million (23·4-24·6 million) by 2060, with an estimated annual increase of 12·2% (12·1-12·3); while that for cognitive impairment only is estimated to increase from 11·4 million (11·3-11·5 million) in 2015 to 47·8 million (47·5-48·2 million) by 2060-this representing an annual growth of 7·07% (7·05-7·09)., Conclusion: Our findings suggest there will be an increase in demand for intermediate and long-term care services among the older adults with functional disability and cognitive impairment.

Background: In dealing with community spread of COVID-19, two active interventions have been attempted or advocated-containment, and mitigation. Given the extensive impact of COVID-19 globally, there is international interest to learn from best practices that have been shown to work in controlling community spread to inform future outbreaks. This study explores the trajectory of COVID-19 infection in Singapore had the government intervention not focused on containment, but rather on mitigation. In addition, we estimate the actual COVID-19 infection cases in Singapore, given that confirmed cases are publicly available., Methods and Findings: We developed a COVID-19 infection model, which is a modified SIR model that differentiate between detected (diagnosed) and undetected (undiagnosed) individuals and segments total population into seven health states: susceptible (S), infected asymptomatic undiagnosed (A), infected asymptomatic diagnosed (I), infected symptomatic undiagnosed (U), infected symptomatic diagnosed (E), recovered (R), and dead (D). To account for the infection stages of the asymptomatic and symptomatic infected individuals, the asymptomatic infected individuals were further disaggregated into three infection stages: (a) latent (b) infectious and (c) non-infectious; while the symptomatic infected were disaggregated into two stages: (a) infectious and (b) non-infectious. The simulation result shows that by the end of the current epidemic cycle without considering the possibility of a second wave, under the containment intervention implemented in Singapore, the confirmed number of Singaporeans infected with COVID-19 (diagnosed asymptomatic and symptomatic cases) is projected to be 52,053 (with 95% confidence range of 49,370-54,735) representing 0.87% (0.83%-0.92%) of the total population; while the actual number of Singaporeans infected with COVID-19 (diagnosed and undiagnosed asymptomatic and symptomatic infected cases) is projected to be 86,041 (81,097-90,986), which is 1.65 times the confirmed cases and represents 1.45% (1.36%-1.53%) of the total population. A peak in infected cases is projected to have occurred on around day 125 (27/05/2020) for the confirmed infected cases and around day 115 (17/05/2020) for the actual infected cases. The number of deaths is estimated to be 37 (34-39) among those infected with COVID-19 by the end of the epidemic cycle; consequently, the perceived case fatality rate is projected to be 0.07%, while the actual case fatality rate is estimated to be 0.043%. Importantly, our simulation model results suggest that there about 65% more COVID-19 infection cases in Singapore that have not been captured in the official reported numbers which could be uncovered via a serological study. Compared to the containment intervention, a mitigation intervention would have resulted in early peak infection, and increase both the cumulative confirmed and actual infection cases and deaths., Conclusion: Early public health measures in the context of targeted, aggressive containment including swift and effective contact tracing and quarantine, was likely responsible for suppressing the number of COVID-19 infections in Singapore., Competing Interests: The authors have declared that no competing interests exist.

Coronavirus disease 2019 (COVID-19) has caused a global pandemic and exerted a profound physiological and mental impact on the public. Due to anxiety from being bombarded by information from the news and social media, people may constantly read and repost, with a fear of missing out (FOMO), information about COVID-19 on social media. So far, there has been little research on COVID-19 FOMO. We therefore compiled the COVID-19 information fear of missing out scale (CIFS) and administered it to 1178 adults in Taiwan to identify the possible factors influencing CIFS scores. We demonstrated that the CIFS had good reliability, factor validity, and criterion validity. With regard to demographic variables, we found that gender, marital status, travel time to the nearest hospital, and educational background influenced CIFS scores. In contrast, the participant age and whether he or she lived in an urban area did not affect the CIFS scores. With regard to social media usage, social media usage time ( r = 0.025) and the numbers of COVID-19-related posts read on social media ( r = 0.117) or instant messaging ( r = 0.169) were not highly correlated with CIFS scores. Rather, CIFS scores were found to be significantly correlated to the frequency of reposting COVID-19-related information on social media ( r = 0.497) and on instant messaging ( r = 0.447). These results indicate that CIFS scores are closely associated not with passive browsing on social media but with the frequency at which an individual actively reposts information. In other words, what creates CIF is not an overabundance of information (i.e., an infodemic) but the active reposting and interpretation of information. Individual autonomy for interpretation of the received information and self-determination about reposting are key factors for COVID-19 information FOMO. When facing the COVID-19-related news on social media, it is the active information-related FOMO, not the passive infodemic, that influences our social media usage.

Purpose: The purpose of this study was to determine the clinical efficacy of an all-arthroscopic approach to autologous matrix-induced chondrogenesis (AMIC) for patients with articular cartilage lesions of the knee joint. We hypothesize that an all-arthroscopic, single-stage AMIC using a hyaluron-based cell-free scaffold improves the postoperative clinical scores for patients with isolated articular cartilage lesions of the knee in the early follow-up period., Methods: All patients with focal osteochondral lesions of the knee treated with AMIC at our institution from November 2013 to January 2018 were included for analysis. Demographic information, baseline clinical characteristics, perioperative imaging, and follow-up International Knee Documentation Committee (IKDC) scores at 6 and 24 months postoperatively were collected. One-way analysis of variance (ANOVA) with a Bonferroni correction was used to assess for improvement before and after surgery, with statistical significance defined as p < .05., Results: A total of 22 patients met the inclusion criteria and were analyzed for this study. Articular cartilage lesions were most commonly found at the center of the medial and lateral femoral condyles. Statistically significant improvements in IKDC scores were seen at the 6- and 24-month follow-up periods ( p < .05)., Conclusion: An all-arthroscopic technique for single-stage autologous matrix-induced chondrogenesis demonstrates significant early clinical improvement for the treatment of articular cartilage lesions of the knee., Level of Evidence: 4., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier Inc.)

Saksenaea vasiformis complex is an emerging cause of mucormycosis. We report a case of an immunocompetent patient presenting with a non-resolving lung mass who developed multiple skin nodules. Skin biopsy yielded Saksenaea vasiformis complex. This showcases an uncommon occurrence of disseminated Saksenaea infection without cutaneous inoculation that improved with posaconazole.

Background: The effect of perioperative music listening has been proven to relieve preoperative anxiety and depression, while improving patient satisfaction. However, music listening has not been extensively studied in Singapore. Therefore, the primary aim of our study is to investigate the patient satisfaction towards perioperative music listening in the local setting. The secondary aim is to investigate the effect of perioperative music listening in reducing patient surgery-related anxiety and depression., Methods: After obtaining ethics board approval, we conducted a quasiexperimental study on a cohort of female patients who were undergoing elective minor gynaecological surgeries. Apple iPod Touch™ devices containing playlists of selected music genres and noise-cancelling earphones were given to patients to listen during the preoperative and postoperative periods. Hospital Anxiety and Depression Scale (HADS), EQ-5D-3L questionnaire, music listening preferences, and patient satisfaction surveys were administered. Wilcoxon signed-rank and McNemar's tests for paired data were used for analysis., Results: 83 patients were analysed with 97.6% of patients in the preoperative period and 98.8% of patients in the postoperative period were satisfied with music listening. The median (IQR [range]) score for preintervention HADS anxiety was 7.0 (6.0 [0-17]), significantly higher than that in postintervention at 2.0 (4.0 [0-12]) ( P < 0.001). Similarly, there was a significant reduction in preintervention HADS depression as compared to postintervention ( P < 0.001). Similarly, there was a significant reduction in preintervention HADS depression as compared to postintervention (., Conclusion: Perioperative music listening improved patient satisfaction and can reduce patient anxiety and depression. We hope to further investigate on how wider implementation of perioperative music listening could improve patient care., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this article., (Copyright © 2020 Daryl Jian An Tan et al.)

Mucus plugging plays a vital role in the pathophysiology of fatal and near fatal asthma as demonstrated in various postmortem studies. There is a paucity of published literature on how to manage mucus plugging in adult patients with refractory asthma exacerbation not responding to conventional therapies as compared with its paediatric cohort. We describe a dramatic improvement with the use of rhDNase, following bronchoalveolar lavage in an intubated adult female patient, with status asthmaticus refractory to conventional treatment.

Dynamic and time-of-flight (TOF) secondary ion mass spectrometry (SIMS) was performed on vertically standing III-V nanowire ensembles embedded in Cyclotene polymer. By embedding the NWs in Cyclotene, the top surface of the sample was made planar, while the space between the NWs was filled to protect the background substrate from the ion beam, thus allowing for the NWs to be sputtered and analyzed evenly as a function of depth. Using thin film standards, SIMS analysis was used to calculate the impurity dopant concentration as a function of height in the NW ensemble. This marked the first use of conventional SIMS to accurately determine the doping density with excellent depth resolution. Additionally, this is the first presentation of SIMS as the only reported tool for characterizing the segment height uniformity of any arbitrary axial heterostructure NW ensemble.

The viability of four organic polymers (S1808, SC200, SU8 and Cyclotene) as filling materials to achieve planarization of ensemble nanowire arrays is reported. Analysis of the porosity, surface roughness and thermal stability of each filling material was performed. Sonication was used as an effective method to remove the tops of the nanowires (NWs) to achieve complete planarization. Ensemble nanowire devices were fully fabricated and I-V measurements confirmed that Cyclotene effectively planarizes the NWs while still serving the role as an insulating layer between the top and bottom contacts. These processes and analysis can be easily implemented into future characterization and fabrication of ensemble NWs for optoelectronic device applications.