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To examine the association of the working stress with posttraumatic stress disorder symptoms (PTSD), and burnout as the mediator for this association among emergency nurses during COVID-19 pandemic.Longitudinal survey study.Online survey was used to collect data during the period from August to November 2020 with a sample of 169 emergency nurses. They were invited to complete the following questionnaires at the 6th and 9th months after COVID-19 outbreak: Posttraumatic Symptom Scale (PTSS-10), the emergency nurses' COVID-19 stress questionnaire and Chinese version of 21-item Copenhagen Burnout Inventory (CBI).During the 3-month follow-up, there were no changes in the number of suspected PTSD cases (6 and above symptoms): 41% at the 6th month and 33.3% at the 9th month. The increases of the personal burnout levels and living apart from families were the main factors associated with the PTSD symptoms. The risk for emergency nurses suffering from PTSD is through stress levels increasing their burnout levels.Over 30 percent of emergency nurses remained at high risk for suspected PTSD. The burnout levels mediated the relationship between the stress levels and the risks of PTSD.Little as know about the impact of COVID-19 on emergency nurses' stress. This study found emergency nurses remained to be the high risk for the suspected PTSD cases. It is urged to develop a stress-reduction program targeting at causes of stress and improving burnout for emergency nurses during COVID-19 pandemic.

Background The COVID-19 frontline nurses' stress-reduction program by the cooperation of manager with the nurses is not-well developed. Aim This study aimed to examine the effect of an emergency nurse-led stress reduction project on reducing stress levels during the COVID-19 pandemic. Methods The action research was conducted using online and person-to-person group brainstorming strategies. The online survey was used to evaluate emergency nurses' stress levels, causes of stress, and needs at the 50th, 80th, and 110th days of the pandemic from March to May 2020. Results The numbers of nurses participating in three-time survey were 160, 166, and 160, respectively. There was a decrease in the nurses' work-related stress after implementing the improvement strategies. Stress from PPE, information about infection control, family's worry about being infected reduced across 2 months. Needs regarding PPE, COVID-19 information, and a forum for sharing experiences of COVID-19 care decreased while needs of allowing more days off increased. Conclusions The stress-reduction project targeting at nurses' views of their needs can reduce their' stress during the COVID-19 pandemic. Implication for nursing management The online and person-to-person group brainstorming building a good partnership between nurses and managers can be an effective nursing management.

Targeted-therapy failure in treating nonsmall cell lung cancer (NSCLC) frequently occurs because of the emergence of drug resistance and genetic mutations. The same mutations also result in aerobic glycolysis, which further antagonizes outcomes by localized increases in lactate, an immune suppressor. Recent evidence indicates that enzymatic lowering of lactate can promote an oncolytic immune microenvironment within the tumour. Here, we review factors relating to lactate expression in NSCLC and the utility of lactate oxidase (LOX) for governing therapeutic delivery, its role in lactate oxidation and turnover, and relationships between lactate depletion and immune cell populations. The lactate-rich characteristic of NSCLC provides an exploitable property to potentially improve NSCLC outcomes and design new therapeutic strategies to integrate with conventional therapies Refereed/Peer-reviewed

ObjectivesThis study examined the effects of compassion-based intervention on mental health in cancer patients by using systematic review and meta-analysis of randomized controlled trials (RCTs).MethodsEleven bibliographic databases were searched from their earliest data available date up to March 1, 2022. The databases were PubMed, CINAHL, MEDLINE, PsycINFO, WOS, Cochrane, Embase, Scopus, ProQuest Dissertations, Airiti Library, and the National Digital Library of Theses and Dissertations in Taiwan.ResultsTen studies from 2015 to 2021 were included with a total of 771 cancer patients. Most were targeted at women with breast cancer. Brief compassion-based interventions of approximately 30 minutes were conducted by audio file, paper, and web-based self-guided writing prompts. Most were conducted after the completion of active treatment. Anxiety was the most measured outcome. Constructive compassion-based interventions with 4- to 12-week sessions were conducted by a trained facilitator. Most were conducted for patients who had undergone treatment, and depression was the most measured outcome. The meta-analysis indicated that compassion-based interventions had a significant effect of reducing depression and increasing self-compassion. Moderation analysis indicated that constructive intervention showed more benefits of increased self-compassion than brief intervention. Both face-to-face and non-face-to-face web-delivered formats had benefits for increasing self-compassion compared with the control condition.Significance of resultsCompassion-based interventions might provide an effective strategy for improving self-compassion and depression among patients with breast cancer. Suggestions for further research and health-care providers follow.

Oncolytic virotherapy was approved as a localized treatment for advanced melanoma by the US Food and Drug Administration (FDA) in 2015. Granulocyte macrophage colony stimulating factor (GM-CSF) encoded by clinical virus-infected tumor cells, acting as a pro-inflammatory cytokine or growth factor, increases tumor antigen presentation, leading to the activation of macrophages and T cells. Notably, tumor-secreted lactate can promote the suppressive functions of M2-polarized tumor-associated macrophages and subsequently promote tumor growth. Furthermore, the consumption of tumor-secreted lactate has been implicated in the beneficial polarization of macrophages. Here, we report that GM-CSF-encoded recombinant adeno-associated virus (AAV2-GM-CSF) infection in B16-F10 mouse melanoma cells combined with lactate oxidase (LOX) leads to the recruitment of M1 macrophages for the inhibition of cancer cell growth. This study suggests that GM-CSF combined with LOX has potential as cancer virotherapy.

The present study examined the potential mediating influences of meaning in life and quality of life in the relationship of trait mindfulness and depressive symptoms in lung cancer patients. Design...

Metabolic reprogramming of tumors with the accompanying reprogramming of glucose metabolism and production of lactate accumulation is required for the subsequent development of tumors. Recent evidence has indicated that tumor-secreted lactate can promote an oncolytic immune microenvironment within the tumor. Furthermore, tumor-secreted lactate directly induces polarization of tumor-supportive M2 macrophages. However, oxidized tumor-secreted lactate in the tumor microenvironment can be exploited. Iron oxide nanoparticles have shown promising anticancer potential by activating tumor-suppressing macrophages. Furthermore, lactate oxidase (LOX) generally oxidizes tumor-secreted lactate and subsequently converts to pyruvate. Particularly, the ratio of M2 macrophages to M1 macrophages corresponds with tumor growth. In this study, we present iron oxide nanoparticles with carboxylic acid combined with LOX that enhance antitumor efficacy as a synergistic effect on the repolarization of tumor-supportive M2 macrophages to tumor-suppressive M1 macrophages in a tumor microenvironment. After M2 macrophages treated with iron oxide nanoparticles were combined with LOX, the ratio of M1 macrophages was significantly greater than iron oxide nanoparticles alone or with LOX alone. It is concluded that the inhibition of cancer cell proliferation by ratio of M1 macrophages was observed. This study suggests that the iron oxide nanoparticles combined with LOX could be potentially used for potentiating immune checkpoint inhibitor therapies for cancer treatment.

Background. Anemia and pancytopenia are not uncommon in patients with chronic kidney disease (CKD). Nevertheless, there is insufficient literature analyzing bone marrow pathology in patients with CKD or end-stage kidney disease (ESKD) receiving dialysis. Methods. This observational cohort study included 22 patients with ESKD and 23 patients with CKD that received bone marrow biopsy and aspiration at Chang Gung Memorial Hospital. Demographic, hematological, and biochemical data were collected at the time of bone marrow study for analysis. Results. Bone marrow aspiration demonstrated that patients with ESKD had a lower percentage of blasts than patients with CKD (0.52 ± 0.84 versus 1.06 ± 0.78 %, p = 0.033). Bone marrow biopsy revealed that the overall incidence of hypocellular bone marrow was 55.6%. Furthermore, patients with ESKD had higher proportion of hypocellular bone marrow than patients with CKD (72.7% versus 39.1%, p = 0.023). In a multivariate logistic regression model, it was revealed that ESKD status (odds ratio 9.43, 95% confidence interval 1.66–53.63, p = 0.011) and megakaryocyte count within bone marrow (odds ratio 0.48, 95% confidence interval 0.29–0.79, p = 0.004) were significant predictors for bone marrow hypocellularity. Conclusion. Bone marrow hypocellularity is common in patients with kidney dysfunction. Hypocellular marrow occurs more frequently in patients with ESKD than patients with CKD.

Objective The present study aimed to identify the most important protective factors predicting caregivers' depressive symptoms among factors of caregivers' dispositional mindfulness, self-compassion, compassion from others, and patients' dispositional mindfulness and their moderator effects on the relationship between caregiving stress and depressive symptoms. Methods A total of 72 lung cancer outpatients and their family caregivers participated in this study. Family caregivers completed the Kingston Caregiver Stress Scale, Beck Depression Inventory-II (BDI-II), Five Facet Mindfulness Questionnaire (FFMQ), Self-Compassion Scale, and Compassion from Others Scale. Patients completed the EORTC Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), BDI-II, and FFMQ. Results After controlling for patients' factors (treatment status, symptom distress, and depressive symptoms) and caregivers' health status, caregivers' stress and dispositional mindfulness, the domain of mindful awareness, and self-compassionate action were significantly associated with their depressive symptoms. Further analysis indicated that mindful awareness or self-compassionate action could buffer the effect of caregiving stress on depressive symptoms. When the two moderators, mindful awareness and self-compassionate action, were tested simultaneously, only self-compassionate action remained as a significant moderating effect. Conclusions Caregivers' mindful awareness and self-compassionate action were protective factors, which mitigate the impact of caregiving stress on their depressive symptoms. Therefore, the future supportive program aims at training the competencies of self-compassionate action with mindful awareness, which may enhance caregivers' coping resources.

Objectives Using a prospective longitudinal design, this paper examines a serial mediation model of the associations between self-compassion, trait mindfulness, caregiver stress, and depressive symptoms among the family caregivers of patients with lung cancer. Methods A four-wave design was used, with initial assessment (T1) and three follow-ups, at the 2nd month (T2), the 5th month (T3), and the 8th month (T4). A total of 123 family caregivers completed the baseline measurements, including caregiver stress, self-compassion, trait mindfulness, and depressive symptoms. Data were analyzed by serial mediation models to determine the causal ordering of these variables. Results Nearly one-quarter of the family caregivers suffered from clinically significant depressive symptoms and the severity of their depression remained unchanged throughout the 8-month follow-up period. Both cross-sectional and longitudinal path analyses revealed that the relationship between self-compassion and depressive symptoms was mediated sequentially by trait mindfulness and caregiver stress. The subscale analysis indicated that the association of higher compassionate action with fewer depressive symptoms was through chain-mediating effects of higher mindful awareness and lower caregiver stress. Conclusions Family caregivers who have higher levels of self-compassion tend to have more mindfulness; greater mindfulness leads to lower levels of perceived caregiving stress which, in turn, links to fewer symptoms of depression. Both self-compassion and mindfulness could be regarded as protective factors for caregivers to reduce caregiving stress and depression.

Objectives Work is often a barrier for women to continue breastfeeding after they have given birth. Breastfeeding support is an important part of workplace health promotion. We investigated the implementation of breastfeeding promotion and gender equality polices in workplaces with the Taiwan Badge of Accredited Healthy Workplace. Methods Our samples consisted of 1648 corporations with the badge of Accredited Healthy Workplace issued by the Bureau of Health Promotion from 2007 to 2008. Concomitantly, 2000 corporations without accreditation were randomly selected from the National Business Directory as the control group. Data were collected from self‐administered questionnaires. Logistic regression was used to examine the association with breast‐feeding promotion and other variables in Taiwanese workplaces. Results Members of accredited group of 1089/1648 (66.1%) and the control group of 526/2000 (26.3%) responded to the questionnaire. The accredited companies had more mother‐friendly settings, including breastfeeding policies and documents, appropriate breastmilk preserving equipment and settings in the workplace. In the accredited group, breastfeeding rate of mothers returning to work after giving birth was 64.3% in 2008 (1 year after giving birth) and 60.4% in 2009 (1 year after giving birth), while the rate of the control group was 59.1% in 2008 and 51% in 2009. Conclusion Accredited corporations are better at breastfeeding support than those of the control group. This might be related to the company size, location, and the implementation of tobacco control and/or occupational health promotion policies, which may increase awareness of healthy workplaces and influence maternal protection positively.

Garlic (Allium sativum L.) has been used extensively as a food ingredient and medicinally, but the effect on asthmatic airway inflammation has not been studied in detail. We accordingly explored the protective effects exerted by various garlic fraction extracts against airway inflammation with Dermatophagoides pteronyssinus (Der p)&ndash, induced allergic asthma in vivo and in vitro. Garlic extraction was realized using n-hexane, dichloromethane, ethylacetate, n-butanol, and water in sequence to obtain different fraction extracts. Mice were orally administered different fractions (80 mg/kg) daily for four weeks. The histological results showed that the water fraction could ameliorate lung-based goblet cell hyperplasia, inflammatory cell infiltration, and mucus hypersecretion. The water fraction extracts decreased IgE and IgG1, and they decreased inflammatory cells as quantified in bronchoalveolar lavage fluid (BALF), however, they increased IgG2a in serum. Moreover, the water fraction extracts increased IFN-&gamma, and IL-12 (both constituting Th1 cytokines) in BALF, but they reduced IL-13, -4, and -5 (all constituting Th2 cytokines), and also inhibited the expression of IL-1&beta, IL-6, and TNF-&alpha, The water fraction also inhibited the PI3K/Akt/NF-&kappa, B signal pathways in A549 cells. These findings suggest that water fraction extracts of garlic have a clear anti-inflammatory effect on Der p&ndash, induced allergic asthma.

Objective:Our aim was to examine the effect of supportive care interventions on depressive symptoms in patients with lung cancer.Method:We searched the databases of the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid EMBASE, PubMed, and the Chinese Electronic Periodical Services (CEPS) from their inception until September of 2015. We included randomized controlled trial studies that compared standard care with supportive care interventions. The standardized mean difference (SMD) (Cohen's d) was calculated to estimate the effect of interventions. Subgroup analysis was conducted to identify possible sources of heterogeneity.Results:A total of 1,472 patients with lung cancer were identified. Compared with standard care, the overall effects of all supportive care interventions significantly reduced depressive symptoms (SMD = –0.74, CI95% = –1.07 to –0.41), and the effects could be maintained at weeks 4, 8, and 12 of follow-up. Three types of supportive care interventions were identified: psychotherapy combined with psychoeducation, psychoeducation alone, and an exercise program. Both psychotherapy combined with psychoeducation and exercise significantly improved depressive symptoms, while psychoeducation alone did not yield significant effects. The moderating effects indicated that greater improvements in depressive symptoms were found in lung cancer patients with a severe level of depressive symptoms at baseline.Significance of results:Personalized supportive care interventions can be developed based on the main causes of depressive symptoms. Psychotherapy combined with psychoeducation can target the causes of depressive symptoms, including both physical distress and psychological trauma due to lung cancer, while exercise programs can effectively improve depressive symptoms for lung cancer patients with impaired respiratory function.

In this paper, we examine single carrier modulation with frequency domain equalization (SC-FDE) for optical communication systems using intensity modulation with direct detection (IM/DD) in the presence of additive white Gaussian noise. SC-FDE is a technique whose processing is quite similar to that of OFDM. Unlike OFDM, however, SC-FDE is compatible with IM/DD channels because it does not require the transmission of a strong dc. For an IM/DD channel, at high data rate regime, the effect of intersymbol interference (ISI) starts to dominate system performance. In this paper, we examine the use of SC-FDE and pulse position modulation (PPM) to combat ISI for IM/DD channels. Such a system enjoys the average power efficiency of PPM and the low complexity equalization of SC-FDE. We analyze the bit error performance of SC-FDE and compare it with a few known techniques.

Permanent cardiac-pacemaker therapy is widely recognized as beneficial in the treatment of various types of symptomatic bradycardia. However, the seasonal distribution of pacemaker implantation has never been discussed. The purpose of this study was to investigate the seasonal distribution of pacemaker implantation in a large population of patients with symptomatic bradycardia. The study population consisted of 904 patients who underwent implantation of a new permanent pacemaker between January 1999 and December 2001 and were registered in the database of CPI Company in Taiwan. The number of pacemaker implantations in each month was analyzed to investigate the seasonal distribution of pacemaker implantations in a year. The number of patients who underwent pacemaker implantation between October and December was significantly higher than that of other seasons (P < 0.007). The results indicate that there is a tendency for bradyarrhythmic patients to have symptoms between October and December.