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Background Breast cancer is the most common malignancy affecting women, yet effective targets and related candidate compounds for breast cancer treatment are still lacking. The lipogenic enzyme, stearoyl-CoA desaturase-1 (SCD1), has been considered a potential target for breast cancer treatment. Icaritin (ICT), a prenylflavonoid derivative from the Traditional Chinese Medicine Epimedii Herba, has been reported to exert anticancer effects in various types of cancer. The purpose of the present study was to explore the effect of the new ICT derivative, IC2, targeting SCD1 on breast cancer cells and to explore the specific mechanism. Methods Immunohistochemistry and semiquantitative evaluation were performed to detect the expression level of SCD1 in normal and tumor samples. Computer-aided drug design (CADD) technology was used to target SCD1 by molecular docking simulation, and several new ICT derivatives were prepared by conventional chemical synthesis. Cell viability was evaluated by an MTT assay and dead cell staining. SCD1 expression in cancer cells was determined by Western blot and qRT-PCR analyses. The enzymatic activity of SCD1 was evaluated by detecting the conversion rate of [d31] palmitic acid (PA) using Gas chromatography-mass spectrometry (GC–MS). DAPI staining, flow cytometry and Western blot were used to detect cell apoptosis. Mitochondrial membrane potential and reactive oxygen species (ROS) assays were used to determine cell mitochondrial function. Lentiviral transduction was utilized to generate SCD1-overexpressing cell lines. Results We found that SCD1 was overexpressed and correlated with poor prognosis in breast cancer patients. Among a series of ICT derivatives, in vitro data showed that IC2 potentially inhibited the viability of breast cancer cells, and the mechanistic study revealed that IC2 treatment resulted in ROS activation and cellular apoptosis. We demonstrated that IC2 inhibited SCD1 activity and expression in breast cancer cells in a dose-dependent manner. Moreover, SCD1 overexpression alleviated IC2-induced cytotoxicity and apoptosis in breast cancer cells. Conclusions The new ICT derivative, IC2, was developed to induce breast cancer cell apoptosis by inhibiting SCD1, which provides a basis for the development of IC2 as a potential clinical compound for breast cancer treatment.

Taiwanese nurses face increasingly demanding working conditions along with a distinctive culture where family members participate in medical decisionmaking. This research explores Taiwanese nurses' perceptions of patient education, with a focus on the difficulties. Data were collected by in-depth focus group discussions with nursing staff (n=53) from the medical and surgical wards of two teaching hospitals. Transcripts were analyzed and revealed six themes: source of fulfillment and pressure; excessive workload; alternating between patients; not knowing who to teach; difficulty in communication; and disrupted confidence and work rhythm. Research findings could help managers understand the difficulties faced by nurses in providing health education. Nurses should broaden the scope of patient education activities to include family members. Additionally, nurses should discuss patients' desires and expectations from family members in medical treatment and decisionmaking.

Background: The morbidity and mortality of gastric cancer (GC) is in the fourth and third place among all malignant tumors in the world. The prognosis is poor due to the lack of biomarkers for treatment selection. Methods: To select the methylation biomarkers related to overall survival of GC patients and improve the prognosis, we analyzed the methylation sequences of 388 GC patients from the Cancer Genome Atlas (TCGA) database. These patients were divided into training and testing datasets. Results: A total of 233 patients were randomly allocated to training dataset and 155 were allocated to testing dataset. The survival analysis showed that the three-DNA methylation signature was significantly correlated with overall survival of GC patients and could differentiate between high-risk and low-risk patients in training and testing datasets. Moreover, the three-DNA methylation signature could predict prognosis of GC patients with high sensitivity and specificity using receiver operating characteristic (ROC) analysis. The three-DNA methylation signature, independent of age, gender, radiation-therapy and histologic differentiation, could predict the prognosis of GC. It is noteworthy that the three-DNA methylation signature has higher prediction accuracy than the known biomarkers. Interpretation: Our results suggest that the three-DNA methylation signature was a useful prognostic indicator of GC and may have translational implications in GC clinical treatment. Funding Statement: This study was supported in part by grants from the National Natural Science Foundation of China (No. 31671311 and 81371033), the National first-class discipline program of Light Industry Technology and Engineering (LITE2018-14), the “Six Talent Peak” Plan of Jiangsu Province (No. SWYY-127), the Innovative and Entrepreneurial Talents of Jiangsu Province, the Program for High-Level Entrepreneurial and Innovative Talents Introduction of Jiangsu Province, Guangdong High-level Personnel of Special Support Program and Yangfan Plan of Talents Recruitment Grant, and Fundamental Research Funds for the Central Universities (JUSRP51712B and JUSRP1901XNC). Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: Authors stated: "Not applicable."

In this study, thiol-modified siRNA (SH-siRNA) was delivered by bioreducible polyethylenimine (ssPEI), to enhance physicochemical properties of polyplexes and function of siRNA through disulfide bonding between SH-siRNA and ssPEI. The ssPEI was utilized to deliver Akt1 SH-siRNA for suppression of Akt1 mRNA and blockage of Akt1 protein translation, resulting in reduced cellular proliferation and the induction of apoptosis. Disulfide bondings between the ssPEI and SH-siRNA through thiol groups in both were confirmed by DTT treatment. Complexation between ssPEI and Akt1SH-siRNA was enhanced and reduced surface charge of ssPEI/Akt1SH-siRNA complexes with smaller average particle sizes even at lower N/P ratios was obtained compared with PEI/Akt1siRNA ones. Cellular uptake of ssPEI/Akt1SH-siRNA complexes in CT-26 mouse colon cancer cells was also enhanced. The ssPEI/Akt1SH-siRNA complexes reduced proliferation and increased apoptosis of mouse colon cancer cells in vitro. In an in vivo mouse tumor model, the complexes reduced tumor proliferation and downregulation of Akt1 compared to controls.

A dry type electro-active biopolymer actuator was newly developed with electrospun cellulose–polyaniline bio-composite membranes. Through electrospinning with the mixture of cellulose acetate and polyaniline solutions, well-defined cellulose acetate nanofibers reinforced with chopped polyaniline nanoparticles were obtained and extracellular nano-porous bio-composite membranes with a good biocompatibility were fabricated. The electro-active bio-composite actuator based on cellulose acetate nanofibers with specially chopped polyaniline nanoparticles through electrospinning shows much larger electromechanical deformations than a pure cellulose acetate actuator.

Dietary patterns are associated with morbidity and mortality of heart failure. Volume overload was the most common cause for re-hospitalization for heart failure patients. However, recommended preventive strategies of restricting excessive dietary sodium and fluid intake were found to be in vain. This study looks at the preventive dietary instructions from a cultural context, and examined the effects of sodium and fluid restriction on twelve elderly Chinese patients hospitalized with heart failure through a qualitative design. Four themes emerged from the data: medicine-food homology, salt and sodium as synonymous, activity intolerance but still wanting social connections, and barriers to asking questions. Results suggested that living with heart failure is a complex and changeable process for both patients and caregivers. Many patients reported low levels of understanding concerning their symptoms and heart function deterioration. The findings found that good communication requires cultural sensitivity, objective listening to the patient's narrative, and helping patients find meaning between their experiences and symptom control.

Coronary artery disease (CAD) has been reported to be a major cause of death worldwide. Current treatment methods include atherectomy, coronary angioplasty (as a percutaneous coronary intervention), and coronary artery bypass. Among them, the insertion of stents into the coronary artery is one of the commonly used methods for CAD, although the formation of in-stent restenosis (ISR) is a major drawback, demanding improvement in stent technology. Stents can be improved using the delivery of DNA, siRNA, and miRNA rather than anti-inflammatory/anti-thrombotic drugs. In particular, genes that could interfere with the development of plaque around infected regions are conjugated on the stent surface to inhibit neointimal formation. Despite their potential benefits, it is necessary to explore the various properties of gene-eluting stents. Furthermore, multifunctional electronic stents that can be used as a biosensor and deliver drug- or gene-based on physiological condition will be a very promising way to the successful treatment of ISR. In this review, we have discussed the molecular mechanism of restenosis, the use of drug- and gene-eluting stents, and the possible roles that these stents have in the prevention and treatment of coronary restenosis. Further, we have explained how multifunctional electronic stents could be used as a biosensor and deliver drugs based on physiological conditions.

For effective treatment of restenosis, therapeutic genes are delivered locally from a coated stent at the site of injury, leading to inhibition of smooth muscle proliferation and neo-intimal hyperplasia while promoting re-endothelialization. In a previous study, we delivered Akt1 siRNA nanoparticles (ASNs) from a hyaluronic acid (HA)-coated stent surface to specifically suppress the pro-proliferative Akt1 protein in smooth muscle cells (SMCs). In the present study, therapeutic efficacy was investigated in a rabbit restenosis model after percutaneous implantation of an ASN-immobilized stent in a rabbit iliac artery. Quantitative and qualitative analyses of in-stent restenosis were investigated in an in vivo animal model by micro-CT imaging and SEM observation, respectively. Proliferation status and neo-intima formation of the vascular tissues located near ASN-immobilized stents were analyzed by immunohistochemical staining using anti-Akt1 and anti-Ki67 antibodies and histological analyses, such as hematoxylin and eosin staining and Verhoeff's elastic stain. Re-endothelialization after implantation of an ASN-immobilized stent was also analyzed via immunohistochemistry using an anti-CD31 antibody. To elucidate the molecular mechanism related to reducing SMC proliferation and subsequent inhibition of in-stent restenosis in vivo, protein and mRNA expression of Akt1 and downstream signaling proteins were analyzed after isolating SMC-rich samples from the treated vasculature. The implanted Akt1 siRNA-eluting stent efficiently mitigated in-stent restenosis without any side effects and can be considered a successful substitute to current drug-eluting stents.

Transgenic cloned animals expressing beneficial human nutritional traits offer a new strategy for large-scale production of some kinds of functional substances. In some cases, the required safety testing for genetically modified (GM) foods do not seem appropriate for human food safety, though regulations do not seem to provide alternatives. A 90-day rat feeding study is the core study for the safety assessment of GM foods. The test material in this 90-day study was prepared nonfat milk powder containing recombinant human lactoferrin (rhLF), which was expressed in transgenic cloned cattle. Groups of 10 male and female Sprague-Dawley rats were given a nutritionally balanced purified diet containing 7.5, 15, or 30% transgenic or conventional milk powder for 90 days. A commercial AIN93G diet was used as an additional control group. Clinical, biological, and pathological parameters were compared between groups. The only significant effect of treatment was higher mean ferritin and Fe(+) concentrations for both male and female rats fed the transgenic milk powder diets, as compared to rats fed nontransgenic milk diets or the commercial diet. The results of the present study are consistent with previous research, which indicates that milk powder containing rhLF derived from healthy transgenic cloned cattle is as safe as conventional milk powder.

Aims. The purpose of this study was to explore the concepts and processes for successful abstinence from alcohol for Taiwanese Alcoholics Anonymous members. Background. Attempting to identify the psychological and social influences upon alcohol consumption remission outside of alcoholism treatment could help professionals to engage in a broad array of community interventions in an informed fashion. Methods. Grounded theory method was utilized in this study. The study chose nine participants who had succeeded in abstinence, using theoretical sampling and conducted in-depth interviews by an open-ended questionnaire. Results. The results of this study indicated that the core of the process during which alcoholic individuals succeeded in abstaining from further alcohol consumption was an empowerment process for the involved individual. Alcoholics felt that their family, interpersonal relationships, jobs and personal finances all had been at ‘rock-bottom’ level following a long period of alcohol dependence. This feeling caused the individual to experience an emotion of a loss of control and provoked the arousal of an alcoholic's inner consciousness levels, this then resulting in the generation of a driving force for abstinence from alcohol for these individuals. Conclusions. The expansion of an individual's internal awakening power helps the individual to obtain assistance and to resist the temptation of further alcohol consumption. Therefore, the power derived by individuals from the stages of repositioning, releasing, active sharing, resistance and assistance are the maintenance factors for an individual's empowerment process that help maintain the successful recovery from alcohol for the involved individual. Relevance to clinical practice. A good comprehension of the recovery processes for alcoholics, we believe, will trigger clinical professionals to pay appropriate attention to the specific problems and needs of alcoholic individuals, to build an effective resource network for treatment and to help solve alcoholics’ physical and psychosocial problems.

In this study, we present anti-cancer drug containing nanofiber-mediated gene delivery to treat liver cancer. Electro-spun nanofibers have big potential for local delivery and sustained release of therapeutic gene and drugs. We reported a temperature-responsive nanofibers mainly compounded by branched poly(ε-caprolactone) (PCL) macro-monomers and anti-cancer drug paclitaxel. The nanofiber could be administrated into liver tumors to dramatically hinder their growth and prevent their metastasis. As a result, paclitaxel encapsulated PCL (PTX/PCL) nanofibers with diameters of around several tens nanometers to 10 nm were successfully obtained by electro-spinning andobserved in scanning electron microscopy (SEM). Nanoparticles composed of disulfide cross-linked branched PEI (ssPEI) and anti-cancer therapeutic gene miRNA-145 were complexed based on the electrostatic interaction and coated over the paclitaxel-loaded nanofiber. MicroRNA 145/ssPEI nanoparticles (MSNs) immobilized on the PTX/PCL nanofiber showed time-dependent sustained release of the microRNA for enhanced uptake in neighboring liver cancer cells without any noticeable cytotoxicity. From this study we are expecting a synergistic effect on the cancer cell suppression since we have combined the drug and gene delivery. This approach uses the nanofibers and nanoparticles together for the treatment of cancer and the detailed investigation in vitro and in vivo must be conducted for the practicality of this study. The polymer is biodegradable and the toxicity issues must be cleared by our approach.

Taiwanese nurses face increasingly demanding working conditions along with a distinctive culture where family members participate in medical decisionmaking. This research explores Taiwanese nurses' perceptions of patient education, with a focus on the difficulties. Data were collected by in-depth focus group discussions with nursing staff (n=53) from the medical and surgical wards of two teaching hospitals. Transcripts were analyzed and revealed six themes: source of fulfillment and pressure; excessive workload; alternating between patients; not knowing who to teach; difficulty in communication; and disrupted confidence and work rhythm. Research findings could help managers understand the difficulties faced by nurses in providing health education. Nurses should broaden the scope of patient education activities to include family members. Additionally, nurses should discuss patients' desires and expectations from family members in medical treatment and decisionmaking.

Aims. This paper reports on a study carried out to establish a decision tree model to describe how women in Taiwan make the decision whether or not to have a hysterectomy. In addition, we examined the predictability of the decision-tree model. Background. Hysterectomy is the second most common surgical procedure performed worldwide. Medical professionals believe that the operation can relieve pain and prevent cervical cancer, thus improving a woman's quality of life. While most physicians advise hysterectomy even for benign uterine conditions, feminists decry the belief that the uterus has no purpose, believing that it is an important symbol of womanhood. Methods. The study was conducted in two phases. Phase I, the model development phase, was carried out to generalize data from a qualitative study of 14 women and to establish a tree model outlining their decision to proceed with hysterectomy. The second phase was the model prediction phase that applied inductive and deductive methods to data analysis and development of the decision-tree model. The model tree was then tested with 18 women who were deciding whether or not to undergo hysterectomy. Using the decision-making tree, we studied the women's thought processes and analysed their primary concerns. The study was carried out in 1999–2001. Results. The study determined 13 criteria that Taiwanese women use when deciding about having a hysterectomy. Developed in accordance with Gladwin's methodology, the model tree successfully predicted 90% of decisions whether or not to have a hysterectomy. Conclusions. Nurses working in gynaecological services should understand how women decide to undergo hysterectomy so that the proper counselling and follow-up can be provided. With further testing, our decision tree may help in this process.

Aims and objectives To explore women's perspectives on deciding to undergo hysterectomy for benign conditions based on physicians' recommendations and the women's own judgement. Background Hysterectomy is the second most common surgical procedure worldwide. Although most hysterectomies are elective, physicians may recommend treatment that involves a loss of sexuality or ovary removal, creating a difficult choice for women. Design Qualitative, in-depth interview Methods A purposive sample of 17 women was recruited. The women had decided to undergo hysterectomy after the diagnosis of uterine fibroids. All these women had already decided not to have more children. Data were collected by in-depth interviewing, and content analysis was used to analyse the data. Results Our study revealed five themes: release from stress, inescapable fate, positive support, hoping for peace of mind and sense of trust. Conclusions The participants felt that mental and physical health were the most important considerations, noting that when women no longer want children, a uterus is useless. The women believed that they retained their womanhood, even without a uterus, and were satisfied with the outcomes of their hysterectomy decisions. Relevance to clinical practice Our findings might serve as educational and counselling reference materials for healthcare providers, ensuring that women receive appropriate care quality and have their needs met. Healthcare providers can then maximise women's empowerment, deepen their awareness of body image and their concept of self-care and help them to clearly perceive their own concerns and needs so that they can make suitable decisions.

Restenosis is the formation of blockages occurring at the site of angioplasty or stent placement. In order to avoid such blockages, the suppression of smooth muscle cells near the implanted stent is required. The Akt1 protein is known to be responsible for cellular proliferation, and specific inhibition of Akt1 gene expression results in the retardation of cell growth. To take advantage of these benefits, we developed a new delivery technique for Akt1 siRNA nanoparticles from a hyaluronic acid (HA)-coated stent surface. For this purpose, the disulfide cross-linked low molecular polyethyleneimine (PEI) (ssPEI) was used as a gene delivery carrier because disulfide bonds are stable in an oxidative extracellular environment but degrade rapidly in reductive intracellular environments. In this study, Akt1 siRNA showed efficient ionic interaction with the ssPEI carrier, which was confirmed by polyacrylamide gel electrophoresis. Akt1 siRNA/ssPEI nanoparticles (ASNs) were immobilized on the HA-coated stent surface and exhibited stable binding and localization, followed by time-dependent sustained release for intracellular uptake. Cellular viability on the nanoparticle-immobilized surface was assessed using A10 vascular smooth muscle cells, and the results revealed that immobilized ASNs exhibited negligible cytotoxicity against the adhering A10 cells. Transfection efficiency was quantified using a luciferase assay; the transgene expression of Akt1 suppression through the delivered Akt1 siRNA was measured using RT-PCR and western blot, demonstrating higher gene silencing efficiency when compared to other carriers. ASN coated on HA stents were deployed in the balloon-injured external iliac artery in rabbits in vivo. It was shown that the Akt1 released from the stent suppressed the growth of the smooth muscle at the peri-stent implantation area, resulting in the prevention of restenosis in the post-implantation phase.

Superparamagnetic iron oxide nanoparticle (SPION)-based diagnostic properties with accompanying therapeutics such as drugs or genes have been explored for improvement of their therapeutic efficacy. Positively charged SPION-loaded polymersomes was prepared to deliver genes to the target sites; this process was concomitantly monitored by magnetic resonance imaging (MRI). The surface characteristics and morphology were respectively measured by dynamic light scattering and transmission electron microscopy. The complex between the polymer and the pDNA was confirmed by a gel retardation assay. The transfection efficiency and cytotoxicity in vitro were tested by treating of the CT-26 colon cancer cell line with luciferase-expressing plasmids/SPION complex. MRI was also used to check the detectability of SPION in vitro and in vivo. A SPION-loaded polymersome carrying genetic materials was delivered and then accumulated in the tumor site of the murine colon cancer xenograft model after intravenous injection, possibly through a passive targeting mechanism. The accumulation was monitored using clinical MRI. This result indicates that the SPION-loaded polymersome can be applied to MR imageguided gene therapy.

In this study, we present nanofiber-mediated gene delivery for myocardial infarction (MI). Branched polyethylenimine cross-linked via disulfide bonds (ssPEI) complexed with vascular endothelial growth factor (VEGF) were immobilized on electrospun polycaprolactone (PCL)/polyethylenimine (PEI) nanofibers for the local expression of VEGF angiogenic factor. We studied whether the production of VEGF from myoblast cells adhering on the nanofibers has therapeutic potential for MI. In this method, the non-specific adsorption of VEGF nanoparticles to the nanofibers occurred uniformly over all of the surface area of the nanofibers, resulting in increased transgene uptake and expression in a great number of cells. The amount of DNA required for transfection was also minimal compared to bolus delivery, because the adhered DNA was directly available in the cell microenvironment, which also helps in localized delivery. Reporter genes luciferase (Luc), red fluorescence protein (RFP), and therapeutic gene VEGF were tested to evaluate the transfection efficiency of ssPEI nanoparticles immobilized on the nanofiber surface. Our results demonstrated that the delivery of therapeutic genes from biodegradable nanoparticles immobilized on the nanofiber represented minimal cytotoxicity of H9C2 myoblasts than branched PEI 25 kDa did. According to Luc assay, fluorescence microscope analysis, and reverse transcription polymerase chain reaction (RT-PCR), this vector showed high transgene expression efficiency to the reporter gene and VEGF gene. The surface-mediated delivery of the DNA nanoparticles did not adversely affect cell growth, and facilitated the transgene expression inside the cells.

Positively charged superparamagnetic iron oxide nanoparticle (SPION)-loaded polymersome was prepared in order to deliver genes to the target sites, which was monitored by magnetic resonance imaging (MRI), concomitantly. The transfection efficiency in vitro was tested by treating CT-26 colon cancer cell line with luciferase-expressing plasmids/SPION complex. MRI was also used to check the detectability of SPION in vitro and in vivo. SPION-loaded polymersome, carrying genetic materials, was delivered and then accumulated at the tumor site of the murine colon cancer xenograft model after intravenous injection, possibly through a passive targeting mechanism. Clinical MRI monitored this accumulation. This result indicates that the SPION-loaded polymersomecan be applied to MR image-guided gene therapy.

OBJECTIVES Improving nurses' competence in resolving clinical ethical issues must start with ethics education in training and clinical practice. However, many students complain that they cannot apply classroom learning to actual clinical scenarios. This study explored ethical issues and dilemmas, and their impact experienced by student nurses in clinical practice. METHODS Focus groups were conducted with 44 first-year student nurses from a 2-year college course in northern Taiwan. Interviews were tape-recorded and verbatim transcripts were analysed using content analysis. RESULTS Students expressed and discussed their views in eight focus groups. Analysis of interviews revealed five themes: frustration at inability to help some patients; oppression caused by lower status; lack of honesty and ethical courage; powerlessness, and self-encouragement in adversity. CONCLUSIONS Taiwanese nurse ethics training was only recently introduced and the curriculum has not addressed the clinical reality in Taiwan. This reality includes limitations arising from the medical hierarchy and the socio-cultural role of families in medical decision making, which may inhibit ethical judgements and decision making. In clinical dilemmas, the most common problems faced by Taiwanese nursing students involved not knowing how to handle some situations, inability to abide by principles, and a lack of appropriate role models. Hence, we suggest that nursing ethics education should: (i) integrate scenarios involving ethical dilemmas into daily routines; (ii) give students opportunities to discuss their feelings about their experiences; (iii) allow teachers and students to talk about scenarios with ethical implications, and (iv) provide students with opportunities to reflect on clinical scenarios in order to clarify their values and learn how to respect the value of life.

Background Most people being treated for alcoholism are unable to successfully quit drinking within their treatment programs. In few cases do we know the full picture of how abstinence is achieved in Taiwan. We tracked processes of abstinence in alcohol-dependency disorders, based on study evidence and results. This research explores the process of recovery from the viewpoint of the alcohol-dependent. Methods Semi-structured interviews were conducted in two different settings, using purpose sampling, during 2003-2004. The data were analyzed using content analysis. Participants were 32 adults, purposefully selected from an Alcoholics Anonymous group and a psychiatric hospital in North Taiwan. Results We found that the abstinence process is an ongoing process, in which the alcohol-dependent free themselves of addiction progressively. This process never ends or resolves in complete recovery. We have identified three stages in the struggle against alcoholism: the Indulgence, Ambivalence and Attempt (IAA) cycle, in which the sufferer is trapped in a cycle of attempting to give up and failing; the Turning Point, in which a Personal Nadir is reached, and the Ongoing Process of abstinence, in which a constant effort is made to remain sober through willpower and with the help of support groups. We also discuss Influencing Factors that can derail abstinence attempts, pushing the sufferer back into the IAA cycle. Conclusion This study provides important points of reference for alcohol and drug service workers and community healthcare professionals in Taiwan, casting light on the abstinence process and providing a basis for intervention or rehabilitation services.

Background and Objectives MicroRNA 145 is known to be responsible for cellular proliferation, and its enhanced expression reportedly inhibits the retardation of vascular smooth muscle cell growth specifically. In this study, we developed a microRNA 145 nanoparticle immobilized, hyaluronic acid (HA)-coated stent. Materials and Methods For the gene therapy, we used disulfide cross-linked low molecular polyethylenimine as the carrier. The microRNA 145 was labeled with YOYO-1 and the fluorescent microscopy images were obtained. The release of microRNA 145 from the stent was measured with an ultra violet spectrophotometer. The downstream targeting of the c-Myc protein and green fluorescent protein was determined by Western blotting. Finally, we deployed microRNA 145/ssPEI nanoparticles immobilized on HA-coated stents in the balloon-injured external iliac artery in a rabbit restenosis model. Results Cellular viability of the nanoparticle-immobilized surface tested using A10 vascular smooth muscle cells showed that MSN exhibited negligible cytotoxicity. In addition, microRNA 145 and downstream signaling proteins were identified by western blots with smooth muscle cell (SMC) lysates from the transfected A10 cell, as the molecular mechanism for decreased SMC proliferation that results in the inhibition of in-stent restenosis. MicroRNA 145 released from the stent suppressed the growth of the smooth muscle at the peri-stent implantation area, resulting in the prevention of restenosis at the post-implantation. We investigated the qualitative analyses of in-stent restenosis in the rabbit model using micro-computed tomography imaging and histological staining. Conclusion MicroRNA 145-eluting stent mitigated in-stent restenosis efficiently with no side effects and can be considered a successful substitute to the current drug-eluting stent.

The purpose of this qualitative research was to explore and develop the process of self-empowerment for primary caregivers responsible for caring for elderly with dementia. Nine primary caregivers who lived in northern Taiwan were interviewed through a theoretical sampling procedure. In-depth, face-to-face interviews were tape-recorded and transcribed verbatim. The grounded theory method was applied for analyzing data. The six main components that emerged in this model: "filial piety", "feeling of out of control", "inner awareness", "care ability", "emotion reconstruction", and "life management". This model starts from "filial piety" and "feeling of out of control," then evokes caregivers' "inner awareness". The inner awareness powerfully influences caregivers' "care ability", "emotion reconstruction" and "life management," which account for the three inner mechanism parts in their caregiving experience. Each part comprises three stages that are influenced by "inner awareness". The lower stage of each part supports the next higher stage. The same stages in all parts parallel one another, and influence each other by providing support or creating barriers. On the other side, competition between support and barriers from the outside environment determines the completion of this self-empowerment process. Results of this research extend the knowledge in understanding the psychological processes related to caring for elderly with dementia. The findings also provide readers a positive viewpoint on the caring experiences of primary caregivers of elderly with dementia.