The expression profiles of cyp19a1, sf-1, esrs and gths in the brain-pituitary during gonadal sex differentiation in juvenile Japanese eels.

Eels are gonochoristic species whose gonadal differentiation initiates at the yellow eel stage and is influenced by environmental factors. We revealed some sex-related genes were sex dimorphically expressed in gonads during gonadal sex differentiation of Japanese eel (Anguilla japonica); however, the expression of sex-related genes in the brain-pituitary during gonadal sex differentiation in eels is still unclear. This study aimed to investigate the sex-related gene expressions in the brain-pituitary and tried to clarify their roles in the brain and gonads during gonadal sex differentiation. Based on our previous histological study, the control eels developed as males, and estradiol-17ß (E2) was used for feminization. Our results showed that during testicular differentiation, the brain cyp19a1 transcripts and aromatase proteins were increased significantly; moreover, the cyp19a1, sf-1, foxl2s, and esrs (except gperb) transcripts in the midbrain/pituitary also were increased significantly. Forebrain gnrh1 transcripts increased slightly during gonadal differentiation of both sexes, but the gnrhr1b and gnrhr2 transcripts in the midbrain/pituitary were stable during gonadal differentiation. The expression levels of gths and gh in the midbrain/pituitary were significantly increased during testicular differentiation and were much higher in males than in E2-feminized females. These results implied that endogenous estrogens might play essential roles in the brain/pituitary during testicular differentiation, sf-1, foxl2s, and esrs may have roles in cyp19a1 regulation in the midbrain/pituitary of Japanese eels. For the GnRH-GTH axis, gths, especially fshb, may be regulated by esrs and involved in regulating testicular differentiation and development in Japanese eels.

The relationships between stress, coping strategies, and quality of life among gynecologic cancer survivors.

Many studies have reported that gynecologic cancer diagnosis, surgery, adjuvant therapy, and survivorship can be extremely stressful for many people during their cancer journey, and most cancer survivors have experienced stress after cancer, which impacts their quality of life. Importantly, healthy stress management will assist patients in overcoming obstacles in their lives and enhance both the quality of life and the cancer adjustment process. This study aimed to investigate the relationships between stress, coping strategies, and quality of life among gynecologic cancer survivors and to assess the mediating effects of coping on the relationship between quality of life and stress. A series of regression models and Sobel test were conducted to investigate whether coping strategies mediated the relationship between stress and quality of life. Stress was a predictor of quality of life. Acceptance was the mediator between stress and quality of life. Tailored programs that foster coping strategies, such as the strategy of acceptance, to reduce stress and maintain quality of life in this vulnerable group need to be developed.

Effectiveness of Cryotherapy on Cancer Therapy-Induced Oral Mucositis: An Umbrella Review.

BACKGROUND: Oral mucositis (OM) considerably affects the experience of patients with cancer during treatment. This study investigated the effects of cryotherapy on cancer therapy-induced OM. OBJECTIVE: This study aimed to systematically appraise evidence on whether cryotherapy can reduce the incidence and severity of OM. METHODS: We conducted an umbrella review to examine the effect of cryotherapy on cancer-related OM. The primary outcome was the incidence and severity of OM. We performed a subgroup analysis including solid cancers and hematological malignancies. RESULTS: Five meta-analyses were included. Cryotherapy could more effectively reduce the incidence of severe OM (risk ratio [RR], 0.37; 95% prediction interval [PI], 0.22-0.64). In the subgroup analyses of solid cancers or hematological malignancies, cryotherapy significantly reduced the incidence of grades 2 to 4 OM in patients with solid cancers (RR, 0.51; 95% PI, 0.34-0.78 and RR, 0.52; 95% PI, 0.36-0.74). However, no significant difference was observed in the incidence of OM in patients with hematological malignancies regarding any grade or grade 3 or 4 OM. Moreover, cryotherapy did not significantly reduce the OM duration (mean difference, -0.13; 95% PI, -20.89 to 20.63; mean difference, -2.99, 95% PI, -8.10 to 2.12). CONCLUSION: Cryotherapy can reduce the incidence of severe OM induced by chemotherapy or radiotherapy. IMPLICATION FOR PRACTICE: We recommend the inclusion of this safe, simple, and convenient intervention in chemotherapy or radiotherapy plans. Additional clinical trials are warranted to extend the limited evidence on the effectiveness of cryotherapy in reducing the severity and duration of OM.

Effects of computer-aided rowing exercise systems on improving muscle strength and function in older adults with mild knee osteoarthritis: a randomized controlled clinical trial.

BACKGROUND: Osteoarthritis (OA) is common in aged adults and can result in muscle weakness and function limitations in lower limbs. Knee OA affects the quality of life in the elderly. Technology-supported feedback to achieve lower impact on knee joints and individualized exercise could benefit elderly patients with knee OA. Herein, a computer-aided feedback rowing exercise system is proposed, and its effects on improving muscle strength, health conditions, and knee functions of older adults with mild knee OA were investigated. METHODS: Thirty-eight older adults with mild knee OA and satisfying the American College of Rheumatology (ACR) clinical criteria participated in this randomized controlled clinical trial. Each subject was randomly assigned to a computer-aided rowing exercise (CRE) group (n = 20) or a control group (CON) (n = 18) that received regular resistance exercise programs two times per week for 12 weeks. Outcome measurements, including the Western Ontario and MacMaster Universities (WOMAC), muscle strength and functional fitness of the lower limbs, were evaluated before and after the intervention. RESULTS: Participants' functional fitness in the CRE group exhibited significantly higher adjusted mean post-tests scores, including the WOMAC (p = 0.006), hip abductors strength (kg) (MD = 2.36 [1.28, 3.44], p = 5.67 × 10-5), hip adductors strength (MD = 3.04 [1.38, 4.69], p = 0.001), hip flexors strength (MD = 4.01 [2.24, 5.78], p = 6.46 × 10-5), hip extensors strength (MD = 2.88 [1.64, 4.12], p = 4.43 × 10-5), knee flexors strength (MD = 2.03 [0.66, 3.41], p = 0.005), knee extensors strength (MD = 1.80 [0.65, 2.94], p = 0.003), and functional-reach (cm) (MD = 3.74 [0.68, 6.80], p = 0.018), with large effect sizes (η2 = 0.17-0.42), than those in the CON group after the intervention. CONCLUSIONS: Older adults with knee OA in the CRE group exhibited superior muscle strength, health conditions, and functional fitness improvements after the 12-week computer-aided rowing exercise program than those receiving the conventional exercise approach. TRIAL REGISTRATION: The Institutional Review Board of the Taipei Medical University approved the study protocol (no. N201908020, 27/05/2020) and retrospectively registered at ClinicalTrials.gov (trial registry no. NCT04919486, 09/06/2021).

Psychological distress among immigrant women who divorced: Resilience as a mediator.

PURPOSE: The purpose of this study was to investigate relationships among the demands of immigration, resilience, and psychological distress in divorced immigrant women, and determine the mediating effects of resilience on the relationship between demands of immigration and psychological distress. DESIGN: The cross-sectional study included 117 women who had immigrated and married Taiwanese men but later got divorced. METHODS: The Chinese health questionnaire-12 scale, the resilience scale-Chinese version, and the demands of immigration (DI) scale were used to measure in this study. A multiple regression and Sobel test were used to examine whether resilience mediated the relationship between demands of immigration and psychological distress. FINDINGS: In this study, 47% of the divorced immigrant women were experiencing psychological distress, and 25.6% exhibited high levels of demands of immigration. Women with psychological distress had higher demand scores (t = 2.592, p = 0.011) and lower resilience scores (t = -3.965, p < 0.001) compared to women without psychological distress. The demands of immigration negatively predicted resilience (t = -3.050, p = 0.003). Finally, resilience mediated the association of demands of immigration with psychological distress (z = 2.497, p = 0.0125). CONCLUSIONS: Relationships among the demands of immigration, resilience, and psychological distress in divorced immigrant women were demonstrated in this study. Resilience played an important role in the relationship between demands of immigration and psychological distress. CLINICAL RELEVANCE: Tailored programs that foster resilience to reduce risks of demands of immigration and psychological distress in this vulnerable population should be developed.

Knowledge of and Barriers to Palliative Care Perceived by Healthcare Providers before and after Promotion of the Patient Autonomy Act: A Cross-Sectional Study.

This study was designed to investigate healthcare providers' knowledge of palliative care and perceptions of palliative care barriers before and after promoting the Patient Autonomy Act (PAA). A convenience sample was recruited, including 277 healthcare providers in 2013 and 222 healthcare providers in 2018. Multivariate linear regression analyses were used to identify predictors of knowledge of and perceived barriers to palliative care. A principal component analysis was carried out to identify the most appropriate factorial structure for the contents of knowledge and perceived barriers to palliative care. Three factors related to knowledge of palliative care were identified in both 2013 and 2018 data: 'policy, regulation, and promotion', 'philosophy and treatments', and 'myths and misunderstandings'. Study findings for the two periods were similar. As for barriers to providing palliative care, three factors were identified for 2013: 'quality care', 'difficulties' and 'communication', and for 2018, 'information', 'attitudes' and 'quality care' were identified. Study findings differed between the two periods. Policies can better reinforce mitigating strategies-including opportunities for education, shared decision making, and changes in institutions and care systems. Additionally, assessing barriers creates important opportunities for further research to address the most critical aspects in improving end-of-life care for patients and their families.

Psychometrics and measurement invariance: Health Literacy Scale for Vietnamese and Indonesian married immigrants.

AIMS: To examine the psychometrics and measurement invariance of the Short-Form Health Literacy 12-item questionnaire (HL-SF12) among Vietnamese and Indonesian married immigrants. DESIGN: A cross-sectional survey design. METHODS: In total, 1171 Vietnamese and Indonesian married immigrants were enrolled between September 2019 and December 2019. An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to verify the structural validity of the suggested factor structure. The multiple-group CFA (MGCFA) used a series of hierarchical nested-in models as a measurement invariance test which confirmed the adequacy of the model fit at each stage. RESULTS/FINDINGS: The Kaiser-Meyer-Olkin coefficient was 0.898, and the Bartlett test of sphericity was statistically significant (χ2 [66] = 1965.97, p < 0.01). According to a scree plot and Kaiser's criterion for eigenvalues of >1, the EFA explained 61.6% of the total variance and confirmed three theoretically supported factors of health care, disease prevention and health promotion. The 12 items showed factor loadings of >0.4 and four items were in each subscale. The CFA showed adequate structural validity, including a relative chi-squared/degrees of freedom (X2 /df) of 2.01, a comparative fit index (CFI) of 0.98 and a root mean square error of approximation (RMSEA) of 0.04 (95% confidence interval [0.03, 0.05]) in married immigrants. For the measurement invariance, a change in the goodness-of-fit measures did not exceed 0.02 for the RMSEA or 0.01 for the CFI. The results indicated Cronbach's α values of 0.87 for the HL-SF12 scale in Vietnamese and Indonesian combined samples (n = 1171). A t-test showed that the HL-SF12 and its three subscales were unable to significantly differentiate between Vietnamese and Indonesian groups (all p > 0.05). CONCLUSIONS: The HL-SF12 scale showed acceptable theoretically supported structural validity, equivalent measurement invariance and reliable internal consistency among Vietnamese and Indonesian married immigrants. Measurements of immigrants' HL using the HL-SF12 could be integrated into future immigrant health policies. IMPACT: As the first study of the measurement invariance of the HL-SF12 instrument among immigrants. Related factors of immigrants' HL can be further explored to increase immigrants' health and empowerment.

Correlations between Psychiatric Symptoms and Quality of Life in Patients with Psychological Disorders: Hospital-Based Retrospective Study.

Little research has been conducted on the relationship between the five-item Brief Symptom Rating Scale (BSRS-5) and quality of life in patients with mood disorders. The purpose of this study was to investigate potential effects of psychological symptoms on quality of life in patients with psychological disorders. We recruited 124 patients with psychological disorders from a psychological teaching hospital in northern Taiwan. Data were obtained from medical records of all patients with a diagnosis of mood or adjustment disorder. We assessed psychological symptoms on the BSRS-5 and examined quality of life by using the Taiwanese version of the abbreviated World Health Organization Quality of Life Questionnaire (WHOQOL-BREF). We performed hierarchical linear regression analysis to explore the relationship between psychological symptoms and quality of life. The analysis revealed a significant correlation between the items on the BSRS-5 and WHOQOL and their correlations with the total scores on these assessments (p < 0.01 and p < 0.05). Our findings indicated that scores on the BSRS-5 can predict scores on quality of life. This suggests that psychometrically measured psychological symptoms constitute critical determinants of quality of life.

Analysis of Vibration Frequency and Direction for Facilitating Upper-Limb Muscle Activity.

We aimed to determine the effect of vibration frequency and direction on upper-limb muscle activation using a handheld vibrator. We recruited 19 healthy participants who were instructed to hold a handheld vibrator in their dominant hand and maintain the elbow at 90° flexion, while vertical and horizontal vibrations were applied with frequencies of 15, 30, 45, and 60 Hz for 60 s each. Surface electromyography (EMG) measured the activities of the flexor digitorum superficialis (FDS), flexor carpi radialis (FCR), extensor carpi ulnaris (ECU), extensor carpi radialis (ECR), biceps, triceps, and deltoid anterior muscles. EMG changes were evaluated as the difference in muscle activity between vibration and no-vibration (0 Hz) conditions. Muscle activity was induced under vibration conditions in both vertical and horizontal (p < 0.05) directions. At 45 Hz, FDS and FCR activities increased during horizontal vibrations, compared with those during vertical vibrations. ECU activity significantly increased under 15-Hz vertical vibrations compared with that during horizontal vibrations. Vibrations from the handheld vibrator significantly induced upper-limb muscle activity. The maximum muscle activations for FDS, ECR, ECU, biceps, and triceps were induced by 45-Hz horizontal vibration. The 60-Hz vertical and 30-Hz horizontal vibrations facilitated maximum muscle activations for the FCR and deltoid anterior, respectively.

The Effect of Paternal Skin-to-Skin Care: A Systematic Review and Meta-analysis of Randomized Control Trials.

BACKGROUND: Research about skin-to-skin care (SSC) experiences in early period after birth has focused on mothers and infants. PURPOSE: The purpose of this study was to determine the outcomes of paternal skin-to-skin care (P-SSC) in both fathers and infants. METHODS: The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed/MEDLINE, Embase, CINAHL, PsycInfo, Airiti Library, and Google Scholar were searched for randomized controlled trials (RCTs) that reported outcomes of P-SSC in both fathers and infants. We calculated pooled mean differences (MDs) and 95% confidence intervals (CIs) using RevMan 5.3 for the meta-analysis [PROSPERO: CRD42018106790]. RESULTS: Seven RCTs including a total of 552 participants were eligible for inclusion. Compared to the maternal skin-to-skin care (M-SSC), fathers in the P-SSC exhibited no significant differences in salivary oxytocin levels (MD: -0.35 pg/mL; 95% CI: -0.75, 0.05), salivary cortisol levels (MD: 0.25 µg/dL; 95% CI: -0.82, 1.33), or anxiety scores (MD: -0.17; 95% CI: -0.57, 0.22) during the period of SSC. Similarly, there were no significant differences in the salivary cortisol levels (MD: -0.11 µg/dL; 95% CI: -0.05, 0.28) among preterm infants between the 2 groups. However, the crying time was less among full-term infants in the P-SSC group compared with infants in the incubator care or cot care groups. IMPLICATIONS FOR PRACTICE AND RESEARCH: P-SSC had similar effects as M-SSC on stress-related outcomes during and after SSC among fathers and infants in the early stages after birth. We recommend that P-SSC be implemented in the early stages after birth. Further RCTs with a longitudinal design and large samples are needed to better understand the long-term effects of P-SSC on fathers and infants.

The impact of aging and reaching movements on grip stability control during manual precision tasks.

BACKGROUND: Operating an object by generating stable hand-grip force during static or dynamic posture control of the upper extremities simultaneously is an important daily activity. Older adults require different attentional resources during grip strength control and arm movements. However, the impact of aging and reaching movements on precise grip strength and stability control among older adults is not well understood. This study investigated the impact of aging and reaching movements on grip strength and stability control in both hands of the upper extremities. METHODS: Fifty healthy young adults (age: 28.8 ± 14.0 years) and 54 healthy older adults (73.6 ± 6.3 years) were recruited to perform isometric grip strength test at 20% maximal voluntary contraction as the target force during three manual precision tasks simultaneously: stationary task (without arm movements), forward-reach task, and backward-reach task. The average grip force (in kg) and coefficient of variation values (expressed as a percentage) during manual precision tasks were calculated to determine the quality of participants' grip strength. The deviation error, absolute error, and force-stability index values were calculated to determine the strength control relative to the target force. RESULTS: For both the young and older groups, the force-stability index values in both hands were significantly higher during forward- and backward-reaching movements than in the stationary condition (p < 0.05). The older group exhibited a significantly lower hand-grip strength and stability of strength control in both hands than the young group (p < 0.05). CONCLUSIONS: Aging and reaching task performance reduced the grip strength of participants and increased the variations in strength control of both hands relative to the target force, indicating that older adults exhibit poor grip strength and stability control when performing arm-reaching movements. These findings may help clinical therapists in establishing objective indexes for poor grip-stability control screening and developing appropriate rehabilitation programs or health-promotion exercises that can improve grip strength and stability control in older people.

Self-Efficacy Mediates Acculturation and Respite Care Knowledge of Immigrant Caregivers.

Past studies have shown that acculturation and self-efficacy can affect respite care knowledge, which are notable issues among immigrant caregivers due to the rapid increasing aging family members. The aim of this study was to investigate relationships among acculturation, self-efficacy, and respite care knowledge in immigrant caregivers, and to determine the mediating effects of self-efficacy on the relationship between acculturation and respite care knowledge. A cross-sectional design was used. We enrolled 134 female immigrant caregivers who had married Taiwanese men and lived with care recipients who used LTC services. Based on Baron and Kenny' mediating analytic framework, multiple regression and Sobel tests were used to examine whether self-efficacy mediated the relationship between acculturation and respite care knowledge. The findings showed that after controlling for confounding factors, acculturation and self-efficacy separately affected respite care knowledge (B = 0.229, standard error (SE) = 0.084; B = 0.123, SE = 0.049, respectively). Acculturation had a positive impact on respite care knowledge through self-efficacy (B = 0.181, SE = 0.084). Therefore, self-efficacy partially mediated the effect of acculturation on respite care knowledge, and accounted for 20.9% of the total mediating effect in this study. Acculturation predicted immigrant caregiver' respite care knowledge partially through self-efficacy. The association between acculturation and respite care knowledge was partially mediated by immigrant caregivers' self-efficacy. As a result, it was proposed that boosting self-efficacy could increase and drive immigrant caregivers' respite care knowledge. To assist this population in obtaining enough resources, targeted educational programs to promote immigrant caregivers' self-efficacy should be designed and implemented. Furthermore, health care practitioners should be aware of the relevance of immigrant caregivers' acculturation.

Can foot reflexology be a complementary therapy for sleep disturbances? Evidence appraisal through a meta-analysis of randomized controlled trials.

AIMS: To systematically summarize and quantify the effects of foot reflexology on improvements in sleep disturbances. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Datasets including PubMed, Web of Science, Scopus, EMBASE, Cochrane Library, Google Scholar, CINAHL and two Chinese electronic databases (i.e., AiritiLibrary and China National Knowledge Infrastructure) were used to search from their inception to 31 January 2019. REVIEW METHODS: Studies which were randomized controlled trials that reported changes in sleep disturbances after the intervention among adults over 18 years old and written in the English or Chinese language were included. Two reviewers' independently assessed the eligibility, extracted data, and conducted a quality assessment. Based on the extracted data, two separate meta-analyses were performed. RESULTS: Forty-two articles with a total sample of 3,928 participants were included in the systematic review and were eligible for the meta-analysis. The most commonly employed outcome measurement tool was the Pittsburgh Sleep Quality Index, followed by the therapeutic effect between the intervention and control groups (as evaluated by participants with sleep problems compared with those without sleep problems in each group after the intervention). Results revealed that foot reflexology resulted in a greater reduction in the sleep quality score compared with the controls (Hedges' g = -1.37; 95% confidence interval (CI) = -1.81~-0.94). As for the therapeutic effect, participants in the intervention group were less likely to have sleep problems than those in the control group (pooled odds ratio = 0.25; 95% CI = 0.19 ~ 0.31). CONCLUSION: The findings suggested that foot reflexology produced significant improvements in sleep disturbances. IMPACT: Foot reflexology is a non-invasive and convenient intervention and regularly receiving foot reflexology can be considered complementary therapy to improve the sleep quality of adults with sleep disturbances. Furthermore, healthcare providers can actively press the solar plexus and heart zones to alleviate sleep disturbances when performing foot reflexology.

Mediating effects of shoulder-arm exercise on the postoperative severity of symptoms and quality of life of women with breast cancer.

BACKGROUND: The postoperative severity of symptoms among women with breast cancer affects their quality of life (QoL). Although it is recommended that performing shoulder-arm exercise 30 min/day can alleviate symptoms and improve the QoL, there is little research on the mediating effects of performing shoulder-arm exercise 30 min/day on the postoperative severity of symptoms and QoL among patients with breast cancer. METHODS: A cross-sectional study was conducted 2 ~ 4 months after surgery on women diagnosed with breast cancer but with no distant metastasis and who had undergone breast cancer surgery for the first time. A structured questionnaire was employed which included a severity of symptoms scale, performing shoulder-arm exercise for 30 min/day, a QoL scale, demographic characteristics, and medical status. RESULTS: In total, 117 women with breast cancer completed the survey. The severity of symptoms and performing shoulder-arm exercise 30 min/day separately affected the QoL (B = -0.447, standard error (SE) = 0.050, p < 0.001; B = 15.666, SE = 4.542, p = 0.001, respectively). In model 3, performing shoulder-arm exercise for 30 min/day played a partial mediating role in the relationship of the severity of symptoms and QoL (R2 = 0.51, F = 5.41, p < 0.001). CONCLUSIONS: During 2 ~ 4 months after surgery, regular shoulder-arm exercise for 30 min/day could decrease the effect of the severity of symptoms on the QoL among women with breast cancer. Clinical healthcare providers may inform and educate patients as to the benefits of regular shoulder-arm exercise for 30 min/day.

Effectiveness of Tailored Rehabilitation Education in Improving the Health Literacy and Health Status of Postoperative Patients With Breast Cancer: A Randomized Controlled Trial.

BACKGROUND: The improvement of breast cancer treatment and the extension of survivorship have led to the development of postoperative complications among cancer survivors. Health literacy (HL), defined as patients' capability of using health information to maintain their health status, can enable breast cancer patients to manage postoperative complications. OBJECTIVE: The aims of this study were to develop a tailored rehabilitation education (TRE) program and examine the effectiveness of this program in improving the HL and health status with breast cancer. METHODS: This randomized controlled trial recruited 99 breast cancer patients (49 and 50 in the intervention and control groups, respectively) within 1 week after surgery. Four-week individualized TRE programs were implemented to improve their HL and health status. RESULTS: Our results showed that the TRE program produced significant improvements in HL and health status in the components of the International Classification of Functioning, Disability and Health. However, no significant difference was observed in the activity scores obtained using the Barthel Index between the 2 groups. CONCLUSION: Our finding supports the effectiveness of 1-month TRE in improving HL and all components of the International Classification of Functioning, Disability and Health status, except the activity component among breast cancer in Taiwan. IMPLICATIONS FOR PRACTICE: Clinicians could incorporate the TRE techniques in the rehabilitation sessions according to the healthcare, disease prevention, and health promotion domains to improve the clinical outcomes as well as change their health behaviors and attitudes of patients with breast cancer.

U-shaped relationship between left ventricular mass index and estimated glomerular filtration rate in patients with primary aldosteronism.

Estimated glomerular filtration rate (eGFR) is an important topic in patients with primary aldosteronism (PA). However, the relationship between left ventricular structure and eGFR is unclear. We conducted a prospective, observational, and cross-sectional study to analyze 168 patients with PA and 168 propensity score-matched patients with essential hypertension (EH) as the control group, matched by age, gender, and systolic blood pressure. In the patients with PA, the eGFR was not correlated with left ventricular mass index (LVMI; r=-0.065, p=0.404), while in the patients with EH, the eGFR was negatively correlated with LVMI (r=-0.309, p<0.001). To test whether eGFR had a non-linear relationship with LVMI among the patients with PA, we stratified the patients with PA according to the tertile of eGFR (low, medium, and high tertile). The medium tertile of patients had a significantly lower LVMI than those in the other two tertiles (LVMI: 143.5±41.6, 120.5±40.5, and 133.1±34.3 g/m2, from the lowest to highest tertile of eGFR; analysis of covariance p=0.032). The medium tertile of eGFR is associated with lowest LVMI. Patients with PA with high and low eGFR were associated with higher LVMI. The findings implied that the reasons for an increased LVMI in patients with PA may be different to those in patients with EH.

Dmrt1 (doublesex and mab-3-related transcription factor 1) expression during gonadal development and spermatogenesis in the Japanese eel.

Dmrt1, doublesex- and mab-3-related transcription factor-1, has been suggested to play critical roles in male gonadogenesis, testicular differentiation and development, including spermatogenesis, among different vertebrates. Vasa is a putative molecular marker of germ cells in vertebrates. In this study, we cloned the full-length dmrt1 cDNA from Japanese eel, and the protein comprised 290 amino acids and presented an extremely conserved Doublesex and Mab-3 (DM) domain. Vasa proteins were expressed in gonadal germ cells in a stage-specific manner, and were expressed at high levels in PGC and spermatogonia, low levels in spermatocytes, and were absent in spermatids and spermatozoa of Japanese eels. Dmrt1 proteins were abundantly expressed in spermatogonia B cells, spermatocytes, spermatids, but not in spermatozoa, spermatogonia A and Sertoli cells. To our knowledge, this study is the first to show a restricted expression pattern for the Dmrt1 protein in spermatogonia B cells, but not spermatogonia A cells, of teleosts. Therefore, Dmrt1 might play vital roles at the specific stages during spermatogenesis from spermatogonia B cells to spermatids in the Japanese eel. Moreover, the Dmrt1 protein exhibited a restricted localization in differentiating oogonia in the early differentiating gonad (ovary-like structure) of male Japanese eels and in E2-induced feminized Japanese eels. We proposed that dmrt1 may be not only required for spermatogenesis but might also play a role in oogenesis in the Japanese eel.

Development and psychometric testing of the Chinese version of the Resilience Scale for Southeast Asian immigrant women who divorced in Taiwan.

BACKGROUND: Only a few studies exist on the resilience of divorced women. Furthermore, relevant instruments for assessing the resilience of divorced immigrant Southeast Asian women are rare. Accordingly, the aim of this study was to develop and examine a new Resilience Scale-Chinese version (RS-C) that is specific to divorced immigrant Southeast Asian women in Taiwan. METHODS: The study was conducted in two phases. In phase 1, 20 items were used to evaluate face and content validities. In phase 2, a cross-sectional study was conducted. In total, 118 immigrant women participated in this study and were recruited from three nongovernmental organizations providing services for immigrants in Taipei City and Miaoli and Chiayi Counties. Psychometric properties of the instrument (i.e., internal consistency, test-retest reliability, item-to-total correlation, construct validity, and convergent validity) were examined. Significance was set at p < 0.05 for all statistical tests. RESULTS: The final 16-item RS-C resulted in a three-factor model. The three factors, namely personal competence, family identity, and social connections, were an acceptable fit for the data and explained 54.60% of the variance. Cronbach's α of the RS-C was 0.85, and those of its subscales ranged from 0.77 to 0.82. The correlation value of the test-retest reliability was 0.87. The RS-C was significantly associated with the General Self-Efficacy scale and the Chinese Health Questionnaire-12. CONCLUSION: The RS-C is a brief and specific self-report tool for evaluating the resilience of divorced immigrant Southeast Asian women and demonstrated adequate reliability and validity in this study. This RS-C instrument has potential applications in both clinical practice and research with strength-based resiliency interventions. However, additional research on the RS-C is required to further establish its reliability and validity.

Prevalence of workplace violent episodes experienced by nurses in acute psychiatric settings.

Nurses who experience workplace violence exhibit compromised care quality and decreased work morale, which may increase their turnover rate. This study explored prevalence of workplace violence, the reaction of victims, and workplace strategies adopted to prevent violence among acute psychiatric settings in northern Taiwan. A cross-sectional study was conducted, which consisted of 429 nurses who completed the Chinese version of the Workplace Violence Survey Questionnaire developed by the International Labor Office, International Council of Nurses, World Health Organization, and Public Services International. The rates of physical and psychological violence were 55.7% and 82.1%, respectively. Most perpetrator of the workplace violence were patients. Most victims responded by instructing the perpetrator to stop, followed by narrating the incident to friends, family, and colleagues. Only 4.9%-12% of the victims completed an incident or accident form, and the main reason for not reporting these violent incidents was the belief that reporting such incidents was useless or unimportant. The major strategies adopted by workplaces to prevent violence were security measures, patient protocols, and training. Institutions should train staff to handle violence, provide a therapeutic environment, simplify the reporting process, and encourage reporting of all types of violence.

Gonadal development and expression of sex-specific genes during sex differentiation in the Japanese eel.

The process of gonadal development and mechanism involved in sex differentiation in eels are still unclear. The objectives were to investigate the gonadal development and expression pattern of sex-related genes during sex differentiation in the Japanese eel, Anguilla japonica. For control group, the elvers of 8-10cm were reared for 8months; and for feminization, estradiol-17ß (E2) was orally administered to the elvers of 8-10cm for 6months. Only males were found in the control group, suggesting a possible role of environmental factors in eel sex determination. In contrast, all differentiated eels in E2-treated group were female. Gonad histology revealed that control male eels seem to differentiate through an intersexual stage, while female eels (E2-treated) would differentiate directly from an undifferentiated gonad. Tissue distribution and sex-related genes expression during gonadal development were analyzed by qPCR. The vasa, figla and sox3 transcripts in gonads were significantly increased during sex differentiation. High vasa expression occurred in males; figla and sox3 were related to ovarian differentiation. The transcripts of dmrt1 and sox9a were significantly increased in males during testicular differentiation and development. The cyp19a1 transcripts were significantly increased in differentiating and differentiated gonads, but did not show a differential expression between the control and E2-treated eels. This suggests that cyp19a1 is involved both in testicular differentiation and development in control males, and in the early stage of ovarian differentiation in E2-treated eels. Importantly, these results also reveal that cyp19a1 is not a direct target for E2 during gonad differentiation in the eel.