Psychological responses, coping and supporting needs of healthcare professionals as second victims.

AIM: To provide an overview of healthcare professionals' psychological responses, coping strategies and supporting needs in the aftermath of an adverse event, thus informing health policy implications and future research in this aspect. BACKGROUND: Trauma experienced by healthcare professionals as second victims potentially provokes intense emotional distress, detrimental professional outcomes and imposes harsh long-term effects. METHODS: A systematic literature review was performed to synthesize the experiences and needs of second victims who are healthcare professionals being traumatized by an unanticipated adverse event, medical error or patient-related injury. CINAHL, Embase, PsycINFO, PubMed and Scopus databases were searched for relevant articles published in English from January 2000 to October 2015. RESULTS: Data extraction was performed for the 30 studies selected. Second victims experienced enduring intense negative psychological responses. They adopted multiple coping mechanisms and desired emotional and informational support. CONCLUSION: Second victims experience substantial psychological impact which can be mitigated with supportive environments. It is imperative that subsequent research consider the potential factors affecting second victims' emotional experience, efficacy of coping strategies in facilitating recovery and obtain a comprehensive understanding of second victims' experience. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nursing and health management's role in establishing organizational support structures is necessary to meet second victims' needs. This existing knowledge is significant to guide policy makers in developing a holistic and effective second victim support programme.

Second Toe Systolic Pressure Measurements are Valid Substitutes for First Toe Systolic Pressure Measurements in Diabetic Patients: A Prospective Study.

OBJECTIVE: Toe systolic pressure is a component of the standard vascular and diabetic foot assessment. Until now,clinicians have measured only first toe pressure given a lack of evidence for measurements of the other toes. In diabetic patients, first toe measurements are often not possible because of ulceration or amputation. It was hypothesized that the adjacent second toe systolic pressure measurements would be interchangeable with those of the first toe. METHODS: A prospective study was performed on 100 participants with diabetes mellitus. Duplicate systolic toe pressures were measured in the first toe and adjacent second toe using the Systoe Automated Toe Pressure System, Systoe Photophlethysmograph Sensor Cuff, and occlusion cuffs measuring 120 x 25 mm for the first toe and 90 x 15 mm for the second toe. Correlation analysis was followed by Ordinary Least Products regression to detect and distinguish fixed and proportional bias between the two toe measurements. The acceptable limits of interchangeable results were defined as 5-10 mmHg. RESULTS: Correlation coefficient r » 0.908; p < 0.001. Eighty-two percent of the variations in the second toe measurements were accounted for by knowing the first toe measurements and vice versa. Ordinary Least Products regression showed no fixed or proportional bias between the two methods of measurement: second toe systolic pressure = (-0.579) + (1.038) * first toe systolic pressure. Repeatability analysis showed a 0.5%variation between duplicate measurements. CONCLUSIONS: This is the first study which demonstrates that second toe systolic pressures are interchangeable with those of the first toe. Second toe pressures can be used in diabetic patients whose first toe pressures cannot be assessed.

Non-myeloablative transplantation of bone marrow expressing self-antigen establishes peripheral tolerance and completely prevents autoimmunity in mice.

Myeloablative transplantation of bone marrow (BM) engineered to express myelin oligodendrocyte glycoprotein (MOG) establishes central intrathymic tolerance and completely prevents MOG-induced experimental autoimmune encephalomyelitis (EAE) in mice. Here we asked whether non-myeloablative transplantation of MOG expressing BM (pMOG-bone marrow transplantation (BMT)) can also provide the same protection. Using stepwise reduction of irradiation doses, 275 cGy irradiation with pMOG-BMT protected 100% of mice from EAE development even with two subsequent re-challenge with MOG. Irradiation doses <275 cGy produced dose-dependent partial protection with significant disease protection still evident at 50 cGy. Splenocytes from 275 cGy recipients proliferated to MOG stimulation in vitro, indicating that MOG-reactive cells are present in the periphery but failed to induce disease. MOG-stimulated splenocytes produced little or no interleukin-17, interferon-γ, granulocyte-monocyte colony stimulating factor and tumor necrosis factor-α compared with EAE control. Adoptive transfer of CD4 T cells from EAE-resistant mice into Rag2(-/-) mice devoid of MOG expression resulted in MOG-induced EAE in ~74% of mice. Treatment of EAE-resistant mice with anti-programmed death 1 (PD-1) monoclonal antibody-induced EAE in 67% of mice. We conclude that non-myeloablative transplantation of self-antigen expressing BM induces robust peripheral tolerance that completely prevented EAE development. Our findings implicate clonal anergy and the PD-1 pathway in the maintenance of peripheral tolerance.

Natural transmission of Plasmodium knowlesi to humans by Anopheles latens in Sarawak, Malaysia.

Four species of malaria parasites are known to infect humans. A fifth species, Plasmodium knowlesi, has been reported to infect humans in Malaysian Borneo. Here we report for the first time the incrimination of Anopheles latens as the vector of P. knowlesi among humans and monkeys in Sarawak, Malaysia.

Epidemiology of malaria in Attapeu Province, Lao PDR in relation to entomological parameters.

Surveys were conducted in malaria-endemic villages in the southern province of Attapeu, Lao PDR during various seasons over a 3-year period. All-night mosquito landing collections, blood surveys and a case-control study were conducted. Plasmodium falciparum was the predominant species, and slide positivity rates were higher during the transition/dry season compared with the wet season. Anopheles dirus A was found to be the primary vector, and sporozoite rates were highest during the transition/dry season. Anopheles dirus was found to be endophagic and endophilic. Not using insecticide-treated bed nets, houses close to breeding sites and sleeping away from home were risk factors associated with malaria.

The impact of development and malaria control activities on its vectors in the Kinabatangan area of Sabah, East Malaysia.

A study was carried out from July 2001 until January 2003 in the Kinabatangan area of Sabah, part of Borneo island, where malaria used to be mesoendemic. Vector surveys determined that Plasmodium falciparum was the predominant species and Anopheles balabacensis the primary vector. Malaria cases have dropped drastically over the years but P. falciparum is still predominant. In the present study, Anopheles donaldi was the predominant species and was positive for sporozoites. Although An. balabacensis was present, none were infective. An. donaldi bite more outdoors than indoors and have a peak biting time from 18:00 to 19:00 h when most people are still out of their homes. An integrated malaria control programme along with area development has helped in the control of malaria and its vector.

Production of anti-phosphorylcholine antibodies of the T15 idiotype in CBA/N xid mice: investigation of the defect using a T15 immunoglobulin transgene.

A notable defect in CBA/N xid mice is their relative inability to make antibodies to phosphorylcholine (PC), particularly those of the T15 idiotype which predominate in the anti-PC responses of immunologically normal mice. To investigate the basis of this defect, we introduced functionally rearranged genes encoding a T15+ PC-binding immunoglobulin G antibody into the germline of these animals. Expression of these genes in the xid cells was observed, shown by the existence of a distinct population of T15+ cells (3 x 10(6)) in the spleen of the transgenic animals, and the presence of PC-binding T15+ IgG antibodies (1-15 micrograms/ml) in the serum. Mixed antibody molecules were also found, however, which were composed of both transgene-encoded and endogenously-derived chains. Existence of the T15+ cells in these animals seemed normal, since these were not depleted (to any great extent) and were immunocompetent as well. The latter was shown by the increased T15+ antibody production in the transgenic animals when stimulated with a PC-associated thymus-independent type 1 (TI-1) antigen and anti-idiotype antibodies, but not with the pneumococcal TI-2 antigen. This is similar to the PC-specific (T15-) responsiveness of normal CBA/N xid mice. Based on these results, we argue that a reason why T15+ antibodies are not normally made by CBA/N xid animals is because T15+ genes are not utilized or, as with any T15+ precursors present, selected for in these animals, in contrast to normal mice where the Lyb-5 or CD5 cells (which are absent in CBA/N xid animals) are known to be specially endowed to make such antibodies.

A survey on the prevalence and utilization characteristics of gua sha in the Hong Kong community.

OBJECTIVE: To conduct a community-based survey to describe the demographics, experience, and utilization variables among the users of gua sha living in Hong Kong. METHOD: A total of 3209 adult respondents were surveyed by using a short Chinese questionnaire. RESULTS: Gua sha was found to have a one-year prevalence of 22.7% and four-week prevalence of 6.6%. The users were seen to be old of age and less educated. The majority believed that gua sha is beneficial to health, practiced in non-regular basis, and mainly employed for treating illnesses. For both male and female, the top two common illnesses to be treated were the respiratory and pain problems, which accounting for 74% of all users. Other illnesses included nervousness, heat stroke, fever, infection, dizziness, diarrhoea and vomiting, oedema, and constipation. As practiced by most respondents, unidirectional pressured stroking was applied repeatedly on the lubricated skin surface at the back region using various smooth-edged tools typically spoons. Almost all users reported the occurrence of skin blemishing and subsequently faded within 7 days after the gua sha treatment. CONCLUSION: The general population of Hong Kong was found to have high prevalence of gua sha usage. The utilization characteristics as reported by the users were generally aligned with the current scientific knowledge, in particular the treatment procedures and response.

Differential expression of adenosine A1 receptors in colorectal cancer and related mucosa.

Adenosine A1 receptors (A1R) are known to inhibit while the A2 receptors (A2R) stimulate the G-protein cAMP second messenger system and may play a role in cell growth and carcinogenesis. Using a quantitative reverse transcription-polymerase chain reaction (RT-PCR) method, mRNA for A1R and A2R was measured in human colorectal adenocarcinomas and individual peritumoural colon tissues. There was differential expression of the mRNA for A1R with tumour tissues having significantly higher amounts compared to peritumoural normal tissues. The mRNA for A2R was not found to be differentially expressed. The increase in the inhibitory A1 receptor in tumour tissues may be in response to increased adenosine release from the hypoxic cells found in malignant tumour tissues, thus indicating a possible role for the adenosine A1 receptor in carcinogenesis.

Steroidogenesis in preovulatory follicles of patients given human menopausal and chorionic gonadotrophins as judged by the radioimmunoassay of steroids in follicular fluid.

The administration of human menopausal gonadotrophin (HMG) followed by human chorionic gonadotrophin (HCG) stimulated the development of various numbers of follicles in patients treated for infertility. Graafian follicles from these patients were aspirated 32-33 h after the injection of HCG and the levels of steroids in the follicular fluid and matching serum samples were measured by radioimmunoassay. The follicles could not be grouped into two distinct clusters as found in patients given HCG during the menstrual cycle but a broad classification of follicles into four groups was indicated from the dendrogram. Two of the groups were similar to the ovulatory and non-ovulatory groups found previously, whereas the other two groups of follicles were more intermediate in nature. The use of a discriminant analysis showed that these two groups had clearly been stimulated by the HMG and HCG, although they were not yet fully ovulatory. Our data indicate that the number of developing follicles is considerably increased by treatment with HMG and HCG but there is asynchrony in follicular development because the pattern of steroid synthesis differs in many follicles. The effects of this asynchronous development on oocyte maturation and disorders of the luteal phase are discussed.

Steroidogenesis in human follicles approaching ovulation as judged from assays of follicular fluid.

Human chorionic gonadotrophin (HCG) was given to patients at mid-cycle before the endogenous LH surge. Graafian follicles were aspirated 32-33 h later, before ovulation was expected, and the levels of several steroids in follicular fluid and in matching serum samples were measured by radioimmunoassay. Two types of Graafian follicle were identified at laparoscopy , based on the nature of the oocyte, granulosa cells and follicular fluid withdrawn from the follicles. Some were large, preovulatory and presumably becoming luteinized while others were generally smaller, non-ovulatory and still growing. The concentrations of dehydroepiandrosterone (DHEA) and 17alpha-hydroxypregnenolone (delta5 intermediates), androstenedione and testosterone were higher in non-ovulatory follicles, whereas large follicles usually contained high levels of progesterone, 17alpha-hydroxyprogesterone, pregnenolone and oestradiol-17beta. A cluster analysis of these data grouped follicles into two distinct clusters, which accorded with their identification as ovulatory or non-ovulatory at laparoscopy. Levels of progesterone, 17alpha-hydroxyprogesterone and oestradiol-17beta in follicular fluid were high in preovulatory follicles in comparison with plasma. Results in two patients indicated that plasma levels of these steroids were determined by the preovulatory follicle. Levels of plasma delta5 steroids were closer to follicular fluid concentrations, whereas DHEA was higher in plasma. The role of the theca and granulosa is discussed in relation to the synthesis of progesterone and oestradiol-17beta in follicles as ovulation approaches.

Transfection of rat brain cells by electroporation.

Genetic intervention is a powerful means for answering basic biological questions about molecular events taking place in brain cells underlying complex behaviors. Traditional transfection method has proved difficult to apply to neuronal cells. We therefore described an alternative procedure for introducing DNA into cultured rat brain cells by electroporation. The various parameters involving the voltage, capacitance and electroporation buffer are investigated. We found that this transfection procedure is simple, reproducible and applicable to rat brain cells in vitro.

The incidence of cytoplasmic fragmentation in mouse embryos in vitro is not affected by inhibition of caspase activity.

OBJECTIVE: To investigate the relationship between cytoplasmic fragmentation and caspase activity in the mouse embryo. DESIGN: Experimental laboratory study. SETTING: University gynacology unit. ANIMAL(S): One-cell zygote of mouse (MF1 x BALB/c). INTERVENTION(S): Mouse embryos were treated with caspase inhibitors: benzyloxycarbonyl-Val-Ala-Asp fluoromethylketone (z-VAD-fmk) and benzyloxycarbonyl-Asp-glu-Val-Asp-fluoromethyl ketone (Z-DEVD-fmk). MAIN OUTCOME MEASURE(S): Morphological development of the embryo, proportion of fragmented embryos, caspase-3-like activity, DNA breakage, and phosphatidylserine exposure in blastomeres. RESULT(S): The proportion of embryo reaching two-cell, three- to four-cell, and morula stage at 48, 72, and 96 hours after hCG administration, respectively, were comparable between the control embryos and those treated with either z-VAD-fmk or z-DEVD-fmk, at three concentrations (10 microM, 50 microM, and 200 microM). Although the inhibitors suppressed the caspase-3-like activity in the embryo fragment before compaction and decreased DNA breakages, there was no statistically significant difference in the percentage of fragmented embryo between the control and those treated with caspase inhibitors. The inhibitors did not affect the incidence of phosphatidylserine exposure in the blastomere of the treated embryos. CONCLUSION(S): Cytoplasmic fragmentation in precompaction mouse embryos is not a consequence of caspase-related apoptosis.

Human oviductal cells reduce the incidence of apoptosis in cocultured mouse embryos.

OBJECTIVE: To investigate the effect of human oviductal cell coculture on the incidence of apoptosis in mouse embryos. DESIGN: Experimental laboratory study. SETTING: University gynecology unit. PATIENT(S): Fallopian tubes were obtained from patients undergoing hysterectomy. INTERVENTION(S): Mouse embryos were cocultured with human oviductal cells. MAIN OUTCOME MEASURE(S): Blastocyst development, allocation of inner cell mass (ICM) and trophectoderm (TE) in blastocyst, and apoptosis in embryos. RESULT(S): Oviductal cells significantly enhanced the blastulation (38%) and hatching rate (22%) of the cocultured zygotes. The corresponding values in medium alone culture were 21% and 9%, respectively. The cocultured embryos also had higher blastomere count at blastocyst stage (P<0. 005). This was due to increase in both the cell count of ICM (P<0. 05) and TE (P<0.001). Coculture reduced the incidence of apoptosis in the cultured morula and blastocyst from 38% and 48% to 16% (P<0. 001) and 27% (P<0.05), respectively. The number of apoptotic blastomeres per morula (1.5 +/- 0.6; P<0.005) and blastocyst (2.3 +/- 0.7; P<0.005) after coculture was also significantly lower than that of the corresponding control (morula, 2.1 +/- 0.8; blastocyst, 3.5 +/- 1.1). CONCLUSION(S): Human oviductal cells improved mouse embryo development partly by decreasing the incidence of apoptosis.

Chronic encapsulated intracerebral hematoma in a young Chinese adult: case report.

Chronic encapsulated intracerebral hematoma is rare. Six cases have been reported. A case of chronic encapsulated intracerebral hematoma in a young Chinese adult is presented. The possible pathoetiology underlying these cases is discussed.

Sparganosis of the brain. Report of two cases.

Cerebral sparganosis is a rare disease; to date only eight cases have been described. Two new cases of cerebral sparganosis occurring in Chinese patients living in a metropolitan area are reported. Their clinical presentation and investigative results are presented and the operative and histological findings detailed. A brief review of the condition is given and the possible source of infection discussed.

Cadmium toxicity on mouse pre-implantation zygotes in vitro: interactions of cadmium with manganese, zinc and calcium ions.

Simultaneous treatment with cadmium chloride (5 micrograms/ml medium) and manganese chloride (5 or 10 micrograms/ml medium) was less toxic to mouse pre-implantation zygotes in vitro than cadmium alone. Such a protective effect of manganese, resembling that of zinc, suggests that amelioration of cadmium-treated pre-embryos in vitro is not unique to zinc. The amelioration may require only the presence of another divalent metallic ion, such as zinc or manganese, which is capable of competing with cadmium for binding sites possibly involved in uptake. Under calcium-free conditions cadmium embryotoxicity is enhanced, showing a summation effect of the cadmium toxicity and the lack of calcium. This supports the notion that excessive exogenous calcium may render the effects of cadmium on compaction inconspicuous. The non-compacted pre-embryos treated with 5 micrograms/ml cadmium in a calcium-free medium had fewer blastomeres than those treated at a lower dose of 1 microgram/ml. Cadmium appeared to inhibit the cleavage from 8-cell to 16-cell stage, but not from 4-cell to 8-cell.

Transcellular movement and intracellular concentration of sodium in erythrocytes after surgery and in seriously ill patients.

Erythrocyte intracellular sodium concentration and transmembrane sodium flux were measured in nine healthy patients undergoing uncomplicated elective abdominal surgery. Intracellular sodium concentration was determined by in vitro washing of cells in a solution approximating to intracellular constituents and measuring extracellular sodium contamination with 51Cr EDTA. Sodium flux was determined by radioactive 22Na tracer both as influx and efflux. No change in erythrocyte intracellular sodium concentration or in sodium flux was found postoperatively. In 14 seriously ill surgical patients, all of whom had plasma sodium levels outside the tolerance range of our surgical population, erythrocyte intracellular sodium concentration decreased, but not significantly, compared with patients undergoing uncomplicated surgery (p = 0.16). Furthermore, sodium flux in seriously ill patients was proportional to intracellular sodium concentration. These results are at variance with the hypothesis of 'sick cell syndrome' which is said to be typified by a high intracellular sodium concentration and a reduced sodium efflux. In the surgical patients studied, it is more likely this hyponatremia does not result from a change in sodium flux but is dilutional.

Alteration of thyroid blood flow during the normal menstrual cycle in healthy Chinese women.

The purpose of this study was to investigate the relationship between thyroid activity and the menstrual cycle by measuring the Doppler parameters of the superior thyroid arteries in women of reproductive age. The study was performed in 27 healthy Chinese women aged between 19 and 28 y for one menstrual cycle, and 25 age-matched healthy Chinese men for 3 weeks for comparison. In women, the peak systolic velocity increased from the follicular phase to the luteal phase, and the pulsatility index decreased from the follicular phase to the ovulatory phase and increased slightly in the luteal phase. In men, alterations in the pattern of thyroid blood flow were not observed; however, the average values of Doppler parameters during the study period in women were similar to those in men. The gender difference in the pattern of flow characteristics in the superior thyroid artery suggests effects of estrogen on thyroid function.