Proteomic profiling of TBC1 domain family member 21-null sperms reveals the critical roles of TEKT 1 in their tail defects.

BACKGROUND: Approximately 7% of the males exhibit reduced fertility; however, the regulatory genes and pathways involved remain largely unknown. TBC1 domain family member 21 (TBC1D21) contains a conserved RabGAP catalytic domain that induces GDP/GTP exchange to inactivate Rabs by interacting with microtubules. We previously reported that Tbc1d21-null mice exhibit severe sperm tail defects with a disrupted axoneme, and that TBC1D21 interacts with RAB10. However, the pathological mechanisms underlying the Tbc1d21 loss-induced sperm tail defects remain unknown. RESULTS: Murine sperm from wild-type and Tbc1d21-null mice were comparatively analyzed using proteomic assays. Over 1600 proteins were identified, of which 15 were significantly up-regulated in Tbc1d21-null sperm. Notably, several tektin (TEKT) family proteins, belonging to a type of intermediate filament critical for stabilizing the microtubular structure of cilia and flagella, were significantly up-regulated in Tbc1d21-/- sperm. We also found that TBC1D21 interacts with TEKT1. In addition, TEKT1 co-localized with RAB10 during sperm tail formation. Finally, we found Tbc1d21-null sperm exhibited abnormal accumulation of TEKT1 in the midpiece region, accompanied by disrupted axonemal structures. CONCLUSIONS: These results reveal that TBC1D21 modulates TEKTs protein localization in the axonemal transport system during sperm tail formation.

Deleterious genetic changes in AGTPBP1 result in teratozoospermia with sperm head and flagella defects.

Approximately 10%-15% of couples worldwide are infertile, and male factors account for approximately half of these cases. Teratozoospermia is a major cause of male infertility. Although various mutations have been identified in teratozoospermia, these can vary among ethnic groups. In this study, we performed whole-exome sequencing to identify genetic changes potentially causative of teratozoospermia. Out of seven genes identified, one, ATP/GTP Binding Protein 1 (AGTPBP1), was characterized, and three missense changes were identified in two patients (Affected A: p.Glu423Asp and p.Pro631Leu; Affected B: p.Arg811His). In those two cases, severe sperm head and tail defects were observed. Moreover, AGTPBP1 localization showed a fragmented pattern compared to control participants, with specific localization in the neck and annulus regions. Using murine models, we found that AGTPBP1 is localized in the manchette structure, which is essential for sperm structure formation. Additionally, in Agtpbp1-null mice, we observed sperm head and tail defects similar to those in sperm from AGTPBP1-mutated cases, along with abnormal polyglutamylation tubulin and decreasing △-2 tubulin levels. In this study, we established a link between genetic changes in AGTPBP1 and human teratozoospermia for the first time and identified the role of AGTPBP1 in deglutamination, which is crucial for sperm formation.

Deficiency of the Tbc1d21 gene causes male infertility with morphological abnormalities of the sperm mitochondria and flagellum in mice.

Approximately 2-15% of couples experience infertility, and around half of these cases are attributed to male infertility. We previously identified TBC1D21 as a sterility-related RabGAP gene derived from infertile men. However, the in vivo function of TBC1D21 in male fertility remains unclear. Here, we show that loss of Tbc1d21 in mice resulted in male infertility, characterized by defects in sperm tail structure and diminished sperm motility. The mitochondria of the sperm-tail had an abnormal irregular arrangement, abnormal diameter, and structural defects. Moreover, the axoneme structure of sperm tails was severely disturbed. Several TBC1D21 interactors were selected via proteomic analysis and functional grouping. Two of the candidate interactors, a subunit protein of translocase in the outer membrane of mitochondria (TOMM20) and an inner arm component of the sperm tail axoneme (Dynein Heavy chain 7, DNAH7), confirmed in vivo physical co-localization with TBC1D21. In addition, TOMM20 and DNAH7 detached and dispersed outside the axoneme in Tbc1d21-deficient sperm, instead of aligning with the axoneme. From a clinical perspective, the transcript levels of TBC1D21 in sperm from teratozoospermia cases were significantly reduced when compared with those in normozoospermia. We concluded that TBC1D21 is critical for mitochondrial and axoneme development of mammalian sperm.

[Celebrating the 70th Anniversary of The Journal of Nursing].

The Journal of Nursing (JN) was first published in Taiwan seventy years ago in 1953 under its former name, Nursing Quarterly. The first issue of JN under its current name was published in 1961. JN mainly publishes academic papers. Despite the vicissitudes of history, the Taiwan Nurses Association (TWNA) remained true to its mission of serving its members, and resumed publication of JN after relocating to Taiwan from China after 1949. JN articles published over the past seven decades have focused on promoting professional competence, advocating clinical practice, advancing nursing education, introducing new concepts of administrative reform, and disseminating research findings and clinical case reports with goals of promoting nurses' understanding of nursing professional theory, cultivating critical thinking and creativity, helping nurses acquire and accumulate knowledge and skills in scientific language, and solving problems encountered in clinical care and education. In addition, in response to advances in medical care and the COVID-19 pandemic, the content of JN published in 2020 highlighted the current pandemic situation in special articles, research, and case reports to provide readers with knowledge about related care and research results. Through the publication of journal papers, we are promoting more interactions and inspiring more sparks of insight. JN is valued by readers around the world because the contributions and support of its many authors have allowed the journal to grow and thrive. At the same time, I would also like to thank the editor of each topic for their enthusiasm and enthusiastic welcoming of manuscript contributions and all Review Committee members for their careful review of manuscripts and tireless modification and review of articles, so as to provide readers with reliable reference resources. Therefore, the quality of the content published in JN has been recognized globally, and has been successively indexed in the globally recognized databases, including MEDLINE/PubMed (indexed from 2004), CINAHL (Cumulative Index to Nursing & Allied Health Literature; indexed from 1996), EBSCO Publishing (indexed from 2002), Scopus (indexed from 2004), ProQuest (indexed from 2012), and Airiti Library (indexed from 2004). Moreover, JN has been a RIHSS-accredited tier three journal since 2019. In addition, JN has won awards for five consecutive years since 2017. The excellent content quality of JN has made it an important source of knowledge dissemination and influence in domestic academic circles. Since becoming Editor-in-Chief of JN, I have read many contributors' articles and feel regularly grateful to the authors for their submissions, whether their articles are accepted for publication or not. With the efforts of previous Editors-in-Chief and Editorial Committee members, JN has continuously adjusted its mode of operations to meet social changes and has gradually established a comprehensive process for submission, review and publication. In recognition of JN's 70th anniversary in publication, we look forward to continued, sustainable development of the journal and of service for our global readership. We look forward for JN to do even more in the coming decade and beyond!

[The Effects of Supportive Caring on Symptoms Distress, Nursing Needs, and Depression in Patients With Brain Tumor After Surgery: A Preliminary Study].

BACKGROUND: Brain tumors are mainly treated with surgery. However, patients still experience many symptoms and nursing needs due to disease and treatment-related factors that, if not improved in a timely manner, may result in depression. PURPOSE: The purpose of this study was to examine the effectiveness of supportive caring on symptom distress, nursing needs, and depressive symptoms in patients with brain tumor after surgery. METHODS: This study adopted a two-group, pre- and post-test experimental design. The enrolled participants were randomized into two groups. Those in the experimental group received a phone-based supportive caring intervention twice at 1 and 3 months after surgery. Those in the control group received usual discharge care. The measurement outcomes included a supportive care needs survey, symptom distress scales, and the center for epidemiological studies of depression. Baseline data was collected prior to hospital discharge (T0), with follow-up data collected at one month (T1), three months (T2), and six months (T3) after surgery. RESULTS: The results of the generalized estimating equation analysis showed that nursing needs in the experimental group at T1 (ß = -23.61, p < .001), T2 (ß = -22.51, p < .001), and T3 (ß = -22.26, p < .001) were significant lower than in the control group. Also, symptom distress in the experimental group at T1 (ß = -7.03, p = .019) and T2 (ß = -8.39, p = .003) was significantly lower than in the control group. However, depressive symptoms in the experimental group were lower than in the control group only at T2 (ß = -8.55, p = .005). CONCLUSIONS: The results of this study confirm that supportive care helps improve nursing needs, symptoms distress, and depressive symptoms in patients with brain tumor after surgery. Medical team members should pay attention to these issues following surgery.

Comparison of oncological outcomes for hand-assisted and pure laparoscopic radical nephroureterectomy: results from the Taiwan Upper Tract Urothelial Cancer Collaboration Group.

PURPOSE: Laparoscopic radical nephroureterectomy (LNU) has gradually become the new standard treatment for localized upper tract urothelial cancer (UTUC). With more blunt dissection and tactile sensation, hand-assisted LNU might shorten the operative time compared with the pure laparoscopic approach. However, whether the use of the hand-assisted or the pure laparoscopic approach has an effect on oncological outcomes remains unclear. METHODS: We retrospectively identified 629 patients with non-metastatic UTUC who underwent hand-assisted (n = 515) or pure LNU (n = 114) at 9 hospitals in Taiwan between 2004 and 2019. Overall survival, cancer-specific survival, recurrence-free survival, and bladder recurrence-free survival were compared between these two groups using inverse-probability of treatment weighting (IPTW) derived from the propensity scores for baseline covariate adjustment. RESULTS: The median follow-up period was 32.9 and 28.7 months in the hand-assisted and the pure groups, respectively. IPTW-adjusted Cox proportional hazards models showed that the laparoscopic approach (pure vs. hand-assisted) was not significantly associated with all-cause mortality (HR 0.79, 95% CI 0.49-1.24, p = 0.304), cancer-specific mortality (HR 0.88, 95% CI 0.51-1.51, p = 0.634), or extra-vesical recurrence (HR 0.65, 95% CI 0.41-1.04, p = 0.071). However, the pure laparoscopic approach was significantly associated with lower intra-vescial recurrence (HR 0.64, 95% CI 0.43-0.96, p = 0.029) for patients who underwent LNU. Kaplan-Meier curves also revealed that the pure laparoscopic approach was associated with better bladder recurrence-free survival compared with the hand-assisted laparoscopic approach in both the original cohort and the IPTW-adjusted cohort (log-rank p = 0.042 and 0.027, respectively). CONCLUSIONS: The performance of hand-assisted or pure LNU does not significantly affect the all-cause mortality, cancer-specific mortality, or extra-vesical recurrence for patients with non-metastatic UTUC. However, the hand-assisted laparoscopic approach could increase the risk of intra-vesical recurrence for patients who undergo LNU.

Localization Patterns of RAB3C Are Associated with Murine and Human Sperm Formation.

Background and Objectives: Septins (SEPTs) are highly conserved GTP-binding proteins and the fourth component of the cytoskeleton. Polymerization of SEPTs contributes to several critical cellular processes such as cytokinesis, cytoskeletal remodeling, and vesicle transportation. In our previous study, we found that SEPT14 mutations resulted in teratozoospermia with >87% sperm morphological defects. SEPT14 interactors were also identified through proteomic assays, and one of the peptides was mapped to RAB3B and RAB3C. Most studies on the RAB3 family have focused on RAB3A, which regulates the exocytosis of neurotransmitters and acrosome reactions. However, the general expression and patterns of the RAB3 family members during human spermatogenesis, and the association between RAB3 and teratozoospermia owing to a SEPT14 mutation, are largely unknown. Materials and Methods: Human sperm and murine male germ cells were collected in this study and immunofluorescence analysis was applied on the collected sperm. Results: In this study, we observed that the RAB3C transcripts were more abundant than those of RAB3A, 3B, and 3D in human testicular tissues. During human spermatogenesis, the RAB3C protein is mainly enriched in elongated spermatids, and RAB3B is undetectable. In mature human spermatozoa, RAB3C is concentrated in the postacrosomal region, neck, and midpiece. The RAB3C signals were delocalized within human spermatozoa harboring the SEPT14 mutation, and the decreased signals were accompanied by a defective head and tail, compared with the healthy controls. To determine whether RAB3C is involved in the morphological formation of the head and tail of the sperm, we separated murine testicular tissue and isolated elongated spermatids for further study. We found that RAB3C is particularly expressed in the manchette structure, which assists sperm head shaping at the spermatid head, and is also localized at the sperm tail. Conclusions: Based on these results, we suggest that the localization of RAB3C proteins in murine and human sperm is associated with SEPT14 mutation-induced morphological defects in sperm.

[The Spread of the Epidemic Among Vulnerable Groups and Related Epidemic Prevention Issues].

The COVID-19 pandemic has highlighted the adverse health, economic and social consequences of longstanding social inequality on various communities, groups, and individuals. Because they lack sufficient access to health and social resources, vulnerable groups affected by lower incomes, geographic remoteness, and/or low awareness of disease prevention and control measures are more susceptible to infection (McDonald, 2022; Mein, 2020; Moghanibashi-Mansourieh, 2021). According to The Lancet (2020) editorial board, vulnerable groups are defined as segments of the population disproportionately exposed to risk. People not considered vulnerable at the start of the pandemic may become vulnerable afterward due to pandemic-related effects such as loss of income and lack of access to social support. Thus, during the COVID-19 pandemic, vulnerable groups include not only traditionally vulnerable populations (e.g., older adults, infants, immuno-compromised individuals) but socioeconomic groups that may be financially, mentally, or physically struggling to cope. In addition, schools of all levels around the world have adopted remote online synchronous or asynchronous teaching methods to avoid pandemic-related school closures and interruptions in student learning (Dreesen et al., 2020). However, issues such as the accessibility, availability, acceptability, and applicability of online learning equipment for vulnerable students should be comprehensively considered by the government. Governments encounter multiple challenges related to the above-mentioned issues, including (1) dealing with the public health effects of the pandemic crisis; (2) dealing with related economic and social impacts such as social and economic depression due to isolation, tax reductions, increased payments, subsidies, compensation, and the provision of unemployment insurance (Moghanibashi-Mansourieh, 2021); and (3) reforming education teaching methods and providing appropriate information and equipment of vulnerable groups. In responding to COVID-19, policymakers should consider the risks of exacerbating the inequalities faced by vulnerable groups. Moreover, vulnerable groups should be clearly identified to limit the long-term consequences of the pandemic. Governments must continually identify vulnerable / at-risk populations and provide equitable support to those most at risk.

[Human Health Rights: Discussing Health Inequality for Taiwanese Indigenous Peoples and the Appropriateness of Current Epidemic Policies].

Many studies from around the world demonstrate that COVID-19 has had significantly higher rates of infection, hospitalization, and mortality among indigenous and other vulnerable groups than among mainstream population groups. This situation has exposed and reinforced pre-existing health inequalities. This article investigates the rates of infection and mortality among different cultural groups during the COVID-19 pandemic, and then deconstructs the key elements related to systemic or structural racism. The impacts on the human rights and health of indigenous peoples and issues of policy formulation and resource equity during the epidemic are also mentioned. Based on the identified root causes of health inequality, suggestions for reducing health inequality for Taiwanese indigenous peoples are proposed. Further, during epidemics, policymakers must design and implement culturally appropriate epidemic prevention policies, systems, and strategies for indigenous and other disadvantaged populations.

[Analysis of the Effects of Femoral Nerve Block on Pain Level and Knee Mobility in Patients With Total Knee Replacement].

BACKGROUND: Osteoarthritis is a common cause of inactivity and reduced quality of life in the elderly. Total knee replacement (TKR) surgery, a last-stage treatment option for osteoarthritis, often results in postoperative pain that influences knee flexion and the ability to perform prescribed rehabilitation exercises. PURPOSE: This study was designed to examine the effectiveness of single femoral nerve block (FNB) on pain level and knee mobility in patients with TKR. METHODS: A quasi-experimental, two-group, longitudinal study was designed. The participants were distributed into the FNB group (n = 86) and non-FNB group (n = 86). The outcome measurements included pain scale (Numerical Rating Scale) score and knee continuous passive motion knee flexion angle. The five assessments and followed-up times were as follows: admission day (T0) and post-surgery day 1, 2, 3, and 4. RESULTS: The results of the generalized estimating equations model showed that the pain level in the FNB group was significantly lower than in the non-FNB group, (p < .001). In terms of analgesics demand from post-surgery day 1 to day 4, the FNB group exhibited a significantly lower demand than the non-FNB group (p < .01). In addition, significant differences in the continuous passive motion rehabilitation exercise angle were found between the two groups from post-surgery day 1 through day 4 (p < .05). Finally, significant differences in knee flexion angles between the two groups were observed between hospital admission and discharge (p < .001). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The findings of this study support the positive effects of the femoral nerve block intervention on patients who receive total knee replacement surgery. The results were significant in terms of pain relief and knee mobility recovery. This intervention should be made available for use in the clinical care of TKR patients.

[Nutritional Care in Acute and Chronic Illness].

Nutrition is essential for maintaining good health and preventing diseases, especially in patients suffering from acute or chronic diseases, infectious diseases, or critical illnesses because dietary intake involves both quantitative and qualitative changes and may disturb energy homeostasis (Richardson & Davidson, 2003). The metabolism of patients with critical illnesses is categorized as hypercatabolic, with significant loss of lean body tissue facilitated by the immune-neuroendocrine response of acute critical illness (Mechanick & Brett, 2005). Therefore, facing hunger during a period of physiological stress because of disease or treatment, results in an increased basal metabolic rate, accelerated protein breakdown, and increased energy and nutritional requirements in response to tissue damage, infection, and inflammation. This situation will develop rapidly into malnutrition or further exacerbate malnutrition because of inflammation and metabolic stress associated with diseases and injuries (Wortinger & Burns, 2015). The inflammatory response triggers the neurophysiology of patients and severely affects digestive behavior (Konsman & Dantzer, 2001), especially in terms of increasing demand for protein to provide amino acids for immunoglobulin and acute-phase protein production, both of which are fundamental to proper immune system functions. Under conditions of severe nutrient deficiency, the protein catabolism of the viscera and skeletal muscle for energy and protein generation will occur quickly in the acute phase. This catabolism has the potential to affect the cardiovascular, respiratory, immune, and all other body systems (Chan, 2015). Therefore, malnutrition during hospitalization may initiate immunosuppression and increase the risk of bacterial spread and sepsis, delayed wound healing, impaired organ function, prolonged hospitalization, and morbidity and mortality (Chan, 2015). As severe malnutrition is related to poor illness or treatment outcomes, which is associated with longer hospitalization and increased medical expenses, assessing patients' nutritional status and providing adequate nutritional care are critical. A nutritional assessment that includes body weight, physical condition and muscle condition, and calculation of resting energy requirements must be included as a standard part of the initial examination received by each patient. The results of this assessment should be considered together with the patient's illness status to formulate a nutritional care plan to provide the nutrition (energy, protein, essential fatty acids, and micronutrients) necessary to meet daily requirements, minimize metabolism, and break down proteins to support the immune system and wound healing (Chan, 2010). It is necessary to provide patients with full-spectrum nutrition and be aware that overeating may also cause metabolic and gastrointestinal complications, liver dysfunction, increased carbon dioxide production, and respiratory muscle weakness (Chan, 2010). Natural food should be provide the main source of nutrition as much as possible, and patients should be encouraged to eat a high-quality, complete diet. Although nutritionists may contribute to the assessment and design of nutritional plans for patients in clinical practice, their limited availability in hospitals disallows their providing the individualized attention required by each patient (Xu et al., 2017). Nurses have the most contact with patients and are most sensitive to their illness conditions. They are able to quickly assess the patient's nutritional needs according to changes in the situation, make referrals, and provide consultations on diet modifications. As the nutritional status of patients is involved in their treatment and physical recovery, nurses have always shouldered inter-professional responsibilities and played an essential role in the nutritional care of patients (Xu et al., 2017). For hospitalized patients and residents of long-term care institutions, nurses are able to pay attention to their nutritional related problems during the process of care, respond rapidly to nutrition-related treatment needs, and participate in the transdisciplinary professional team to prevent patient malnutrition.

[Enteral Feeding and Nutrition for Patients With Critical Illnesses].

Patients with critical illnesses often require nasogastric tube feeding (NG feeding) to support their nutritional and caloric-intake needs because of therapeutic issues and an inability to self-maintain proper nutritional intake. The four primary NG feeding methods include continuous feeding, cyclic feeding, intermittent feeding, and bolus feeding. Each method is unique in terms of timing and relative advantages and disadvantages. In this article, the related literature is reviewed to strengthen the correct concepts of clinical medical staff with regard to NG feeding and nutritional care for patients with critical illnesses with the ultimate goal of improving the quality of care provided to this vulnerable patient population.

[Intensive Care During a Global Epidemic].

The global spread of coronavirus disease 2019 (COVID-19) is rapidly increasing the number of patients who are critically ill with this disease, with the related rate of mortality expected to peak in 2020 (Alhazzani et al., 2020). As severe acute respiratory syndrome is the major cause of mortality after COVID-19 infection, patients with COVID-19 who are prone to severe acute respiratory problems may require mechanical ventilation or extracorporeal membrane oxygenation (ECMO; Alhazzani et al., 2020). Ongoing advances in intensive care medicine are continuing to improve survival in critically ill patients (Kaukonen, Bailey, Suzuki, Pilcher, & Bellomo, 2014). However, intensive care unit (ICU) survivors may experience complications and problems related to their disease and treatment such as critical illness polyneuropathy, critical illness myopathy, and post intensive care syndrome (PICS; Alhazzani et al., 2020). Harvey (2012) reported that 85%-95% of ICU patients have ICU-acquired weakness after ICU discharge and 74% of ICU patients with acute respiratory distress syndrome have cognitive impairment after ICU discharge. Physical disabilities, cognitive impairment, and mental or psychological distress (e.g., anxiety, depression, and post-traumatic stress disorder) after ICU discharge may be symptoms of PICS, and may continue to affect surviving patients for several years after ICU discharge (Elliott et al., 2014; Held & Moss, 2019; Jackson et al., 2014; Jubran et al., 2010). Efforts to prevent and treat COVID-19 in Taiwan have proven more effective compared to most other places in the world. In addition to the low number of diagnosed cases, the mortality rate (seven of 440 confirmed cases) in Taiwan has been significantly lower than in most other countries (Taiwan Centers for Disease Control, ROC, 2020, May 14). However, post-discharge care for ICU survivors, especially those hospitalized after a sudden onset of severe disease symptoms and then discharged after a long ICU stay or after receiving mechanical ventilation, require specialized care to minimize PICS. Nurses are responsible not only for treating patients with the disease but also for preventing the further spread of disease. Therefore, providing continued care to patients discharged from the ICU is essential. Specifically, interventions to avoid PICS must be implemented rapidly by multidisciplinary medical teams during and immediately after ICU discharge.

[Post-Intensive Care Syndrome in Intensive Care Patients and Their Families].

The population of survivors of critical illness has increased with advancements in medicine and technology. However, many patients and their families experience post-intensive care syndromes after discharge from intensive care units (ICUs) due to the comorbidities and side-effects of severe illnesses and related treatments. The problems faced by these survivors are mainly physical symptoms, cognitive disorders, and psychological problems (including anxiety, depression, and traumatic stress disorder). Moreover, patient family members frequently experience psychological problems as well. This article introduces the post-intensive care syndromes (PICS) of survivors and their families; describe the physical symptoms, risk factors, and prevention strategies related to PICS; and primary instruments currently used to measure PICS. The authors hope to provide intensive care health staff with the knowledge necessary to implement preventive strategies for patients as early as possible during their ICU stay to improve the quality of intensive care.

[The Effects of a Diet Education Program on Nutritional Status and Quality of Life in Oral Cancer Patients Who Underwent Surgery].

BACKGROUND: Surgery, the primary treatment for oral cancer, results in oral and facial structural defects that may cause difficulties in swallowing or mastication and thereby affect nutrition status and quality of life. PURPOSE: This study was designed to understand nutritional status and quality of life in oral cancer patients who had undergone surgery and to examine the effects of a dietary education program on nutritional status and quality of life in these patients. METHODS: A quasi-experimental design was conducted. Eligible patients were enrolled immediately after they could sip water after surgery. The participants were randomized into the experimental group (n = 42) and the control group (n = 42). Both groups were provided guidance for swallowing exercise and performed a pre-test (T0) and three post-tests (T1-T3) for a total of three months. The experimental group additionally received a diet assessment and dietary education program intervention. The outcome measures included the nursing nutritional risk screening tool (NNRST) and oral health impact profile (OHIP-14T). RESULTS: The level of malnutrition risk (T0 vs. T3) was 47.6% vs. 4.8% in the experimental group and 35.7% vs. 42.9 in the control group. Generalized estimating equation (GEE) statistics were used to assess the effects of the dietary education program on nutritional status. Quality of life was found to be significantly better in the experimental group than in the control group (p < .001). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: A dietary education program may be used to effectively improve the nutritional status and quality of life of patients after oral cancer surgery. We suggest that specialized nutritional support be provided during cancer treatment in order to achieve good nutritional status and improve quality of life.

The effect of music therapy on reducing depression in people with dementia: A systematic review and meta-analysis.

The aim of this study was to determine the effectiveness of music therapy on reducing depression for people with dementia during different intervention intervals. A systematic review with a meta-analysis of randomized controlled trials. The databases surveyed include AgeLine, CINAHL, MEDLINE, PsycINFO, PubMed, and Cochrane. Seven studies were included in this review. The result revealed that music therapy significantly reduced depression at six, eight, and 16 weeks. This study also supported that music therapy significantly improved depression when the results of six studies with medium-term interventions were pooled. However, no evidence of effect of music therapy on depression was observed at three, four, 12 weeks, and five months during intervention, and one and two months after the cease of music therapy. Music therapy without a music therapist involved did not significantly reduce depression at any time. Medium-term of music therapy might be appropriate in reducing depression for people with dementia.

Effects of nurse-led lower extremity strength training on knee function recovery in patients who underwent total knee replacement.

AIMS AND OBJECTIVES: To examine the effects of lower extremity muscle strength training on knee function recovery and quality of life in patients who underwent total knee replacement. BACKGROUND: Patients with knee osteoarthritis after surgery experience decreased knee function that impacts their quality of life. However, patients typically lack a long-term, home-based and continuous leg exercise training method and rarely have studies explored the effects of exercise training on knee function recovery and quality of life. DESIGN: A experimental and longitudinal study design. METHODS: The simple randomised sampling (based on patients' admission priority order) was used to collect participant data. Outcome measurements included the Knee Injury and Osteoarthritis Outcome Score. Participants were randomised to receive and starting lower extremity muscle strength training before surgery (training group, n = 100) or to receive usual care (nontraining group, n = 100). Data were collected and followed up with the patients before surgery (T1) and at 2 weeks (T2), 1 month (T3), 2 months (T4) and 3 months (T5) after discharge. RESULTS: The Knee Injury and Osteoarthritis Outcome Score subscale scores showed that both groups of patients experienced knee function and quality of life decreases 2 weeks after total knee replacement, but all subscale scores gradually increased from the first month to the third month after total knee replacement. Both groups and times were significantly different, but the training group's knee function and quality of life recovered earlier and better than the nontraining group does. CONCLUSIONS: This study confirmed that lower extremity muscle strength training helps to improve quality of life and knee function in patients who undergo total knee replacement. Healthcare staff should include this training in presurgical nursing care and in patients' discharge plans as a continuous, daily rehabilitation activity at home. RELEVANCE TO CLINICAL PRACTICE: When patients are diagnosed with knee osteoarthritis and undergo surgery, a presurgical exercise education and discussion of knee function rehabilitation should be part of standard care.

[Spiritual Care of Patients With Depression].

Spiritual care is a component of holistic care. Patients with depression often experience body-mind-spirit health problems and may suffer from spiritual crises, particularly during the acute stage of a diseases, due to low self-esteem, negative attitudes toward life goals, daily life issues, and beliefs caused by physical, psychological, and occupational dysfunctions. Nonetheless, psychical care is the main treatment for patients with depression. This paper focuses on patients with depression and addresses the concepts of spiritual needs and spiritual care, identifying the factors that influence spiritual needs, the essentials of spiritual intervention, and the health effects of spiritual intervention outcomes on patients with depression. Courses that teach practical spiritual interventions are recommended for nurses. These courses should address topics such as individual approaches, building trusting relationships, setting diverse goals for spiritual interventions based on disease stage, and spiritual interventions involving the body-mind-spiritual aspects for patients with depression.

Evaluation of disulfide scrambling during the enzymatic digestion of bevacizumab at various pH values using mass spectrometry.

Disulfide linkages play an important role in protein stability and activity. Thus, it is critical to characterize disulfide bonds to ensure the quality and function of protein pharmaceuticals. There are, however, problems associated with maintaining disulfide linkages in the conventional procedures that are used to digest a protein. In order to preserve enzyme activity during the digestion of a protein, it is commonly carried out at neutral to basic environment which increases the possibilities of disulfide bond scrambling. However, it is not easy to differentiate whether the scrambled disulfide linkages are initiated by the sample itself or whether they are induced during the protease digestion process. In this study, the optimum pH for minimizing disulfide bond rearrangements during the digestion process was determined. Three sets of proteases, trypsin plus Glu-C, Lys-C and thermolysin were used, followed by dimethyl labeling and mass spectrometry for a bevacizumab (Avastin) disulfide linkage analysis. No disulfide linkage scrambling was detected at pH6 when Lys-C or trypsin plus Glu-C were used as enzymes. When thermolysin was applied, some scrambled disulfide bonds were identified at pH5, 6 and 7. Nevertheless, there was less disulfide bond scrambling at a lower pH. All correct disulfide bonds on bevacizumab could be identified using this approach. The results demonstrated that by choosing the proper enzymes, using a lower pH environment for the digestion could reduce the degree of artifact disulfide scrambling.

Risk factors of post-traumatic stress symptoms in patients with cancer.

AIMS AND OBJECTIVES: To determine the level of post-traumatic stress symptoms and to identify demographics, disease history and clinical symptoms that were associated with post-traumatic stress symptoms among patients with gynaecological, breast or colorectal cancer in Taiwan. BACKGROUND: Literature indicated that 7·3-35·2% of patients with cancer had experienced level of post-traumatic stress symptoms. However, the post-traumatic stress symptoms among patients with cancer in Taiwan was not documented. DESIGN: A cross-sectional study. METHODS: A total of 347 participants recruited from two general hospitals in southern Taiwan. They completed the Chinese version of Davidson Trauma Scale and a profile describing their demographics and clinical symptoms. Disease history was collected from medical records. RESULTS: Approximately 21·6% of participants reported higher score on Chinese version of Davidson Trauma Scale (Mean ± SD = 22·85 ± 24·12). The top four scores on Chinese version of Davidson Trauma Scale were painful memories, insomnia, shortened lifespan and flashbacks. The risk factors of post-traumatic stress symptoms were suicidal intention (OR = 2·29, 95% CI = 1·86-2·82), chemotherapy (OR = 2·13, 1·18-3·84), metastasis (OR = 2·07, 1·29-3·34), cancer-specific symptoms (OR = 1·21, 1·15-1·27) and high education (OR = 1·75, 1·10-2·78). CONCLUSION: To prevent post-traumatic stress symptoms, patients with cancer should be routinely screened by psychiatrists for post-traumatic stress symptoms, for ongoing symptom control and suicidal intention. Patients with cancer who are at risk of suicidal behaviour should be enrolled in suicide prevention programmes. RELEVANCE TO CLINICAL PRACTICE: Nurses need to assess post-traumatic stress symptoms of patients with cancer, particularly those who with high education, suffered from complications of chemotherapy, metastasis and cancer-specific symptoms and suicidal intention.