Preoperative respiratory muscle training combined with aerobic exercise improves respiratory vital capacity and daily life activity following surgical treatment for myasthenia gravis.

OBJECTIVE: The effects of preoperative respiratory muscle training (RMT) on postoperative complications in patients surgically treated for myasthenia gravis (MG) remain unclear. The present study therefore evaluated the effects of preoperative moderate-to-intense RMT and aerobic exercise, when added to respiratory physiotherapy, on respiratory vital capacity, exercise capacity, and duration of hospital stay in patients with MG. METHODS: Eighty patients with MG scheduled for extended thymectomy were randomly divided into two groups. The 40 subjects in the study group (SG) received preoperative moderate-to-intense RMT and aerobic exercise in addition to respiratory physiotherapy, whereas the 40 subjects in the control group (CG) received only chest physiotherapy. Respiratory vital capacity (as determined by VC, FVC, FEV1, FEV1/FVC, and PEF) and exercise capacity (as determined by the 6-min walk test [6 MWT]) were measured pre- and postoperatively and before discharge. The duration of hospital stay and activity of daily living (ADL) were also determined. RESULTS: Demographic and surgical characteristics, along with preoperative vital capacity and exercise capacity, were similar in the two groups. In the CG, VC (p = 0.001), FVC (p = 0.001), FEV1 (p = 0.002), PEF (p = 0.004), and 6MWT (p = 0.041) were significantly lower postoperatively than preoperatively, whereas the FEV1/FVC ratio did not differ significantly. Postoperative VC (p = 0.012), FVC (p = 0.030), FEV1 (p = 0.014), and PEF (p = 0.035) were significantly higher in the SG than in the CG, although 6MWT results did not differ. ADL on postoperative day 5 was significantly higher in the SG than in the CG (p = 0.001). CONCLUSION: RMT and aerobic exercise can have positive effects on postoperative respiratory vital capacity and daily life activity, and would enhance recovery after surgery in MG patients.

Preoperative QRS Duration Predicts the Responsiveness of Chronic Heart Failure Patients with Pacemaker Indications to Left Bundle Branch Area Pacing Treatment.

BACKGROUND: This study investigated the predictive value of preoperative QRS duration (QRSd) in responsiveness of chronic heart failure (CHF) patients with pacemaker indications to the left bundle branch area pacing (LBBAP). METHODS: Thirty-one CHF patients with cardiac function categorized as NYHA class II or above and indications for pacemaker therapy who successfully underwent LBBAP treatment were enrolled in this study. Based on the 12-month postoperative responsiveness to treatment, patients were divided into a responsiveness group (N = 16) and a no-responsiveness group (N = 15). Data from all patients were collected for analysis. Multivariate binary logistic regression analysis was used to determine the independent factors associated with the responsiveness to LBBAP treatment. RESULTS: Among the 31 patients with LBBAP, 16 patients (51.6%) responded to the treatment, and 15 patients (48.4%) had no response. There were significant differences between the two groups with regard to complete left bundle branch block (CLBBB), preoperative QRSd, and preoperative left ventricular peak time (LVAT). Univariate logistic regression analysis showed that CLBBB, preoperative QRSd, and preoperative LVAT all were significantly correlated with responsiveness to LBBAP. Multivariate binary logistic regression analysis showed that QRSd was an independent predictor of responsiveness to LBBAP. The maximum area under the ROC curve for QRSd was 0.827 (95%C.I.:0.663-0.991), the maximum Youden index was 0.679, with the optimal cutoff point of QRSd ≥ 153 ms, a sensitivity of 81.3%, and a specificity of 86.7%. CONCLUSION: Preoperative QRSd predicts the responsiveness of CHF patients with pacemaker indications to LBBAP.

Histone deacetylase inhibitor MGCD0103 causes cell cycle arrest, apoptosis, and autophagy in liver cancer cells.

Background: Liver cancer is a common cause of cancer-related death all over the world. MGCD0103, a histone deacetylase inhibitor, exerts antitumor effect on various cancers. However, its role in liver cancer remains unclear. Methods: The effect of MGCD0103 on HepG2 and Huh7 cells was verified by several experiments such as cell viability assay, colony formation assay, cell cycle analysis, apoptosis analysis, reactive oxygen species (ROS) assay, western blotting, immunohistochemistry, and xenograft assay. Results: Cell viability and colony formation assays showed that MGCD0103 inhibited the proliferation of liver cancer cells in vitro. Flow cytometry and western blotting analysis demonstrated that MGCD0103 induced G2/M phase arrest and mitochondrial-related apoptosis. A pan-caspase inhibitor and ROS scavenger inhibited apoptosis induced by MGCD0103. What's more, MGCD0103 led to autophagy associated with cell death and an autophagy inhibitor inhibited apoptosis and autophagy induced by MGCD0103. Ultimately, MGCD0103 attenuated tumor growth but did not show significant systemic toxicity in animal model. Conclusions: MGCD0103 suppressed the growth of liver cancer cells in vitro and in vivo. It could serve as a novel therapeutic approach for liver cancer.

Laparoendoscopic rendezvous versus ERCP followed by laparoscopic cholecystectomy for the management of cholecysto-choledocholithiasis: a retrospectively cohort study.

BACKGROUND: There are a variety of strategies for the treatment of patients with cholecysto-choledocholithiasis (CCL). Although the surgical approach of choice is preoperative ERCP and laparoscopic cholecystectomy (ERCP + LC), controversy remains regarding which procedure is optimal for CCL. METHODS: To evaluate the safety and effectiveness of laparoendoscopic rendezvous (LERV) versus ERCP + LC for CCL, a total of 528 patients with CCL were retrospectively studied from January 2013 to December 2018. The patients were scheduled to undergo either the LERV or ERCP + LC procedure. The LERV group included 123 cases, whereas the ERCP + LC group contained 137 cases. The incidence of postoperative complications, success of stone clearance, length of hospital stay, and hospitalization charges were statistically analyzed. RESULTS: The incidence of pancreatitis was lower in the LERV group than in the ERCP + LC group (3/123 vs. 12/137, P = 0.0291). The median level of post-ERCP amylase was much lower in the LERV group (202.5 U/dL vs. 328.1 U/dL, P < 0.01). However, there was no significant difference in the stone clearance rate or other early complications between the two groups. Further study showed that the length of hospital stay and cost in the LERV group were less than those in the ERCP + LC group (12 days vs. 18 days, P < 0.01; 53591.4¥ vs. 60089.2¥, P < 0.01). In addition, more patients in the two-stage procedure group experienced later biliary complications compared with those in the one-stage approach group (34/137 vs. 4/123, P < 0.05). However, the median operation time was 107.7 min in the two-stage group and 139.8 min in the one-stage group (P < 0.05). CONCLUSIONS: The LERV technique is a safe and effective approach for CCL with lower pancreatitis; it was associated with few later biliary complications, shortened hospital stays, and fewer charges but significantly longer operative time.

Clozapine induces autophagic cell death in non-small cell lung cancer cells.

BACKGROUND/AIMS: Previous studies have shown that patients with schizophrenia have a lower incidence of cancer than the general population, and several antipsychotics have been demonstrated to have cytotoxic effects on cancer cells. However, the mechanisms underlying these results remain unclear. The present study aimed to investigate the effect of clozapine, which is often used to treat patients with refractory schizophrenia, on the growth of non-small cell lung carcinoma cell lines and to examine whether autophagy contributes to its effects. METHODS: A549 and H1299 cells were treated with clozapine, and cell cytotoxicity, cell cycle and autophagy were then assessed. The autophagy inhibitor bafilomycin A1 and siRNA-targeted Atg7 were used to determine the role of autophagy in the effect of clozapine. RESULTS: Clozapine inhibited A549 and H1299 proliferation and increased p21 and p27 expression levels, leading to cell cycle arrest. Clozapine also induced a high level of autophagy, but not apoptosis, in both cell lines, and the growth inhibitory effect of clozapine was blunted by treatment with the autophagy inhibitor bafilomycin A1 or with an siRNA targeting atg7. CONCLUSIONS: Clozapine inhibits cell proliferation by inducing autophagic cell death in two non-small cell lung carcinoma cell lines. These findings may provide insights into the relationship between clozapine use and the lower incidence of lung cancer among patients with schizophrenia.

[The two-year post graduate training program for nurses: implementation status and personal perspectives].

The Taiwan Joint Commission on Hospital Accreditation (TJCHA) authorized the Teaching Quality Improvement Program for Teaching Hospitals as a way for the Department of Health to plan and implement improvements. The program assists medical and paramedical professionals to establish a postgraduate clinical training system. The two-year postgraduate training program for nurses is one of the program's regular activities, divided into three phases that include location-based curriculum training (3 months), core curriculum training (9 months), and professional courses training (12 months). This paper describes the origin, current implementation status, and efficacy / key problems of this two-year post graduate training program, Information regarding the opinions of new nurses, preceptors, and nursing managers on the three aspects is drawn from the author's relevant professional experience, interactions with nurses, and a review of the literature. Findings include: (1) nursing departments should operate in accordance with TJCHA guidelines; (2) department training should be adequate to promote the ability and willingness of nurses to train a new generation of clinical preceptors; and (3) participant opinions on project execution progress and difficulties. Findings may be referenced to better achieve Teaching Quality Improvement Program for Teaching Hospital objectives.

Exploring the association between nurse workload and nurse-sensitive patient safety outcome indicators.

BACKGROUND: Nurses affect patient safety. Although studies have associated patient safety with nurse staffing levels, Taiwan's Department of Health does not yet support changing nurse workforce standards for medical institutions. PURPOSE: This study was designed to gain insight into the workload of nurses employed at medical institutions and to determine the relationship between nurse workload and nurse-sensitive patient safety outcome indicators. METHODS: This study adopted a cross-sectional quantitative method and collected data using a self-designed logbook. The study population comprised nurses from acute medical institutions, including medical centers and regional and district hospitals. One thousand five hundred logbooks were distributed to participants selected by random sampling from 21 city/county nursing associations across Taiwan. One thousand three hundred seventy-three questionnaires were retrieved; the 1,358 valid responses yielded a valid response rate of 90.5%. Nurses used the logbook to record individual working conditions for 2 weeks. Descriptive statistics included mean values, standard deviations, and percentages; inferential statistics included the Spearman rho correlation and odds ratios. RESULTS: Nurse overtime working hours were positively associated with the following nurse-sensitive patient safety outcome indicators: patient falls, decubitus/pressure ulcers, near errors in medication, medication errors, unplanned extubation, hospital-acquired pneumonia, and hospital-acquired urinary tract infections; risks of patient falls, decubitus/pressure ulcers, unplanned extubation, hospital-acquired pneumonia, and hospital-acquired urinary tract infections significantly increased when the patient-nurse ratio exceeded 7:1. CONCLUSION: Nurse workforce and nurse-sensitive patient outcome indicators are positively correlated. The results of this study will help professional nursing groups define suitable nursing workforce standards for medical institutions.

[The assertive nursing administrator].

This article explains assertive behavior in nursing administrators. This is an important quality that helps safeguard the interests of nursing staff and enhances the dignity of the nursing profession. Assertive behavior differs from non-assertive behavior and aggressive behavior. It is a learned interpersonal communications skill that communicates one's professional position and feelings, confirms one's needs, expressess opinions clearly at the right time and place, provides appropriate facts to illustrate problems and avoid judgment errors, and politely and firmly sustains an appropriate degree of independent authority necessary to upholding the rights and dignity of nurses.

[Effect of nurse staffing on patient outcomes: a review of the literature].

Staff shortages present nurses with ever increasing levels of stress and working hours. This has resulted in a corresponding increase in talent flight away from the nursing profession. Responding to financial constraints imposed by the Bureau of National Health Insurance (NHI), Taiwan hospitals have reduced nursing staff numbers and recruited nurses at lower levels of competencies and experience. However, few studies have explored the impact of nurse staffing on patient outcomes in Taiwan. Accordingly, we review relevant literature on nurse classifications, the current status of Taiwan nursing manpower, Taiwan and other national regulations on nursing staffing, and the impact of nursing staffing on patient outcomes in an effort to facilitate future study. Our literature review demonstrated that insufficient nursing staffing relates significantly to rates of nosocomial infections, patient mortality, patient falls, pressure ulcers, and rates of patient and family satisfaction. Insufficient nurse staffing leads to increases in adverse patient events, prolonged average hospital stay lengths, and total healthcare expenditures. Evidence shows that nurse staffing is closely linked to patient outcomes.

[Retrospective review and analysis of the results of taiwan nurses association nursing projects from 2004 to 2005].

Although a nursing project is one of the important N4 professional competence training courses in the clinical ladder system, little research on its effectiveness can be found. This study therefore aimed to analyze the demographics, hospital characteristics, scores, and pass rates for the Taiwan Nurses Association's 2004 to 2005 nursing projects and to compare the differences between them. The design was retrospective content analysis and the data sources were nursing project reviewer sheets from the years 2004 and 2005. Data were analyzed using descriptive statistics, such as number, percentage, mean, standard deviation, and Chi-square test, or Fisher exact test. We analyzed 1,062 nursing projects. Of these, 423 projects had third reviewers. After that, 2,547 reviewer sheets were used as final samples. The average project score was 59.7 points (SD = 9.3 points) and the majority of the projects were categorized as administrative and from medical centers, or private hospitals in northern areas of Taiwan. The pass rate was found to be higher in public hospitals, however, than in private hospitals. Almost all the projects (n = 2,515; 98.7%) included reviewers'comments. There was no significant difference between project pass rate and clinical specialty, scope, hospital location, and level of hospital accreditation (p > .05). A significant difference was found, however, between project scores and hospital characteristics (p = .01). These findings may serve as references in the development of future requirements for nursing projects in the clinical ladder system, to improve the quality and quantity of such projects.

Expression of Survivin in pancreatic cancer and its correlation to expression of Bcl-2.

AIM: To investigate the expression of Survivin in pancreatic cancer and its correlation to the expression of Bcl-2. METHODS: Survivin and Bcl-2 expressions were examined by immunohistochemistry in 42 tissue samples from pancreatic cancer and 10 from normal pancrease. RESULTS: No survivin expression was detected in the tissue samples from normal pancrease, while it was detected in 34 of 42 tissue samples from pancreatic cancer (81.95%). There was a correlation between survivin expression and differentiation and stages of pancreatic cancer. Survivin positive cases were strongly correlated to Bcl-2 expression (28/30 vs 6/12, P<0.05). CONCLUSION: Overexpression of survivin plays an important role in the development and progression of pancreatic cancer, and correlates to the expression of Bcl-2. Survivin expression can be used as a prognostic factor.