Caregiving burden and positive aspects of caregiving in schizophrenia: Mediating roles of hope and social support.

Caring for an ill relative with schizophrenia can lead to both negative and positive experiences. The study aimed to determine the relationship between caregiving burden and positive caregiving experiences and evaluate the roles of hope and social support as possible mediators in this relationship. This study included 344 Chinese family caregivers of adults with schizophrenia. Instruments included Positive Aspects of Caregiving, Herth Hope Index, Caregiver Burden Inventory, and Multidimensional Scale of Perceived Social Support. Data was analysed by Mann-Whitney U tests, Kruskal-Wallis H tests, Spearman correlation, and a serial mediation model. Results showed that hope and social support separately and serially mediated the relationship between caregiving burden and positive caregiving experiences. The mediation effect of hope was stronger than that of social support and their serial mediation effect. Increasing hope and social support of family caregivers may alleviate caregiving burden and improve positive caregiving experiences.

A model incorporating serum C3 complement levels may be useful for diagnosing biliary atresia in infants.

INTRODUCTION: Correctly identifying patients with biliary atresia (BA), while avoiding invasive diagnostic methods is challenging. The purpose of this study was to determine the value of serum immune indicators for distinguishing BA from other causes of cholestasis in infants. PATIENTS AND METHODS: The data of infants with a surgical/histological diagnosis of BA and those with other causes of cholestatic jaundice were retrospectively analyzed. Patients were divided into a BA group and a cholestasis control (CC) group. Biochemical parameters, major lymphocyte subsets, immunoglobin and C3 and C4 complement levels were compared between the groups. RESULTS: A total of 129 infants with BA and 63 with other causes of cholestasis (CC control group) with a median age of 2.2 months were included in the analysis. The levels of CD3+ T cells, CD3+CD4+ T cells, and premature T cells and the levels of C3 and C4 were all significantly higher in the BA group compared to the CC group (all P<0.05). Pair-wise correlation analyses indicated that C3 and C4 had a significant positive correlation with γ-GT in the BA group, but not in the CC group. Five indices were found to be significantly associated with BA: stool color, globulin, γ-GT, C3 and C4. A model incorporating stool color, gamma-glutamyl transpeptidase level, and C3 level exhibited an area under the ROC curve (AUC) of 0.93, and a sensitivity of 93% and specificity of 83% for the diagnosis of BA. CONCLUSIONS: Models incorporating serum C3 levels may be useful for accurately diagnosing BA in infants.

Obstetricians' perspectives on trial of labor after cesarean (TOLAC) under the two-child policy in China: a cross-sectional study.

BACKGROUND: As the birth policy has been adjusted from one-child-one-couple to universal two-child-one-couple in China, there is an increasing number of women undergoing a second pregnancy after a previous cesarean section (CS). Undertaking an elective repeat CS (ERCS) has been taken for granted and has thus become a major contributor to the increasing CS rate in China. Promoting trial of labor after CS (TOLAC) can reduce the CS rate without compromising delivery outcomes. This study aimed to investigate Chinese obstetricians' perspectives regarding TOLAC, and the factors associated with their decision-making regarding recommending TOLAC to pregnant women with a history of CS under the two-child policy. METHODS: A cross-sectional survey was carried out between May and July 2018. Binary logistic regression was used to determine the factors associated with the obstetricians' intention to recommend TOLAC to pregnant women with a history of CS. The independent variables included sociodemographic factors and perceptions regarding TOLAC (selection criteria for TOLAC, basis underlying the selection criteria for TOLAC, and perceived challenges regarding promoting TOLAC). RESULTS: A total of 426 obstetricians were surveyed, with a response rate of ≥83%. The results showed that 31.0% of the obstetricians had no intention to recommend TOLAC to pregnant women with a history of CS. Their decisions were associated with the perceived lack of confidence regarding undergoing TOLAC among pregnant women with a history of CS and their families (odds ratio [OR] = 2.31; 95% CI: 1.38-1.38); obstetricians' uncertainty about the safety of TOLAC for pregnant women with a history of CS (OR = 0.49; 95% CI: 0.27-0.96), and worries about medical lawsuits due to adverse delivery outcomes (OR = 0.14; 95% CI: 0.07-0.31). The main reported challenges regarding performing TOLAC were lack of clear guidelines for predicting or avoiding the risks associated with TOLAC (83.4%), obstetricians' uncertainty about the safety of TOLAC for women with a history of CS (81.2%), pregnant women's unwillingness to accept the risks associated with TOLAC (81.0%) or demand for ERCS (80.7%), and the perceived lack of confidence (77.5%) or understanding (69.7%) regarding undergoing TOLAC among pregnant women and their families. CONCLUSION: A proportion of Chinese obstetricians did not intend to recommend TOLAC to pregnant women with a history of CS. This phenomenon was closely associated with obstetricians' concerns about TOLAC safety and perceived attitudes of the pregnant women and their families regarding TOLAC. Effective measures are needed to help obstetricians predict and reduce the risks associated with TOLAC, clearly specify the indications for TOLAC, improve labor management, and popularize TOLAC in China. Additionally, public health education on TOLAC is necessary to improve the understanding of TOLAC among pregnant women with a history of CS and their families, and to improve their interactions with their obstetricians regarding shared decision making.

Severity of illness and distress in caregivers of patients with schizophrenia: Do internalized stigma and caregiving burden mediate the relationship?

AIMS: To test a multiple mediation model of internalized stigma and caregiving burden in the relationship between severity of illness and distress among family caregivers of persons living with schizophrenia. DESIGN: This is a cross-sectional study. METHODS: Data were collected from a consecutive sample of 344 Chinese family caregivers of persons living with schizophrenia between April-August 2018. Instruments used in this research included the Clinical Global Impression-Severity of Illness, the Internalized Stigma of Mental Illness Scale, the Caregiver Burden Inventory, and the Distress Thermometer. Data analysis was conducted using descriptive statistics, the Spearman correlation, and regression analysis to estimate direct and indirect effects using bootstrap analysis. RESULTS: This research found that internalized stigma and caregiving burden can separately and sequentially mediate the relationship between severity of illness and distress. Moreover the mediation of internalized stigma plays the largest role among the multiple mediations. CONCLUSION: The severity of illness, internalized stigma, and caregiving burden are significant factors of distress among family caregivers of persons living with schizophrenia. The future intervention studies which be designed aiming at the three factors may be beneficial for family caregivers of persons living with schizophrenia. IMPACT: This research examined the psychosocial development of distress and indicated that interventions improving patients' symptoms and decreasing internalized stigma and caregiving burden can help to prevent or reduce distress among family caregivers.

The experiences of cooperation among healthcare workers who participated in COVID-19 aid mission in China: A qualitative study.

AIMS AND OBJECTIVES: To assist future offsite planning for pandemics, we documented lived experiences of cooperation among healthcare workers (HCWs) during the coronavirus disease (COVID-19) pandemic. BACKGROUND: The COVID-19 pandemic poses a global health crisis. Most recent studies on the COVID-19 focus on frontline HCWs' physio-psychological experiences, with few studies examining their experiences of cooperation. DESIGN: A descriptive phenomenological design reported based on COREQ checklist. METHODS: 25 HCWs (17 nurses and eight physicians) were interviewed, selected through convenience and purposive sampling, who participated in a medical aid mission in China during the COVID-19 pandemic. Data were collected via semi-structured online video interviews, and the transcripts were analysed using Colaizzi's phenomenological method. RESULTS: The HCWs experienced stressed and anxious, but rated their overall cooperation experience as positive. We categorised the reported experiences in five themes: (1) a multi-level management structure; (2) nurse managers as internal and external team coordinators; (3) high morale and a mutual supportive context; (4) a continuous streamlined workflow; and (5) the value of multidisciplinary collaboration in care. Reasonable management structure and division of work were the basis for successful aid mission. High morale and a mutual supportive context were foundational for growth and stress mitigation. The HCWs continuously streamlined workflow through communication and met patients' individual need through multidisciplinary collaboration. CONCLUSIONS: Planning for a pandemic aid mission is challenging, given the unpredictable nature of the working circumstances. Our results underline the importance of supportive strategies for COVID-19 aid mission. RELEVANCE TO CLINICAL PRACTICE: Recommendations for future pandemic planning: (1) positive morale and supportive working text should be paid prioritised attention; (2) sufficient experienced and ancillary staff should be recruited; (3) multiple communication channels such as regular handover meetings, online chat applications and electronic recording devices are essential, and (4) multidisciplinary cooperation are is necessary in COVID-19 wards.

Validation of the distress thermometer for caregivers of children and adolescents with schizophrenia.

AIM: To develop and psychometrically test the distress thermometer for caregivers (DT-C) and document the distress level in primary caregivers of children and adolescents diagnosed with schizophrenia. DESIGN: A validation diagnostic accuracy study and descriptive cross-sectional survey. METHODS: DT-C was adopted based on Harverman's distress thermometer for parents. The cut-off score was detected by using receiver operating characteristic analysis with the Depression Anxiety Stress Scale-21 as a reference standard in a sample of 324 caregivers of children and adolescents diagnosed with schizophrenia in China collected between Jan 2017 and Feb 2018. RESULTS: One-item DT of DT-C indicated a good retest reliability (r = 0.86) and one-item DT and the Problem List (PL) indicated good convergent validity (r = 0.67-0.88). Overall and individual PL domains showed good internal consistency (KR 20 values ranged from 0.70-0.90). Setting seven as the cut-off score, the values of sensitivity (0.72-0.81), specificity (0.86-0.90), Youden's index (0.61-0.70), positive predictive value (0.67-0.74), and negative predictive value (0.84-0.92) were most satisfactory and area under curve values showed significantly excellent discrimination (0.88-0.90). The average DT score for the 324 participants was 6.34 (SD 2.49), with 46.9% of the participants above the cut-off. Caregivers above the cut-off score faced significant multiple problems in practical, family/social, cognitive, emotional, and parenting domains. CONCLUSION: The DT-C, with six domains containing 35 items in Problem List and with the cut-off score at seven, can be a rapid screening tool to measure distress in these caregivers. The level of distress in caregivers was relatively high. Psychoeducation on specific needs and a solid mutual support network are recommended for mitigating caregivers' distress. IMPACT: This study adapted a reliable DT-C to measure distress of caregivers, which has the potential to be introduced to caregivers of other types of child and adolescent mental disorders in research, assessments and care planning for health professionals.

Using the theory of planned behaviour to predict nurse's intention to undertake dual practice in China: A multicentre survey.

AIMS AND OBJECTIVES: To identify the intention of nurses to dual practice (DP) and inform policymaking in centralised government settings. BACKGROUND: DP is pervasive worldwide but was not permitted in China until 2009, with a primary goal of encouraging nurses from over-staffed health services to work additional shifts in understaffed settings. DESIGN: A descriptive cross-sectional survey. METHODS: A DP questionnaire based on the theory of planned behaviour was developed and issued to nurses from three comprehensive public hospitals in 24 units selected by stratified random cluster sampling (n = 526). This study was reported based on STROBE checklist. RESULTS: The mean for intention was 3.47 with strongly disagree as one point, neutral as three point and strongly agree as five point in scaling. Nurses with any of these characteristics: female, aged between 40 and 49, married, working more than 15 years, and managers were significantly reluctant to undertake DP. The structural equation model showed that the level of positive attitude, subjective norm and perceived behavioural control could positively predict intention, and attitude had highest effect value. Perceived behavioural control and attitude acted as sequential mediators between subjective norm and intention. Nurses preferred large or private hospitals if conducting DP without restriction from the government. CONCLUSIONS: Nurses' intention to undertake DP was not strong, which was impacted by attitude, subjective norm, time and energy. Nurses preferred large or private hospitals; therefore, the goal of improving equity by DP in developing countries might be undermined. RELEVANCE TO CLINICAL PRACTICE: To encourage DP, attitude and subjective norm are important paths, the latter being the initial step. Reasonable incentives or restrictions, such as specifying regulations on practice place and time limitation, qualifications and legal liability and remuneration are recommended to ensure successful DP implementation from over-staffed health services to understaffed settings.

Effects of tolerogenic dendritic cells generated by siRNA-mediated RelB silencing on immune defense and surveillance functions of T cells.

Dendritic cells (DCs) can initiate immune responses or induce immune tolerance, according to their level of maturation. In this study, we inhibited RelB expression in immature (im)DCs using small interfering RNA (siRNA) to maintain their immature status. RelB-silenced DCs induced donor-specific hyporesponsiveness in T cells. In contrast, T cells primed by RelB-silenced DCs maintained normal proliferation and cytokine secretion when stimulated by influenza virus antigen. Proliferation was similar between T cells stimulated with syngeneic tumor antigen or donor-specific antigen stimulation, but was significantly lower compared with T cells stimulated with influenza virus antigen. Moreover, an altered pattern of micro181a and micro155 transcriptional levels in T cells was involved in the differential regulation. This study demonstrates that RelB-silenced DCs could induce donor-specific hyporesponsiveness and slightly impair immune surveillance of T cells, while retaining their immune defense functions.

Is re-Rex shunt a better choice for patients with failed Rex shunt?

Purpose: To review our single-center surgical outcomes of redo operations after failed Rex shunt procedures. Methods: From September 2017 to October 2021, a total of 20 patients (11 males, 9 females; median age: 8.6 years) with Rex shunt occlusions were admitted to our hospital. Two of these patients were previously operated on in our hospital, and the remaining 18 were from other centers. All patients underwent repeat operations after detailed preoperative evaluations. Results: Preoperative wedged hepatic vein portography (WHVP) was conducted for 18 patients. Thirteen patients exhibited well-developed Rex recessus and intrahepatic portal vein during WHPV examination, consistent with the intraoperative exploration results. Fifteen patients (75%, 15/20) underwent redo-Rex shunt, four underwent Warren shunt and one underwent devascularization surgery. During the redo-Rex shunt operations, the left internal jugular veins (IJV) were used as bypass grafts in 11 patients; the intra-abdominal veins were used in 4 patients. The patients were followed up for 12-59 months (mean, 24.8 months). After redo Rex shunts, the grafts were patent in 14 patients (93.3%, 14/15), but 1 graft had thrombosis (6.7%, 1/15). Three patients suffered from postoperative anastomotic stenosis, and all of the stenosis was relieved with balloon dilatations. After re-Rex shunts, esophageal varices and spleen size were substantially reduced, and the platelet count significantly increased. Postoperative graft thrombosis was found in 1 patient after Warren shunt (1/4, 25%), and there was no graft stenosis. Compared with Warren surgery, patients who underwent re-Rex shunt had a significantly higher rate of platelet increase. Conclusions: Redo-rex shunts can be finished in most patients with failed Rex shunts. Re-Rex shunt is a preferred surgical choice after a failed Rex shunt when a good bypass graft is available, and the surgical success rate can reach more than 90%. A suitable bypass graft is essential for a successful redo Rex shunt. Preoperative WHVP is recommended for the design of a redo surgical plan preoperatively.

Caring for Psychological Distress of Patients With COVID-19: A Mixed-Method Cross-Sectional Study.

Introduction: The 2019-2020 pandemic COVID-19 has become a global health crisis. While many recent studies on COVID-19 pandemic have focused on disease epidemiology and psychological status of patients, few have explored the multi-facet influential factors or combined perspectives from both the patients and healthcare workers. The purposes of this study were to: analyze the influencing factors of psychological distress of COVID-19 patients; and describe the experience of healthcare workers relieving psychological distress. Materials and Methods: This study uses a mixed-method cross-sectional design, including a quantitative study and a qualitative study, targeting two populations: COVID-19 patient and health workers, respectively. In the quantitative part, we recruited a convenience sample of patients with COVID-19 from five hospitals in Wuhan, Hubei Province from 10 to 15 April, 2020. Besides, we collected data by using participants' socio-demographic information sheet, the Connor-Davidson Resilience Scale-10, the Herth Hope Index, the Distress Thermometer, the Revised Chinese Version of Mishel Uncertainty in Illness Scale, and the Chinese Version of Wake Forest Physician Trust Scale. In the qualitative part, the participants were healthcare workers involved in medical aid missions in Hubei Province, China. Meanwhile, we used sampling with convenient and purposive, data collection with a semi-structured online video interview, and text transcription with Colaizzi's phenomenological method. Results: The results reveal that 25.7% of patients reported higher level of psychological distress (n = 31, scoring ≥4). After controlling the sociodemographic variables, only severity of COVID-19 (ß = 0.282, P = 0.025) and uncertainty in illness (ß = 0.345, P = 0.007) shown significant effect on psychological distress in the regression model (F = 10.862, R 2 = 0.222, P < 0.001). The experience of healthcare workers emerged five themes: Particularly needed psychological care, Manifestation of negative emotion, Manifestation of proactive adaptation, Strategies relieving psychological distress, and gains of healthcare workers after delivering effective psychological care. Conclusion: The 25.7% of patients with COVID-19 still suffered from psychological distress, which should receive timely attention from healthcare workers. And the severity of the disease and disease uncertainty have a significant impact on distress. It is critical to train the healthcare workers on detecting the different manifestation of psychological distress, offering timely disease related information, and applying communication strategies.

Feasibility of brief distress screening for family caregivers of adults diagnosed with schizophrenia in Changsha, Hunan, China.

What is known on the subject? Distress screening amongst FGs is emphasized in worldwide studies, but existing general tools were found time-consuming and sometimes inconvenient when using them amongst FGs of patients diagnosed with schizophrenia. The DT, a single-item scale, was widely used to detect distress amongst FGs of cancer patients, showing good reliability, validity and discrimination power. The 21-item Depression Anxiety and Stress Scale (DASS21) can identify distress in the general population and serve as a criterion to determine an optimal cut-off score of the DT. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The DT presented good reliability, validity and discriminatory power amongst FGs of adults diagnosed with schizophrenia. A cut-off score of six maximized sensitivity (77%) and specificity (76%). Over half of the FGs of adults diagnosed with schizophrenia reached this cut-off score and experienced significant distress. Distress was higher in FGs of male patients, when FGs were parents, and for FGs whose educational background was primary school or below. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The DT is an effective alternative to existing instruments in identifying distressed FGs of adults diagnosed with schizophrenia. It is important to provide FGs with distress screening programmes and interventions (e.g. skill-building psychoeducation) to identify and relieve distress. In addition, future research could explore brief measures to simultaneously recognize potential negative and positive impacts of caregiving in FGs.

Pyriform sinus fistula in children: A comparison of endoscopic-assisted surgery and endoscopic radiofrequency ablation.

BACKGROUND: Pyriform sinus fistula (PSF) is a rare congenital anomaly, and the preferred definitive treatment is yet to be verified. In this study, we investigated the treatment outcomes of PSF specifically comparing endoscopic-assisted surgery and endoscopic radiofrequency ablation (RA). METHODS: The medical records of patients treated for PSF at the Shanghai Children's Hospital between October 2016 and September 2019 were retrospectively evaluated. RESULTS: There were 93 girls and 98 boys. The median age at onset and operation was 3 years and 5 years, respectively. Endoscopic-assisted surgery was performed in 143 patients. During the same period, RA was performed in 48 patients, and 10 of them concurrently underwent incision and drainage of neck abscesses. Longer hospital stay was found in the endoscopic-assisted surgery group than in the RA group (10.50 ±â€¯3.93 vs. 5.02 ±â€¯3.30 days, P < 0.001). Postoperative complications were not significantly different between the two groups, except for neck infection (0 vs. 8.3%, P = 0.004). After a median follow-up period of 21 months, no significant difference was found between the two groups in terms of recurrence (1.4% vs. 0, P = 0.560). CONCLUSION: Patients treated with RA had a significantly shorter hospital stay than those treated with endoscopic-assisted surgery. Outcomes of endoscopic-assisted surgery and RA were not significantly different for the management of PSF and treatment method should be tailored to the patient. LEVEL OF EVIDENCE: IV.

Mitigating distress and promoting positive aspects of caring in caregivers of children and adolescents with schizophrenia: Mediation effects of resilience, hope, and social support.

Assistance for distressed caregivers can indirectly facilitate recovery of the people being cared for, yet how resilience, hope, and social support mediate between caregiving burden and adjustment outcomes is unclear. A structural equation model was constructed based on data from a cross-sectional survey of 324 caregivers of children and adolescents with schizophrenia using multidimensional caregiver burden inventory, Connor-Davidson resilience scale, Herth hope index, perceived social support scale, distress management screening measure, and positive aspects of caregiving instruments. On distress, caregiving burden had a relatively large direct effect, and an indirect effect, mainly mediated by resilience. Resilience had a greater effect than social support or hope on distress. On positive aspects of caregiving (PAC), caregiving burden had only an indirect effect, primarily via the processes from social support and resilience to hope. Hope had a significant direct effect, while resilience and support had moderate indirect effects on PAC via hope. Resilience is an important mediator between caregiving burden and distress, with a greatest effect. Resilience, hope, and social support all mediated between caregiving burden and PAC, with hope having a greatest effect. Reducing the care burden may greatly help to relieve caregiver distress. Providing needed social support, encouraging caregivers to proactively utilize the support, and enhancing resilient coping skills will be helpful in developing resilience and mitigating distress. Health professionals should assess and ameliorate burden, be particularly aware of caregiver hopes, provide formal support, and encourage informal support to promote PAC.

Internalized stigma and its correlates among family caregivers of patients diagnosed with schizophrenia in Changsha, Hunan, China.

WHAT IS KNOWN ON THE SUBJECT?: Schizophrenia is a severe and highly stigmatized mental illness. High internalized stigma affects FGs' quality of life and caregiving capacity. Worldwide studies aimed at internalized stigma among patients diagnosed with mental illness or their FGs have reported significant stigma and some correlates, but studies involving FGs that focus on a specific mental illness (e.g. schizophrenia) and report the impact of potential psychosocial variables (e.g. coping and hope) on internalized stigma are limited. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Internalized stigma was common among Chinese FGs of patients diagnosed with schizophrenia and half of them presented at a mild level. Internalized stigma was negatively associated with hope and positively associated with passive coping. FGs, who live with patients, have difficulty supervising medication, or care for a male relative has higher internalized stigma. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Regarding informative support, interventions (e.g. enhancing mental health literacy programs and cognitive therapies) to provide knowledge about schizophrenia, the skills to manage patients' adherence to medications, the benefits of treatment and the possibilities of rehabilitation are necessary for FGs. Regarding psychosocial processes, effective interventions (e.g. group psychoeducation and group social skills training) aimed to enhance hope, social support and coping styles towards internalized stigma should be implemented among FGs. Both informative support and psychosocial interventions used to decrease FGs' internalized stigma can be delivered by healthcare providers or by peer caregivers. ABSTRACT: Introduction Internalized stigma is prevalent among patients diagnosed with schizophrenia. Their family caregivers (FGs) also suffer from internalized stigma, but limited studies have addressed the issue. Aim The aim of this study was to determine the severity of internalized stigma and its correlates among FGs of patients diagnosed with schizophrenia in Changsha, Hunan, China. Methods A consecutive sample of 299 FGs was recruited at the psychiatric outpatient department of a tertiary hospital in Changsha. This study explored the relationships between internalized stigma and potential factors. Results Nearly 50% of the FGs perceived mild internalized stigma, 24% of the FGs reported moderate level, and 6% had a severe level. Internalized stigma was associated with patients' characteristics (severity of illness) and FGs' characteristics (hope, social support, passive coping, age, education background, residence with the patient, caring for a male or a young patient and difficulty in supervising medication). Discussion and implications for practice Informative and psychosocial interventions based on education and contact for FGs such as enhancing mental health literacy programs, cognitive therapies and group psychoeducation can provide FGs with a better understanding of schizophrenia and to promote hope, active coping and social support.

Challenge of parents caring for children or adolescents with early-stage schizophrenia in China: A qualitative study.

PURPOSE: To explore the challenges of parents caring for early-stage schizophrenia (ESS) children/adolescents in China. DESIGN AND METHODS: Thirteen parents of ESS subjects completed semi-structured interviews. Thematic analysis was used to analyze data. FINDINGS: Seven themes emerged from the data: psychological shock and emotional burden; lack of disease knowledge and care skill; poor treatment compliance of the patient; difficulty getting along with the patient; conflict within the family or in the workplace; financial burden; and need sufficient social support. Each challenge was produced and influenced under the Chinese special social context. PRACTICE IMPLICATIONS: Professional support was needed to help patients with schizophrenia to cope with their situation promptly. Education initiatives should focus on mental health to prevent discrimination from society and enable people to recognize the early symptoms of schizophrenia in children. Telemedicine should be explored for application in the treatment of mental illness. Also, a broader nationwide healthcare policy would be needed to help to reduce the individual and societal financial burdens associated with schizophrenia.

A case report of a giant mature teratoma of the thyroid gland in a young girl.

RATIONALE: Teratomas are extremely rare in the thyroid gland. A cervical teratoma presenting as a cystic or mixed thyroid lesion can be easily confused with a thyroglossal duct cyst. It is difficult for pediatricians to differentiate between these 2 types of lesions. PATIENTS CONCERNS: A 2-year-old girl who presented a growing thyroid mass for 14 months showed a mass in her left thyroid lobe under contrast-enhanced computed tomography (CT). DIAGNOSIS AND INTERVENTIONS: Ultrasonography found a mass of 5 × 3.5 cm within the left lobe of the thyroid gland, and the sonogram revealed areas with echo-free and mixed-echo patterns. There was no accumulation of technetium-99m pertechnetate on the thyroid scintigraphy (cold thyroid nodule). CT scan showed a mass (5.0 × 3.0 × 2.5 cm in size) that extended from the left thyroid lobe to the anterior mediastinum with no evident enhancement and clear margins that contained calcifications. Complete excision without intraoperative capsule disruption was achieved. Histologically, the thyroid mass was diagnosed as a mature teratoma. OUTCOMES: The postoperative course was uneventful after follow-ups for 2 years, and the patient had no inflammatory signs or evidence of recurrence. LESSONS: Thyroid teratoma is rare in infants and is usually benign; however, some thyroid teratomas are malignant and inclined to relapse. The authors emphasize that thyroid teratomas in children should be included in the differential diagnosis of cystic lesions located in the head and neck area. Complete resection is essential for good outcomes. In addition, long-term follow-ups are warranted to follow the complications of the malignant or recurrent disease.

Career intentions of PhD students in nursing: A cross-sectional survey.

BACKGROUND: Despite the rapid growth of Chinese nursing PhD programs, little is known about the career intentions of students in this field. OBJECTIVE: To investigate the career intentions of nursing PhD students. DESIGN: Online cross-sectional survey. PARTICIPANTS: Nursing PhD students at Chinese universities. METHODS: An online questionnaire was designed and the data were analyzed using SPSS. RESULTS: The mean age of the participants was 31.53 ±â€¯4.92 years, and most were female (89.9%), married (74.2%), and had been employed previously (69.7%). Most intended to work in the city where their family lived (34.8%) or near their previous workplace (32.6%). Most (60.7%) desired to work in an educational institution (e.g., a university or college). The most common expected salary was 8000-11,999 RMB/month. The work benefits perceived as indispensable were "Five Insurances and One Fund" (77.5%), good educational resources for children (59.6%), financial allowances for PhD graduates (52.8%), staff dormitories/housing subsidies (50.6%), and tenure (50.6%). Nursing education (75.3%) and research (70.8%) were the most favored fields. The key job characteristics were the opportunity to put strengths to fullest use (79.8%), time to conduct research (60.7%), and work-life balance (51.7%). The key research conditions included a good research incentive mechanism (77.5%), a Basic Scientific Research Foundation (68.5%), opportunity to apply to conduct research projects (66.3%), and the nursing team's atmosphere regarding research (64.0%), and 91.0% were eager to study abroad (e.g., as part of an international exchange). CONCLUSIONS: Nursing PhD students would like to work in their hometown or near their previous workplace. Most preferred working in an educational institution, and the most popular fields were nursing education and research (rather than clinical care), despite the high demand of hospital management for nursing PhD graduates. Flexible work, high-quality research conditions, a certain salary, work benefits, and training were key expectations.

The involvement of nitric oxide in ultraviolet-B-inhibited pollen germination and tube growth of Paulownia tomentosa in vitro.

The role of nitric oxide (NO) in the ultraviolet-B radiation (UV-B)-induced reduction of in vitro pollen germination and tube growth of Paulownia tomentosa Steud. was studied. Results showed that exposure of the pollen to 0.4 and 0.8 W m(-2) UV-B radiation for 2 h resulted in not only the reduction of pollen germination and tube growth but also the enhancement of NO synthase (NOS, EC 1.14.13.39) activity and NO production in pollen grain and tube. Also, exogenous NO donors sodium nitroprusside and S-nitrosoglutathione inhibited both pollen germination and tube growth in a dose-dependence manner. NOS inhibitor N(G)-nitro-l-Arg-methyl eater (l-NAME) and NO scavenger 2-(4-carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide (c-PTIO) not only largely prevented the NO generation but also partly reversed the UV-B-inhibited pollen germination and tube growth. These results indicate that UV-B radiation inhibits pollen germination and tube growth partly via promoting NO production in pollen grain and tube by a NOS-like enzyme. Additionally, a guanylyl cyclase inhibitor 6-anilino-5,8-quinolinequinone (LY-83583) prevented both the UV-B- and NO donors-inhibited pollen germination and tube growth, suggesting that the NO function is mediated by cyclic guanosine 5'-monophosphate. However, the effects of c-PTIO, l-NAME and LY-83583 on the UV-B-inhibited pollen germination and tube growth were only partial, suggesting that there are NO-independent pathways in UV-B signal networks.

[Multicenter investigation on cognition about preoperative nursing of emergency PCI].

OBJECTIVE: To know the mastery degree of percutaneous coronary intervention (PCI) preoperative nursing knowledge in nurses who are working in emergency department and cardiac ward. METHODS: 158 cases of nurses who came from three different class III grade hospitals with qualification for emergency PCI surgery of the Guizhou province were surveyed with self-made questionnaire. The survey was conducted in nurses who were working in different departments, and the educational background, age, title, category, the cognitive situation of the PCI preoperative nursing knowledge and necessity of preoperative preparations were investigated in nurses. RESULTS: The whole pass rate was 48.10%; high qualification, high education, higher title of nurses for the nursing knowledge of the emergency PCI were better; the emergency PCI preoperative preparations for the necessity of cognitive about nurses were on the low side. CONCLUSIONS: The cognition of the nursing knowledge and the necessity of emergency PCI in preoperative preparations as whole are on the low level, so specialized training should be strengthened to enhance the ability of specialized nursing.

Enhanced acoustoelectric coupling in acoustic energy harvester using dual Helmholtz resonators.

In this paper, enhanced acoustoelectric transduction in an acoustic energy harvester using dual Helmholtz resonators has been reported. The harvester uses a pair of cavities mechanically coupled with a compliant perforated plate to enhance the acoustic coupling between the cavity and the plate. The experimental results show that the volume optimization of the second cavity can significantly increase the generated electric voltage up to 400% and raise the output power to 16 times as large as that of a harvester using a single Helmholtz resonator at resonant frequencies primarily related to the plate.