Phytochrome B mediates dim-light-reduced insect resistance by promoting the ethylene pathway in rice.

Increasing planting density is one of the most effective ways to improve crop yield. However, one major factor that limits crop planting density is the weakened immunity of plants to pathogens and insects caused by dim light (DL) under shade conditions. The molecular mechanism underlying how DL compromises plant immunity remains unclear. Here, we report that DL reduces rice (Oryza sativa) resistance against brown planthopper (BPH; Nilaparvata lugens) by elevating ethylene (ET) biosynthesis and signaling in a Phytochrome B (OsPHYB)-dependent manner. The DL-reduced BPH resistance is relieved in osphyB mutants, but aggravated in OsPHYB overexpressing plants. Further, we found that DL reduces the nuclear accumulation of OsphyB, thus alleviating Phytochrome Interacting Factor Like14 (OsPIL14) degradation, consequently leading to the up-regulation of 1-Aminocyclopropane-1-Carboxylate Oxidase1 (OsACO1) and an increase in ET levels. In addition, we found that nuclear OsphyB stabilizes Ethylene Insensitive Like2 (OsEIL2) by competitively interacting with EIN3 Binding F-Box Protein (OsEBF1) to enhance ET signaling in rice, which contrasts with previous findings that phyB blocks ET signaling by facilitating Ethylene Insensitive3 (EIN3) degradation in other plant species. Thus, enhanced ET biosynthesis and signaling reduces BPH resistance under DL conditions. Our findings provide insights into the molecular mechanism of the light-regulated ET pathway and host-insect interactions and potential strategies for sustainable insect management.

Bidirectional relationship between late-onset epilepsy (LOE) and dementia: A systematic review and meta-analysis of cohort studies.

OBJECTIVE: To explore the bidirectional relationship of late-onset epilepsy (LOE) with dementia and Alzheimer's disease (AD). METHODS: Using the common electronic databases, including PubMed, Cochrane Library databases and EMBASE, we systematically reviewed published cohort studies that assessed the risk of LOE in individuals comorbid with dementia or AD, and those with dementia or AD comorbid with LOE that had been published up to 31 March 2023. The data extraction process was carried out independently by two authors. The summary adjusted relative ratio (aRR) was calculated by employing Rev Man 5.3 for the inclusion of studies. To investigate the origins of heterogeneity, we conducted both subgroup and sensitivity analyses. In the presence of heterogeneity, a random-effects model was employed. To evaluate potential publication bias, we utilized the funnel plot and conducted Begg's and Egger's tests. RESULTS: We included 20 eligible studies in the final analysis after a rigorous screening process. Pooled results indicated that LOE was association with an increased risk of all-cause dementia (aRR: 1.34, 95% confidence interval [CI]: 1.13-1.59) and AD (aRR: 2.49, 95% CI: 1.16-5.32). In addition, the pooled effect size for LOE associated with baseline AD and all-cause dementia were 3.51 (95% CI: 3.47-3.56) and 2.53 (95% CI: 2.39-2.67), respectively. Both sensitivity and subgroup analyses showed that these positive correlations persisted. According to the results of the Egger's and Begg's tests, as well as visual inspection of funnel plots, none of the studies appeared to be biased by publication. CONCLUSION: The findings suggested that LOE is a potential risk factor for dementia and AD, and vice versa, dementia and AD are both potential risk indicators for LOE. Since there is substantial heterogeneity among the cohorts analyzed and more cohort studies should be conducted to confirm the correlations found in the current study.

Effectiveness of Exercise Interventions on Body Composition, Exercise Capacity, Fatigue, and Quality of Life in Patients with Liver Cirrhosis: A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Diminished muscle protein synthesis in cirrhosis leads to reduced strength and mass, impacting daily activities and overall quality of life. AIMS: This study aimed to examine the effectiveness of exercise intervention in body composition, exercise capacity, fatigue, and quality of life in patients with liver cirrhosis. METHODS: A systematic search of medical databases, including PubMed, Embase, Cochrane, and CINAHL, was executed from their inception to November 2022. The inclusion criteria were randomized controlled trials comparing exercise interventions with a control group that did not receive exercise interventions. RESULTS: From the initially identified 2,565 articles, eight studies with a total of 220 patients were eligible for inclusion in this meta-analysis. According to the meta-analysis, exercise significantly improved the six-minute walk distance (6MWD) by 68.93 m (95% CI 14.29-123.57) compared to the control group. Furthermore, the subgroup analysis revealed that combing exercise with amino acid supplementation had a greater positive effect on the 6MWD (MD = 144.72, 95% CI 87.44-202.01). Exercise also significantly increased thigh circumference (MD = 1.26, 95% CI 0.12-2.39) and the thigh ultrasound average compression index (MD = 0.07, 95% CI 0.00-0.14). Moreover, exercise significantly decreased fatigue levels by 0.7 points in patients with liver cirrhosis (95% CI 0.38-1.03). However, no significant effects were observed on body mass index (BMI), fat mass, fat-free mass, and quality of life. CONCLUSIONS: Exercise can improve exercise capacity, thigh muscle thickness, and fatigue in patients with cirrhosis, but it does not have a significant impact on fat mass, BMI, or quality of life.

Reliability of predicting low-burden (≤ 2) positive axillary lymph nodes indicating sentinel lymph node biopsy in primary operable breast cancer - a retrospective comparative study with PET/CT and breast MRI.

BACKGROUND: Sentinel lymph node biopsy (SLNB) is the standard of care for axillary staging in early breast cancer patients with low-burden axillary metastasis (≤ 2 positive nodes). This study aimed to determine the diagnostic performances of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and breast magnetic resonance imaging in detecting axillary lymph node (ALN) metastases and the reliability to predict ALN burden. METHODS: A total of 275 patients with primary operable breast cancer receiving preoperative PET/CT and upfront surgery from January 2001 to December 2022 in a single institution were enrolled. A total of 244 (88.7%) of them also received breast MRI. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT and breast MRI were assessed. The predictive values to determine ALN burden were evaluated using radio-histopathological concordance. RESULTS: PET/CT demonstrated a sensitivity of 53.4%, specificity of 82.1%, PPV of 65.5%, NPV of 73.5%, and accuracy of 70.9% for detecting ALN metastasis, and the corresponding values for MRI were 71.8%, 67.8%, 56%, 80.8%, and 69.2%, respectively. Combining PET/CT and MRI showed a significantly higher PPV than MRI (72.7% vs 56% for MRI alone, p = 0.037) and a significantly higher NPV than PET/CT (84% vs 73.5% for PET/CT alone, p = 0.041). For predicting low-burden axillary metastasis (1-2 positive nodes), the PPVs were 35.9% for PET/CT, 36.7% for MRI, and 55% for combined PET/CT and MRI. Regarding patients with 0-2 positive ALNs in imaging, who were indicated for SLNB, the predictive correctness was 96.1% for combined PET/CT and MRI, 95.7% for MRI alone, and 88.6% for PET/CT alone. CONCLUSIONS: PET/CT and breast MRI exhibit high predictive values for identifying low-burden axillary metastasis in patients with operable breast cancer with ≦ 2 positive ALNs on imaging.

Influence of body mass index on severity of rotator cuff tears.

BACKGROUND: Research on the relationship between obesity and rotator cuff tears (RCTs) has been limited to the impact of obesity on the results of arthroscopic repair of RCTs; thus, a need for rigorous research controlling for other factors affecting RCTs is warranted, especially to better understand the impact of body mass index (BMI) on RCT severity. METHODS: A retrospective study of admission records contained in electronic medical records pertaining to patients who were admitted for RCT repair on 1 shoulder between January 2018 and July 2022 was conducted. In total, 386 patients were included. In accordance with guidance regarding obesity from Taiwan's Ministry of Health and Welfare, patients were divided into three groups: underweight or normal weight (BMI <24.0 kg/m2), overweight (BMI 24.0-26.9 kg/m2), or obese (BMI ≥27.0 kg/m2). Magnetic resonance imaging was used to assess RCT severity in terms of four parameters: Patte stage (PS), fatty infiltration (FI), anteroposterior tear size (AP), and retraction size. Multinomial logistic regression analysis was performed on PS and FI grade data, and multiple linear regression analysis was performed on AP tear size and retraction size in order to analyze impact. RESULTS: Our results revealed that the average age of the 386 patients was 63.41 years (SD = 9.29) and the mean BMI was 25.88 (SD = 3.72) kg/m2. We found significant differences in PS (P = .003), FI (P < .001), retraction size (P = .001), and AP tear size (P = .001) among patients who were underweight or normal weight, overweight, and obese. After controlling for other risk factors, including age, gender, RCT-prone occupation, duration of shoulder pain prior to surgery, history of shoulder injury, and tobacco use, we found that obese patients had higher severity levels in PS (B = 1.21, OR = 3.36, P = .029), FI (B = 1.38, OR = 3.96, P < .001), retraction size (ß = 0.18, P = .001), and AP tear size (ß = 0.18, P = .001) compared to underweight or normal weight patients. CONCLUSIONS: Our study demonstrates that a correlation exists between BMI-measured obesity and RCT severity. We therefore suggest that adults control their weight given that maintaining a healthy weight is highly associated with better shoulder health.

PA200-Mediated Proteasomal Protein Degradation and Regulation of Cellular Senescence.

Cellular senescence is closely related to DNA damage, proteasome inactivity, histone loss, epigenetic alterations, and tumorigenesis. The mammalian proteasome activator PA200 (also referred to as PSME4) or its yeast ortholog Blm10 promotes the acetylation-dependent degradation of the core histones during transcription, DNA repair, and spermatogenesis. According to recent studies, PA200 plays an important role in senescence, probably because of its role in promoting the degradation of the core histones. Loss of PA200 or Blm10 is a major cause of the decrease in proteasome activity during senescence. In this paper, recent research progress on the association of PA200 with cellular senescence is summarized, and the potential of PA200 to serve as a therapeutic target in age-related diseases is discussed.

Hematologic and Serum Biochemical Values Associated With Different Stages of Hospital-Acquired Pressure Injuries in Patients: A Retrospective Study.

PURPOSE: The primary purpose of this study was to determine whether hematologic and serum biochemical values used as indicators of nutritional status, anemia, and/or infection were associated with the risk of hospital-acquired pressure injuries (PIs) and stage of PIs in patients. DESIGN: A retrospective review of medical records. SUBJECTS AND SETTING: Data were collected from medical records including official PI records and PI incident reports of inpatients at a teaching hospital in Taiwan between January 2019 and October 2020. METHODS: We collected demographic variables of the inpatients and their hematologic and serum biochemical values within 1 day of PI occurrence (including the day of PI occurrence), 6 to 7 days before PI occurrence, and 13 to 14 days before PI occurrence. RESULTS: Among the 309 inpatients with official PI records, 105 (34.0%) had Stage 1 PIs, 131 (42.4%) had Stage 2 or 3 PIs, and 73 (23.6%) had unstageable or suspected deep tissue injuries. After controlling for the type of department where PIs occurred and length of hospital stay up to the day of PI occurrence, we found significant differences in levels of hemoglobin (odds ratio [OR] = 0.47, P = .009) within 1 day of PI occurrence and in albumin (OR = 0.30, P = .001) 13 to 14 days before PI occurrence. CONCLUSIONS: Study findings suggest that lower hemoglobin levels on the day of PI occurrence and lower albumin levels 2 weeks before PI occurrence resulted in a significantly higher risk of developing unstageable or suspected deep tissue injuries than of developing Stage 1 PIs.

Influence of severity of illnesses on risk of death in intensive care unit patients with severity of pressure injuries as mediating variable.

This study was to verify whether the severity of pressure injuries (PIs) in intensive care unit (ICU) patients plays a mediating role in the relationship between severity of their illnesses and risk of death. I examined adult patients admitted to the ICUs between 1 January 2014 and 31 August 2021. The average follow-up period was 11.34 months. A total of 390 ICU patients suffered from PIs. The influences of the APACHE II score of the ICU patients on the mediating variable 'unstageable & DTPIs vs. Stage 1&2 PIs' and on risk of death were significant. After controlling the influence of APACHE II score on risk of death, the influences of mediating variables 'Stage 3&4 PIs vs. Stage 1&2 PIs' and 'unstageable & DTPIs vs. Stage 1&2 PIs' on risk of death were also significant. The regression coefficient of APACHE II score of the ICU patients declined after the severity of PIs was included. The Sobel test on the indirect effects also reached the level of significance. The severity of illnesses is a factor that is beyond my control, severe PIs should still be prevented to lower the risk of death.

Relationship between shift type and sleep quality in rotating-shift nurses with chronotype as a moderator variable.

BACKGROUND: Rotating-shift nurses are susceptible to sleep disorders due to numerous factors, such as their biological clock, emotions, and age. At present, a lack of research exists on whether chronotype and shift type jointly influence the sleep quality of nurses. AIM: To verify whether chronotype is a moderator variable of the relationship between shift type and sleep quality in nurses in order to provide empirical evidence for future mental and physical health improvement. METHOD: Clinical rotating-shift nurses at a medical center in northern Taiwan were recruited as participants between November 1, 2023, and December 13, 2023. All of the nurses were working a monthly rotating shift schedule. Hierarchical multiple regression analysis was employed to investigate whether the influence of shift type on sleep quality in nurses varied with chronotype. The STROBE checklist was used for reporting this study. RESULTS: The participants were 255 rotating-shift nurses in this study. Hierarchical multiple regression results revealed that rotating-shift nurses who were older (B = 0.19, p = 0.029), had greater physical fatigue (B = 0.27, p = 0.016), and had more negative emotions (B = 0.17, p = 0.011) suffered from poorer sleep quality. After controlling the above factors, we further found that chronotype indeed had moderating effects on the influence of shift type on sleep quality (B = -1.83, p = 0.049). CONCLUSIONS: This study demonstrates that early- and intermediate-type nurses are more suitable for working the day and evening shifts, whereas late-type nurses are more suitable for working the night shift. IMPLICATION FOR NURSING AND HEALTH POLICY: Coordinating chronotype with shift type will ensure that shift schedules better match the biological clocks of nurses; such individual considerations could help to improve their sleep quality.

Cardiac-to-Bronchial Fistula in Hepatocellular Carcinoma: A Case Report.

Hepatocellular carcinoma (HCC) stands as a significant contributor to cancer-related mortality globally. While the acute and often fatal manifestations of locally advanced HCC primarily present within the abdomen, it is crucial to recognize that the respiratory and circulatory systems can also fall victim due to the liver's unique anatomical position within the body. Here, we present the case of a 63-year-old male recently diagnosed with locally advanced HCC with vascular invasion. Shortly after receiving target therapy and focal radiotherapy, the patient developed repeated secondary infections and a persistent diaphragmatic defect. As the necrotic tissue invaded the pleural space, subsequent tumor-to-bronchial and tumor-to-cardiac fistulas emerged, resulting in an abnormal connection between the respiratory and cardiovascular systems, leading to massive air emboli in circulation. This report highlights the risk of supradiaphragmatic complications in HCC patients with post-treatment secondary infections, particularly in patients predisposed to developing diaphragmatic defects.

Regulator of G-protein signaling 14 protects the liver from ischemia-reperfusion injury by suppressing TGF-ß-activated kinase 1 activation.

BACKGROUND AND AIMS: Hepatic ischemia-reperfusion injury (IRI) is a common complication of hepatectomy and liver transplantation. However, the mechanisms underlying hepatic IRI have not been fully elucidated. Regulator of G-protein signaling 14 (RGS14) is a multifunctional scaffolding protein that integrates the G-protein and mitogen-activated protein kinase (MAPK) signaling pathways. However, the role of RGS14 in hepatic IRI remains unclear. APPROACH AND RESULTS: We found that RGS14 expression increased in mice subjected to hepatic ischemia-reperfusion (IR) surgery and during hypoxia reoxygenation in hepatocytes. We constructed global RGS14 knockout (RGS14-KO) and hepatocyte-specific RGS14 transgenic (RGS14-TG) mice to establish 70% hepatic IRI models. Histological hematoxylin and eosin staining, levels of alanine aminotransferase and aspartate aminotransferase, expression of inflammatory factors, and apoptosis were used to assess liver damage and function in these models. We found that RGS14 deficiency significantly aggravated IR-induced liver injury and activated hepatic inflammatory responses and apoptosis in vivo and in vitro. Conversely, RGS14 overexpression exerted the opposite effect of the RGS14-deficient models. Phosphorylation of TGF-ß-activated kinase 1 (TAK1) and its downstream effectors c-Jun N-terminal kinase (JNK) and p38 increased in the liver tissues of RGS14-KO mice but was repressed in those of RGS14-TG mice. Furthermore, inhibition of TAK1 phosphorylation rescued the effect of RGS14 deficiency on JNK and p38 activation, thus blocking the inflammatory responses and apoptosis. CONCLUSIONS: RGS14 plays a protective role in hepatic IR by inhibiting activation of the TAK1-JNK/p38 signaling pathway. This may be a potential therapeutic strategy for reducing incidences of hepatic IRI in the future.

E3 ubiquitin ligase ring finger protein 5 protects against hepatic ischemia reperfusion injury by mediating phosphoglycerate mutase family member 5 ubiquitination.

BACKGROUND AND AIMS: Hepatic ischemia-reperfusion (HIR) injury, a common clinical complication of liver transplantation and resection, affects patient prognosis. Ring finger protein 5 (RNF5) is an E3 ubiquitin ligase that plays important roles in endoplasmic reticulum stress, unfolded protein reactions, and inflammatory responses; however, its role in HIR is unclear. APPROACH AND RESULTS: RNF5 expression was significantly down-regulated during HIR in mice and hepatocytes. Subsequently, RNF5 knockdown and overexpression of cell lines were subjected to hypoxia-reoxygenation challenge. Results showed that RNF5 knockdown significantly increased hepatocyte inflammation and apoptosis, whereas RNF5 overexpression had the opposite effect. Furthermore, hepatocyte-specific RNF5 knockout and transgenic mice were established and subjected to HIR, and RNF5 deficiency markedly aggravated liver damage and cell apoptosis and activated hepatic inflammatory responses, whereas hepatic RNF5 transgenic mice had the opposite effect compared with RNF5 knockout mice. Mechanistically, RNF5 interacted with phosphoglycerate mutase family member 5 (PGAM5) and mediated the degradation of PGAM5 through K48-linked ubiquitination, thereby inhibiting the activation of apoptosis-regulating kinase 1 (ASK1) and its downstream c-Jun N-terminal kinase (JNK)/p38. This eventually suppresses the inflammatory response and cell apoptosis in HIR. CONCLUSIONS: We revealed that RNF5 protected against HIR through its interaction with PGAM5 to inhibit the activation of ASK1 and the downstream JNK/p38 signaling cascade. Our findings indicate that the RNF5-PGAM5 axis may be a promising therapeutic target for HIR.

Relationships between stroke prevalence, health literacy, and oral health-related quality of life in middle-aged and older adults: a national survey study.

BACKGROUND: Stroke may cause debilitating neurological deficiencies that result in motor, sensory, and cognitive deficits and poorer psychosocial functioning. Prior studies have provided some initial evidence for the significant roles of health literacy and poor oral health for old people. However, few studies have focused on the health literacy of individuals who had a stroke; therefore, the relationships between the health literacy and oral health-related quality of life (OHRQoL) among middle-aged and older adults who had a stroke are unknown. We aimed to assess the relationships between stroke prevalence, health literacy status, and OHRQoL in middle-aged and older adults. METHODS: We retrieved the data from The Taiwan Longitudinal Study on Aging, a population-based survey. For each eligible subject, we gathered data in 2015 on age, sex, level of education, marital status, health literacy, the activity daily living (ADL), stroke history and OHRQoL. We evaluated the respondents' health literacy by using a nine-item health literacy scale and categorized their health literacy level as low, medium, or high. OHRQoL was identified based on the Taiwan version of the Oral Health Impact Profile (OHIP-7T). RESULTS: The final study contained 7702 community-based dwelling elderly people (3630 male and 4072 female) were analysis in our study. Stroke history was reported in 4.3% of participants, 25.3% reported low health literacy, and 41.9% had at least one ADL disability. Furthermore, 11.3% of participants had depression, 8.3% had cognitive impairment, and 3.4% had poor OHRQoL. Age, health literacy, ADL disability, stroke history, and depression status were significantly associated with poor OHRQoL after sex and marital status was adjusted. Medium (odds ratio [OR] = 1.784, 95% confidence interval [CI] = 1.177, 2.702) to low health literacy (OR = 2.496, 95% CI = 1.628, 3.828) was significantly associated with poor OHRQoL. CONCLUSIONS: Base our study results, people with stroke history had poor OHRQoL. Lower health literacy and ADL disability were associated with worse QHRQoL. Further studies are necessary to define practical strategies for reducing the risk of stroke and oral health with constantly lower health literacy, thereby improving the quality of life and providing health care of older people.

Psychometric Evaluation of The Irritability Scale-Initial Version in Chinese Cancer Patients.

BACKGROUND: Irritability is a common experience of depressed Chinese patients but is understudied and poorly measured. OBJECTIVE: We aimed to assess psychometric properties of a new measure of irritability in Chinese cancer patients across the social and political spectrum. METHODS: The Irritability Scale-Initial Version (TISi) was translated into Chinese and tested in two samples of Chinese cancer patients undergoing treatments: 52 patients in Beijing, China, between 2018 and 2019 and 65 patients in Taipei, Taiwan, in 2020. RESULTS: The Chinese version of TISi demonstrated high internal consistency, high reliability based on the split-half method in the two samples, and satisfactory discriminant validity using the Chinese version of the 17-item Hamilton Rating Scale for Depression and the seven-item depression subscale of the Hospital Anxiety and Depression Scale in the Beijing sample. A confirmatory factor analysis produced factor loadings in both samples, which resembled a sample of American cancer patients. Three TISi items were loaded more highly on the physical instead of the original behavioral subscale in the Beijing sample. A possible influence of cultures was explained. CONCLUSION: The Chinese version of TISi has satisfactory psychometric properties for assessing the level of irritability in Chinese cancer patients. Future large-sample studies are needed to further determine TISi's factorial structure, test-retest reliability, sensitivity to change, and predictive validity for depression in Chinese cancer patients.

Nipple-areolar complex (NAC) or skin flap ischemia necrosis post nipple-sparing mastectomy (NSM)-analysis of clinicopathologic factors and breast magnetic resonance imaging (MRI) features.

BACKGROUND: The purpose of this study is to identify clinicopathologic factors and/or preoperative MRI vascular patterns in the prediction of ischemia necrosis of the nipple-areola complex (NAC) or skin flap post nipple-sparing mastectomy (NSM). METHODS: We performed a retrospective analysis of 441 NSM procedures from January 2011 to September 2021 from the breast cancer database at our institution. The ischemia necrosis of NAC or skin flap was evaluated in correlation with clinicopathologic factors and types of skin incision. Patients who received NSM with preoperative MRI evaluation were further evaluated for the relationship between vascular pattern and the impact on ischemia necrosis of NAC or skin flap. RESULTS: A total of 441 cases with NSM were enrolled in the current study, and the mean age of the cases was 49.1 ± 9.8 years old. A total of 41 (9.3%) NSM procedures were found to have NAC ischemia/necrosis. Risk factors were evaluated of which old age, large mastectomy specimen weight (> 450 g), and peri-areola incision were identified as predictors of NAC necrosis. Two-hundred seventy NSM procedures also received preoperative MRI, and the blood supply pattern was 18% single-vessel type and 82% double-vessel pattern. There were no correlations between MRI blood supply patterns or types of skin flap incisions with ischemia necrosis of NAC. There were also no correlations between blood loss and the pattern or size of the blood vessel. CONCLUSION: Factors such as the type of skin incision, age, and size of mastectomy weight played an important role in determining ischemia necrosis of NAC; however, MRI vascular (single or dual vessel supply) pattern was not a significant predictive factor.

MSTA-SlowFast: A Student Behavior Detector for Classroom Environments.

Detecting students' classroom behaviors from instructional videos is important for instructional assessment, analyzing students' learning status, and improving teaching quality. To achieve effective detection of student classroom behavior based on videos, this paper proposes a classroom behavior detection model based on the improved SlowFast. First, a Multi-scale Spatial-Temporal Attention (MSTA) module is added to SlowFast to improve the ability of the model to extract multi-scale spatial and temporal information in the feature maps. Second, Efficient Temporal Attention (ETA) is introduced to make the model more focused on the salient features of the behavior in the temporal domain. Finally, a spatio-temporal-oriented student classroom behavior dataset is constructed. The experimental results show that, compared with SlowFast, our proposed MSTA-SlowFast has a better detection performance with mean average precision (mAP) improvement of 5.63% on the self-made classroom behavior detection dataset.

Retrospective study on the factors influencing the severity of pressure injuries among intensive care unit patients.

AIMS AND OBJECTIVES: This study investigated the factors of pressure injuries in patients in intensive care units (ICU). BACKGROUND: Pressure injuries among patients in ICUs can be prevented by the early assessment of risk factors and taking appropriate preventative measures. DESIGN: A retrospective study. METHODS: ICU patients who suffered from pressure injuries between January 2016 and August 2018 at a hospital in Taiwan were selected. Patient medical histories and data associated with pressure injuries and medical treatment were collected from electronic medical records. A total of 256 patients were included in our analysis. The study adhered to the STROBE checklist. RESULTS: A multivariate model of multinomial logistic regression analysis indicated that when compared to Stage 1 pressure injuries, Stage 2-4 pressure injuries were associated with albumin levels. Patients with lower albumin levels were at greater odds of Stage 2-4 pressure injuries than Stage 1 pressure injuries. In addition, when compared to unstageable pressure injuries or deep tissue injuries, Stage 1 pressure injuries were associated with the use of fentanyl and haemoglobin levels. Patients using fentanyl were more likely to suffer from unstageable pressure injuries, and those with lower haemoglobin levels were more likely to suffer from unstageable pressure injuries or deep tissue injuries. CONCLUSION: When patients were simultaneously on ventilators and taking midazolam or fentanyl, the incidence of pressure injuries with greater severity became higher. Furthermore, ICU patients with lower albumin and haemoglobin levels were more likely to suffer from pressure injuries of greater severity. RELEVANCE TO CLINICAL PRACTICE: For critically ill patients on ventilators, it is recommended to devise a means of assessing each patient daily as well as systematically reduce their dosage of midazolam or fentanyl. Furthermore, regularly monitoring albumin and haemoglobin levels to understand their nutritional status is necessary.

Adverse effects of non-intubated airway suctioning: a clinical data-based study.

AIMS AND OBJECTIVES: The purpose of this study was to investigate the adverse effects of non-intubated suctioning. BACKGROUND: Airway hygiene aims to maintain a patent airway to ensure adequate ventilation. Nasopharyngeal, oropharyngeal or nasotracheal suctioning may be used in patients who require airway suctioning but do not have an artificial airway. However, no studies till date provide insight into the adverse effects of non-intubated airway suctioning. DESIGN: A clinical data-based retrospective design. METHOD: Using institutional and clinical databases of three university hospitals in 2008-2016, we conducted a study with a propensity score matching method of 3,326 hospitalised patients who had undergone suction therapy with or without a tracheotomy. Conditional logistic regression analyses were performed to investigate the link between suctioning and the probabilities of adverse effects. STROBE checklist was used to report the current study. RESULTS: Patients who required nasopharyngeal, oropharyngeal or nasotracheal suctioning had a higher risk of gastrointestinal ulcers than tracheotomised patients (adjusted OR 1.99; 95% CI, 1.24-3.20). Patients who received non-intubated suction had a higher risk of developing pneumonia (adjusted OR 1.59; 95% CI, 1.26-2.00), and the risk of aspiration pneumonia was three times higher than tracheotomised patients (adjusted OR 3.04; 95% CI, 1.40-6.60). CONCLUSIONS: Non-intubated patients who require suctioning for airway clearing are more susceptible to gastrointestinal ulcers, pneumonia and aspiration pneumonia. The findings would facilitate in alerting healthcare professionals to this group of patients. However, more clinical research is needed to elucidate the mechanisms of adverse effects in non-intubated patients who require suctioning. RELEVANCE TO CLINICAL PRACTICE: The adverse effects of suctioning can easily be overlooked in debilitated patients with no intubation. Professionals must be aware of the discomfort and risks that patients may experience.

Extrinsic factors of pressure injuries in patients during surgery: A frequency matched retrospective study.

This study was to clarify the connection between extrinsic factors and the risk of perioperative pressure injuries (PIs) through the case-control approach, which involved making the intrinsic factors of the patients in the control group with no PIs consistent with those of the case group with PIs. We collected samples from a teaching hospital in Taiwan. We found a total of 132 patients deemed to have developed perioperative PIs. Using 1:2 frequency matching, we matched these cases with patients who had not developed PIs by gender, age, and BMI. Binary logistic regression analysis of the odds ratios of the extrinsic factors and PI risk revealed that the independent variables with statistical significance included duration of anaesthesia 3 h, amount of blood loss, use of electric blankets, diastolic blood pressure below 60 mmHg during surgery, and oxyhemoglobin saturation by pulse oximetry (SPO2 ) below 93% during surgery. Emphasis should be placed on cooperation among the medical team during surgery, less use of electric blankets, control over the duration of anaesthesia and blood loss, continuous monitoring of the patient during surgery for any emergencies, and the maintenance of patient diastolic blood pressure and blood oxygen levels to reduce the risk of PIs.

Influence of basic attributes and attitudes of nurses toward death on nurse turnover: A prospective study.

BACKGROUND: Facing patient death is an unavoidable aspect of work for nurses working in healthcare settings. The attitudes of nurses toward death, however, can exert a negative psychological impact on themselves that can even cause them to quit this occupation. AIM: The objective of this study was to explore the attitudes of nurses toward death, the factors influencing said attitudes, and whether nurses basic attributes and attitudes toward death were associated with their future turnover behavior. METHOD: A prospective study design was adopted. The recruitment period ran from October 2017 to March 2018. A total of 323 nurses completed a basic attributes survey as well as the Death Attitude Profile-Revised questionnaire and were followed until May 30, 2021. The factors influencing turnover were then analyzed using the Cox proportional hazard model. The STROBE checklist was used for reporting in this study. RESULTS: Age was found to be significantly associated with fear of death and death avoidance. Compared with nurses with no religion, nurses who were Buddhists/Taoists were more inclined toward neutral acceptance in their attitude toward death, whereas those who were Christians/Catholics were more inclined toward escape acceptance. Nurses with less than three years of work experience were more likely to resign earlier than those with more than 3 years of work experience. Fear of death and approach acceptance could be used to predict turnover. CONCLUSIONS: Younger nurses were more likely to exhibit fear of death and escape behavior, and those with less work experience or a greater fear of death were more likely to resign. Nurses with religious beliefs could accept patient death more positively, whereas those who faced death with positive approach acceptance displayed reductions in turnover. IMPLICATION FOR NURSING AND HEALTH POLICY: Younger nurses should receive more education regarding death early in their training. Hospitals should also offer more education from a religious aspect in order to reduce turnover.