[Anesthetic Care of Patient With Heroin Addiction: A Case Report].

The use of illegal drugs in Taiwan is on the rise. Drug addicts often have complex physical, psychological, and social problems. In addition, they often avoid disclosing their illicit drug use by deceit, concealment, or under-reporting. Building and maintaining relationships of trust with drug-addict patients has become a critical issue in achieving better care quality. In this case report, we report on an anesthesia care process for a heroin addict who was admitted for open reduction and internal fixation surgery for the femur and patella fractures after a car accident. During the six-hour perioperative care period, starting from 11pm on November 30th to 5am on December 1st, 2015, the patient was not willing to disclose his illicit drug use before the surgery. However, the nurse anesthetist noticed signs and symptoms of drug use. The nurse empathized with the patient's worries, provided him with a safe communication environment, and gained trust from the patient in a timely manner, which then enabled the patient to fully disclose his illicit drug use with the nurse anesthetist. The anesthesia-care strategy was then modified according to client's condition. The nurse anesthetist played an important role of bridging communications between the patient and medical care staffs and of modifying the care strategies in a timely manner. During the care period, the blood-borne disease contamination was successfully prevented, the client received uneventful pain management, there was a lack of withdrawal symptoms, and the staffs and patient safety was maintained. The literature on the anesthetic care of heroin patients undergoing surgery is relatively limited in Taiwan. The findings in the current case report add information on providing anesthetic care to patients with drug addiction. Publishing additional case reports, research, and clinical recommendations is essential for improving care quality for this vulnerable population.

[The Perioperative Management of Pain in Patients Who Are Addicted to Heroin].

Heroin addicts admitted to the hospital for surgery should be treated as high-risk patients because these patients face a significantly higher risk of experiencing severe drug withdrawal symptoms and of pain management complications during hospitalization. The lack of proper pain management often suffered by heroin addicts during hospitalization has been attributed to care providers' insufficient knowledge regarding opioid medications and their addicting effects as well as fears that opioid medications may cause addiction symptoms to reemerge. The objective of this article is to illustrate the pain management process across the entire hospitalization period for heroin-addicted patients undergoing surgical procedures. This process includes management of the heroin-related physical and psychological reactions from surgery, of the mechanism of pain induced specifically from surgery, and of the heroin addiction during the surgical procedure and subsequent clinical management and nursing care. It is hoped that this article assists healthcare providers to better understand the need for the proper pain management and care of heroin-addicted surgical patients over the entire period of hospitalization and thus the enhancement of the overall quality and safety of patient care management procedures.

Extending the Omega model with momentum and reversal strategies to intraday trading.

This study develops the Omega model integrated with momentum and reversal strategies using high-frequency data on the component stocks of the S&P 500 Index and the NASDAQ 100. The Omega model based on the momentum strategy (M_Omega), the reversal strategy (R_Omega), and both strategies (M_R_Omega) are designed to simulate trading over three periods. The portfolio is rebalanced every transaction day to optimize asset allocation by incorporating intraday winners or losers' information and trading cost. The study finds that the proposed models generate positive returns (net of trading costs), in spite of fact that intraday trading frequently erodes profits. The M_Omega and R_Omega models produce a higher return than that of the S&P 500 index or NASDAQ 100 index, considering the intraday trading cost. The performance of the Omega model integrated with the momentum or reversal strategy is more profitable in a volatile market or period. The M_Omega and R_Omega reach the highest final market value from 2020 to 2021, when COVID 19 pandemic emerged. The rebalancing of the momentum or reversal strategy is suitable for the short term but not recommended in the long term for intraday trading as the trading costs become increasingly significant over time.

[A project to reduce the incidence of facial pressure ulcers caused by prolonged surgery with prone positioning].

BACKGROUND & PROBLEMS: We observed in our institute a 13.6% incidence of prolonged surgery (>4 hours) induced facial pressure ulcers that required prone positioning. Causes identified included: (1) customized silicon face pillows used were not suited for every patient; (2) our institute lacked a standard operating procedure for prone positioning; (3) our institute lacked a postoperative evaluation and audit procedure for facial pressure ulcers. PURPOSE: We designed a strategy to reduce post-prolonged surgery facial pressure ulcer incidence requiring prone positioning by 50% (i.e., from 13.6% to 6.8%). RESOLUTIONS: We implemented the following: (1) Created a new water pillow to relieve facial pressure; (2) Implemented continuing education pressure ulcer prevention and evaluation; (3) Established protocols on standard care for prone-position patients and proper facial pressure ulcer identification; (4) Established a face pressure ulcers accident reporting mechanism; and (5) Established an audit mechanism facial pressure ulcer cases. RESULTS: After implementing the resolution measures, 116 patients underwent prolonged surgery in a prone position (mean operating time: 298 mins). None suffered from facial pressure ulcers. The measures effectively reduced the incidence of facial pressure ulcers from 13.6% to 0.0%. CONCLUSIONS: The project used a water pillow to relieve facial pressure and educated staff to recognize and evaluate pressure ulcers. These measures were demonstrated effective in reducing the incidence of facial pressure ulcers caused by prolonged prone positioning.

Humanization of T cell-mediated immunity in mice.

Despite the enormous promise of T cell therapies, the isolation and study of human T cell receptors (TCRs) of dedicated specificity remains a major challenge. To overcome this limitation, we generated mice with a genetically humanized system of T cell immunity. We used VelociGene technology to replace the murine TCRαß variable regions, along with regions encoding the extracellular domains of co-receptors CD4 and CD8, and major histocompatibility complex (MHC) class I and II, with corresponding human sequences. The resulting "VelociT" mice have normal myeloid and lymphoid immune cell populations, including thymic and peripheral αß T cell subsets comparable with wild-type mice. VelociT mice expressed a diverse TCR repertoire, mounted functional T cell responses to lymphocytic choriomeningitis virus infection, and could develop experimental autoimmune encephalomyelitis. Immunization of VelociT mice with human tumor-associated peptide antigens generated robust, antigen-specific responses and led to identification of a TCR against tumor antigen New York esophageal squamous cell carcinoma-1 with potent antitumor activity. These studies demonstrate that VelociT mice mount clinically relevant T cell responses to both MHC-I­ and MHC-II­restricted antigens, providing a powerful new model for analyzing T cell function in human disease. Moreover, VelociT mice are a new platform for de novo discovery of therapeutic human TCRs.

Studies in humanized mice and convalescent humans yield a SARS-CoV-2 antibody cocktail.

Neutralizing antibodies have become an important tool in treating infectious diseases. Recently, two separate approaches yielded successful antibody treatments for Ebola-one from genetically humanized mice and the other from a human survivor. Here, we describe parallel efforts using both humanized mice and convalescent patients to generate antibodies against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein, which yielded a large collection of fully human antibodies that were characterized for binding, neutralization, and three-dimensional structure. On the basis of these criteria, we selected pairs of highly potent individual antibodies that simultaneously bind the receptor binding domain of the spike protein, thereby providing ideal partners for a therapeutic antibody cocktail that aims to decrease the potential for virus escape mutants that might arise in response to selective pressure from a single-antibody treatment.

Interactions of RXR with coactivators are differentially mediated by helix 11 of the receptor's ligand binding domain.

RXR is a nuclear hormone receptor that is activated by the vitamin A metabolite 9-cis-retinoic acid. Previously, it was shown that, in the absence of a cognate ligand, RXR self-associates into tetramers, thereby silencing its own transcriptional activity. It was also shown that the tetramerization region of RXR critically contains two of three consecutive phenylalanine residues found in helix 11 (H11) of the receptor's ligand binding domain. Mutation of these residues abolishes the ability of RXR to form tetramers but also results in a receptor that is defective in its ligand-induced transcriptional activity. These observations suggest that the region may be involved in the association of RXR with transcriptional coactivators. Here, it is demonstrated that mutation of the H11 phenylalanine residues diminishes the ability of RXR to associate with the p160 coactivators TIF2 and p/CIP, but has little effect on ligand-dependent interactions of the receptor with the unrelated coactivator TIF1. It is further shown that a peptide comprised of the H11 sequence effectively competes with RXR for binding of TIF2 but not of TIF1. Finally, transactivation assays demonstrate that the defective transcriptional activity of the H11 mutant can be rescued by ectopic expression of TIF1 but not of TIF2. Taken together, the results indicate that H11 is directly involved in stabilizing the interactions of RXR with p160 coactivators, but is not required for association with TIF1. This region is thus a novel coactivator interaction surface which selectively mediates the association of RXR with transcriptional coactivators.