The effect of a scenario-based cognitive behavioral therapy mobile app on end-stage kidney disease patients on dialysis.

It has been reported that a scenario-based cognitive behavioral therapy mobile app including Todac Todac was effective in improving depression in the general public. However, no study has been conducted on whether Todac Todac is effective in dialysis patients. Therefore, this study was intended to determine whether the use of this app was effective in improving depression in dialysis patients. Sixty-five end-stage kidney disease patients receiving dialysis at Soonchunhyang University Cheonan Hospital were randomly assigned to the Todac Todac app program (experimental group) or an E-moods daily mood chart app program (control group) for 3 weeks. The degree of depression was measured before and after using the app.After the end of the 3-week program, a small but significant improvement was observed in the Trait anxiety (p < 0.05) and Beck depression index (p < 0.05) in E-moods group and DAS-K scores (p < 0.05) in Todac Todac group. However, no differences were seen in any parameters between the two groups. In addition, Todac Todac was not statistically more effective than the control intervention in the subgroup analysis. The Todac Todac, a scenario-based cognitive behavioral therapy mobile app, seemed to have a limited effect on improving depression in dialysis patients. Therefore, it is necessary to develop new tools to improve depression in dialysis patients.

Transcriptomic and physiological responses of Quercus acutissima and Quercus palustris to drought stress and rewatering.

Establishment of oak seedlings, which is an important factor in forest restoration, is affected by drought that hampers the survival, growth, and development of seedlings. Therefore, it is necessary to understand how seedlings respond to and recover from water-shortage stress. We subjected seedlings of two oak species, Quercus acutissima and Quercus palustris, to drought stress for one month and then rewatered them for six days to observe physiological and genetic expression changes. Phenotypically, the growth of Q. acutissima was reduced and severe wilting and recovery failure were observed in Q. palustris after an increase in plant temperature. The two species differed in several physiological parameters during drought stress and recovery. Although the photosynthesis-related indicators did not change in Q. acutissima, they were decreased in Q. palustris. Moreover, during drought, content of soluble sugars was significantly increased in both species, but it recovered to original levels only in Q. acutissima. Malondialdehyde content increased in both the species during drought, but it did not recover in Q. palustris after rewatering. Among the antioxidant enzymes, only superoxide dismutase activity increased in Q. acutissima during drought, whereas activities of ascorbate peroxidase, catalase, and glutathione reductase increased in Q. palustris. Abscisic acid levels were increased and then maintained in Q. acutissima, but recovered to previous levels after rewatering in Q. palustris. RNA samples from the control, drought, recovery day 1, and recovery day 6 treatment groups were compared using transcriptome analysis. Q. acutissima exhibited 832 and 1076 differentially expressed genes (DEGs) related to drought response and recovery, respectively, whereas Q. palustris exhibited 3947 and 1587 DEGs, respectively under these conditions. Gene ontology enrichment of DEGs revealed "response to water," "apoplast," and "Protein self-association" to be common to both the species. However, in the heatmap analysis of genes related to sucrose and starch synthesis, glycolysis, antioxidants, and hormones, the two species exhibited very different transcriptome responses. Nevertheless, the levels of most DEGs returned to their pre-drought levels after rewatering. These results provide a basic foundation for understanding the physiological and genetic expression responses of oak seedlings to drought stress and recovery.

Effects of seasonal management programs on PM2.5 in Seoul and Beijing using DN-PMF: Collaborative efforts from the Korea-China joint research.

South Korea and China have implemented increasingly stringent mitigation measures to reduce the health risks from PM2.5 exposure, jointly conducting a ground-based air quality observation study in Northeast Asia. Dispersion normalized positive matrix factorization (DN-PMF) was used to identify PM2.5 sources in Seoul and Beijing and assess the effectiveness of the seasonal management programs (SMPs) through a comparative study. Samples were collected during three periods: January-December 2019, September 2020-May 2021, and July 2021-March 2022. In Seoul, ten sources were resolved (Secondary nitrate: 8.67 µg/m3, 34 %, Secondary sulfate: 5.67 µg/m3, 22 %, Motor vehicle: 1.83 µg/m3, 7.2 %, Biomass burning: 2.30 µg/m3, 9.1 %, Residual oil combustion: 1.66 µg/m3, 6.5 %, Industry: 2.15 µg/m3, 8.5 %, Incinerator: 1.39 µg/m3, 5.5 %, Coal combustion: 0.363 µg/m3, 1.4 %, Road dust/soil: 0.941 µg/m3, 3.7 %, Aged sea salt: 0.356 µg/m3, 1.4 %). The SMP significantly decreased PM2.5 mass concentrations and source contributions of motor vehicle, residual oil combustion, industry, coal combustion, and biomass burning sources (p-value < 0.05). For Seoul, the reduction effects of the SMPs were evident even considering the influence of the natural meteorological variations and the responses to COVID-19. In Beijing, nine sources were resolved (Secondary nitrate: 12.6 µg/m3, 28 %, Sulfate: 8.27 µg/m3, 18 %, Motor vehicle: 3.77 µg/m3, 8.4 %, Biomass burning: 2.70 µg/m3, 6.0 %, Incinerator: 4.50 µg/m3, 10 %, Coal combustion: 3.52 µg/m3, 7.8 %, Industry: 5.01 µg/m3, 11 %, Road dust/soil: 2.92 µg/m3, 6.5 %, Aged sea salt: 1.63 µg/m3, 3.6 %). Significant reductions in PM2.5 mass concentrations and source contributions of industry, coal combustion, and incinerator (p-value < 0.05) were observed, attributed to the SMP and additional measures enforced before the 2022 Beijing Winter Olympics. Unlike comparing PM2.5 mass concentration variations using conventional methods, investigation of the source contribution variations of PM2.5 by using DN-PMF can provide a deeper understanding of the effectiveness of the air quality management policies.

Genome-Wide Characterization of Glyceraldehyde-3-Phosphate Dehydrogenase Genes and Their Expression Profile under Drought Stress in Quercus rubra.

Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) is crucial in plant metabolism and responses to various abiotic stresses. In the glycolysis pathway, glyceraldehyde-3-phosphate (G3P) is oxidized to 1,3-bisphosphate glycerate (1,3-BPG) through the catalytic action of GAPDH. However, the GAPDH gene family in Quercus rubra has been minimally researched. In this study, we identified 13 GAPDH-encoding genes in Q. rubra through a bioinformatics analysis of genomic data. Evolutionary studies suggest that these QrGAPDH genes are closely related to those in Glycine max and Triticum aestivum. We conducted a comprehensive whole-genome study, which included predictions of subcellular localization, gene structure analysis, protein motif identification, chromosomal placement, and analysis of cis-acting regions. We also examined the expression of GAPDH proteins and genes in various tissues of Q. rubra and under drought stress. The results indicated diverse expression patterns across different tissues and differential expression under drought conditions. Notably, the expression of Qurub.02G290300.1, Qurub.10G209800.1, and Qrub.M241600.1 significantly increased in the leaf, stem, and root tissues under drought stress. This study provides a systematic analysis of QrGAPDH genes, suggesting their pivotal roles in the drought stress response of trees.

A randomised controlled trial of the Learning Skills Together (LST) intervention to improve dementia family caregivers' self-efficacy with complex care.

BACKGROUND: Nearly two-thirds of family caregivers of persons living with Alzheimer's disease or related dementias (AD/ADRD) provide complex care, including medical care. Family caregivers typically receive little to no training on how to provide this care. Furthermore, family caregivers simultaneously grapple with the presence of behavioral and psychological symptoms of dementia (BPSD), diminished communication abilities, and comorbidities such as diabetes. We developed Learning Skills Together (LST), a 6-week digitally delivered psychoeducational program, to facilitate family caregiver abilities to administer complex care tasks. The goal of the present study is to test the efficacy of LST and to reduce adverse outcomes associated with caregiving, such as depressive symptomology and negative appraisal of BPSD. METHODS: To test the efficacy of LST, we will conduct a two-arm single-site randomized controlled trial (RCT) with N = 200 family caregivers of persons living with AD/ADRD. Eligible family caregivers will be randomly assigned to participate in either the LST intervention or a structurally equivalent control condition focused on healthy living. All family caregivers will complete four surveys, including a baseline survey administered prior to randomization, a post-intervention survey, and a 3- and 6-month follow-up survey to assess change in study outcomes. Between-group comparisons of each outcome will be evaluated using generalized estimating equation models. Mediation analyses will assess family caregiver self-efficacy as the intervention's mechanism of change in depressive symptomology and BPSD. We will also examine caregiver race, ethnicity, and gender as effect modifiers of the intervention. DISCUSSION: LST findings will inform the field of AD/ADRD and caregiving regarding optimally supporting family caregivers in managing complex care tasks. If efficacious, the LST intervention will support family caregivers in preserving their own mental health while providing complex care. TRIAL REGISTRATION: Clinical Trials.gov NCT05846984 . This study was registered on May 6, 2023.

A randomised controlled trial of the Learning Skills Together (LST) intervention to improve dementia family caregivers' self-efficacy with complex care.

Background: Nearly two-thirds of family caregivers of persons living with Alzheimer's disease or related dementias (AD/ADRD) provide complex care, including medical care. Family caregivers typically receive little to no training on how to provide this care. Furthermore, family caregivers simultaneously grapple with the presence of behavioral and psychological symptoms of dementia (BPSD), diminished communication abilities, and comorbidities such as diabetes. We developed Learning Skills Together (LST), a six-week digitally delivered psychoeducational program, to facilitate family caregiver abilities to administer complex care tasks. The goal of the present study is to test the efficacy of LST and to reduce adverse outcomes associated with caregiving, such as depressive symptomology and negative appraisal of BPSD. Methods: To test the efficacy of LST, we will conduct a two-arm single-site randomised controlled trial (RCT) with N = 200 family caregivers of persons living with AD/ADRD. Eligible family caregivers will be randomly assigned to participate in either the LST intervention or a structurally equivalent control condition focused on healthy living. All family caregivers will complete four surveys, including a baseline survey administered prior to randomisation, a post-intervention survey, and a three- and six-month follow-up survey to assess change in study outcomes. Between-group comparisons of each outcome will be evaluated using generalized estimating equation models. Mediation analyses will assess family caregiver self-efficacy as the intervention's mechanism of change in depressive symptomology and BPSD. We will also examine caregiver race, ethnicity, and gender as effect modifiers of the intervention. Discussion: LST findings will inform the field of AD/ADRD and caregiving regarding optimally supporting family caregivers in managing complex care tasks. If efficacious, the LST intervention will support family caregivers in preserving their own mental health while providing complex care.

Validating the knowledge represented by a self-organizing map with an expert-derived knowledge structure.

BACKGROUND: Professionals are reluctant to make use of machine learning results for tasks like curriculum development if they do not understand how the results were generated and what they mean. Visualizations of peer reviewed medical literature can summarize enormous amounts of information but are difficult to interpret. This article reports the validation of the meaning of a self-organizing map derived from the Medline/PubMed index of peer reviewed medical literature by its capacity to coherently summarize the references of a core psychiatric textbook. METHODS: Reference lists from ten editions of Kaplan and Sadock's Comprehensive Textbook of Psychiatry were projected onto a self-organizing map trained on Medical Subject Headings annotating the complete set of peer reviewed medical research articles indexed in the Medline/PubMed database (MedSOM). K-means clustering was applied to references from every edition to examine the ability of the self-organizing map to coherently summarize the knowledge contained within the textbook. RESULTS: MedSOM coherently clustered references into six psychiatric knowledge domains across ten editions (1967-2017). Clustering occurred at the abstract level of broad psychiatric practice including General/adult psychiatry, Child psychiatry, and Administrative psychiatry. CONCLUSIONS: The uptake of visualizations of published medical literature by medical experts for purposes like curriculum development depends upon validation of the meaning of the visualizations. The current research demonstrates that a self-organizing map (MedSOM) can validate the stability and coherence of the references used to support the knowledge claims of a standard psychiatric textbook, linking the products of machine learning to a widely accepted standard of knowledge.

Targeted deletion of CD244 on monocytes promotes differentiation into anti-tumorigenic macrophages and potentiates PD-L1 blockade in melanoma.

BACKGROUND: In the myeloid compartment of the tumor microenvironment, CD244 signaling has been implicated in immunosuppressive phenotype of monocytes. However, the precise molecular mechanism and contribution of CD244 to tumor immunity in monocytes/macrophages remains elusive due to the co-existing lymphoid cells expressing CD244. METHODS: To directly assess the role of CD244 in tumor-associated macrophages, monocyte-lineage-specific CD244-deficient mice were generated using cre-lox recombination and challenged with B16F10 melanoma. The phenotype and function of tumor-infiltrating macrophages along with antigen-specific CD8 T cells were analyzed by flow cytometry and single cell RNA sequencing data analysis, and the molecular mechanism underlying anti-tumorigenic macrophage differentiation, antigen presentation, phagocytosis was investigated ex vivo. Finally, the clinical feasibility of CD244-negative monocytes as a therapeutic modality in melanoma was confirmed by adoptive transfer experiments. RESULTS: CD244fl/flLysMcre mice demonstrated a significant reduction in tumor volume (61% relative to that of the CD244fl/fl control group) 14 days after tumor implantation. Within tumor mass, CD244fl/flLysMcre mice also showed higher percentages of Ly6Clow macrophages, along with elevated gp100+IFN-γ+ CD8 T cells. Flow cytometry and RNA sequencing data demonstrated that ER stress resulted in increased CD244 expression on monocytes. This, in turn, impeded the generation of anti-tumorigenic Ly6Clow macrophages, phagocytosis and MHC-I antigen presentation by suppressing autophagy pathways. Combining anti-PD-L1 antibody with CD244-/- bone marrow-derived macrophages markedly improved tumor rejection compared to the anti-PD-L1 antibody alone or in combination with wild-type macrophages. Consistent with the murine data, transcriptome analysis of human melanoma tissue single-cell RNA-sequencing dataset revealed close association between CD244 and the inhibition of macrophage maturation and function. Furthermore, the presence of CD244-negative monocytes/macrophages significantly increased patient survival in primary and metastatic tumors. CONCLUSION: Our study highlights the novel role of CD244 on monocytes/macrophages in restraining anti-tumorigenic macrophage generation and tumor antigen-specific T cell response in melanoma. Importantly, our findings suggest that CD244-deficient macrophages could potentially be used as a therapeutic agent in combination with immune checkpoint inhibitors. Furthermore, CD244 expression in monocyte-lineage cells serve as a prognostic marker in cancer patients.

Genetic parameter changes and age-age correlations in Pinus koraiensis growth over 40-year progeny testing.

BACKGROUND: Early selection in tree breeding could be achieved by addressing the longevity of tree improvement activities. Genetic parameter changes and age-age correlations are essential for determining the optimal timing of early selection. Practical tracking of genetic parameters of Pinus koraiensis, a major timber species with economic and ecological value, has become feasible as its progeny testing has entered the mid-term age in Korea. However, research on the age-age correlation of P. koraiensis as progeny trials approach rotation age is limited. This study aimed to investigate genetic parameter trends and age-age correlations in P. koraiensis progeny. P. koraiensis progeny were assessed at two sites using a linear mixed-effects model with two-dimensional spatial autoregressive structure. Height, diameter, and volume growth were measured in 11 assessments over 40 years. RESULTS: Genetic parameters, such as height and diameter, showed different patterns of change. The heritability ranged for the three growth traits in 0.083-0.710, 0.288-0.781, and 0.299-0.755 across the sites and age. Height heritability and its coefficient of variance decreased, whereas the diameter and volume estimates remained relatively constant. Correlations with Age 40 for phenotypic, genetic, and rank of breeding values ranged between 0.16 and 0.92, 0.594 and 0.988, and 0.412 and 0.965, respectively. These correlations generally increased as the age approached Age 40, with particularly high levels observed at Age 26 and Age 30. CONCLUSION: The observed genetic trends in P. koraiensis progeny testing offer valuable insights for early and precise selection. Notably, selecting superior genotypes at Ages 26-30 is supported by discernible genetic gains and robust correlations. Future research should integrate unbalanced data for selecting mother trees or families and conduct a comprehensive economic analysis of early selection to validate its practical benefits.

Health-related quality of life of premenopausal young breast cancer survivors undergoing endocrine therapy.

PURPOSE: The incidence of breast cancer in premenopausal women in South Korea is higher compared to the West. This study aimed to identify factors associated with the health-related quality of life (HRQoL) among survivors with premenopausal young breast cancer undergoing endocrine therapy by examining the effects of menopausal symptoms, social support, and resilience on HRQoL. METHODS: Cross-sectional study was used to select survivors with breast cancer undergoing endocrine therapy. The study instruments used included a basic information questionnaire, Menopause Rating Scale, Multidimensional Scale of Perceived Social Support, Connor-Davidson Resilience Scale, and Health-Related Quality of Life Instrument with 8 items. Researchers utilized independent t-tests, one-way analysis of variance, Pearson's correlation coefficients, and multiple linear regression to analyze the data. The data were collected from August to September 2021, and the questionnaire was administered via a link posted on a bulletin board of an online breast cancer survivors community. Finally, 133 questionnaires were included in the final analysis. RESULTS: Among 150 participants, 133 completed the questionnaires. HRQoL was higher in the groups with a monthly income of ≥5 million KRW (ß = 0.231, p = .011), fewer menopausal symptoms (ß = -0.399, p < .001), and higher social support (ß = 0.170, p = .038), and lower in the group receiving endocrine therapy and OFS (ß = -0.192, p = .010). The explanatory power for HRQoL of premenopausal young breast cancer survivors undergoing endocrine therapy was 38.3% (F = 10.634, p < .001). CONCLUSION: Breast cancer survivors should be supported to participate in economic activity, utilize rehabilitation and intervention programs to alleviate menopausal symptoms, and benefit from a social support network formed by the hospital, community, and government.

Defining the Boundaries of Psychiatric and Medical Knowledge: Applying Cartographic Principles to Self-Organising Maps.

Biases in selection, training, and continuing professional development of medical specialists arise in part from reliance upon expert judgement for the design, implementation, and management of medical education. Reducing bias in curriculum development has primarily relied upon consensus processes modelled on the Delphi technique. The application of machine learning algorithms to databases indexing peer-reviewed medical literature can extract objective evidence about the novelty, relevance, and relative importance of different areas of medical knowledge. This study reports the construction of a map of medical knowledge based on the entire corpus of the MEDLINE database indexing more than 30 million articles published in medical journals since the 19th century. Techniques used in cartography to maximise the visually intelligible differentiation between regions are applied to knowledge clusters identified by a self-organising map to show the structure of published psychiatric evidence and its relationship to non-psychiatric medical domains.

Tm4sf19 deficiency inhibits osteoclast multinucleation and prevents bone loss.

BACKGROUND: Multinucleation is a hallmark of osteoclast formation and has a unique ability to resorb bone matrix. During osteoclast differentiation, the cytoskeleton reorganization results in the generation of actin belts and eventual bone resorption. Tetraspanins are involved in adhesion, migration and fusion in various cells. However, its function in osteoclast is still unclear. In this study, we identified Tm4sf19, a member of the tetraspanin family, as a regulator of osteoclast function. MATERIALS AND METHODS: We investigate the effect of Tm4sf19 deficiency on osteoclast differentiation using bone marrow-derived macrophages obtained from wild type (WT), Tm4sf19 knockout (KO) and Tm4sf19 LELΔ mice lacking the large extracellular loop (LEL). We analyzed bone mass of young and aged WT, KO and LELΔ mice by µCT analysis. The effects of Tm4sf19 LEL-Fc fusion protein were accessed in osteoclast differentiation and osteoporosis animal model. RESULTS: We found that deficiency of Tm4sf19 inhibited osteoclast function and LEL of Tm4sf19 was responsible for its function in osteoclasts in vitro. KO and LELΔ mice exhibited higher trabecular bone mass compared to WT mice. We found that Tm4sf19 interacts with integrin αvß3 through LEL, and that this binding is important for cytoskeletal rearrangements in osteoclast by regulating signaling downstream of integrin αvß3. Treatment with LEL-Fc fusion protein inhibited osteoclast function in vitro and administration of LEL-Fc prevented bone loss in an osteoporosis mouse model in vivo. CONCLUSION: We suggest that Tm4sf19 regulates osteoclast function and that LEL-Fc may be a promising drug to target bone destructive diseases caused by osteoclast hyper-differentiation.

Association Between Fear of Cancer Recurrence, Fatigue, and Healthy Lifestyle Behaviors Among Breast Cancer Survivors in South Korea.

BACKGROUND: Improving healthy lifestyle behaviors in breast cancer survivors can promote their physical and mental health, thereby reducing the risk of cancer recurrence. Therefore, it is crucial to identify and control the factors affecting healthy lifestyle behaviors among breast cancer survivors. OBJECTIVE: This study aimed to examine the effects of physiological, psychological, and situational factors and symptoms on healthy lifestyle behaviors in breast cancer survivors. METHODS: Data were collected from August to September 2021, and a questionnaire was administered through an online breast cancer patient community's bulletin board. Finally, 162 questionnaires were included in the analysis. RESULTS: The model was statistically significant, explaining 33.2% of the variance. A decrease in healthy lifestyle behaviors in breast cancer survivors was influenced by an age of 40 years or younger, 5 years or more since a breast cancer diagnosis, low income, fear of cancer recurrence, and fatigue. CONCLUSIONS: Intervention strategies, such as easily accessible online content that accounts for age and survival period after cancer diagnosis, should be used to promote healthy lifestyle behaviors among breast cancer survivors. Healthcare providers should be given appropriate guidelines on managing patients' fear of cancer recurrence and reducing fatigue to ensure timely access to clinical interventions. Adequate financial support from local communities and governments is needed to promote healthy lifestyle behaviors. IMPLICATIONS FOR PRACTICE: To improve breast cancer survivors' healthy lifestyle behaviors, an understanding of the influencing factors and a multidimensional approach are required. Nurses play a role in developing and implementing interventions to improve healthy lifestyle behaviors.

Factors affecting depression in adolescents with increased suicidal ideation during the COVID-19 pandemic.

This study examines factors influencing depression in adolescents with increased suicidal ideation during the COVID-19 pandemic, based on an ecological model and using data from the Korean Children and Youth Panel Survey, 2018. We selected adolescents whose suicidal ideation increased between the third and fourth years of the pandemic and who identified their parents as their guardians. Factors related to depression in adolescents were analyzed using stepwise multiple regression, while considering personal and environmental characteristics in the family and school domains. All models were significant, and Model 3 explained 26.8% of the variance. In Model 3, personal characteristics-physical activity, sleep quality on school days, and smartphone dependence-affected adolescents' depression. Parents' life satisfaction and a rejective childrearing attitude were also found to be significant factors affecting adolescents' depression, along with school life satisfaction and school type. Our findings can inform evidence-based nursing interventions to reduce depression in adolescents with increased suicidal ideation. They can also contribute to building strategies to promote mental health in schools after the pandemic, forming healthy life habits, and laying the foundation for lifelong health.

Suppression of the antitumoral activity of natural killer cells under indirect coculture with cancer-associated fibroblasts in a pancreatic TIME-on-chip model.

BACKGROUND: Recently, natural killer (NK) cells emerged as a treatment option for various solid tumors. However, the immunosuppressive tumor immune microenvironment (TIME) can reduce the cytotoxic ability of NK cells in pancreatic ductal adenocarcinoma. Cancer-associated fibroblasts within the tumor stroma can suppress immune surveillance by dysregulating factors involved in the cellular activity of NK cells. Herein, the effect of activated pancreatic stellate cells (aPSCs) on NK cell-mediated anticancer efficacy under three-dimensional (3D) coculture conditions was investigated. METHODS: 3D cocultures of PANC-1 tumor spheroids (TSs) with aPSCs and NK-92 cells in a collagen matrix were optimized to identify the occurring cellular interactions and differential cytokine profiles in conditioned media using microchannel chips. PANC-1 TSs and aPSCs were indirectly cocultured, whereas NK-92 cells were allowed to infiltrate the TS channel using convective medium flow. RESULTS: Coculture with aPSCs promoted PANC-1 TSs growth and suppressed the antitumor cytotoxic effects of NK-92 cells. Mutual inhibition of cellular activity without compromising migration ability was observed between aPSCs and NK-92 cells. Moreover, the reduced killing activity of NK-92 cells was found to be related with reduced granzyme B expression in NK cells. CONCLUSIONS: Herein, a novel TIME-on-chip model based on the coculture of PANC-1 TSs, aPSCs, and NK-92 cells was described. This model may be useful for studying the detailed mechanisms underlying NK cells dysregulation and for exploring future therapeutic interventions to restore NK cell activity in the tumor microenvironment.

Family caregiver roles and challenges in assisting patients with cancer treatment decision-making: Analysis of data from a national survey.

BACKGROUND: We aimed to describe the roles and challenges of family caregivers involved in patients' cancer treatment decision-making. METHODS: Family caregiver-reported data were analyzed from a national survey conducted in the United States by CancerCare® (2/2021-7/2021). Four select-all-that-apply caregiver roles were explored: (1) observer (patient as primary decision-maker); (2) primary decision-maker; (3) shared decision-maker with patient and (4) decision delegated to healthcare team. Roles were compared across five treatment decisions: where to get treatment, the treatment plan, second opinions, beginning treatment and stopping treatment. Ten challenges faced by caregivers (e.g., information, cost, treatment understanding) were then examined. χ2 and regression analyses were used to assess associations between roles, decision areas, challenges and caregiver sociodemographics. RESULTS: Of 2703 caregiver respondents, 87.6% reported involvement in patient decisions about cancer treatment, including 1661 who responded to a subsection further detailing their roles and challenges with specific treatment decisions. Amongst these 1661 caregivers, 22.2% reported an observing role, 21.3% a primary decision-making role, 53.9% a shared decision-making role and 18.1% a role delegating decisions to the healthcare team. Most caregivers (60.4%) faced ≥1 challenge, the most frequent being not knowing how treatments would affect the patient's physical condition (24.8%) and quality of life (23.2%). In multivariable models, being Hispanic/Latino/a was the strongest predictor of facing at least one challenge (b = -0.581, Wald = 10.69, p < .01). CONCLUSIONS: Most caregivers were involved in patients' cancer treatment decisions. The major challenge was not understanding how treatments would impact patients' physical health and quality of life. Challenges may be more commonly faced by Hispanic/Latino/a caregivers. PATIENT OR PUBLIC CONTRIBUTION: The CancerCare® survey was developed in partnership with caregiving services and research experts to describe the role of cancer family caregivers in patient decision-making and assess their needs for support. All survey items were reviewed by a CancerCare advisory board that included five professional patient advocates and piloted by a CancerCare social worker and other staff who provide counselling to cancer caregivers.

G-Quadruplex-Filtered Selective Ion-to-Ion Current Amplification for Non-Invasive Ion Monitoring in Real Time.

Living cells efflux intracellular ions for maintaining cellular life, so intravital measurements of specific ion signals are of significant importance for studying cellular functions and pharmacokinetics. In this work, de novo synthesis of artificial K+ -selective membrane and its integration with polyelectrolyte hydrogel-based open-junction ionic diode (OJID) is demonstrated, achieving a real-time K+ -selective ion-to-ion current amplification in complex bioenvironments. By mimicking biological K+ channels and nerve impulse transmitters, in-line K+ -binding G-quartets are introduced across freestanding lipid bilayers by G-specific hexylation of monolithic G-quadruplex, and the pre-filtered K+ flow is directly converted to amplified ionic currents by the OJID with a fast response time at 100 ms intervals. By the synergistic combination of charge repulsion, sieving, and ion recognition, the synthetic membrane allows K+ transport exclusively without water leakage; it is 250× and 17× more permeable toward K+ than monovalent anion, Cl- , and polyatomic cation, N-methyl-d-glucamine+ , respectively. The molecular recognition-mediated ion channeling provides a 500% larger signal for K+ as compared to Li+ (0.6× smaller than K+ ) despite the same valence. Using the miniaturized device, non-invasive, direct, and real-time K+ efflux monitoring from living cell spheroids is achieved with minimal crosstalk, specifically in identifying osmotic shock-induced necrosis and drug-antidote dynamics.

Fatal outcome of severe fever with thrombocytopenia syndrome (SFTS) and severe and critical COVID-19 is associated with the hyperproduction of IL-10 and IL-6 and the low production of TGF-ß.

Severe fever with thrombocytopenia syndrome virus (SFTSV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause the hyperproduction of inflammatory cytokines, which have pathological effects in patient including severe or fatal cytokine storms. To characterize the effect of SFTSV and SARS-CoV-2 infection on the production of cytokines in severe fever with thrombocytopenia syndrome (SFTS) and COVID-19 patients, we performed an analysis of cytokines in SFTS and COVID-19 patients and also investigated the role of interleukin-10 (IL-10) in vitro studies: lipopolysaccharide-induced THP-1-derived macrophages, SFTSV infection of THP-1 cells, and SARS-CoV-2 infection of THP-1 cells. In this study, we found that levels of both IL-10 and IL-6 were significantly elevated, the level of transforming growth factor-ß (TGF-ß) was significantly decreased and IL-10 was elevated earlier than IL-6 in severe and critical COVID-19 and fatal SFTS patients, and inhibition of IL-10 signaling decreased the production of IL-6 and elevated that of TGF-ß. Therefore, the hyperproduction of IL-10 and IL-6 and the low production of TGF-ß have been linked to cytokine storm-induced mortality in fatal SFTS and severe and critically ill COVID-19 patients and that IL-10 can play an important role in the host immune response to severe and critical SARS-CoV-2 and fatal SFTSV infection.

Lived experiences of breast cancer in patients under the age of 40: A phenomenological study.

PURPOSE: The purpose of this study was to understand and describe the experiences of breast cancer in patients under age 40 years in South Korea. METHODS: Data were collected from December 2020 to January 2021 through individual in-depth semi-structured interviews with 10 patients aged <40 years less than one year after they had completed treatment for breast cancer. We performed a qualitative study using Colaizzi's phenomenological method. RESULTS: The six theme clusters for intrapersonal, interpersonal, and sociocultural categories were as follows: 1) physical pain, 2) psychological response and need, 3) positive relationships with family members, 4) non-familial support system, 5) age stereotypes of cancer, and 6) Confucian culture in Korea. CONCLUSIONS: The study provides insights into the specific issues and major concerns of young breast cancer patients from multiple perspectives. Based on the results, optimized support should be developed to relieve the physical, psychological, and social burden on young breast cancer patients. Specific information and communication training should be offered to oncology nurses to provide counseling in order to reduce patient anxiety and fear related to these issues. The study emphasizes the importance of positive relationships with family and the non-familial support system and suggests that nursing intervention can help support these relationships to prevent social isolation.