Work-related flow and its correlates among frontline nurses during the COVID-19 pandemic.

BACKGROUND: Ample evidence across non-healthcare fields highlights the role of work-related flow in enhancing resilience against work stress and work engagement. Understanding flow and its factors can support staff development and management. AIMS: This study aimed to investigate the level of work-related flow and its associated factors among frontline nurses during the COVID-19 pandemic. METHODS: A cross-sectional multicenter study included 336 nurses caring for COVID-19 patients between March and April 2022. Cluster random sampling was used to select 9 nurse groups from 29 Taiwanese hospitals specialized in COVID-19 care. A web survey link was shared on the selected nurses' social media. Hierarchical regression analyses examined predictor-outcome relationships, following the STROBE checklist for reporting findings. RESULTS: Among demographic characteristics, sex (ß = -0.11; p = 0.016) and living arrangement (ß = -0.12; p = 0.017) reached statistical significance in model 3. Social support from family, friends, and significant others, managerial position, and sufficiency of personal protective equipment showed significant associations with work-related flow (all ß > 0.12; p < 0.05). The variables included in the final model accounted for 35% of the variance in work-related flow for COVID-19 patient care tasks. CONCLUSIONS: Flow experience is influenced by factors associated with demographics, work conditions, and social support. Nurse administrators should consider these factors when evaluating nurses' flow at work. IMPLICATIONS FOR NURSING PRACTICE AND MANAGEMENT: Allocating care tasks to nurses based on their flow levels can be beneficial, particularly during healthcare crises. Ensuring a sufficient supply of personal protective equipment and offering social support to nurses are vital strategies for facilitating their flow experience in the workplace.

Hypermethylation Loci of ZNF671, IRF8, and OTX1 as Potential Urine-Based Predictive Biomarkers for Bladder Cancer.

Bladder cancer (BCa) is a significant health issue and poses a healthcare burden on patients, highlighting the importance of an effective detection method. Here, we developed a urine DNA methylation diagnostic panel for distinguishing between BCa and non-BCa. In the discovery stage, an analysis of the TCGA database was conducted to identify BCa-specific DNA hypermethylation markers. In the validation phase, DNA methylation levels of urine samples were measured with real-time quantitative methylation-specific PCR (qMSP). Comparative analysis of the methylation levels between BCa and non-BCa, along with the receiver operating characteristic (ROC) analyses with machine learning algorithms (logistic regression and decision tree methods) were conducted to develop practical diagnostic panels. The performance evaluation of the panel shows that the individual biomarkers of ZNF671, OTX1, and IRF8 achieved AUCs of 0.86, 0.82, and 0.81, respectively, while the combined yielded an AUC of 0.91. The diagnostic panel using the decision tree algorithm attained an accuracy, sensitivity, and specificity of 82.6%, 75.0%, and 90.9%, respectively. Our results show that the urine-based DNA methylation diagnostic panel provides a sensitive and specific method for detecting and stratifying BCa, showing promise as a standard test that could enhance the diagnosis and prognosis of BCa in clinical settings.

Experience in Professional Resilience for Nurses Caring for Patients with COVID-19: A Qualitative Descriptive Study.

PURPOSE: During the COVID-19 pandemic, nurses have faced many professional and ethical dilemmas and challenges along with bearing physical, mental, and emotional stress resulting from worrying about themselves or their family being infected and stigmatized. This stress can potentially lead to burnout and resignation. Professional resilience is crucial for nurses to cope with these adverse situations. This study aimed to investigate the process by which nurses adapt, change, and overcome challenges during the COVID-19 pandemic and ultimately demonstrate professional resilience. METHODS: Descriptive phenomenology was applied. Semi-structured interviews were conducted with 11 nurses working in COVID-19 wards and intensive care units to collect data. Giorgi's phenomenological analysis method was employed. RESULTS: Based on the interview responses, four major themes were identified: 1) balancing patient care, self-protection, and passing on experience; 2) providing timely pandemic team resources and social support; 3) nurses' perseverance amid social discourse and constrained lives; and 4) selfless dedication shaping nursing's pinnacle experiences. CONCLUSIONS: In the face of a sudden pandemic, frontline nurses play a critical role in maintaining medical capacity. Consequently, they must balance their families, lives, and work while adapting to the impact of the pandemic and changing practices and procedures based on the development of the pandemic and policy demands. The study findings provide insights into the challenges and emotional experiences encountered by nurses during a sudden pandemic outbreak and can serve as a reference for developing strategies to help nurses overcome these challenges and enhance their professional resilience.

Thermal ages of the Huatung Basin determined from seismic waveform modeling: insights into Southeast Asia's evolution.

The Huatung Basin (HB), situated on the leading part of the Philippine Sea Plate, is directly involved in oblique subduction and mountain building in the Taiwan region. However, previous studies have reported a wide range of ages for the HB, from 30 to 130 Ma, making it difficult to properly constrain regional tectonics. We analyzed teleseismic waveforms recorded on Taiwan that traveled through the slab associated with the HB. By waveform matching, we have constrained the slab dimensions to approximately 400 km in length and 150 km in width, accompanied by an enhanced P-wave velocity of 6% within the slab core and an apparent dip angle of 55°. We used age-dependent subduction zone thermal models to estimate the thermal ages or the ages since the last thermal event of the HB. The best-fit thermal model indicates thermal ages ranging from 20 to 50 Ma, which is consistent with a suite of geophysical observations and the age inferred from geomagnetic anomaly data. However, our results differ considerably from the ages obtained through radiometric dating of rocks dredged from the seafloor. The discrepancy in age may be attributed to either thermal rejuvenation of the plate or dating of allochthonous samples dredged from the border of the basin.

mHealth and eHealth Applications for a Medicalized Quarantine Hotel during the COVID-19 Pandemic.

BACKGROUND: In Taiwan, the number of confirmed cases of coronavirus disease 2019 (COVID-19) has risen significantly in May 2021. The second wave of the epidemic occurred in May 2022. mHealth (mobile health, social media communities) and eHealth (electronic health, Hospital Information System) can play an important role in this pandemic by minimizing the spread of the virus, leveraging health care providers' time, and alleviating the challenges of medical education. OBJECTIVES: This study aimed to describe the process of using mHealth and eHealth to build a medicalized quarantine hotel (MQH) and understand the physical and mental impact of COVID-19 on patients admitted to the MQH. METHODS: In this retrospective observational study, data from 357 patients who stayed at the MQH were collected and their psychological symptoms were assessed using an online Brief Symptom Rating Scale (BSRS). Descriptive statistics, independent sample t-test, univariate analysis of variance, and multiple linear regression analysis were performed. RESULTS: The patients' mean age was 35.5 ± 17.6 years, and 52.1% (n = 186) of them were males. Altogether, 25.2% (n = 90) of the patients had virtual visits. The average duration of the hotel stay was 6.8 ± 1.4 days, and five patients (0.01%) were transferred to the hospital. The three most common symptoms reported were cough (39%), followed by the sore throat (22.8%), and stuffy/runny nose (18.9%). Most patients achieved a total BSRS score of 0 to 5 points (3,569/91.0%), with trouble falling asleep (0.65 ± 0.65), feeling tense or high-strung (0.31 ± 0.66), and feeling down or depressed (0.27 ± 0.62) scoring highest. The BSRS score was the highest on the first day. The sex of the patients was significantly related to the BSRS score (p < 0.001). CONCLUSION: mHealth and eHealth can be used to further monitor an individual's physiological and psychological states. Early intervention measures are needed to improve health care quality.

Mitochondrial Dysfunction and Oxidative Stress in Aging and Disease.

Mitochondria are considered to have a significant influence on aging due to their critical role in the regulation of bioenergetics, oxidative stress, and cell death [...].

Applying the Technology Acceptance Model to Explore Nursing Students' Behavioral Intention to Use Nursing Information Smartphones in a Clinical Setting.

The integration of mobile devices and nursing information systems has become a trend in modern clinical practice with various information and communication technologies available. Smartphones are gradually replacing notebooks in clinical practice as a medium for nursing information systems. Clinical nursing practicums are a necessary means for nursing students to foster their professional competence. In addition to professional skills, nursing students must also learn to apply information technologies in clinical settings. This study aimed to understand nursing students' behavioral intention toward nursing information smartphones and to further identify the factors influencing nursing students' behavioral intentions based on the technology acceptance model. A cross-sectional research design was used in this study. Eighty nursing students were recruited from a regional teaching hospital in Central Taiwan. The findings demonstrated that subjects' perceived ease of use and perceived usefulness of nursing information smartphones, as well as their attitude toward using and behavioral intention to use the smartphones, were positive, and they provided constructive feedback and suggestions to improve nursing information systems in hospitals. The findings can serve as a reference for hospitals and clinical training institutions seeking to integrate nursing information systems in clinical nursing education.

Integrative Multiomics Evaluation of IIDH1 Metabolic Enzyme as a Candidate Oncogene That is Correlated with Poor Prognosis and Immune Infiltration in Prostate Adenocarcinoma.

Mutations in the isocitrate dehydrogenase gene (IDH1) are involved in the progression of tumors. Although IDH1 has a role in various tumors, its clinical relevance and its expression in response to the immune response have not been investigated in prostate adenocarcinoma (PRAD). In the present study, we investigated the utility of IDH1 as a prognostic biomarker for PRAD by analyzing IDH1 mRNA expression and its association with patient survival and immune cell infiltration. IDH1 mRNA expression was significantly higher in PRAD tissue than in normal tissue, and Kaplan-Meier survival analysis showed that IDH1 expression was significantly associated with poor prognosis in PRAD patients. To elucidate the mechanisms involved, the correlation between IDH1 expression and the level of immune cell infiltration, in particular of immunosuppressive cells such as CD8+ T-cells, CD4+ T-cells, and macrophages, was further analyzed by single-cell RNA sequencing. We also screened a pharmacogenetic database for IDH1-specific drugs that inhibited high expression in PRAD. In the present study, we used a combination of databases to identify a significant correlation between IDH1 expression and cellular infiltration and to explain the mechanism by which IDH1 confers poor prognosis in PRAD, thus demonstrating the relevance of IDH1 expression as a prognostic biomarker with clinical utility in PRAD patients.

Molecular Machinery and Pathophysiology of Mitochondrial Dynamics.

Mitochondria are double-membraned organelles that exhibit fluidity. They are the main site of cellular aerobic respiration, providing energy for cell proliferation, migration, and survival; hence, they are called "powerhouses." Mitochondria play an important role in biological processes such as cell death, cell senescence, autophagy, lipid synthesis, calcium homeostasis, and iron balance. Fission and fusion are active processes that require many specialized proteins, including mechanical enzymes that physically alter mitochondrial membranes, and interface proteins that regulate the interaction of these mechanical proteins with organelles. This review discusses the molecular mechanisms of mitochondrial fusion, fission, and physiopathology, emphasizing the biological significance of mitochondrial morphology and dynamics. In particular, the regulatory mechanisms of mitochondria-related genes and proteins in animal cells are discussed, as well as research trends in mitochondrial dynamics, providing a theoretical reference for future mitochondrial research.

The effectiveness of simulation education program on shared decision-making attitudes among nurses in Taiwan.

BACKGROUND: Shared decision-making (SDM) is significantly associated with promoting the quality of end-of-life (EOL). The attitude of nurses toward the end of life can affect EOL care, but there are few SDM-related clinical learning programs focused on EOL. In this study, therefore, we evaluated the effectiveness of an EOL-simulation education program on attitudes toward SDM among nurses, using an objective structured clinical examination (OSCE). METHODS: We used a quasi-experimental study design to evaluate nurses working at a medical center in Taiwan. We recruited 100 nurses and assigned them to an experimental group (n = 50) and a control group (n = 50). The experimental group received the SDM attitude (SDMA) cultivation program, and the control group did not. After the intervention, all participants were examined in an OSCE to assess the efficacy of their learning. A p value of.05 was considered statistically significant. RESULTS: The average score of the experimental group was higher than that of the control group in the dimensions "empathic communication" and "mastery learning", but these differences were not significant. SDMA score is significantly and positively correlated with SDMA global score, standardized patient survey (SPS) score, and SPS global score (r = .92, .56, and .50, respectively; p < .01). CONCLUSIONS: Simulations concerning EOL care that incorporate SDM components would be effective for training clinical nurses. This study can serve as a reference for nursing-administration managers who may consider designing SDM-related education programs to improve the quality of clinical nursing care.

Development and testing of the shared decision-making attitudes scale among nurses in Taiwan: a cross-sectional scale development study.

OBJECTIVE: Shared decision-making (SDM) enhances medical care, but an appropriate tool for evaluating nursing staff's attitudes towards SDM in clinical practice is lacking. The objective of this study is to develop the Nursing Shared Decision-Making Attitude (NSDMA) scale and verify its psychometric properties. DESIGN: Instrument design study. PARTICIPANTS: A sample of 451 nursing staff. INTERVENTION: This study comprised two phases. In phase 1, qualitative research and expert content validity were adopted to develop the first draft of the scale. In phase 2, Taiwanese nursing staff were recruited through convenience sampling, and the sample was divided into a calibration sample and a validation sample. An objective structured clinical examination of SDM attitudes was administered to 100 nursing staff to determine the scale's cut-off score. MAIN OUTCOME MEASUREMENTS: Exploratory factor analysis and confirmatory factor analysis were used to obtain the underlying factors of the NSDMA scale; McDonald's omega value was used to determine the reliability; known-group validity was used to test the construct validity; and the receiver operating characteristic curve was adopted to determine the scale's cut-off score. RESULTS: In total, two factors were identified from the instrument results, which were termed 'empathic communication' and 'mastery learning'. The McDonald's omega value of the overall scale was 0.92. Known-group validity testing was performed based on the staff's participation in SDM courses and experience of SDM, and the results exhibited significant differences (t=5.49, p<0.001; t=2.43, p<0.05). Based on the receiver operating characteristic curve, the optimal cut-off for SDM attitudes was determined as 48.5 points. CONCLUSIONS: The NSDMA scale enables the evaluation of SDM attitudes among clinical nursing staff and nursing managers; the results may serve as a reference for incorporation of SDM into nursing policy formulation.

Nurses' knowledge, attitude, and competence regarding palliative and end-of-life care: a path analysis.

BACKGROUND: Nurses' knowledge regarding palliative and end-of-life (EOL) care has been documented, but the competence of nurses in Taiwan has not been deeply analyzed and may affect the use of EOL care. PURPOSE: We aimed to (1) assess the palliative care knowledge, competence and attitude of nurses in a general hospital and (2) examine the paths connecting nurses' demographic characteristics, previous experiences, knowledge, competence, and attitude. METHOD: A correlational, cross-sectional survey design was implemented to recruit 682 eligible nurses. The questionnaires included demographic information and palliative and EOL care knowledge, attitude, and competence scales. Path analysis was employed for statistical analysis using structural equation modeling. RESULTS: Overall, 76% of the questions assessing palliative and hospice knowledge were answered correctly. Nurses' palliative attitudes were divided into "positive perception" and "negative perception". "Positive perception" was highly correlated with competence (r = 0.48, p < 0.001), but "negative perception" was not significantly correlated with competence (r = -0.07, p = 0.25). "Positive perception" (ß =  -0.01, p = 0.84) and competence (ß =  0.02, p = 0.80) were not related to palliative knowledge. "Negative perception", however, was negatively associated with palliative knowledge (ß =  -0.20, p < 0.01). CONCLUSIONS: This study suggests continuing education to decrease nurses' "negative perception" attitude regarding the provision of information to patients and families to provide better palliative and EOL care. IMPLICATIONS FOR PRACTICE: Nurses' attitudes and competences with respect to palliative care and EOL care are critical. Areas for further research and advanced palliative and EOL care-related education and training are suggested and may be applied in future clinical interventions.

Shared clinical decision-making experiences in nursing: a qualitative study.

BACKGROUND: Shared decision making (SDM) is a patient-centered nursing concept that emphasizes the autonomy of patients. SDM is a co-operative process that involves information exchange and communication between medical staff and patients for making treatment decisions. In this study, we explored the experiences of clinical nursing staff participating in SDM. METHODS: This study adopted a qualitative research design. Semistructured interviews were conducted with 21 nurses at a medical center in northern Taiwan. All interview recordings were transcribed verbatim. Content analysis was performed to analyze the data. RESULTS: The findings yielded the following three themes covering seven categories: knowledge regarding SDM, trigger discussion and coordination, and respect of sociocultural factors. CONCLUSIONS: The results of this study describe the experiences of clinical nursing staff participating in SDM and can be used as a reference for nursing education and nursing administrative supervisors wishing to plan and enhance professional nursing SDM in nursing education.

The Association Between Traditional Chinese Medicine Body Constitution Deviation and Essential Hypertension: A Case-Control Study.

BACKGROUND: The prevention and treatment of hypertension is valued globally. The World Health Organization advocates combining traditional medicines in the prevention and treatment of diseases. Traditional Chinese medicine (TCM) assumes that diseases originate from the attenuation of one's body constitution. A few studies have found that hypertension is correlated with TCM body constitution. However, body constitution is also affected by living environment. Therefore, investigating the correlation between deviations in body constitution and essential hypertension in different living environments is necessary to provide the basis for using TCM in combination with conventional Western medicine to prevent and treat hypertension. PURPOSE: The aim of this study was to explore the association between TCM body constitution deviation and essential hypertension. METHODS: A case-control study was designed. Participants were selected from the outpatient clinics and neighboring communities of a regional teaching hospital in southern Taiwan. The study included 210 hypertension and 210 nonhypertension cases. Blood pressures were measured using an electronic sphygmomanometer to confirm the presence or absence of hypertension. The TCM Body Constitution Questionnaire, demographic datasheet, and hypertension-related factors questionnaire were used to collect data. RESULTS: A higher proportion of patients with body constitution deviation were found in the hypertension group than the nonhypertension group. The proportions of patients with Yin-Xu, Yang-Xu, and stasis constitution were 44.8%, 32.4%, and 30.6%, respectively, in the hypertension group and 28.6%, 25.2%, and 19.6%, respectively, in the nonhypertension group. After performing univariate analysis, the results showed significant differences between the two groups in terms of average body mass index; emotional traits of anger, worry, and fear; hyperlipidemia; hyperuricemia; Yin-Xu constitution; and stasis constitution. However, the multivariate analysis revealed having a Yin-Xu constitution to be a risk factor of essential hypertension after adjusting for age, gender, body mass index, emotional traits, drinking habit, hyperlipidemia, and hyperuricemia. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results suggest that Yin-Xu and stasis constitutions are respectively associated with essential hypertension. The findings offer a valuable reference to governments and healthcare professionals to prevent the risk of essential hypertension. Screening and healthcare measures for TCM Yin-Xu or stasis constitution may be included in related prevention plans to minimize public exposure to the risk factors of essential hypertension.

Objective structural clinical examination for evaluating learning efficacy of Cultural Competence Cultivation Programme for nurses.

BACKGROUND: Culture serves as an adhesive to bind the lives of people. There are no objective, useful tools to assess cultural competence and practice. In this study, we evaluated whether the cultural competence of nurses was strengthened through the Cultural Competence Cultivation Programme. METHODS: A quasi-experimental research design was used to evaluate nurses working at a medical centre in Taiwan. They were randomly allocated into an experimental group (n = 47), which received the Cultural Competence Cultivation Programme, or a control group (n = 50), which did not receive the educational programme. After the intervention, learning efficacy of the participants was assessed using an Objective Structured Clinical Examination (OSCE). The research data were statistically analysed on SPSS. RESULTS: The average score of the experimental group was significantly higher in the 'communication ability and skill' category. Furthermore, OSCE scores and Standardised Patient Survey assessment and total scores were significantly and positively correlated. CONCLUSION: The findings of this study can serve as a reference for designing future clinical education programmes.

Exploring the factors affecting musculoskeletal disorders risk among hospital nurses.

BACKGROUND: Musculoskeletal disorder (MSD) is currently recognized as one of the most common occupational injuries for which nursing personnel in the medical service industry have been identified as a high-risk group. In this study, we explore the prevalence of MSD in various body parts as well as their risk factors among hospital nurses. METHODS: A cross-sectional descriptive design with stratified cluster sampling was used to collect data from 1,803 nurses. The survey included a demographic questionnaire, and Nordic Musculoskeletal Questionnaire. RESULTS: The results showed that the greatest prevalence of MSD symptoms by body regions were in the right shoulder (85.8%), the left shoulder (80.9%), the neck (62.4%), the right wrist (62.2%) and the lower back (60.4%). Risk factors for shoulder discomfort includes department type, exercise habits, and age (p < .05). Risk factors for neck discomfort includes seniority in the current unit, "job title, and "history of MDS (p < .05). Risk factors for upper back discomfort includes age and seniority in the current unit (p < .05). Risk factors for lower back discomfort including seniority in the current unit, department type, and number of days worked per week (p < .05). CONCLUSIONS: The results of this study can serve as a reference for nursing administration managers and decision-makers for reducing musculoskeletal discomfort among nurses and thereby achieving superior quality in clinical care.

Inhibiting casein kinase 2 overcomes paclitaxel resistance in gastric cancer.

PURPOSE: Casein kinase (CK) 2 activation has been implicated in the proliferation of various tumor types and resistance to chemotherapy. We investigated the mechanistic basis for the association between CK2 activation and paclitaxel resistance in a gastric cancer (GC). EXPERIMENTAL DESIGN: CK2 expression was evaluated in 59 advanced GC patients treated with paclitaxel as the second-line therapy. The efficacy of a CK2 inhibitor, CX-4945, and paclitaxel was evaluated in GC cell lines and a xenograft model. RESULTS: Patients with high CK2 expression (29/59, 39%) showed lower disease control rates (47.7% vs. 72.3%, p = 0.017) and shorter progression-free survival (2.8 vs. 4.8 months, p = 0.009) than patients with low CK2 expression. CK2 protein expression was associated with sensitivity to paclitaxel in 49 GC cell lines. Combination therapy with CX-4945 and paclitaxel exerted synergistic antiproliferative effects and inhibited the downregulation of phosphatidylinositol 3-kinase/AKT signaling in SNU-1 cells. In the SNU-1 xenograft model, the combination treatment was significantly superior to either single agent, suppressing tumor growth without notable toxicities. CONCLUSIONS: These results demonstrated that CK2 activation was related to paclitaxel resistance and that CX-4945 in combination with paclitaxel could be used as a potential treatment for paclitaxel resistance in GC.

Casein Kinase 2 Inhibitor, CX-4945, as a Potential Targeted Anticancer Agent in Gastric Cancer.

BACKGROUND/AIM: Casein kinase 2 (CK2) is involved in multiple cellular processes. Furthermore, its overexpression in several human cancers has been associated with tumor progression. In this study, we evaluated the efficacy of the CK2 inhibitor, CX-4945, in gastric cancer cell lines and explored the potential predictive biomarkers for CX-4945 sensitivity. MATERIALS AND METHODS: The sensitivity to CX-4945 was screened in 49 gastric cancer cell lines by the MTT assay. The mRNA and protein expression of CK2 subunits (α and α') were determined using qRT-PCR and western blot. Furthermore, the activity of CK2α was measured by ELISA. Gene expression and mutations were analyzed via whole-exome and RNA sequencing. RESULTS: The sensitivity to CX-4945 was determined by the inhibition rate (%) at the effective dose (10 µM) which ranged from -1% to 89% in 49 gastric cancer cell lines. CK2α', but not CK2α, mRNA expression was correlated with CX-4945 sensitivity. CONCLUSION: In this study, CX-4945 showed modest antitumor efficacy in gastric cancer cell lines. CK2 might represent a potential therapeutic target for gastric cancer.

Characterization of the hepatitis B virus DNA detected in urine of chronic hepatitis B patients.

BACKGROUND: Detection of human hepatitis B virus (HBV) DNA in the urine of patients with chronic hepatitis B infection (CHB) has been reported previously, suggesting urine could provide a potential route of horizontal HBV transmission. However, it is not clear whether the HBV DNA detected in urine is indeed full-length, infectious viral DNA. The aim of this study is to assess the potential infectivity of urine from patients with CHB and to correlate HBV DNA detection in urine with clinical parameters, such as serum viral load and HBeAg status. METHODS: Urine from 60 CHB patients with serum viral loads ranging from undetectable to 108 IU/mL were analyzed for HBV DNA and serum immune markers. HBV DNA was detected from total urine DNA and size-fractionated urine DNA (separated into ≤1 kb and > 1 kb fractions) by PCR analysis of six regions of the HBV genome. RESULTS: Twenty-seven of 59 (45.7%) patients with HBV serum viral load (≥20 IU/mL) contained at least 20 copies per mL of fragmented HBV DNA in urine detected in at least 1 of the 6 PCR assay regions. Only one patient contained HBV DNA detected by all six regions, and was found to have evidence of blood in the urine. Sixteen of 25 urine samples with high viral load (> 105 IU/mL) and 11 of 34 urine samples with low viral load (< 105 IU/mL) contained detectable HBV DNA. Twelve of 27 (44.44%) patients with detectable HBV DNA in urine were HBeAg positive, and only 5 of these HBeAg positive patients were in the group of 33 (15.15%) patients with no detectable HBV DNA in urine. By Fishers' exact test, HBV DNA in urine is significantly associated with high serum viral load (P = 0.0197) and HBeAg (P = 0.0203). CONCLUSIONS: We conclude that urine from CHB patients with healthy kidney function should not contain full-length HBV DNA, and therefore should not be infectious.

Glycyrrhizic acid induces human MDA-MB-231 breast cancer cell death and autophagy via the ROS-mitochondrial pathway.

Glycyrrhizic acid (GA), the main component of licorice root extracts, has been shown to suppress cell proliferation and induce apoptosis in various types of cancers. However, the molecular mechanism of its anticancer activity remains poorly understood and warrants further investigation. MDA-MB­231 cells were treated with various concentrations of GA and the cytotoxic effects of GA were determined using the CCK-8 assay. Apoptosis and cell cycle status were detected by flow cytometry. Reactive oxygen species (ROS) levels and mitochondrial membrane potential (∆Ψm) were assessed using DCFDA, MitoSOX and JC-1 staining. Western blot analysis was used to quantify the expression of autophagy-related proteins. In the present study, induction of autophagic cell death was observed in GA-treated MDA-MB­231 cells. Downregulation of p62- and beclin 1-associated proteins occurred after GA treatment, and, the conversion of LC3 and increased ROS without significant changes in caspase­associated proteins and intracellular responses were detected. Furthermore, loss of mitochondria and its membrane potential in cells demonstrated that mitochondria were involved in the GA-regulated MDA-MB-231 cell death. The addition of a pan-caspase inhibitor (z-VAD-fmk) did not suppress the GA-induced apoptotic effect, and GA-induced apoptosis was not accompanied by processing of procaspase-8, -9 and -3. However, GA triggered the translocation of the apoptosis-inducing factor (AIF) from the mitochondria into the nucleus. In contrast, GA-induced LC3 conversion was significantly inhibited by 3 methlyadenine (3MA), an inhibitor of PI3K­regulated autophagy. Therefore, these results suggest that enhancement of both AIF- and LC3-dependent GA-derived ROS generation plays an important role in the inhibition of the growth of MDA-MB-231 human breast cancer cells.