Mediating Effect of White Blood Cells and Tobacco Exposure on Cervical Neoplasm Risk Among Taiwanese Women.

Background: Both the high-risk human papillomavirus (HR-HPV) infection and tobacco exposure are significantly associated with cervical neoplasm risk. Immune cells play important roles in carcinogenesis. However, it is still unclear whether immune cells have a mediating effect on the HR-HPV infection and tobacco exposure with cervical neoplasm development. Aim: The aim of this study was to determine how the increased white blood cell (WBC) count affects the relationship between HR-HPV DNA load and tobacco exposure in the development of cervical neoplasia. Methods: A hospital-based case-control study design was conducted with a total of 108 cases of Taiwanese women with ≥ cervical intraepithelial neoplasia (CIN) I confirmed by biopsy, and 222 healthy Taiwanese female subjects with negative findings on a Pap smear were assigned to the control group. The study evaluated HR-HPV status and immune cell counts (WBCs, natural killer (NK) cells) and tobacco exposure by a self-construct questionnaire. Results: Both HR-HPV DNA load and tobacco exposure significantly independently increased cervical neoplasm risk (AORs: 1.28 and 1.42, respectively). Similar significant results were found for WBCs and NK cells, with respective AORs of 1.20 and 1.00. Moreover, increased WBCs (ß = 0.04, 95% CI corrected: 0.01-0.07) and tobacco exposure (ß = 0.02, 95% CI corrected: 0.01-0.04) mediated the relationship between the high-risk HPV DNA load and cervical neoplasm risk. Conclusions: Elevated WBC count acts as both predictor and mediator in cervical neoplasm development linked to HR-HPV DNA load. Monitoring and maintaining WBC levels within the normal range could be a preventive strategy for cervical neoplasm development.

Registered nurses' perceptions and experience of working in aged care: A qualitative approach.

AIM: To understand and report on the perceptions and experiences of registered nurses in the aged care sector. DESIGN: An exploratory qualitative study. METHODS: Semi-structured telephone interviews were utilised as the primary data collection method. Fifteen registered nurses were interviewed. All interviews were recorded, transcribed verbatim and analysed using conventional content analysis. Participants were quoted verbatim to ensure authenticity. RESULTS: The results indicated a demand for increased administrative and staffing support in the aged care workplace. Poor morale and unethical practices contributed to negative perceptions and attitudes among nurses towards aged care. Managing and communicating with older people was reported as challenging, which impacts nursing staff recruitment and retention. Future work is needed to ensure that outstanding clinical role models and leadership support nursing staff recruitment and retention. Incorporating aged care content into the nursing curriculum and providing professional development opportunities to aged care professionals would be the foundation towards solutions, as the study primarily explored nurses' perspectives.

Developing an ontology of non-pharmacological treatment for emotional and mood disturbances in dementia.

Emotional and mood disturbances are common in people with dementia. Non-pharmacological interventions are beneficial for managing these disturbances. However, effectively applying these interventions, particularly in the person-centred approach, is a complex and knowledge-intensive task. Healthcare professionals need the assistance of tools to obtain all relevant information that is often buried in a vast amount of clinical data to form a holistic understanding of the person for successfully applying non-pharmacological interventions. A machine-readable knowledge model, e.g., ontology, can codify the research evidence to underpin these tools. For the first time, this study aims to develop an ontology entitled Dementia-Related Emotional And Mood Disturbance Non-Pharmacological Treatment Ontology (DREAMDNPTO). DREAMDNPTO consists of 1258 unique classes (concepts) and 70 object properties that represent relationships between these classes. It meets the requirements and quality standards for biomedical ontology. As DREAMDNPTO provides a computerisable semantic representation of knowledge specific to non-pharmacological treatment for emotional and mood disturbances in dementia, it will facilitate the application of machine learning to this particular and important health domain of emotional and mood disturbance management for people with dementia.

Measuring the effects of a nurse-led intervention on frailty status of older people living in the community in Ethiopia: A protocol for a quasi-experimental study.

BACKGROUND: The recent recognition of the multidimensional features of frailty has emphasised the need for individualised multicomponent interventions. In the context of sub-Saharan Africa, few studies have examined: a) the frailty status of the older population; b) the level of frailty and its health implications and; c) the impact of a nurse-led intervention to reduce frailty. OBJECTIVES: This study aims to design, implement, and evaluate a nurse-led intervention to reduce frailty and associated health consequences among older people living in Ethiopia. METHODS: The study will be conducted on 68 older persons using a pre-, post-, and follow-up single-group quasi-experimental design. Residents of Ethiopia, ≥60 years and living in the community will be invited to participate in a 24-week program designed to decrease frailty and associated health consequences. Data will be collected at three-time points: baseline, immediately after the intervention, and 12 weeks post-intervention. To determine the effect of the intervention, changes in frailty, nutritional status, activities of daily living, depression and quality of life scores will be measured. To measure the effect of a nurse-led intervention on the level of frailty among older people a generalised linear model (GLM) using repeated measures ANOVA will be used. Statistical significances will be set at p-values < 0.05. DISCUSSION: The results of this study will determine the impact of a nurse-led intervention to reduce frailty amongst community-dwelling older people living in Ethiopia. The results of this study will inform the development of future interventions designed to reduce frailty in lower-income countries. TRIAL REGISTRATION: The trial was registered in ClinicalTrials.gov with the identifier of NCT05754398.

Machine Learning Model to Extract Malnutrition Data from Nursing Notes.

Malnutrition is a severe health problem that is prevalent in older people residing in residential aged care facilities. Recent advancements in machine learning have made it possible to extract key insight from electronic health records. To date, few researchers applied these techniques to classify nursing notes automatically. Therefore, we propose a model based on ClinicalBioBert to identify malnutrition notes. We evaluated our approach with two mainstream approaches. Our approach had the highest F1-score of 0.90.

Effects of simulation-based education module on delirium care in undergraduate nursing students: A quasi-experimental study.

AIM: To examine the effects of a delirium education module on undergraduate nursing students' knowledge of and perceived confidence and competence in delirium care. BACKGROUND: Delirium is common in intensive care units (ICUs) and leads to poor clinical outcomes. The under recognition of delirium is a major problem in ICU medicine. Nurses, as first-line health care providers, can address this by recognizing patients who are experiencing delirium. Since undergraduate nursing students will be the future ICU nurses, it is important to deliver the knowledge regarding delirium care. However, education about assessing delirium in ICUs among undergraduate nursing students is lacking. DESIGN: Quasi-experimental study. METHODS: A total of 74 undergraduate students were divided into an intervention group (n=34) and a comparison group (n=40). A 2-hour simulation-based delirium education module integrated into a critical care curriculum was delivered to the intervention group only. The classroom-based intervention was administered at a medical university in northern Taiwan. Study outcomes were measured using a structured survey including (1) a 16-item delirium care knowledge quiz, (2) confidence in delirium care scale and (3) competence in delirium care scale. The survey was distributed to students before and after the module in December 2020. The Mann-Whitney U test, chi-square test and Fisher's exact test were adopted to test the differences of all variables between groups. A generalized estimating equation model was used to investigate the adjusted treatment effects. RESULTS: The participants had a median age of 22 years and 81% were female. The delirium education module yielded greater knowledge (B = 3.04, 95% confidence interval = 2.20-3.88), confidence (B = 4.20, 95% confidence interval = 2.67-5.73) and competence (B = 4.82, 95% confidence interval = 3.33-6.30) in delirium care when the treatment and control groups were compared. CONCLUSIONS: For undergraduate nursing students, simulation-based education module is effective in improving the knowledge of and confidence and competence in delirium care. It is recommended that this be included in critical care nursing curricula.

Innovative technology for evaluation of sperm DNA double-strand breaks diagnoses male factor infertility and prevents reproductive failures.

Neutral comet assay has been available for two decades to evaluate sperm double-strand breaks (DSBs). However, its clinical usability is limited due to its complex and time-consuming procedure, as well as the lack of a standardized scoring system. The aim of this study was to: develop a rapid diagnostic method for DSBs, Sperm DNA Fragmentation Releasing Assay (SDFR), and explore the association between DSBs and reproductive outcomes. We pioneered the use of polyacrylamide (PA) for embedding sperm chromatin and optimized the porosity of PA to be between 10 and 13%. The refined PA network allowed the trapping of DSBs, which dispersed halo on an immunological slide; in contrast, intact chromatin failed to develop a halo. A strong correlation was showed between reproducible values obtained from SDFR and neutral comet assay. SDFR were responsive to dose-/time-dependent simulated DSBs, indicating high sensitivity and specificity. Furthermore, we conducted a retrospective study of couples with embryonic aneuploidy screening, and recording DSB profiles of the male partners. Our findings revealed that DSB enabled to predict embryonic aneuploidy whereas basic semen parameters did not. In conclusion, SDFR offers a rapid and user-friendly approach for evaluating DSBs, with potential implications for predictive healthcare in reproductive medicine.

The effectiveness of nurse-led interventions to manage frailty in community-dwelling older people: a systematic review.

BACKGROUND: The global increase in the number of frail older people and the accompanying increase in chronic conditions underline the need to develop effective health promotion and preventive interventions for these population groups. Wide ranging of physical, psychological, and social health factors influence frailty in older people and leads to increased vulnerability to many adverse outcomes. To reverse or reduce the progression of frailty, nurses play a pivotal role in delivering health promotion and preventive interventions. The purpose of the review is to determine the effectiveness of nurse-led interventions in reducing frailty in community-dwelling older people. METHODS: The following electronic databases: PubMed, MEDLINE, Web of Science, SCOPUS, CINAHL, PsychInfo, and WHO Global Index Medicus were searched until June 2022. Nurse-led, "nurse led", education, training, intervention, program, teaching, frail*, fragile*, "frailty syndrome", debility, infirmity, elder*, aged*, old*, geriatric, "community based settings", "community-based", "community setting", community were the search terms. Before data extraction, eligible articles were assessed for their methodological quality. The JBI critical appraisal checklist for reporting experimental studies was utilised to appraise the methodological quality of the studies. Data were systematically examined using a narrative review to determine the effectiveness of the intervention. RESULTS: Of the 156 studies identified, from the search, six studies with samples ranging from 40 to 1387 older people were eligible for inclusion in the review. Two quasi-experimental studies and one Randomised Controlled Trial (RCT) showed a moderate risk of bias. The Nurse-led frailty interventions used a multi-component intervention approach across the studies. The interventions reversed frailty progression, improve physical functioning, nutritional status, and quality of life, enhance perceptions of social support, improve mental health, and reduce depression. CONCLUSIONS: Few studies have explored the effectiveness of a nurse-led intervention to decrease frailty in older people. Evaluating physical functioning, nutritional status, mental health, and quality of life in community-dwelling frail older people can contribute to developing appropriate interventions. SYSTEMATIC REVIEW REGISTRATION: PROSPERO ID of CRD42022348064.

Delirium assessment tools among hospitalized older adults: A systematic review and metaanalysis of diagnostic accuracy.

Delirium is a common neuropsychiatric syndrome that is often overlooked in clinical settings. The most accurate instrument for screening delirium has not been established. This study aimed to compare the diagnostic accuracy of the 4 'A's Test (4AT), Nursing Delirium Screening Scale (Nu-DESC), and Confusion Assessment Method (CAM) in detecting delirium among older adults in clinical settings. These assessment tools feature concise item sets and straightforward administration procedures. Five electronic databases were systematically searched from their inception to September 7, 2022. Studies evaluating the sensitivity and specificity of the 4AT, Nu-DESC, and CAM against the Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases as the reference standard were included. Bivariate random effects model was used to summarize the sensitivity and specificity results. A total of 38 studies involving 7378 patients were included. The 4AT, Nu-DESC, and CAM had comparable sensitivity in detecting delirium (0.76, 0.78, and 0.80, respectively). However, the specificity of the CAM was higher than that of the 4AT (0.98 vs 0.89, P = .01) and Nu-DESC 0.99 vs 0.90, P = .003). Diagnostic accuracy was moderated by the percentage of women, acute care setting, sample size, and assessors. The three tools exhibit comparable sensitivity, and the CAM has the highest specificity. Based on the feasibility of the tools, nurses and clinical staffs could employ the Nu-DESC and the 4AT on screening out positive delirium cases and integrate these tools into daily practice. Further investigations are warranted to verify our findings.

Cross-Cultural Adaptation, Validity, and Reliability Testing of the Tilburg Frailty Indicator (TFI) Amharic Version for Screening Frailty in Community-Dwelling Ethiopian Older People.

Background: Frailty is a global health problem, including in African countries. Despite this, no reliable or valid frailty instruments incorporate any African language, and no research exists to cross-culturally adapt and test the validity and reliability of instruments commonly used in other countries for use within African countries. The Tilburg Frailty Indicator (TFI) is a reliable and validated instrument with the potential to be relevant for older populations living in Africa. This study aimed to develop the TFI Amharic (TFI-AM) version for use within Ethiopia. Methods: This study employed psychometric testing and the evaluation of a translated and adapted instrument. The original English language version of the TFI was translated and culturally adapted into Amharic using the World Health Organization process of translation and adaptation of an instrument. A convenience sample of ninety-six community-dwelling older people 60 years and over was recruited. Cronbach's alpha was used for the analysis of the internal consistency of the TFI Amharic (TFI-AM) version using IBM SPSS 26.0 (IBM Corp., Armonk, NY, USA). Face and content validities of the TFI-AM were determined. Results: The TFI-AM total mean score was 5.76 (±2.89). The internal consistency of the TFI-AM was very good with an overall Cronbach alpha value of 0.82. The physical domain showed the highest reliability with a 0.75 Cronbach's alpha value while the social domain was the lowest with a 0.68 Cronbach's alpha value. The Cronbach's alpha reliability coefficients of the instrument ranged from 0.68 to 0.75. The item content validity index value ranged from 0.83 to 1.0 and the total content validity index average for the instrument was 0.91. Conclusion: The TFI-AM is reliable, valid, and reproducible for the assessment of frailty among community-dwelling older populations in Ethiopia. TFI-AM proved an easy-to-administer, applicable and fast instrument for assessing frailty in community-dwelling older populations.

Live motile sperm sorting device for enhanced sperm-fertilization competency: comparative analysis with density-gradient centrifugation and microfluidic sperm sorting.

PURPOSE: A live motile sperm sorting device (LensHooke® CA0) developed to prevent the deleterious effects of centrifugation was evaluated comparatively with conventional density-gradient centrifugation (DGC) and microfluidic-based device (Zymot) in sperm selection. METHODS: Semen samples from 239 men were collected. CA0 under different incubation intervals (5, 10, 30, and 60 min) and temperatures (20, 25, and 37℃) was conducted. The sperm quality in CA0-, DGC-, and Zymot-processed samples was then comparatively evaluated. Semen parameters included concentration, motility, morphology, motion kinematics, DNA fragmentation index (DFI), and the rate of acrosome-reacted sperm (AR). RESULTS: Total motility and motile sperm concentration increased in a time- and temperature-dependent manner and the total motility peaked for 30 min at 37℃. In paired analysis, CA0 showed significantly higher total motility (94.0%), progressive motility (90.8%), rapid progressive motility (83.6%), normal morphology (10.3%), and lower DFI (2.4%) and AR (4.7%) than the other two methods in normozoospermic samples (all p < 0.05). For non-normozoospermic samples, CA0 had significantly better results than the other two methods (total motility 89.2%, progressive motility 80.4%, rapid progressive motility 74.2%, normal morphology 8.5%, DFI 4.0%, and AR 4.0%; all p < 0.05). CONCLUSION: CA0 yielded spermatozoa with enhanced sperm fertilization potentials; DFI was minimized in samples processed by CA0. CA0 was effective for both normal and abnormal semen samples due to its consistent selection efficiency.

Malnutrition and its contributing factors for older people living in residential aged care facilities: Insights from natural language processing of aged care records.

BACKGROUND: Malnutrition is a serious health risk facing older people living in residential aged care facilities. Aged care staff record observations and concerns about older people in electronic health records (EHR), including free-text progress notes. These insights are yet to be unleashed. OBJECTIVE: This study explored the risk factors for malnutrition in structured and unstructured electronic health data. METHODS: Data of weight loss and malnutrition were extracted from the de-identified EHR records of a large aged care organization in Australia. A literature review was conducted to identify causative factors for malnutrition. Natural language processing (NLP) techniques were applied to progress notes to extract these causative factors. The NLP performance was evaluated by the parameters of sensitivity, specificity and F1-Score. RESULTS: The NLP methods were highly accurate in extracting the key data, values for 46 causative variables, from the free-text client progress notes. Thirty three percent (1,469 out of 4,405) of the clients were malnourished. The structured, tabulated data only recorded 48% of these malnourished clients, far less than that (82%) identified from the progress notes, suggesting the importance of using NLP technology to uncover the information from nursing notes to fully understand the health status of the vulnerable older people in residential aged care. CONCLUSION: This study identified 33% of older people suffered from malnutrition, lower than those reported in the similar setting in previous studies. Our study demonstrates that NLP technology is important for uncovering the key information about health risks for older people in residential aged care. Future research can apply NLP to predict other health risks for older people in this setting.

Incidence of postoperative delirium in older adults undergoing surgical procedures: A systematic literature review and meta-analysis.

BACKGROUND: With the increase in life expectancy around the globe, the incidence of postoperative delirium (POD) among older people (≥65 years) is growing. Previous studies showed a wide variation in the incidence of POD, from 4% to 53%, with a lack of specific evidence about the incidence of POD by specific surgery type among older people. The aim of this systematic review and meta-analysis was to determine the incidence of POD by surgery type within populations 65 years and over. METHODS: Databases including PubMed, Cochrane library, Embase, and CINAHL were searched until October 2020. Due to the relatively higher number of meta-analyses undertaken in this area of research, a streamlined systematic meta-analysis was proposed. RESULTS: A total of 28 meta-analyses (comprising 284 individual studies) were reviewed. Data from relevant individual studies (n = 90) were extracted and included in the current study. Studies were grouped into eight surgery types and the incidence of POD for orthopedic, vascular, spinal, cardiac, colorectal, abdominal, urologic, and mixed surgeries was 20%, 14%, 13%, 32%, 14%, 30%, 10%, and 26%, respectively. POD detection instruments were different across the studies, with Confusion Assessment Method (CAM & CAM-ICU) being the most frequently adopted. LINKING EVIDENCE TO ACTION: This study showed that POD incidence in older people undergoing surgery varied widely across surgery type. The more complex surgeries like cardiac and abdominal surgeries were associated with a higher risk of POD. This highlights the need to include the level of surgery complexity as a risk factor in preoperative assessments.

The impact of montessori-based programmes on individuals with dementia living in residential aged care: A systematic review.

OBJECTIVES: This systematic review examined the effectiveness of Montessori-based programmes for individuals with dementia living in residential aged care. METHODS: Nine databases were searched between January 2010 to October 2021, including Scopus, CINAHL, MEDLINE, Web of Science, SocINDEX with Full Text, PubMed, PsycINFO, Cochrane library and Cochrane Registry. Publications were included if they used Montessori-based programmes as interventions for individuals with dementia living in residential aged care and were qualitative, quantitative, mixed-method, or pilot studies. The quality of eligible studies was assessed using Joanna Briggs Institute critical appraisal instruments and the Mixed Method Critical Appraisal Tool. The findings were tabulated and narratively synthesised. RESULTS: Fifteen studies were included in this review. The quality scores of the 15 studies ranged from 62 to 100 out of 100. Four key categories of outcomes were observed: (1) significantly improved engagement; (2) significantly improved mental health outcomes, including affect, depression, agitation, excessive eating and psychotropic medication prescriptions; (3) significantly improved feeding difficulty but mixed results regarding nutritional status; and (4) no significant changes in the activities of daily living and quality of life of individuals with dementia. CONCLUSION: Cognitive capacity, personal preferences, individual care needs and the design of Montessori-based activities are pivotal to tailoring personalised Montessori-based activities for individuals with dementia in residential aged care and to maximise intervention outcomes. The synergistic effect of integrating Spaced Retrieval with Montessori-based activities in improving the eating ability and nutritional status of individuals with dementia was also noticed. The study summarised evidence about the effectiveness of Montessori-based programmes for individuals with dementia and informed healthcare professionals about how to implement individualised Montessori-based programmes.

A cross-sectional, observational study of nutritional status and eating behaviours in people living with dementia in acute care settings.

AIMS AND OBJECTIVES: To understand the nutritional status, observing eating difficulties during mealtimes for people living with dementia in acute care settings. BACKGROUND: Changed eating behaviours caused by declining cognitive function is common in people living with dementia which can lead to malnutrition. Malnutrition is associated with prolonged hospitalisation and increased mortality. People living with dementia in acute care settings are at high risk of malnutrition. This highlights the importance of better understanding the nutritional intake and eating behaviours of people living with dementia in acute care settings. DESIGN: This study is a cross-sectional, observational study. METHODS: Data of mealtime difficulties and nutritional status of people living with dementia were collected in four geriatric care wards (in acute or sub-acute hospitals) by using Feeding Difficulty Index and Mini Nutritional Assessment Short-Form. The STROBE checklist was used throughout this study. RESULTS: The study included 94 people living with dementia. The median age of the participants was 85.86 years old, with a Feeding Difficulty Index of 8.27 and had stayed in hospitals for average 14.46 days, with an average total feeding time of 24.61 min. Only 1.2% of participants were considered to be in normal nutritional status, whereas 72.1% were malnourished. All participants required partial or full assistance during mealtime. Participants with higher scores on the Feeding Difficulty Index have longer total feeding times, compared to those with lower scores. CONCLUSIONS: Malnutrition is prevalent in people living with dementia. People living with dementia demonstrate varying mealtime difficulties depending on the level of dependence. Mealtime assistance training programs are warranted and are beneficial for nursing staff and family members to improve their feeding skills and knowledge. NO PATIENT OR PUBLIC CONTRIBUTION: This study did not involve patients, service users, caregivers or members of the public. RELEVANCE TO CLINICAL PRACTICE: The study is relevant to clinical practice by identifying changed eating behaviours or mealtime difficulties in people living with dementia in acute care settings can significantly decrease the risk of malnutrition.

Effectiveness of interventions on feeding difficulties among people with dementia: A systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis aimed to examine non-pharmacological interventions for helping people with dementia who experience feeding difficulties in order to improve their nutritional status. METHODS: The articles were searched using PsycINFO, Medline, PubMed, CINAHL and Cochrane. Two independent investigators critically appraised eligible studies. The PRISMA guidelines and checklist were used. The possibility of risk of bias was assessed using a tool to assess the quality of randomised control trials (RCT) and non-RCT studies. A narrative synthesis was conducted as a method of synthesis. The Cochrane Review Manager (RevMan 5.4) was used for meta-analysis. RESULTS: The systematic review and meta-analysis included seven publications. Six interventions were identified and categorised as: eating ability training for people with dementia, staff training and feeding assistance and support. The meta-analysis found evidence of the effect of eating ability training on feeding difficulty, quantified by the Edinburgh Feeding Evaluation in Dementia scale (EdFED) with a weighted mean difference of -1.36 (95% confidence interval: -1.84 to -0.89, p < 0.001) and on self-feeding time. A spaced retrieval intervention showed a positive effect on EdFED. The systematic review discovered that while feeding assistance had a positive effect on feeding difficulty, staff training had no effect. According to the meta-analysis, these interventions had no effect on improving the nutritional status of people with dementia. CONCLUSIONS: None of the included RCTs met the Cochrane risk-of-bias criteria for randomised trials. This review found that direct training for people with dementia and indirect feeding support from care staff resulted in fewer mealtime difficulties. More RCT studies are needed to determine the efficacy of such interventions.

Development and integration of LensHooke® R10 for automatic and standardized diagnosis for sperm DNA fragmentation.

BACKGROUND: The sperm chromatin dispersion assay is commonly used to assess sperm DNA integrity. This approach is time-consuming, demonstrates poor chromatin preservation, and provides an ambiguous and unstandardized evaluation of fragmented chromatin. OBJECTIVES: We aimed to (i) develop an optimized sperm chromatin dispersion assay with reduced operation time, (ii) validate R10 test accuracy by comparing it to a conventional sperm chromatin dispersion assay, and (iii) standardize the sperm DNA fragmentation analysis procedure by integrating artificial intelligence optical microscopic technology. MATERIALS AND METHODS: This cross-section study included 620 semen samples. Aliquots were analyzed by a conventional Halosperm® G2 assay (G2) and LensHooke® R10 assay (R10). The DNA fragmentation index was scored manually, and R10 slides were automatically determined by a LensHooke® X12 PRO semen analysis system (X12). RESULTS: We demonstrated significant improvements in total assay time (40 vs. 72 min, p < 0.001) and in the halo-cytological resolution using R10 compared to G2. Comparing the G2 and R10, DNA fragmentation index results demonstrated good agreement between the two methods (Spearman's rank correlation, rho = 0.8517, p < 0.0001). We introduced the integration of an auto-calculation system to diagnose sperm DNA fragmentation. X12 interpretation showed excellent agreement with manual interpretation (Spearman's rank correlation, rho = 0.9323, p < 0.0001), but had a low coefficient of variation compared to manual interpretation (4% for R10 by X12 vs. 19% for R10 by manual scoring vs. 25% for G2 by manual scoring). DNA fragmentation index was more correlated with total motility (coefficients = -0.3607, p < 0.0001) than sperm morphology and was positively associated with asthenozoospermic semen samples (p = 0.0001). CONCLUSION: The R10 sperm chromatin dispersion assay combined with the X12 semen analysis system is faster, more objective, and provides standardization for sperm DNA fragmentation.

Comparison of puncture methods in patients with hemodialysis: A randomized controlled trial.

INTRODUCTION: Arteriovenous fistula or arteriovenous graft is essential to long-term survival and quality of life in patients receiving hemodialysis. To date, no research has examined the clinical impacts of different puncture methods. This study compared the rope ladder and area puncture techniques in terms of vascular patency, pain, and quality of life among patients receiving hemodialysis. METHODS: A prospective longitudinal study was performed with 6-month follow-up. A total of 98 participants recruited from a hemodialysis center in Taiwan were randomly assigned to receive the rope ladder technique (experimental group) or the area puncture technique (control group). Vascular patency was assessed by examining access flow and percutaneous transluminal angioplasty rate. Pain and quality of life were measured using the Numerical Pain Rating Scale (NPRS) and Kidney Disease Quality of Life Instrument (KDQOL-36™), respectively. All outcome variables were measured repeatedly and analyzed using a generalized estimating equation. RESULTS: Overall, quality of life was significantly better for the experimental group than for the control group (ß = 47.23, p < 0.001). The percutaneous transluminal angioplasty rate was lower for the experimental group than for the control group (12.0% vs. 18.8%). However, no significant differences were found in access flow and pain level between the two groups over time. CONCLUSION: Hemodialysis patients who received the rope ladder puncture technique had a lower percutaneous angioplasty rate and better quality of life than patients who received the area puncture technique, suggesting that the rope ladder technique could be implemented as a routine cannulation method in hemodialysis clinics.