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1.
Artigo em Inglês | MEDLINE | ID: mdl-32173237

RESUMO

OBJECTIVES: We sought to examine temporal trends in pelvic organ prolapse (POP) surgery in Canada. METHODS: In this observational cross-sectional study, we used diagnostic and procedure codes from all hospitalizations and outpatient clinic visits in Canada (excluding Québec) from 2004 to 2014 to identify and analyze data on POP surgery. RESULTS: There were 204 301 POP surgery visits from 2004 to 2014, and the rate of POP surgery declined from 19.3 to 16.0 per 10 000 women during this period. The rates of "native tissue reconstructive repair" and "hysterectomy without other procedure" declined from 15.0 to 12.8 per 10 000 women and 2.6 to 1.6 per 10 000 women, respectively. The rate of obliteration increased from 0.1 to 0.3 per 10 000 women (all P values for trend <0.01). Mesh procedures increased from 1.6 per 10 000 women in 2004 to 2.4 per 10 000 women in 2007 and 2008, and then declined to 1.3 per 10 000 women in 2014. Reconstructive mesh surgery using an abdominal open approach declined, while laparoscopic procedures increased over the period examined. CONCLUSION: The rates of POP surgery declined in Canada between 2004 and 2014. An increase was observed in obliteration procedures and in laparoscopic vaginal suspension and fixation with mesh.

2.
Am J Epidemiol ; 2020 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-32128571

RESUMO

Previous research has associated snowfall with risk of myocardial infarction (MI). Most studies have been conducted in regions with harsh winters, it remains unclear whether snowfall is associated with risk of MI in regions with milder or more varied climates. This study used a case-crossover design to investigate the association between snowfall and MI mortality in British Columbia, Canada. MI deaths in British Columbia residents between October 15 and March 31 from 2009 to 2017 were identified. The day of each MI death was treated as the case day, and each case day was matched to control days drawn from the same day of week during the same month. Daily snowfall amount was assigned to case and control days at the residential address using weather stations within 15 kilometers distance and 100 meters of elevation. In total, 3300 MI case days were matched to 10,441 control days. Compared with days that had no snowfall, odds (95% confidence interval) of MI mortality increased 34% (0%, 80%) on days with heavy snowfall (≥ 5 cm). In stratified analysis of MI mortality as a function of both maximum temperature and snowfall, risk was significantly increased on snowfall days when the temperature was warmer.

3.
Dalton Trans ; 2020 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-32129379

RESUMO

Herein we report a new 4-fold interpenetrated metal-organic framework (MOF) functionalized with O- groups for selective Th(iv) capture, the activated samples 1a exhibited a high adsorption capacity for pure Th(iv) ions (Kd = 3.16 × 105 mL g-1) and the amount of metal ions adsorbed on the adsorbent was 165.61 mg g-1. A high removal efficiency of 99.75% was achieved within 10 min with an initial Th(iv) concentration of 100 mg L-1 and the adsorption data followed the pseudo-second-order model. In addition, the separation coefficient (S) of Th(iv) to metal ions with different valence states such as Th(iv)/La(iii), Th(iv)/Sm(iii), Th(iv)/Ho(iii), Th(iv)/Cd(ii) and Th(iv)/K(i) achieved values of 19.66, 26.83, 16.90, 11.26 and 255.79, respectively. Even given the fact that MOFs with O- groups showed high affinity for Pb(ii) ions, our adsorption studies for compound 1a revealed a separation coefficient (STh(IV)/Pb(II)) of 4.36. Further, the adsorption of Th(iv) ions to compound 1a was investigated by FT-IR, SEM-EDS and XPS.

4.
EBioMedicine ; 53: 102677, 2020 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-32114389

RESUMO

BACKGROUND: Endothelial cells (ECs) function as an instructive platform to support haematopoietic stem cell (HSC) homeostasis. Our recent studies found that impaired bone marrow (BM) ECs are responsible for the defective haematopoiesis in patients with poor graft function (PGF), which is characterised by pancytopenia post-allotransplant. Although activated autophagy was reported to benefit ECs, whether EC autophagy plays a critical role in supporting HSCs and its effect on PGF patients post-allotransplant remain unclear. METHODS: To evaluate whether the autophagy status of ECs modulates their ability to support haematopoiesis, human umbilical vein endothelial cells (HUVECs) and primary BM ECs derived from healthy donors were subjected to knockdown or overexpression of Beclin-1 (an autophagy-related protein). Moreover, BM ECs derived from PGF patients were studied. FINDINGS: Beclin-1 knockdown significantly reduced the haematopoiesis-supporting ability of ECs by suppressing autophagy, which could be restored by activating autophagy via Beclin-1 upregulation. Moreover, autophagy positively regulated haematopoiesis-related genes in HUVECs. Subsequently, a prospective case-control study demonstrated that defective autophagy reduced Beclin-1 expression and the colony-forming unit (CFU) plating efficiency in BM ECs from PGF patients compared to matched patients with good graft function. Rapamycin, an autophagy activator, quantitatively and functionally improved BM ECs from PGF patients in vitro and enhanced their ability to support HSCs by activating the Beclin-1 pathway. INTERPRETATION: Our results suggest that the autophagy status of ECs modulates their ability to support haematopoiesis by regulating the Beclin-1 pathway. Defective autophagy in BM ECs may be involved in the pathogenesis of PGF post-allotransplant. Rapamycin provides a promising therapeutic approach for PGF patients. FUNDING: Please see funding sources.

5.
J Clin Lab Anal ; : e23293, 2020 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-32157741

RESUMO

BACKGROUND: Atherosclerosis is the most frequent pathological process that causes cardiovascular diseases. OBJECTIVE: The present study aimed to confirm miRNAs associated with atherosclerosis and explore the molecular mechanism of miR-34c and its target high mobility group box protein 1 (HMGB1) in the control of growth of smooth muscle cells in the development of atherosclerosis. METHODS: Real-time PCR was firstly performed to confirm miRNA correlation with atherosclerosis, and computational analysis and luciferase assay were performed to explore the target of miR-34c, Western blot, and real-time PCR were also utilized to reveal the effect of whether high glucose (HG) and miR-34c affect miR-34c, HMGB1 levels, NF-κB p65 and TNF-α levels, and the role of miR-34c on vascular smooth muscle cells (VSMCs) viability induced by HG. Students' unpaired t test was performed to compare data between two groups. RESULTS: MiR-34c level was associated with atherosclerosis with different expression between VSMCs treated with high glucose or normal VSMCs. Then, HMGB1 is a virtual target of miR-34c with predicted binding site resided in HMGB1 3'UTR and further verified by that miR-34c remarkably reduced luciferase activity of wild HMGB1 3'UTR under a concentration-dependent fashion, and miR-34c cannot influence luciferase activity of mutant HMGB1 3'UTR. CONCLUSIONS: The results suggested miR-34c might be a novel therapeutic strategy in the management of atherosclerosis by suppressing the expression of HGMB1 and its downstream effectors.

6.
Adv Mater ; : e1903954, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32115802

RESUMO

Layered graphene oxide membranes (GOMs) offer a unique platform for precise sieving of small ions and molecules due to controlled sub-nanometer-wide interlayer distance and versatile surface chemistry. Pristine and chemically modified GOMs effectively block organic dyes and nanoparticles, but fail to exclude smaller ions with hydrated diameters less than 9 Å. Toward sieving of small inorganic salt ions, a number of strategies are proposed by reducing the interlayer spacing down to merely several angstroms. However, one critical challenge for such compressed GOMs is the extremely low water flux (<0.1 Lm-2 h-1 bar-1 ) that prevents these innovative nanomaterials from being used in real-world applications. Here, a planar heterogeneous graphene oxide membrane (PHGOM) with both nearly perfect salt rejection and high water flux is reported. Horizontal ion transport through oppositely charged GO multilayer lateral heterojunction exhibits bi-unipolar transport behavior, blocking the conduction of both cations and anions. Assisted by a forward electric field, salt concentration is depleted in the near-neutral transition area of the PHGOM. In this situation, deionized water can be extracted from the depletion zone. Following this mechanism, a high rejection rate of 97.0% for NaCl and water flux of 1529 Lm-2 h-1 bar-1 at the outlet via an inverted T-shaped water extraction mode are achieved.

8.
J Org Chem ; 85(5): 3568-3575, 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32041407

RESUMO

Two novel heterowheel [4]pseudorotaxanes consisting of cucurbit[7]uril (Q[7]) and symmetrical-tetramethyl-cucurbit[6]uril (TMeQ[6]) were constructed via the multirecognition mechanism, in which Q[7] can rotate freely around the horizontal axis, while TMeQ[6] cannot. In the construction process, due to strong repulsive forces between carbonyl portals of two neighboring wheels, the dethreading and movement of the wheels along the axle was observed. The dissociation of the [4]pseudorotaxanes was also discussed.

9.
World J Gastroenterol ; 26(6): 562-597, 2020 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-32103869

RESUMO

Colorectal cancer (CRC), a multifactorial disease, is usually induced and developed through complex mechanisms, including impact of diet and lifestyle, genomic abnormalities, change of signaling pathways, inflammatory response, oxidation stress, dysbiosis, and so on. As natural polyphenolic phytochemicals that exist primarily in tea, tea polyphenols (TPs) have been shown to have many clinical applications, especially as anticancer agents. Most animal studies and epidemiological studies have demonstrated that TPs can prevent and treat CRC. TPs can inhibit the growth and metastasis of CRC by exerting the anti-inflammatory, anti-oxidative or pro-oxidative, and pro-apoptotic effects, which are achieved by modulations at multiple levels. Many experiments have demonstrated that TPs can modulate several signaling pathways in cancer cells, including the mitogen-activated protein kinase pathway, phosphatidylinositol-3 kinase/Akt pathway, Wnt/ß-catenin pathway, and 67 kDa laminin receptor pathway, to inhibit proliferation and promote cell apoptosis. In addition, novel studies have also suggested that TPs can prevent the growth and metastasis of CRC by modulating the composition of gut microbiota to improve immune system and decrease inflammatory responses. Molecular pathological epidemiology, a novel multidisciplinary investigation, has made great progress on CRC, and the further molecular pathological epidemiology research should be developed in the field of TPs and CRC. This review summarizes the existing in vitro and in vivo animal and human studies and potential mechanisms to examine the effects of tea polyphenols on CRC.

10.
Nanoscale ; 12(7): 4573-4585, 2020 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-32043104

RESUMO

Nanoparticles (NPs) will inevitably interact with proteins and form protein coronas once they are exposed to biological fluids. This conventional model for nano-bio interactions has been used for over twenty years. Growing numbers of new nanomaterials are emerging every year. Among them, noble metal nanoclusters (NMNCs) are new types of fluorescent nanomaterials with considerable advantages in biomedical applications. Compared with NPs (typically >10 nm) like Au NPs, carbon nanotubes, etc., NMNCs have ultrasmall sizes (∼2 nm), so when NMNCs are exposed to biological milieu, will they form protein coronas like NPs? Due to a lack of characterization techniques for ultrasmall nanoparticles (USNPs), to date, studies on the binding stoichiometries of USNPs to proteins have been heavily hampered. To address this challenge, we combined the characteristics of various methods and selected human serum albumin (HSA) and transferrin (Trf) as model proteins to study their interactions with dihydrolipoic acid (DHLA) protected gold nanoclusters (DHLA-AuNCs). Steady-state fluorescence, transient fluorescence spectroscopy and isothermal titration calorimetry (ITC) were used to study the thermodynamic parameters (K, ΔH, ΔS, ΔG) and interaction mechanisms. The results showed that the intrinsic fluorescence of both proteins was quenched by DHLA-AuNCs, and the quenching process of HSA was an endothermic dynamic process. In contrast, the quenching process of Trf was an exothermic static process. The combination of ITC, agarose gel electrophoresis (AGE) and zeta potential showed that one HSA could bind 8 ± 1 DHLA-AuNCs and one Trf could bind 7 ± 2 DHLA-AuNCs, which was quite different from the conventional model of protein coronas. Based on these findings, the "protein complex" was termed for proteins upon binding with USNPs. Dynamic light scattering (DLS), transmission electron microscopy (TEM), and atomic force microscopy (AFM) showed that DHLA-AuNCs could induce the agglomeration of proteins. Circular dichroism (CD) and synchronous fluorescence spectroscopy showed that DHLA-AuNCs had a very minor effect on the secondary structures of HSA and Trf, which demonstrated the good biocompatibility of DHLA-AuNCs at the molecular scale. This work has shed light on a new interaction model beyond the protein corona, indicating a possible biological identity of USNPs.

11.
Artigo em Inglês | MEDLINE | ID: mdl-32073875

RESUMO

Nasopharyngeal carcinoma (NPC) is a malignant tumor with a unique and complicated pathogenesis and remains to be completely understood. Long noncoding RNA (lncRNA) has been suggested to correlate with NPC. Therefore, the study intended to explore the function of lncRNA FOXD3 antisense RNA 1 (FOXD3-AS1) in NPC. Microarray-based gene expression analysis was performed to investigate the NPC-related differentially expressed gene. Then, NPC and chronic nasopharyngitis tissues were collected to identify expression profiles of FOXD3-AS1, let-7e-5p and Reticulocalbin-1 (RCN1). Moreover, effects of FOXD3-AS1, let-7e-5p and RCN1 in NPC cells concerning endoplasmic reticulum stress and cell growth were evaluated via gain- and loss-of function approaches. Relationships among FOXD3-AS1, let-7e-5p and RCN1 were assessed by dual luciferase reporter gene assay, RNA-pull down and RNA immunoprecipitation assay. Fluorescence in situ hybridization (FISH) assay was adopted to determine the subcellular localization of FOXD3-AS1. The obtained findings revealed that FOXD3-AS1 might be involved in NPC via RCN1 by regulating let-7e-5p. FOXD3-AS1 and RCN1 were upregulated in NPC tissues and cells, and FOXD3-AS1 could competitively bind to let-7e-5p to regulate RCN1 in NPC cells. Importantly, silencing of FOXD3-AS1/RCN1 or upregulated let-7e-5p increased the reactive oxygen species content, Ca2+ concentration, mitochondrial membrane potential, and expression profiles of Caspase-12, Caspase-9, GRP78, CHOP and ATF4. Furthermore, silencing of FOXD3-AS1 or RCN1 or upregulated let-7e-5p elevated NPC cell apoptosis, reduced cell viability, and blocked cell cycle entry. In brief, our findings indicated silencing of FOXD3-AS1 down-regulated RCN1 by competitively binding to let-7e-5p, ultimately promoting endoplasmic reticulum stress-induced apoptosis in NPC.

12.
Apoptosis ; 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31993850

RESUMO

Arterial media calcification is related to mitochondrial dysfunction. Protective mitophagy delays the progression of vascular calcification. We previously reported that lactate accelerates osteoblastic phenotype transition of VSMC through BNIP3-mediated mitophagy suppression. In this study, we investigated the specific links between lactate, mitochondrial homeostasis, and vascular calcification. Ex vivo, alizarin S red and von Kossa staining in addition to measurement of calcium content, RUNX2, and BMP-2 protein levels revealed that lactate accelerated arterial media calcification. We demonstrated that lactate induced mitochondrial fission and apoptosis in aortas, whereas mitophagy was suppressed. In VSMCs, lactate increased NR4A1 expression, leading to activation of DNA-PKcs and p53. Lactate induced Drp1 migration to the mitochondria and enhanced mitochondrial fission through NR4A1. Western blot analysis of LC3-II and p62 and mRFP-GFP-LC3 adenovirus detection showed that NR4A1 knockdown was involved in enhanced autophagy flux. Furthermore, NR4A1 inhibited BNIP3-related mitophagy, which was confirmed by TOMM20 and BNIP3 protein levels, and LC3-II co-localization with TOMM20. The excessive fission and deficient mitophagy damaged mitochondrial structure and impaired respiratory function, determined by mPTP opening rate, mitochondrial membrane potential, mitochondrial morphology under TEM, ATP production, and OCR, which was reversed by NR4A1 silencing. Mechanistically, lactate enhanced fission but halted mitophagy via activation of the NR4A1/DNA-PKcs/p53 pathway, evoking apoptosis, finally accelerating osteoblastic phenotype transition of VSMC and calcium deposition. This study suggests that the NR4A1/DNA-PKcs/p53 pathway is involved in the mechanism by which lactate accelerates vascular calcification, partly through excessive Drp-mediated mitochondrial fission and BNIP3-related mitophagy deficiency.

13.
Oncogene ; 39(12): 2550-2567, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31996785

RESUMO

Aurora B is a serine/threonine kinase that has been implicated in regulating cell proliferation in distinct cancers, including breast cancer. Here we show that Aurora B expression is elevated in basal-like breast cancer (BLBC) compared with other breast cancer subtypes. This high level of expression seems to correlate with poor metastasis-free survival and relapse-free survival in affected patients. Mechanistically, we show that elevated Aurora B expression in breast cancer cells activates AKT/GSK3ß to stabilize Snail1 protein, a master regulator of epithelial-mesenchymal transition (EMT), leading to EMT induction in a kinase-dependent manner. Conversely, Aurora B knock down by short-hairpin RNAs (shRNAs) suppresses AKT/GSK3ß/Snail1 signaling, reverses EMT and reduces breast cancer metastatic potential in vitro and in vivo. Finally, we identified a specific OCT4 phosphorylation site (T343) responsible for mediating Aurora B-induced AKT/GSK3ß/Snail1 signaling and EMT that could be attenuated by Aurora B kinase inhibitor treatment. These findings support that Aurora B induces EMT to promote breast cancer metastasis via OCT4/AKT/GSK3ß/Snail1 signaling. Pharmacologic Aurora B inhibition might be a potential effective treatment for breast cancer patients with metastatic disease.

16.
Artigo em Inglês | MEDLINE | ID: mdl-31944945

RESUMO

Deep domain adaptation methods have achieved appealing performance by learning transferable representations from a well-labeled source domain to a different but related unlabeled target domain. Most existing works assume source and target data share the identical label space, which is often difficult to be satisfied in many real-world applications. There is a more practical scenario called partial domain adaptation, where the target label space is a subset of the source label space. In this case, reinforcing the positive effects of the most relevant source subclasses and reducing the negative impacts of irrelevant source subclasses are crucial. This paper proposes an efficiently-implemented Deep Residual Correction Network by plugging one residual block into the source network, which effectively enhances the adaptation from source to target and explicitly weakens the influence from the irrelevant source classes. Moreover, we design a weighted class-wise domain alignment loss to couple two domains by matching the feature distributions of shared classes between source and target. Comprehensive experiments on partial, traditional and fine-grained cross-domain visual recognition demonstrate that DRCN is superior to the competitive deep domain adaptation approaches.

17.
World J Surg ; 44(1): 213-222, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31637507

RESUMO

BACKGROUND: The prognostic significance of preoperative plasma fibrinogen in patients with operable gastric cancer remains under debate. This study aimed to elucidate the prognostic value of fibrinogen in gastric cancer patients underwent gastrectomy. METHODS: A total of 4351 patients with gastric cancer collected from three comprehensive medical centers were retrospectively evaluated. Patients were categorized by minimum P value using X-tile, while the baseline confounders for fibrinogen was balanced through propensity score matching (PSM). The relationships between fibrinogen and other clinicopathologic features were evaluated, and nomogram was constructed to assess its prognostic improvement compared with TNM staging system. RESULTS: Fibrinogen was significantly correlated with macroscopic type, tumor differentiation, tumor size, and T and N stage. The factors, fibrinogen and T stage as well as N stage, were identified to be independent prognostic factors after PSM. Nomogram based on fibrinogen demonstrated a smaller Akaike information criterion (AIC) and a larger concordance index (C-index) than TNM staging system, illustrating that fibrinogen might be able to improve the prognostic accuracy. CONCLUSIONS: Preoperative plasma fibrinogen levels in gastric cancer patients were significantly correlated with tumor progression, which could be regarded as a reliable marker for survival prognostic prediction.

18.
Biophys J ; 118(1): 15-25, 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31812354

RESUMO

Stress fields emerging from the transfer of forces between cells within multicellular systems are increasingly being recognized as major determinants of cell fate. Current analytical and numerical models used for the calculation of stresses within cell monolayers assume homogeneous contractile and mechanical cellular properties; however, cell behavior varies by region within constrained tissues. Here, we show the impact of heterogeneous cell properties on resulting stress fields that guide cell phenotype and apoptosis. Using circular micropatterns, we measured biophysical metrics associated with cell mechanical stresses. We then computed cell-layer stress distributions using finite element contraction models and monolayer stress microscopy. In agreement with previous studies, cell spread area, alignment, and traction forces increase, whereas apoptotic activity decreases, from the center of cell layers to the edge. The distribution of these metrics clearly indicates low cell stress in central regions and high cell stress at the periphery of the patterns. However, the opposite trend is predicted by computational models when homogeneous contractile and mechanical properties are assumed. In our model, utilizing heterogeneous cell-layer contractility and elastic moduli values based on experimentally measured biophysical parameters, we calculate low cell stress in central areas and high anisotropic stresses in peripheral regions, consistent with the biometrics. These results clearly demonstrate that common assumptions of uniformity in cell contractility and stiffness break down in postconfluence confined multicellular systems. This work highlights the importance of incorporating regional variations in cell mechanical properties when estimating emergent stress fields from collective cell behavior.

19.
Anal Bioanal Chem ; 412(3): 647-655, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31836924

RESUMO

In this work, simple, rapid, and low-cost multiplexed detection of tumor-related micro-RNAs (miRNAs) was achieved based on multi-color fluorescence on a microfluidic droplet chip, which simplified the complexity of light path to a half. A four-T-junction structure was fabricated to form uniform nano-volume droplet arrays with customized contents. Multi-color quantum dots (QDs) used as the fluorescence labels were encapsulated into droplets to develop the multi-path fluorescence detection module. We designed an integrated multiplex fluorescence resonance energy transfer system assisted by multiple QDs (four colors) and one quencher to detect four tumor-related miRNAs (miRNA-20a, miRNA-21, miRNA-155, and miRNA-221). The qualitative analysis of miRNAs was realized by the color identification of QDs, while the quantitative detection of miRNAs was achieved based on the linear relationship between the quenching efficiency of QDs and the concentration of miRNAs. The practicability of the multiplex detection device was further confirmed by detecting four tumor-related miRNAs in real human serum samples. The detection limits of four miRNAs ranged from 35 to 39 pmol/L was achieved without any target amplification. And the linear range was from 0.1 nmol/L to 1 µmol/L using 10 nL detection volume (one droplet) under the detection speed of 320 droplets per minute. The multiple detection system for miRNAs is simple, fast, and low-cost and will be a powerful platform for clinical diagnostic analysis. Graphical abstract.


Assuntos
Colorimetria/métodos , MicroRNAs/metabolismo , Microfluídica , Fluorescência , Humanos , Limite de Detecção
20.
J Nurs Manag ; 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31789437

RESUMO

AIM: The study aimed to investigate nurses' second victim experience and quality of support resources in Singapore. BACKGROUND: The second victim phenomenon, broadly described as the suffering of providers including nurses in the face of a clinical error, is often overlooked. METHODS: A cross-sectional questionnaire survey was adopted. A total of 1,163 nurses from an acute public hospital in Singapore took part in the study. The Second Victim Experience and Support Tool (SVEST) was employed to assess experience of second victims and the quality of support resources. RESULTS: The study results showed that nurses experienced second victim-related physical, psychological and professional distress. About 31.8% of the participants had turnover intentions, while 9.3% had absenteeism following an error. Nurses who are younger and less experienced were more likely to experience greater second victim response. Among the support options, peer support was rated as the most desirable. CONCLUSION: Nurses, being at the forefront of care delivery, are especially susceptible to being a casualty of the second victim phenomenon. IMPLICATIONS FOR NURSING MANAGEMENT: Acknowledging the second victim phenomenon, together with a strong organizational support, is essential in alleviating the trauma and assisting nurses with reconciliation in the aftermath of an unanticipated error.

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