[Experience Caring for an Acute Lymphoblastic Leukemia Patient With COVID-19 in the ICU].

This article describes the author's experience providing care in the ICU to a patient with acute lymphoblastic leukemia who had contracted COVID-19. The period of care spanned from June 29 to July 12, 2021. Data were collected during direct care, observations, and interviews and using medical record reviews. During the course of care, supportive care, bundle care, and other infection control measures were provided. The patient was monitored and tracked regularly for infection-related indicators, which successfully mitigated the impact of the infection and prevented secondary bacterial infections. Respiratory care measures such as assistance with Q3H awake prone positioning on the bed were provided. Also, the safety and smoothness of the ventilator pipeline and catheter when prone were confirmed and the setting of the ventilator was adjusted based on the blood oxygen concentration and gas analysis. These measures improved the patient's oxygenation, allowing their successful removal from the ventilator. Delayed chemotherapy affects the survival rate of patients with acute lymphoblastic leukemia as well as improves their physical and emotional status. Using patient-centered communication skills, empathizing with the patient's negative feelings, encouraging and assisting their participation in self-care, and helping facilitate prescribed hematologist-oncologist care, the author helped increase the patient's perceived self-control and positive attitudes and effectively alleviated their hopelessness regarding their current situation. Several recommendations arise from this care experience. Social media apps may be used to create virtual support groups for patients comprising significant relatives and friends to better support patients in quarantine. Also, a health education brochure addressing the latest COVID-19 disease, treatment, and care information may be given to patients with COVID-19 upon hospital admission to reduce their uncertainties and improve their self-care awareness to maximize their ability to successfully navigate the long quarantine treatment process.

[Advanced Practice Nursing Experience of a Female Adolescent With Leigh Syndrome and Her Family: A Family Strengths-Oriented Therapeutic Conversations Approach].

This article applied a family strengths-oriented therapeutic conversations approach to explore the advanced practice nursing experience of a female adolescent with Leigh Syndrome and her family. During the nursing care period from September 20 to November 19, 2022, the author collected data through direct care, observation, interview, telecare, home visits, and medical record reviews and confirmed the nursing problems to be the inadequate coping capability of the family. The author leveraged her advanced nurse practitioner role and used family strength-oriented therapeutic conversations to enable the parents of the patient to reflect on their experiences with this disease and to improve their quality of life and satisfaction with healthcare services. Three modes of care, including accessibility, coordination, and comprehensiveness, were offered to the female adolescent patient and her family to achieve the goal of family-centered, community-based, and medical-system-centered care. It is suggested that before making healthcare decisions, patients and their families should be given the opportunity to participate in the healthcare process and reach consensus on healthcare decisions based on existing evidence and their values and preferences. The medical decisions made by patients and their families after carefully considering their current situation and needs should be supported and assisted.

Co-designed Land-use Scenarios and their Implications for Storm Runoff and Streamflow in New England.

Landscape and climate changes have the potential to create or exacerbate problems with stormwater management, high flows, and flooding. In New England, four plausible land-use scenarios were co-developed with stakeholders to give insight to the effects on ecosystem services of different trajectories of socio-economic connectedness and natural resource innovation. With respect to water, the service of greatest interest to New England stakeholders is the reduction of stormwater and flooding. To assess the effects of these land-use scenarios, we applied the Soil and Water Assessment Tool to two watersheds under two climates. Differences in land use had minimal effects on the water balance but did affect high flows and the contribution of storm runoff to streamflow. For most scenarios, the effect on high flows was small. For one scenario-envisioned to have global socio-economic connectedness and low levels of natural resource innovation-growth in impervious areas increased the annual maximum daily flow by 10%, similar to the 5-15% increase attributable to climate change. Under modest population growth, land-use decisions have little effect on storm runoff and high flows; however, for the two scenarios characterized by global socio-economic connectedness, differences in choices regarding land use and impervious area have a large impact on the potential for flooding. Results also indicate a potential interaction between climate and land use with a shift to more high flows resulting from heavy rains than from snowmelt. These results can help inform land use and development, especially when combined with assessments of effects on other ecosystem services.

Activation of mutated K-ras in donor endometrial epithelium and stroma promotes lesion growth in an intact immunocompetent murine model of endometriosis.

Endometriosis is a common chronic gynaecological condition, affecting 5-10% of women of child-bearing age. Its study has been hampered by lack of genetically tractable models. We transplanted steroid-manipulated, menstrual-like endometrium from K-ras(G12V/+) /Ah-Cre(+/+) /ROSA26R-LacZ(+/+) mice into gonad-intact immunocompetent wild-type mice. This led to endometriosis-like lesion development. Long-term lesion survival depended on the presence of the activated K-ras in the small proportion of the cells in the mature lesion that had undergone Cre-mediated K-ras activation. LacZ activity demonstrated Cre-mediated recombination in both endometrial epithelial cells and stromal cells, and transgenic K-ras expression was confirmed by RT-PCR. The endometriosis lesions developed without exogenous oestradiol supplementation and anti-oestrogen (fulvestrant, ICI 182780) treatment greatly suppressed their growth. Immunohistochemistry confirmed that as in human endometriosis, there was invasion and activation of fibroblasts, endothelial cells, and macrophages, with marked collagen deposition in the lesions. This model provides an opportunity to investigate endometriosis lesion establishment, growth, and regression in genetically tractable, immunocompetent, and hormonally intact mice. Furthermore, for the first time it provides a suitable model to test clinically validated driver genes in a faithful mouse model of the predisposing endometriotic lesion, thus providing the correct cellular context and microenvironment for ovarian clear cell carcinogenesis.

Long-term ecological research and the COVID-19 anthropause: A window to understanding social-ecological disturbance.

The period of disrupted human activity caused by the COVID-19 pandemic, coined the "anthropause," altered the nature of interactions between humans and ecosystems. It is uncertain how the anthropause has changed ecosystem states, functions, and feedback to human systems through shifts in ecosystem services. Here, we used an existing disturbance framework to propose new investigation pathways for coordinated studies of distributed, long-term social-ecological research to capture effects of the anthropause. Although it is still too early to comprehensively evaluate effects due to pandemic-related delays in data availability and ecological response lags, we detail three case studies that show how long-term data can be used to document and interpret changes in air and water quality and wildlife populations and behavior coinciding with the anthropause. These early findings may guide interpretations of effects of the anthropause as it interacts with other ongoing environmental changes in the future, particularly highlighting the importance of long-term data in separating disturbance impacts from natural variation and long-term trends. Effects of this global disturbance have local to global effects on ecosystems with feedback to social systems that may be detectable at spatial scales captured by nationally to globally distributed research networks.

Ultra-Low-Loss Mid-Infrared Plasmonic Waveguides Based on Multilayer Graphene Metamaterials.

Manipulating optical signals in the mid-infrared (mid-IR) range is a highly desired task for applications in chemical sensing, thermal imaging, and subwavelength optical waveguiding. To guide highly confined mid-IR light in photonic chips, graphene-based plasmonics capable of breaking the optical diffraction limit offer a promising solution. However, the propagation lengths of these materials are, to date, limited to approximately 10 µm at the working frequency f = 20 THz. In this study, we proposed a waveguide structure consisting of multilayer graphene metamaterials (MLGMTs). The MLGMTs support the fundamental volume plasmon polariton mode by coupling plasmon polaritons at individual graphene sheets over a silicon nano-rib structure. Benefiting from the high conductivity of the MLGMTs, the guided mode shows ultralow loss compared with that of conventional graphene-based plasmonic waveguides at comparable mode sizes. The proposed design demonstrated propagation lengths of approximately 20 µm (four times the current limitations) at an extremely tight mode area of 10-6A0, where A0 is the diffraction-limited mode area. The dependence of modal characteristics on geometry and material parameters are investigated in detail to identify optimal device performance. Moreover, fabrication imperfections are also addressed to evaluate the robustness of the proposed structure. Moreover, the crosstalk between two adjacent present waveguides is also investigated to demonstrate the high mode confinement to realize high-density on-chip devices. The present design offers a potential waveguiding approach for building tunable and large-area photonic integrated circuits.

Progestin regulates chemokine (C-X-C motif) ligand 14 transcript level in human endometrium.

Leukocyte populations change profoundly in the human endometrium during the menstrual cycle. However the predominant cell, the uterine natural killer (uNK) cell does not contain steroid receptors. From gene array analysis we identified a transcript encoding chemokine (C-X-C motif) ligand 14 (CXCL14) which is markedly up-regulated in the secretory phase of the cycle. We confirm this data by northern blotting and quantitative PCR. Using in situ hybridization we localized CXCL14 mRNA to the glandular epithelial cells where it was detected only in the secretory phase of the cycle. Candidate progesterone response elements were identified at positions -2028/-2007 and -722/-697 (PRE1 and PRE2, respectively) relative to the translation start site. These were functionally tested using luciferase reporter deletion constructs, electrophoretic mobility shift assays and site-directed mutagenesis. The deletion/mutation of these sites reduced progesterone induction by 40 and 20%, respectively. Finally, we demonstrated that recombinant CXCL14 stimulated uNK cell chemotaxis in vitro. We therefore conclude that CXCL14 is likely to be regulated by progesterone in human endometrium and that it may exert a chemoattractive effect on uNK cells and in part be responsible for their clustering around the epithelial glands.

VEGF-A loss in the haematopoietic and endothelial lineages exacerbates age-induced renal changes.

Renal function declines with age and this is more pronounced in males than females. VEGF-A is essential for glomerular development and function but its role in other aspects of renal function is poorly understood. We therefore investigated the role of VEGF-A, derived specifically from haematopoietic and endothelial lineages in the kidney. We crossed VavCre and floxed Vegf-a mice allowing specific ablation of a single Vegf-a allele in the haematopoietic and endothelial lineages. Mutants were viable and fertile and had normal haematological composition, indicating that 50% gene dosage of Vegf-a in the Vav-expressing lineage is sufficient for establishing a functional haematopoietic system and mature vascular network. However, several abnormalities were observed in the kidney of the adult mutants. These included the formation of inclusion bodies in the proximal tubular cells, tubular atrophy and interstitial fibrosis. These features were observed in 9-11 month-old mutant animals. Most of these abnormalities have been described in aging kidneys in man, and were also observed in the older control mice (24 months). The pathological features appeared in mutant male animals at a younger age than in female mutants. This indicates that reduction in Vegf-a gene dosage in haematopoietic and endothelial lineages accelerates renal aging, suggesting that VEGF-A derived from these lineages may play a role in protecting the kidney from age-associated damage.

Wnt5a-mediated non-canonical Wnt signalling regulates human endothelial cell proliferation and migration.

Cell to cell interaction is one of the key processes effecting angiogenesis and endothelial cell function. Wnt signalling is mediated through cell-cell interaction and is involved in many developmental processes and cellular functions. In this study, we investigated the possible function of Wnt5a and the non-canonical Wnt pathway in human endothelial cells. We found that Wnt5a-mediated non-canonical Wnt signalling regulated endothelial cell proliferation. Blocking this pathway using antibody, siRNA or a down-stream inhibitor led to suppression of endothelial cell proliferation, migration, and monolayer wound closure. We also found that the mRNA level of Wnt5a is up-regulated when endothelial cells are treated with a cocktail of inflammatory cytokines. Our findings suggest non-canonical Wnt signalling plays a role in regulating endothelial cell growth and possibly in angiogenesis.

Analyze the beta waves of electroencephalogram signals from young musicians and non-musicians in major scale working memory task.

Electroencephalograms can record wave variations in any brain activity. Beta waves are produced when an external stimulus induces logical thinking, computation, and reasoning during consciousness. This work uses the beta wave of major scale working memory N-back tasks to analyze the differences between young musicians and non-musicians. After the feature analysis uses signal filtering, Hilbert-Huang transformation, and feature extraction methods to identify differences, k-means clustering algorithm are used to group them into different clusters. The results of feature analysis showed that beta waves significantly differ between young musicians and non-musicians from the low memory load of working memory task.

Transcript profile and localization of Wnt signaling-related molecules in human endometrium.

The mRNAs encoding several Wnt ligands, Frizzled receptors, and Wnt antagonists were detected in human endometrium, including SFRP1; the levels of SFRP1 mRNA were higher in the proliferative phase of the menstrual cycle and increased in endometriotic tissue compared with control eutopic endometrium, and they were detected in both glandular and stromal cells but were more abundant in the stroma. Our results suggest that Wnt signaling could function in normal endometrial physiology and the the Wnt signalling inhibitor SFRP1 might play a role in endometrial growth and endometriosis development.

Quantitative cellular and molecular analysis of the effect of progesterone withdrawal in a murine model of decidualization.

The endometrium is a dynamic tissue that undergoes periodic growth, remodeling and breakdown under the influence of ovarian steroid hormones. To investigate the molecular mechanisms underlying these processes, we used a murine model to mimic the decidualization and regression observed in humans. Ovariectomized mice were treated sequentially with steroid hormones, and subsequently, to induce decidualization, oil was injected into the uterine lumen. The animals were then divided into progesterone-maintained and progesterone-withdrawal groups. In the latter group, a process similar to menstruation was induced. The uterine tissues were collected at several time-points after the induction of decidualization. Histological analysis demonstrated that decidualization and tissue degeneration were successfully induced with similar features to those observed during the human menstrual cycle. Immunohistochemical, morphometric, and microarray-based techniques were used to study the cellular and molecular changes. The volume fractions of leukocytes, macrophages, and neutrophils, but not endothelial cells, increased in decidualized uteri and decreased after major tissue degradation was completed. The microarray data show that the levels of many transcripts that encode immune-related factors changed during the time-course used for this model, and the transcript levels of many of these factors paralleled the changes observed in the volume fractions of the immune cells. The results of the present study suggest that this model is a useful alternative to the use of non-human primates. Our findings also show that immune cells are recruited into the menstruating endometrium, and that immune-related genes are regulated in the uterus throughout menstruation.

Protein microarray using alpha-amino acids as metal tags on chips.

Procedures for synthesizing alpha-amino acids on a chip for coordination with transitional metal ions and a His-Tagged protein have been successfully developed as a stable protein microarray. Using the recombinant His-Tagged 3CL-protease (3CLpro) as a model for attachment to chips containing D-/L-Glu, Asp, Orn, Ser via different transitional metal ions, it was found that the Orn chip was the best of affinity binding and stability by which Zn2+ was the best metal ion for affinity while Co2+ was the best metal ion for stability. Thus, this protein microarray can be alternatively used as a high throughput screening method for rapid detection against SARS CoV 3CLpro and/or efficient purification of other Tagged proteins.

Wnt-1 signaling inhibits human umbilical vein endothelial cell proliferation and alters cell morphology.

Cell to cell interaction is one of the key processes effecting angiogenesis and endothelial cell function. There are many factors which can mediate this interaction including Wnt-signaling-related molecules. Wnt signaling is involved in many developmental processes and cellular functions. There is increasing evidence suggesting that Wnt signaling has a role in regulating endothelial cell growth although the precise mechanism is unclear. In this study, we established a coculture system to examine how Wnt-1 signaling regulates human umbilical vein endothelial cell (HUVEC) growth and behavior. We found that Wnt-1 signals inhibited BrdU incorporation in HUVECs and the number of labeled cells also decreased in proportion to the number of Wnt-1-expressing cells present (P < 0.05). Moreover, HUVECs cocultured with Wnt-1-expressing C57MG cells clumped together rather than remaining scattered throughout the culture. These effects were dependent on cell contact. Treatment of HUVEC with LiCl, which inhibits the activity of GSK-3beta and mimicked Wnt-1 signaling, also inhibited the BrdU incorporation in endothelial cells. Our results suggest that Wnt signaling has a role in endothelial cell growth control and this is mediated through cell-cell contact. They also suggest that Wnt signaling might participate in angiogenesis by regulating endothelial cell growth and function.

Facile synthesis of metal-chelating peptides on chip for protein array.

A unique peptide sequence of HGGHHG screening from a combinatorial synthetic peptide library showed a good chelating ability to bind a transition metal on a chip better than hexa-His peptide. It was directly conjugated with a His-Tagged proteins onto a chip in a mild aqueous solution and can be used this chip as a high throughput technique for protein array in order to detect and purify the His-Tagged proteins.