A document by Shi Ting Pang. Click on the document to view its contents.

Objective The study has been conducted to identify the factors affecting the breastfeeding self-efficacy of pregnant women in the COVID-19 pandemic. Design A descriptive and correlational design has been used in this study. Setting The population of the study comprised all the pregnant women applying to the obstetrics polyclinic of a university hospital. Sample The study sample consisted of 320 pregnant women’s. Methods The data of the study were collected by using an Information Form and the Prenatal Breastfeeding Self-Efficacy Scale. Main Outcome Measures Breastfeeding self-efficacy. Results The seven variables having a significant effect on the pregnant women’s Prenatal Breastfeeding Self-Efficacy Scale scores, in the order of descending importance, have been determined as follows; being knowledgeable on COVID-19, thinking breastfeeding to be beneficial for the baby, going to prenatal care checkups on time, pregnancy duration, educational status , age, and receiving breastfeeding training in the COVID-19 pandemic. Conclusion Although the study findings show similarities to those of the studies conducted before the pandemic analyzing breastfeeding self-efficacy and the factors affecting it, it is an important aspect that this study has been carried out during the COVID-19 pandemic. This study is believed to contribute to the literature and guide interventional studies to be conducted in the COVİD-19 pandemic by evaluating the breastfeeding self-efficacy levels of mothers and the factors affecting them.

Objective: Bronchiectasis is a condition characterized by irreversible abnormal dilation and anatomic breakdown of the bronchial tree. In our study we aimed to understand the causes of osteoporosis at molecular levels and to investigatethe usefulness of RANKL and OPG levels as markers in early diagnosis and follow-up of osteoporosis, RANKL inhibitors in the treatment of osteoporosis. Materials and Methods: 30 noncystic fibrosis bronchiectasis patients were diagnosed as osteoporosis with DEXA and applied to the Pediatrics Chest Diseases Department of Meram Medical Faculty of Necmettin Erbakan University between June 2015 and June 2016 were included in our study. BMD values were determined by DEXA and QUS in the patient group and only QUS in the control group. Results: In the patient group 56.6% (n: 17) were male, 43.4% (n: 13) were. There was no statistically significant difference between RANKL, OPG, RANKL / OPG ratios, BALP, OST, NTX values between the patient and control group (p> 0.05). The median serum Ca level was 9.51 (IQC: 0.74) in the patient group and 9.75 (IQC: 0.47) in the control group, there was a statistically significant difference between them (p = 0.003). There was a strong positive correlation between QUS z scores and DEXA z scores in the patient group (p = 0.008). Conclusion: In conclusion, we could not pinpoint the role of RANK / RANKL / OPG in the pathogenesis of osteoporosis in patients with noncystic fibrosis bronchiectasis. However, we think it is appropriate to conduct studies on a wider series in this topic.

Aims: To investigate the relationship between steady-state voriconazole trough concentration (Ctrough) and adverse effects (AEs). Methods: We conducted a retrospective study in the Jinling Hospital from January 2015 to June 2020. A total of 140 patients receiving voriconazole were enrolled in this study. The determination and scoring of voriconazole-associated hepatotoxicity were performed according to the Roussel Uclaf Causality Assessment Method scoring scale and the severity of hepatotoxicity was graded according to CTCAE. Results: Compared to the group without any AEs, voriconazole Ctrough was significantly higher in the hepatotoxicity and neurotoxicity groups; however, no differences were observed in other AEs. Receiver operating characteristic (ROC) curves showed that steady-state voriconazole Ctrough >3.61 mg/L was associated with an increased incidence of hepatotoxicity (AUC=0.645, P=0.047). Logistic regression analysis showed that timely voriconazole dose adjustment was a predictor of attenuated hepatotoxicity after adjustment for confounders, but hepatotoxicity was not associated with voriconazole Ctrough measured at a single time point. When gamma-glutamyl transpeptidase (GGT) was included in the assessment of hepatotoxicity severity, its AE was overestimated. Steady-state voriconazole Ctrough and length of treatment were associated with GGT elevation. Conclusions: Despite an increasing trend of hepatotoxicity and neurotoxicity with increasing steady-state voriconazole Ctrough, it may not be sufficient for predicting the probability of hepatotoxicity. Concomitant co-monitoring of liver function parameters for 2 weeks after dosing may provide greater prevention of hepatotoxic events. In patients with long-term voriconazole usage, GGT is not a reliable indicator of hepatotoxicity, but it can be used to assess oxidative stress levels.

Glioblastoma multiform is the most aggressive and invasive brain cancer consisting of genetically and phenotypically altering glial cells. It has massive heterogeneity due to its highly complex and dynamic microenvironment. Here, we used dielectrophoresis to measuree electrophysiological properties of glioma cells and quantified population heterogeneity of U87 glioma cell line. We fabricated a gold microelectrode array within a microfluidic channel and applied 3 Vpp and 100 kHz, 200 kHz, 300 kHz, 400 kHz, 500 kHz, 1 MHz, 2 MHz, 5 MHz, and 10 MHz frequencies to monitor behavior of glioma cells under the microscope. We analyzed dielectrophoretic behavior of 500 glioma cells using the acquired images. We revealed that U87 glioma cells has never experienced negative dielectrophoresis and exhibited crossover frequency around 100 kHz -150 kHz. We detected 3 distinct glioma subpopulations by quantifying dielectrophoretic movement of the cells; 50% of the cells experienced positive dielectrophoresis starting from 500 kHz to 10 MHz, 30% of the cells were spread in the microchannel by moderate DEP forces, and other cells were experienced very weak DEP forces. Our results demonstrate the dielectrophoretic spectra of U87 glioma cell line and associates the dielectrophoretic responses of single glioma cells to the population heterogeneity.

Rationale aims, and objectives: Clinical pathways (CP) have the ability to educate providers on guideline-driven recommendations and reduce readmission rates. The aim of this study was to evaluate adherence to the 2020 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline recommendations for the management of an AECOPD after the implementation of an educational CP. Methods: This study was an observational quality improvement study targeting COPD exacerbation hospitalizations with a three-month pre-intervention period from January to March 2020 and a five-month post-intervention period from January to May 2021, following the implementation of a CP. Patients were included if they were hospitalized with a primary diagnosis of an AECOPD. The primary endpoint was to assess adherence to guideline recommendations. Secondary endpoints included an evaluation of oxygen support requirement, hospital length of stay (LOS), 30-day readmission rates, admission to the intensive care unit (ICU), and requirement of mechanical ventilation (MV). Results: There were a total of 78 patients included in this study. There was a significant improvement in guideline appropriate inhalers prescribed at discharge [85%, n=24 vs. 44%, n=22, p=0.01], antibiotic therapy for an AECOPD [90%, n=25 vs. 61%, n =30, p =0.02], smoking cessation pharmacotherapy [80%, n=22 vs. 29%, n=14, p=0.004] and counseling [89%, n=25 vs.15%, n=8, p=0.002] prior to discharge within the post-intervention group compared to the pre-intervention group. A significant reduction in the requirement of oxygen support was demonstrated within the post-intervention group after the implementation of a CP (p=0.03). Conclusion: The implementation of a CP can improve adherence to guideline recommendations and reduce the need of oxygen support for the management of AECOPD.

Background: Influenza causes greater morbidity in pediatric patients with cancer or sickle cell disease (SCD). Limited data exists on influenza vaccination uptake for these populations in a low-vaccination state. Outpatient interventions improve vaccine uptake but isolated inpatient interventions remain unstudied. Procedure: We reviewed influenza vaccination of pediatric patients with cancer or SCD treated at Children’s Healthcare of Atlanta (CHOA) during three influenza seasons. An opt-out inpatient admission order set was implemented prior to the 2019-2020 influenza season. Vaccination status of patients that were admitted during an influenza season was compared pre- and post-intervention via Chi-squared analysis and multivariate logistic regression. Results: 1548 and 2549 patients with cancer and SCD (respectively) were eligible. The oncology (60%-62%) and SCD cohorts (61%-65%) had similar-to-higher vaccination uptake to the US (58-64%, p=0.01-0.79) and higher uptake compared to Georgia (51%-56%, p<0.01). There was no significant improvement in uptake after implementation of the inpatient intervention for admitted patients with cancer (40% vs 56%, p=0.05-0.88) or SCD (44% vs 56%, p=0.01). Multivariate logistic regression also found no significant increase in vaccine uptake (Hematologic Malignancy: 0.8 [0.73-0.98], Solid Tumor: 0.9 [0.80-1.90], CNS Tumor: 0.9 [0.71-1.14], SCD: 0.9 [0.85-0.99]). Conclusion: Pediatric patients with cancer and SCD have similar-to-greater influenza vaccination uptake compared to Georgia and the United States. An intervention focused on vaccinating hospitalized patients did not significantly improve the proportion of cancer or SCD patients who received influenza vaccine in each season. Future studies are needed to identify alternative approaches to improving vaccine uptake in these cohorts.

Since the combination of anticancer drugs and opioids is very common, apatinib and tramadol are likely to be used in combination clinically. Based on this, it is particularly important to explore the effect of apatinib on the metabolism of tramadol. This study evaluated the effects of apatinib on the pharmacokinetics of tramadol and its main metabolite o-desmethyltramadol in SD rats and the inhibitory effects of apatinib on tramadol in rat liver microsomes (RLMs), human liver microsomes (HLMs) and recombinant human CYP2D6.1. The samples were determined by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). The in vivo results showed that compared with the control group, apatinib increased the AUC(0-t), AUC(0-∞) and Cmax values of tramadol and O-desmethyltramadol, and decreased the values of VZ/F and CLz/F. In addition, the MRT(0-t), MRT(0-∞) values of O-desmethyltramadol were increased. In vitro, apatinib inhibited the metabolism of tramadol by a mixed way with IC50 of 1.927µM in RLMs, 2.039µM in HLMs and 15.32µM in CYP2D6.1.

Aims CYP2C19 activity is associated with treatment response to clopidogrel through the formation of the active H4 metabolite. The aims of this study were to develop a physiologically-based pharmacokinetic (PBPK) model of clopidogrel and its metabolites for populations of European ancestry, to predict pharmacokinetics in the Japanese population by CYP2C19 phenotype (extensive metaboliser, EM; intermediate metaboliser, IM; poor metaboliser, PM), and to investigate the effect of clinical and demographic factors. Methods A PBPK model (Simcyp® v18.2) was developed and verified (2-fold acceptance criteria) to describe the two metabolic pathways of clopidogrel (H4 metabolite, acyl glucuronide metabolite) for a population of European ancestry using plasma data from four published studies. Subsequently, model predictions in the Japanese population (2 studies) were evaluated. The effects of CYP2C19 activity, fluvoxamine coadministration (CYP2C19 inhibitor) and population-specific factors (age, sex, BMI, body weight, cancer, hepatic and renal dysfunction) on the pharmacokinetics of clopidogrel and its metabolites were investigated. Results The predicted/observed ratios for clopidogrel and metabolite exposure parameters were acceptable. For all CYP2C19 phenotypes, steady-state AUC0-τ of the H4 metabolite was lower for the Japanese (e.g. EM, 7.69 [6.26 – 9.45] ng·h/mL; geometric mean [95% CI]) than European (EM, 24.8 [20.4 – 30.1] ng·h/mL, P <0.001) population. CYP2C19 PM phenotype, fluvoxamine co-administration, hepatic and renal dysfunction reduced H4 metabolite but not acyl glucuronide metabolite concentrations. Conclusion This is the first PBPK model developed to describe the two major metabolic pathways of clopidogrel which can be applied to populations of European and Japanese ancestry by CYP2C19 phenotype.

The WHIRLY (WHY) DNA/RNA binding proteins fulfil multiple but poorly characterised functions in leaf development. WHY1 transcript levels were highest in the bases of 7-day old barley leaves. Immunogold labelling revealed that the WHY1 protein was more abundant in the nuclei than the proplastids of the leaf bases. Transcript and metabolite profiling analysis of barley lines (W1-1 and W1-7) lacking WHY1, which show delayed greening compared to the wild type. While the transcript profile of leaf development was largely unchanged in W1-1 and W1-7 leaves, there were differences in levels of several transcripts encoding transcription factors associated with chloroplast development. These include a barley homologue of the Arabidopsis GATA transcription factor that regulates stomatal development, greening and chloroplast development, NAC1, two transcripts with similarity to Arabidopsis GLK1 and two transcripts encoding ARF transcriptions factors with functions in leaf morphogenesis and development. Chloroplast proteins were less abundant in the W1-1 and W1-7 leaves than the wildtype. The levels of TCA cycle metabolites and GABA were significantly lower in WHY1 knockdown leaves than the wild type. We conclude that WHY1 functions in the nuclei of the cells in the leaf bases contributes to the regulation of chloroplast development.

Here away used to reduce the porosity of the nanofibers, which is removing polyvinyl alcohol (PVA) nanofibers from PVA/poly amide 6 (PA6) nanofibers by water treatment. Measuring the porosity of the electrospun web before and after treatment by the Brunauer, Emmett and Teller (BET) method proved this. The specific surface area of the web was 60 % reduced after water treatment. Surface roughness and pore volume have reduced after water treatment. Also, I introduced BET as the method for measuring the diameters of mesopores (or lower than 100nm). I used BET to prove that the cracks can make mesopores on the nanofibers.

Here away used to reduce the porosity of the nanofibers, which is removing polyvinyl alcohol (PVA) nanofibers from PVA/poly amide 6 (PA6) nanofibers by water treatment. Measuring the porosity of the electrospun web before and after treatment by the Brunauer, Emmett and Teller (BET) method proved this. The specific surface area of the web was 60 % reduced after water treatment. Surface roughness and pore volume have reduced after water treatment. Also, I introduced BET as the method for measuring the diameters of mesopores (or lower than 100nm). I used BET to prove that the cracks can make mesopores on the nanofibers.

In recent years, piezoelectric nanogenerators, due to their greater durability in high dust or humidity, have become more attractive than triboelectric nanogenerators. Therefore, increasing their outputs is the subject of many studies. I focused on electrodes of acoustic nanofiber nanogenerators for the first time. Compared to other works here, I want to introduce a new electrode that is cheaper and does not result in lower outputs. Here, for the first time, graphene spincoated ink was used for a polyacrylonitrile-based acoustic nanogenerator. The results of the acoustic tests were compared with the in- situ synthesis of nickel nanoparticles on the layer using graphene spin-coated screen ink and conductive tape.

In this letter, we report a large-scale synchronized replacement pattern of the Alpha strain by the Delta strain. We argue that this phenomenon is associated with the invasion timing and transmissibility advantage of the Delta strain. Alpha strain skipped some countries/regions, e.g. India and neighboring countries/regions, which led to a mild first wave before the invasion of the Delta strain, in term of reported COVID-deaths per capita.

In this study, the Franz diffusion kinetic model and Bacitracin’s (BAC) cumulative release kinetic mathematical model are designed. The Franz diffusion mathematical release ki- netic model of Zataria Multiflora (ZM)/BAC nanofiber (NF) structure has been revealed as Zero Order, since there is no antibacterial protection effect for shelf-life, it has been analyzed over the Python program and its shelf-life has been determined as 125 days.

Introduction: Patients with tachycardia and dextrocardia could benefit from catheter ablation. However, anatomical complexities create challenges for that. We aimed to retrospectively summarize the clinical characteristics and the safety and efficiency, and recommended the technique considerations of these patients. Methods and Results: Twenty-one cases from 19 patients with tachycardia and dextrocardia who underwent catheter ablation between 2009 and 2021 were enrolled. All patients underwent echocardiography and computed tomography (CT) to confirm the anatomical malformations. Transseptal puncture was guided by fluoroscopy or intracardiac echocardiography when left atrial access was necessary and the ablation process was guided by three-dimensional mapping. Six cases exhibited situs solitus while nine cases exhibited situs inversus. Fourteen cases exhibited atrial fibrillation, seven cases exhibited atrial flutter, and two cases exhibited atrioventricular reentrant tachycardia (AVRT)；two cases exhibited atrial fibrillation combined with atrial flutter. Acute success was achieved in 18 cases (85.7%, 18/21). The three-dimensional mapping system was not employed in the three cases which failed. During long-term follow-up (20.71 ± 21.86 months), eight cases (72.7%, 8/11) of atrial fibrillation with dextrocardia successfully attained sinus rhythm. None of AVRT cases had recurrence. Half of the atrial flutter cases with dextrocardia, especially those with a history of surgical correction treatment for heart malformations, underwent recurrence. One case had tamponade. Conclusion: Catheter ablation for tachycardia patients with dextrocardia, is safe, efficient, and feasible. It is imperative to integrate echocardiography, cardiac computer tomography, and three-dimensional mapping, and apply three-dimensional reconstruction to facilitate the success of catheter ablation.

Background: Intermediate-conductance calcium-activated potassium channels (KCa3.1) are important for automaticity of sinus nodes. Previous studies have identified that cardiomyocytes with pacemaker activities are existent in pulmonary vein (PV), superior vena cava (SVC). The aim of the present study was to explore the electrophysiological characteristics and differential densities of KCa3.1 in rabbit atrium. Methods: Immune-staining techniques and western blots were used to determine the KCa3.1 expression in PV, SVC, right atrium (RA), and left atrium (LA). Transmembrane action potentials (APs) of PVs, SVC, RA, and LA were recorded. Isoproterenol (1uM) and high calcium (5.4mM) were used to induce delayed afterdepolarization (DAD) and DAD-induced trigger activity. Results: The expression of KCa3.1 was significantly higher in the PVs and SVC than in the RA and LA. After super-fusion with isoproterenol (1μM) and high calcium (5.4mM), the delayed afterdepolarization (DAD) and DAD-induced triggered activity was induced in the PVs and SVC, but not in the RA and LA with isoproterenol and high calcium administration. TRAM-34 (5uM), a KCa3.1 inhibitor, inhibited DAD and DAD-induced triggered activity. Conclusions: Compared with atrium, thoracic veins are the most common sites genesis AF due to different distribution of KCa3.1. Blockade of KCa3.1 could eliminate DAD and DAD-induced trigger activity, KCa3.1 might be a promising target for foci AF.

Introduction: The aim of this study was to evaluate the safety and efficacy of zero-fluoroscopy (ZF) catheter ablation (CA) for supraventricular tachycardias (SVT). Methods: 584 consecutive patients referred to our institution for CA of SVT were analysed. Patients were categorised into two groups; zero-fluoroscopy (ZF) group and conventional fluoroscopy (CF) group. The ZF group was further divided into two subgroups (adults and paediatric). Patient characteristics, procedural information, and follow-up data were compared. Results: The ZF group had a higher proportion of paediatric patients (42.2% vs 0.0 %; p < 0.001), resulting in a younger age (30.9 ± 20.3 years vs 52.7 ± 16.5 years; p < 0.001) and lower BMI (22.8 ± 5.7 kg/m2 vs 27.0 ± 5.4 kg/m2; p < 0.001). Procedure time was shorter in the ZF group (94.2 ± 50.4 min vs 104.0 ± 54.0 min; p = 0.002). There were no major complications and the rate of minor complications did not differ between groups (0.0% vs 0.4%; p = 0.304). Acute procedural success as well as the long-term success rate when only the index procedure was considered did not differ between groups (92.5% vs 95.4 %; p = 0.155; 87.1% vs 89.2%; p = 0.422). When repeated procedures were included, the long-term success rate was higher in the ZF group (98.3% vs 93.5%; p < 0.004). The difference can be partially explained by the operators’ preferences. Conclusion: The safety and efficacy of ZF procedures in adult and paediatric populations are comparable to that of CF procedures.

left bundle branch area pacing has emerged as a novel modality of conduction system pacing which is feasible and safe, with rare complications and a high success rate. In this article, we report the case of a woman with obstructive hypertrophic cardiomyopathy who developed a complete heart block after an alcohol septal ablation procedure. To our knowledge, this is the first case report of this type of pacing in a patient. We want to show that this procedure is safe and can be successful, as well as the possible limitations in this scenario.

Over the last decades there have been increased in the application of information systems (IS) in the form of digital health technologies to enhance access to healthcare services, improve healthcare quality and efficiency of healthcare systems. Evidence on the efficiency of digital health technologies in clinical settings to enable the adoption and scaling up of such technologies is buried in ever increasing and complex extant literature including grey due to lack of the application of robust evidence-based research in IS. By and large, in the medical and health domain, decision-making is based on evidence-based research. In this study, we advocate for the increased use of evidence-based research using systematic literature review (SLR) as reference point in IS interventions especially in healthcare settings as digital health interventions increase. We believe the increased use/application of evidence-based research in the domain of IS will be key to identifying and scaling up relevant digital health technologies, and one step forward from “potential” as they are known for. We demonstrate this by liking IS research to medical research in various aspects. We also provide a step-by-step guide to conducting systematic review in IS including strategies on how to harness evidence through strategic use of the contentious grey literature.

Objective: To develop and assess the Quality of Life Instruments for Chronic Diseases-Gout (QLICD-GO [V2.0]). Methods: The instrument was developed using a programmatic decision-making method to combine the general module of the Quality of Life Instruments for Chronic Diseases and a new specific module. The instrument was assessed by measuring the quality of life of 116 patients with gout. Results: The QLICD-GO (V2.0) included 28 items from the general module of chronic diseases and 12 items in three facets from the specific module. In addition to the field of physiological function, the internal consistency reliability of other fields and dimensions of the instrument was >0.7 and the split-half reliability was >0.5. Three common factors were extracted from the specific module, with a cumulative variance contribution rate of 57.54%. The standardized response means of the specific module and the whole instrument were 0.94 and 1.20, respectively. Conclusions: The QLICD-GO (V2.0) has good reliability, validity, and responsiveness. The instrument comprehensively and objectively reflects the quality of life of patients with gout, and it can be used to assess treatment regimens developed by medical staff.

Objectives: The study aimed to identify subgroups of psychiatric patients in a sample of patients admitted at a tertiary care hospital in Oman who received ECT based on their demographic and clinical outcomes. Methods: Data from adult patients who received ECT at Al-Massarh hospital, Muscat, Oman, were retrospectively collected from medical records from January 2015 to December 2019. Socio-demographic characteristics, clinical profiles, and psychiatric comorbidities were examined. Result: A summary of 179 psychiatric patients who received ECT, 96 (53.6%) are females, and the average age at diagnosis was 42.5 years. The 2-step cluster analysis showed 70 patients in Cluster 1 (39.1%) and 109 patients in Cluster 2 (60.9%). Patients in cluster 1 are more females (61.4%), older (Mean=55.2 years), majority were married (95.7%) and unemployed (88.6%). They reported they had comorbidities medical conditions (55.7%) and less frequent ECT use (Mean=8.7) than patients in Cluster 2. Clusters differences were found on gender (p=0.001), age (<.001), marital status (p<.001), and occupation (p=0.001). In clinical outcomes, significant differences were found on diagnosis (p<.001), had comorbidity medical conditions (p<.001), and use of ECT sessions (p=0.006). Conclusion: This study showed that psychiatric patients receiving ECT are heterogeneous, with different demographic and clinical outcomes. Our study has shown that patients in Cluster 1 are older females, unemployed, with more comorbidities in medical conditions and depressive disorders but received fewer ECT sessions. This study provides important information for clinicians to identify strategies to promote the use of ECT on its effectiveness and safety issues for each group.

The manuscript is devoted to the study of the well-posedness, blow- up phenomena and global existence of solution for the Camassa-Holm equation. By the Kato’s theory of semigroup, we first prove that the Cauchy problem of the Camassa-Holm equation is local well-posed in space H^{s,p}(R); s > 1 + 1/p ; 1

This paper addresses the finite-time H∞ control problem of fuzzy semi-Markovian jump systems with immeasurable premise variables by a new observer-based adaptive event-triggered scheme. More general nonlinear systems can be described by the fuzzy system model since the selected premise variables are dependent on system states. Firstly, our work relaxes the restriction of measurable premise variables of nonlinear plant and the fuzzy observer is designed to estimate unmeasurable system states. Then, our work proposes the new observer-based adaptive event-triggered scheme to better save network resources, which is verified by sufficient comparison experiments in the simulation. Furthermore, a novel method is firstly proposed to deal with the asynchronous problem of premise variables, i.e. the premise variables of nonlinear plant, fuzzy observer and event-triggered controller are asynchronous. By applying the delay system method, free-weighting matrix approach and slack matrix variables, novel sufficient conditions are established to guarantee the finite-time H∞ performance of the closed-loop system, where the nonlinear terms caused by network-induced delay and partly unknown transition rates can be tackled by suitable method. Finally, the single-link robot arm system is presented to demonstrate the efficiency and advantages of the proposed fuzzy control scheme.