Effectiveness of sound and darkness interventions for critically ill patients' sleep quality: A systematic review and component network meta-analysis

BACKGROUND

Noise and lighting are prime factors of poor sleep quality in critically ill patients, which impair recovery and increase the risk of delirium or complications.

AIM

To identify and rank the effectiveness of sound and darkness interventions on the sleep quality of critically ill patients.

STUDY DESIGN

This systematic review and component network meta-analysis was based on the Preferred Reporting Items for Systematic Reviews incorporating the Network Meta-Analyses (PRISMA-NMA) Statement. The Embase, MEDLINE, Cochrane CENTRAL, CINAHL, Airiti Library, and Google Scholar databases were searched from inception to August 10, 2021, for randomized controlled trials (RCTs) on sound and darkness interventions targeting critically ill patients' sleep quality. We applied standard and component NMA to determine the effects of interventions. The certainty of evidence was evaluated using the Cochrane risk-of-bias tool (V.2.0) and the online Confidence in Network Meta-Analysis (CINeMA) application.

RESULTS

Twenty-four RCTs with 1507 participants who used combined interventions constituting seven competing interventions were included in the standard NMA. The combination of earplugs, eye masks, and music; eye masks alone; earplugs combined with eye masks; and music alone had beneficial intervention effects. The combination of earplugs, eye masks, and music was the best intervention, and these components had no interaction effect. An eye mask had the best relative effect, followed by music, quiet time, and earplugs.

CONCLUSIONS

This study provides clinical evidence of the effectiveness of using eye masks, music, and earplugs to improve sleep quality in critically ill patients. We also recommend future research using bedtime music, nocturnal eye masks, and quiet time, which had the best relative effects on sleep quality.

RELEVANCE TO CLINICAL PRACTICE

This study provides recommendations for interventions that nurses can use to improve critically ill patients' sleep quality.

Molecular testing-guided therapy versus susceptibility testing-guided therapy in first-line and third-line Helicobacter pylori eradication: two multicentre, open-label, randomised controlled, non-inferiority trials

BACKGROUND

Helicobacter pylori infection is an important causal factor of gastric cancer and peptic ulcer disease and is associated with immune thrombocytopenic purpura and functional dyspepsia. In H pylori strains, point mutations in the 23S rRNA and gyrA genes are associated with clarithromycin resistance and levofloxacin resistance, respectively. Whether the efficacy of molecular testing-guided therapy is non-inferior to that of susceptibility testing-guided therapy for H pylori eradication is unclear. Therefore, we aimed to compare the efficacy and safety of molecular testing-guided therapy and traditional culture-based susceptibility testing-guided therapy in first-line and third-line treatment of H pylori infection.

METHODS

We did two multicentre, open-label randomised trials in Taiwan. In trial 1 (done at seven hospitals), treatment-naive individuals infected with H pylori who were aged 20 years or older were eligible for study inclusion. In trial 2 (done at six hospitals), individuals aged 20 years or older who failed treatment after two or more eradication therapies for H pylori infection were eligible for enrolment. Eligible patients were randomly assigned (1:1) to receive either molecular testing-guided therapy or susceptibility testing-guided therapy. The randomisation sequence was generated by computer using permuted block randomisation with a block size of 4. All investigators were masked to the randomisation sequence. Clarithromycin and levofloxacin resistance were determined by agar dilution test for measuring minimum inhibitory concentrations in the susceptibility testing-guided therapy group, and by PCR and direct sequencing for detection of 23S rRNA and gyrA mutations in the molecular testing-guided therapy group. Study participants received clarithromycin sequential therapy, levofloxacin sequential therapy, or bismuth quadruple therapy according to the resistance status to clarithromycin and levofloxacin. The 13C-urease breath test was used to determine the status of H pylori infection at least 6 weeks after eradication therapy. The primary outcome was the eradication rate by intention-to-treat analysis. The frequency of adverse effects was analysed in patients with available data. The prespecified margins for non-inferiority were 5% for trial 1 and 10% for trial 2. The trials are ongoing for post-eradication follow-up and registered with ClinicalTrials.gov, NCT03556254 for trial 1, and NCT03555526 for trial 2.

FINDINGS

Between March 28, 2018, and April 23, 2021, 560 eligible treatment-naive patients with H pylori infection were recruited and randomly assigned to the molecular testing-guided therapy group or the susceptibility testing-guided therapy group in trial 1. Between Dec 28, 2017, and Oct 27, 2020, 320 eligible patients with refractory H pylori infection were recruited and randomly assigned to the molecular testing-guided therapy group or the susceptibility testing-guided therapy group in trial 2. 272 men and 288 women were recruited for trial 1, and 98 men and 222 women were recruited for trial 2. In first-line H pylori treatment, infection was eradicated in 241 (86%, 95% CI 82-90) of 280 patients in the molecular testing-guided therapy group and 243 (87%, 83-91) of 280 patients in the susceptibility testing-guided therapy group by intention-to-treat analysis (p=0·81). In third-line H pylori treatment, infection was eradicated in 141 (88%, 83-93) of 160 patients in the molecular testing-guided therapy group and 139 (87%, 82-92) of 160 patients in the susceptibility testing-guided therapy group by intention-to-treat analysis (p=0·74). The difference in the eradication rate between the molecular testing-guided therapy group and the susceptibility testing-guided therapy group was -0·7% (95% CI -6·4 to 5·0; non-inferiority p=0·071) in trial 1 and 1·3% (-6·0 to 8·5; non-inferiority p=0·0018 in trial 2 by intention-to-treat analysis. We found no difference in adverse effects across both treatment groups in trial 1 and trial 2.

INTERPRETATION

Molecular testing-guided therapy was similar to susceptibility testing-guided therapy in first-line therapy and non-inferior to susceptibility testing guided therapy in third-line treatment of H pylori infection, supporting the use of molecular testing-guided therapy for H pylori eradication.

FUNDING

Ministry of Science and Technology of Taiwan, and Centre of Precision Medicine of the Higher Education Sprout Project by the Ministry of Education of Taiwan.

Second-line levofloxacin-based quadruple therapy versus bismuth-based quadruple therapy for Helicobacter pylori eradication and long-term changes to the gut microbiota and antibiotic resistome: a multicentre, open-label, randomised controlled trial

BACKGROUND

Levofloxacin-based therapy or bismuth-based quadruple therapy are the recommended second-line regimens for Helicobacter pylori eradication after failure of clarithromycin-based therapy. However, resistance to levofloxacin has increased in the past decade. Furthermore, little is known about the long-term effects of H pylori eradication on the antibiotic resistome. In this study, we compared these second-line eradication therapies for efficacy, tolerability, and short-term and long-term effects on the gut microbiota, antibiotic resistome, and metabolic parameters.

METHODS

We did a multicentre, open-label, parallel group, randomised controlled trial at eight hospitals in Taiwan. Adult patients (age ≥20 years) with persistent H pylori infection after first-line clarithromycin-based therapy were randomly assigned (1:1, permuted block sizes of four) to receive levofloxacin-based sequential quadruple therapy for 14 days (EAML14; esomeprazole 40 mg and amoxicillin 1 g for 7 days, followed by esomeprazole 40 mg, metronidazole 500 mg, and levofloxacin 250 mg for 7 days, all twice-daily) or bismuth-based quadruple therapy for 10 days (BQ10; esomeprazole 40 mg twice daily, bismuth tripotassium dicitrate 300 mg four times a day, tetracycline 500 mg four times a day, and metronidazole 500 mg three times a day). All investigators were masked to the randomisation sequence. The primary endpoint was H pylori eradication rate measured by ¹³C urea breath test 6 weeks after second-line treatment according to both intention-to-treat (ITT) and per-protocol analysis. The microbiota composition and antibiotic resistome of faecal samples collected at baseline (before treatment) and at 2 weeks, 8 weeks, and 1 year after eradication therapy was profiled by shotgun metagenomic sequencing and 16S rRNA gene sequencing. The frequency of adverse effects and changes in the gut microbiota and antibiotic resistome were assessed in all participants with available data. The trial is complete and registered with ClinicalTrails.gov, NCT03148366.

FINDINGS

Between Feb 25, 2015, and Dec 11, 2020, 560 patients were randomly assigned to receive EAML14 or BQ10 (n=280 per group; 261 [47%] men and 299 [53%] women). Mean age was 55·9 years (SD 12·7) in the EAML14 group and 54·9 years (12·3) in the BQ10 group. Eradication of H pylori was achieved in 246 (88%) of 280 participants in the EAML14 group and 245 (88%) of 280 in the BQ10 group according to ITT analysis (risk difference -0·4%, 95% CI -5·8 to 5·1; p=0·90). In the per-protocol analysis, 246 (90%) of 273 participants in the EAML14 group and 245 (93%) of 264 participants in the BQ10 group achieved H pylori eradication (risk difference 2·7%, 95% CI -0·2 to 7·4; p=0·27). Transient perturbation of faecal microbiota diversity at week 2 was largely restored to basal state 1 year after EAML14 or BQ10. Diversity recovery was slower with BQ10, and recovery in species abundance was partial after both therapies. On shotgun sequencing, we observed significant increases in total resistome after EAML14 (p=0·0002) and BQ10 (p=4·3 × 10^-10) at week 2, which were restored to pretreatment level by week 8. The resistance rates of Escherichia coli and Klebsiella pneumonia to levofloxacin, ciprofloxacin, ampicillin (ampicillin-sulbactam for K pneumonia), and various cephalosporins were significantly increased in the EAML14 group compared with in the BQ10 group at week 2, which were restored to pretreatment levels and showed no significant differences at week 8 and 1 year. The frequency of any adverse effects was significantly higher after BQ10 therapy (211 [77%] of 273 participants) than after EAML14 therapy (134 [48%] of 277; p<0·0001).

INTERPRETATION

We found no evidence of superiority between levofloxacin-based quadruple therapy and bismuth-based quadruple therapy in the second-line treatment of H pylori infection. The transient increase in the antibiotic resistome and perturbation of faecal microbiota diversity were largely restored to pretreatment state from 2 months to 1 year after eradication therapy.

FUNDING

The Ministry of Science and Technology of Taiwan, the Ministry of Health and Welfare of Taiwan, National Taiwan University Hospital, Taipei Veteran General Hospital, and the Australian Federal Government through the St George and Sutherland Medical Research Foundation.

TRANSLATION

For the Chinese translation of the abstract see Supplementary Materials section.

Declining trends of prevalence of Helicobacter pylori infection and incidence of gastric cancer in Taiwan: An updated cross-sectional survey and meta-analysis

BACKGROUND

We aimed to assess the latest prevalence and secular trend of Helicobacter pylori infection and its association with the incidence and mortality of gastric cancer in Taiwan.

MATERIALS AND METHODS

Adults naive to H. pylori eradication received ¹³ C-urea breath test (¹³ C-UBT), H. pylori stool antigen test, and serology test during 2019-2020 in this prospective screening program. Children and adolescent aged between 7 and 19 years received ¹³ C-UBT for H. pylori screening. We also conducted a systematic review and meta-analysis to assess the secular trend of prevalence of H. pylori from 1990 to 2020 in Taiwan. The secular trends of age-standardized incidence and mortality of gastric cancer were obtained from the Taiwan Cancer Registry.

RESULTS

A total of 1494 participants were enrolled, including 294 children or adolescents and 1200 adults. The overall prevalence of active H. pylori infection by ¹³ C-UBT was 26.6% (397/1494), which was 30.8% in adults and 9.5% in adolescents/children. The age-standardized prevalence of active H. pylori infection was 32.3% in adults after adjustment of the population structure in Taiwan. Of the 29 studies including 38,597 subjects eligible for the meta-analysis, the pooled prevalence of H. pylori infection decreased from 63.8% (95% CI: 55.9%-71%) in 1990-2000 to 28.2% (95% CI:21.8%-35.6%) in 2016-2020. The age-standardized incidence and mortality of gastric cancer have also declined from 15.2 to 10.75 per 100,000, respectively, in 1999 to 9.29 and 5.4 per 100,000, respectively, in 2019.

CONCLUSIONS

The prevalence of H. pylori infection has declined in Taiwan, which correlates with the declining trends of age-standardized incidence and mortality of gastric cancer in Taiwan.

Ansamitocin P3-Loaded Gold-NanoCage Conjugated with Immune Checkpoint Inhibitor to Enhance Photo-Chemo-Thermal Maturation of Dendritic Cells for Hepatocellular Carcinoma

Immunotherapy is a newly developed method for cancer treatment, but still generates limited response in partial patients for hepatocellular carcinoma (HCC) because the immunity cycle is limited by the tumor microenvironment (TME). Herein, we introduce multifunctional gold nanocages (AuNCs)-based nanocarriers with Ansamitocin P3 (AP3) loaded and anti-PDL1 binding (AP3-AuNCs-anti-PDL1) which can combine photothermal therapy, chemotherapeutic agent-triggered DCs maturation, and checkpoint immunotherapy in one platform. The AP3-AuNCs-anti-PDL1 using Avidin-biotin to bind anti-PDL1 on the surface of AP3-AuNCs showed specifically cellular targeting compared to AuNCs, which can increase the immune responses. The AP3-AuNCs+NIR-10 min exhibited the highly activated DCs maturation with two-fold higher than control+NIR, which can be attributed to the significant release of AP3. The results illustrated the synergistic effect of tumor-associated antigens (TAAs) and controlled AP3 release under near infrared (NIR) in triggering effective DCs maturation. Among them, AP3 release played the more important role than the TAAs under PTT in promoting T-cell activation. These results illustrate the promising potential of AuNCs-based nanocarriers combined with AP3 and the checkpoint inhibitors to strengthen the positive loop of immunity cycle.

A Theory-Based Self-Management Training Program for Older Adult Peer Leaders with Diabetes: A Feasibility Assessment

Objective

To improve the quality of peer leader training, this study developed a theory-based self-management training program for older adult peer leaders with diabetes and assessed its feasibility.

Background

Current self-management programs are designed mainly to be implemented by healthcare professionals, but healthcare staff may not fully perceive the needs and obstacles of older adults in disease management due to a lack of similar illness experience. To target this problem, peer leaders with successful self-management experiences, similar cultural backgrounds and languages, and related illness experiences are trained to guide and mentor peer patients in self-management programs.

Study Design and Methods

This study was conducted in two stages. In stage 1, a peer leader training program was developed based on experiential learning theory as the framework and self-regulation theory as the activity design strategy. In stage 2, program feasibility was assessed via participants’ feedback toward the training program by three indicators: attendance, future willingness to lead the peer-led self-management program, and leadership skills evaluated by a peer leader training assessment tool.

Results

In this study, peer leaders demonstrated good leadership skills by expressing active willingness to lead self-management programs in the community. Peer leaders’ feedback indicated that the program’s training content was helpful in preparing peer leaders to guide older adults in learning self-management skills and in improving the abilities and confidence of peer leaders in mentoring self-management.

Conclusion

Findings in this study showed that peer leader training can impact the effectiveness and success of self-management in older adults with diabetes. Even in a small-scale study, the impact was evident, which demonstrated the feasibility of the program. More large-scale studies on the effectiveness of various peer leader training programs in diverse disciplines are recommended.

Clinical Trials Registry

ClinicalTrials.gov Identifier: NCT04298424 (the Peer-Led Self-Management Program).

CaNRT2.1 Is Required for Nitrate but Not Nitrite Uptake in Chili Pepper Pathogen Colletotrichum acutatum

Chili peppers are an important food additive used in spicy cuisines worldwide. However, the yield and quality of chilis are threatened by anthracnose disease caused by Colletotrichum acutatum. Despite the impact of C. acutatum on chili production, the genes involved in fungal development and pathogenicity in this species have not been well characterized. In this study, through T-DNA insertional mutagenesis, we identified a mutant strain termed B7, which is defective for the growth of C. acutatum on a minimal nutrient medium. Our bioinformatics analysis revealed that a large fragment DNA (19.8 kb) is deleted from the B7 genome, thus resulting in the deletion of three genes, including CaGpiP1 encoding a glycosylphosphatidyl-inisotol (GPI)-anchored protein, CaNRT2.1 encoding a membrane-bound nitrate/nitrite transporter, and CaRQH1 encoding a RecQ helicase protein. In addition, T-DNA is inserted upstream of the CaHP1 gene encoding a hypothetical protein. Functional characterization of CaGpiP1, CaNRT2.1, and CaHP1 by targeted gene disruption and bioassays indicated that CaNRT2.1 is responsible for the growth-defective phenotype of B7. Both B7 and CaNRT2.1 mutant strains cannot utilize nitrate as nitrogen sources, thus restraining the fungal growth on a minimal nutrient medium. In addition to CaNRT2.1, our results showed that CaGpiP1 is a cell wall-associated GPI-anchored protein. However, after investigating the functions of CaGpiP1 and CaHP1 in fungal pathogenicity, growth, development and stress tolerance, we were unable to uncover the roles of these two genes in C. acutatum. Collectively, in this study, our results identify the growth-defective strain B7 via T-DNA insertion and reveal the critical role of CaNRT2.1 in nitrate transportation for the fungal growth of C. acutatum.

Frequent loss of CD10 expression in follicular lymphoma with leukaemic presentation

INTRODUCTION

Follicular lymphoma (FL) is usually a nodal lymphoma expressing CD10, rarely with leukaemic presentation (FL-LP).

MATERIALS AND METHODS

We searched for FL-LP in our institution from 2000 to 2018 and characterised the neoplastic cells by flow cytometry, immunohistochemistry and fluorescence in situ hybridization. Thirteen (6.1%) of 212 FL cases were FL-LP, all de novo neoplasms. The leukaemic cells were small in 12 cases and large in one. All had concurrent FL, mostly (92%; 12/13) low-grade. The single case with large leukaemic cells had a concurrent primary splenic low-grade FL and a double-hit large B-cell lymphoma in the marrow.

RESULTS

CD10 was expressed in the leukaemic cells in 38% (5/13) cases by flow cytometry and in 77% (10/13) cases in tumours (p= 0.0471). IGH/BCL2 reciprocal translocation was identified in 85% (11/13) cases. Most patients were treated with chemotherapy. In a median follow-up time of 36 months, nine patients were in complete remission. The 2- and 5-year survival rates were at 100% and 83%, respectively. In this study, we characterised a series of de novo FL-LP in Taiwan. All patients had concurrent nodal and/or tissue tumours, which might suggest that these patients seek medical help too late.

CONCLUSION

The lower CD10 expression rate by flow cytometry than by immunohistochemistry might be due to different epitopes for these assays. Alternatively, loss of CD10 expression might play a role in the pathogenesis of leukaemic change. The clinical course of FL-LP could be aggressive, but a significant proportion of the patients obtained complete remission with chemotherapy.

Comparison of the effect of clarithromycin triple therapy with or without N-acetylcysteine in the eradication of Helicobacter pylori: a randomized controlled trial

BACKGROUND

Whether adjunctive N-acetylcysteine (NAC) may improve the efficacy of triple therapy in the first-line treatment of Helicobacter pylori infection remains unknown. Our aim was to compare the efficacy of 14-day triple therapy with or without NAC for the first-line treatment of H. pylori.

MATERIAL AND METHODS

Between 1 January 2014 and 30 June 2018, 680 patients with H. pylori infection naïve to treatment were enrolled in this multicenter, open-label, randomized trial. Patients were randomly assigned to receive triple therapy with NAC [NAC-T14, dexlansoprazole 60 mg four times daily (q.d.); amoxicillin 1 g twice daily (b.i.d.), clarithromycin 500 mg b.i.d., NAC 600 mg b.i.d.] for 14 days, or triple therapy alone (T14, dexlansoprazole 60 mg q.d.; amoxicillin 1 g b.i.d., clarithromycin 500 mg b.i.d.) for 14 days. Our primary outcome was the eradication rates by intention to treat (ITT). Antibiotic resistance and CYP2C19 gene polymorphism were determined.

RESULTS

The ITT analysis demonstrated H. pylori eradication rates in NAC-T14 and T14 were 81.7% [276/338, 95% confidence interval (CI): 77.5-85.8%] and 84.3% (285/338, 95% CI 80.4-88.2%), respectively. In 646 participants who adhered to their assigned therapy, the eradication rates were 85.7% and 88.0% with NAC-T14 and T14 therapies, respectively. There were no differences in compliance or adverse effects. The eradication rates in subjects with clarithromycin-resistant, amoxicillin-resistant, or either clarithromycin/amoxicillin resistant strains were 45.2%, 57.9%, and 52.2%, respectively, for NAC-T14, and were 66.7%, 76.9%, and 70.0%, respectively, for T14. The efficacy of NAC-T14 and T14 was not affected by CYP2C19 polymorphism.

CONCLUSION

Add-on NAC to triple therapy was not superior to triple therapy alone for first-line H. pylori eradication [ClinicalTrials.gov identifier: NCT02249546].

Microelimination of Chronic Hepatitis C by Universal Screening Plus Direct-Acting Antivirals for Incarcerated Persons in Taiwan

Background

Incarcerated persons are a special population with higher hepatitis C virus (HCV) prevalence and should be prioritized for microelimination. In this study, we investigate the seroprevalence and evaluate the effectiveness and safety of direct-acting antiviral (DAA) therapy in custodial settings.

Methods

Incarcerated persons in Yunlin Prison were recruited to receive anti-HCV antibody screening. Patients with positive HCV ribonucleic acid (RNA) were treated with glecaprevir/pibrentasvir (GLE/PIB) in our special chronic hepatitis C (CHC) clinic in prison. The primary endpoint was sustained virologic response at week 12 off therapy (SVR12).

Results

A total of 1402 incarcerated persons were invited to anti-HCV screening and 824 (58.7%) accepted. The prevalence of anti-HCV positivity was 33.5% (276 of 824), and the viremic rate (detectable HCV RNA) was 69.2% (191 of 276). According to fibrosis index based on 4 factors, patients with F3 stage were 6 (3.1%), but none met the criteria of F4 stage. However, 6 (3.1%) had liver cirrhosis with splenomegaly, confirmed by findings of ultrasonography. The median log₁₀ HCV RNA level at baseline was 6.235 (2.394–7.403). Genotype (GT) 6 was predominant (39.3%), followed by GT 1a (22.0%) and 1b (14.1%). Mixed GT HCV infection accounted for 3.6% of total infections. In total, 165 patients received GLE/PIB therapy. The overall SVR12 rates were 100%.

Conclusions

Direct-acting antiviral therapy is highly effective and safe for incarcerated patients in Taiwan. Our special prison-based CHC clinic, linking universal screening to medical care, can serve as a model for microelimination of HCV in custodial settings.

Application of Helicobacter pylori stool antigen test to survey the updated prevalence of Helicobacter pylori infection in Taiwan

BACKGROUND AND AIM

The reported prevalence of Helicobacter pylori infection in Taiwan was 54.4% in 1992. An updated prevalence of H. pylori infection in asymptomatic adults is lacking in Taiwan. We aimed to assess the updated age-standardized prevalence of H. pylori infection in asymptomatic subjects and in patients with dyspepsia and to assess the accuracy of H. pylori stool antigen (HpSA) test for screening of H. pylori in Chinese population.

METHODS

Asymptomatic adult subjects (N = 189) were screened for H. pylori infection using HpSA, serology, and ¹³ C-urea breath test (¹³ C-UBT) in 2016-2017. Adult patients with dyspepsia (N = 145) were screened for H. pylori using ¹³ C-UBT, HpSA, serology, rapid urease test, and histology during 2016-2018. Two types of HpSA, including the Diagnostec HpSA ELISA Kit (HpSA ELISA) and Rapid Test Kit (HpSA Rapid), were used in this study. Sensitivity, specificity, and accuracy of the HpSA tests were calculated using the ¹³ C-UBT as golden standard test.

RESULTS

The unadjusted prevalence of H. pylori was 21.2% in asymptomatic adults and 37.9% in patients with dyspepsia (P < 0.001). The age-standardized prevalence of H. pylori was 28.9% in asymptomatic adults in Taiwan. Of the 334 patients included for analysis, the area under the curve of HpSA ELISA test was 0.978, and the optimal cutoff value of optical density was 0.03. The sensitivity, specificity, and accuracy of the HpSA ELISA were 0.929, 0.983, and 0.967, respectively. The sensitivity, specificity, and accuracy of the HpSA Rapid were 0.929, 0.958, and 0.949, respectively.

CONCLUSIONS

The prevalence of H. pylori infection has decreased in Taiwan. HpSA test is an accurate tool for screening of H. pylori in Chinese population.

Accuracy of rapid Helicobacter pylori antigen tests for the surveillance of the updated prevalence of H. pylori in Taiwan

BACKGROUND

The updated prevalence of Helicobacter pylori (H. pylori) is lacking in Taiwan. We aimed to assess the accuracy of Vstrip® H. pylori Stool Antigen Rapid Test (Vstrip®HpSA) in the detection and surveillance of the updated prevalence of H. pylori in Taiwan.

METHODS

A total of 347 adult subjects including 152 volunteers and 195 symptomatic patients were recruited. Stool samples were collected for detection of H. pylori using Vstrip® HpSA, ImmunoCard STAT!® HpSA and Premier Platinum HpSA® PLUS. All subjects who have completed the stool sample collections were included in the ITT analysis. The sensitivity, specificity, and accuracy of Vstrip® HpSA were calculated compared to gold standard test with ¹³C-Urea breath test.

RESULTS

The un-adjusted prevalence of H. pylori infection was 22.5% (95% CI: 18.3-27%) in 2018. The age-standardized prevalence of H. pylori was 21.8% in asymptomatic adults in Taiwan. The sensitivity, specificity, and accuracy of the Vstrip® HpSA, and ImmunoCard STAT!® HpSA tests were 91% (95% CI: 82-96%) versus 76.9% (95% CI: 66-86%), 97% (95% CI: 94.1-98.6%) versus 97% (95% CI: 94.1-98.6%), and 95.7% (95% CI: 92-97%) versus 92.5% (95% CI: 89-95%), respectively.

CONCLUSION

The age-standardized prevalence of H. pylori infection in Taiwan was 21.8% in asymptomatic adults in 2018. The Vstrip® HpSA had equivalent performance as the ImmunoCard STAT!® HpSA, and can be used in future mass screening of H. pylori infection for gastric cancer prevention.

Real-world effectiveness and safety of glecaprevir/pibrentasvir in Asian patients with chronic hepatitis C

BACKGROUND

Glecaprevir/pibrentasvir (GLE/PIB) is a pangenotypic direct-acting antiviral agent for the treatment of chronic hepatitis C virus (HCV) infection. Real-world data of GLE/PIB in Asian patients other than Japanese are limited. We thus investigated the effectiveness and safety profile of GLE/PIB in Taiwanese patients with chronic hepatitis C (CHC).

METHODS

CHC patients who received 8, 12, or 16 weeks of GLE/PIB between August and October of 2018 were consecutively enrolled. The treatment duration was determined according to drug label. The hepatic fibrosis was staged according to liver histology, transient elastography, fibrosis index based on 4 factors (FIB-4), or findings of ultrasonography/endoscopy. The primary endpoint was sustained virological response at week 12 off therapy (SVR12). The safety profiles were also assessed.

RESULTS

A total of 110 CHC patients with 51% of males were enrolled. The median age was 70 years. A majority (82%) of patients were infected with HCV genotype 2. Forty-six (42%) and 64 (58%) patients had advanced hepatic fibrosis and compensated cirrhosis, respectively. Forty-five (41%) non-cirrhotic patients were treated for 8 weeks. The overall SVR12 rates were 100%, regardless of baseline clinical characteristics. The common adverse events (AEs) were pruritus (12%), anorexia (6%), and fatigue (5%). Nine (8%) serious AEs unrelated to GLE/PIB occurred. Three (2%) patients had Grade 3 elevation of total bilirubin level. None had premature treatment termination, hepatic decompensation, or death.

CONCLUSION

Interferon-free GLE/PIB regimen is highly effective and safe for Asian chronic hepatitis C patients with advanced hepatic fibrosis or compensated cirrhosis.

A systematic review and meta-analysis: Effectiveness of internet empowerment-based self-management interventions on adults with metabolic diseases

AIM

To synthesize the effects of Internet empowerment-based self-management interventions on adults with metabolic diseases.

BACKGROUND

Metabolic diseases are prevalent and burden healthcare systems; they have become a major health problem worldwide. The effects of IESMIs on lifestyle changes have been shown to improve adults' physiological and psychological conditions. However, we found no systematic review evaluating these effects.

DESIGN

Systematic review and meta-analysis of randomized and non-randomized controlled trials, conducted according to the Cochrane handbook.

DATA RESOURCES

A literature search was conducted using the Airiti Library, Association for Computing Machinery, CINAHL, Cochrane Library, Embase, ProQuest, PubMed/MEDLINE and Index of the Taiwan Periodical Literature System databases (earliest-June 2016).

REVIEW METHODS

Two reviewers used the Cochrane Collaboration bias assessment tool to assess the methodological quality of included studies. Extracted data were entered and analysed using RevMan 5.3.5 software. Inverse variance was used to estimate effect sizes. Weighted and standardized mean differences with 95% confidence intervals were calculated using a random effects model. Subgroup and sensitivity analyses were performed.

RESULTS

Twenty-one randomized controlled trials were reviewed. Meta-analysis showed that the intervention significantly improved adults' exercise habits, glycated haemoglobin (HbA1c) levels, body weight, empowerment levels and quality of life.

CONCLUSION

The intervention significantly improve the health status of adults with metabolic diseases, in particular their exercise habits, HbA1c levels, body weight, empowerment and quality of life. The intervention provides more convenient and faster access to healthcare for busy individuals with time constraints. These results suggest that healthcare professionals could develop accessible and friendly interactive online interfaces for patients to expand the use of these interventions in the clinical setting.

[The Efficacy of Near-Infrared Devices in Facilitating Peripheral Intravenous Access in Children: A Systematic Review and Subgroup Meta-Analysis]

BACKGROUND

Peripheral intravenous access is a common and invasive procedure that is performed in pediatric clinical settings. Children often have difficult intravenous-access problems that may not only increase staff stress but also affect the timeliness of immediate treatments.

PURPOSE

To determine the efficacy of near-infrared devices in facilitating peripheral intravenous access in children, using a systematic review and meta-analysis.

METHODS

Six databases, namely the Index to Taiwan Periodical Literature System, Airiti Library, CINAHL, Cochrane Library, PubMed/MEDLINE, and ProQuest were searched for related articles that were published between the earliest year available and February 2017. The search was limited to studies on populations of children that used either a randomized controlled trial or controlled clinical trial approach and used the key words "near-infrared devices" AND "peripheral intravenous access." The 12 articles that met these criteria were included in the analysis. The Cochrane Collaboration bias assessment tool was used to assess the methodological quality. In addition, RevMan 5.3.5 software was used to conduct the meta-analysis.

RESULTS

The near-infrared devices did not significantly improve the first-attempt success rate, number of attempts, or the procedural time of peripheral intravenous access in children. However, the subgroup analysis of difficult intravenous-access factors revealed a significant improvement in the first-attempt success rate of children with difficult intravenous access scores (OR = 1.83, p = .03).

CONCLUSIONS / IMPLICATIONS FOR PRACTICE

Near-infrared devices may improve the first-attempt success rate in children with difficult intravenous access by allowing healthcare professionals to visualize the peripheral veins. Therefore, we suggest that the difficult intravenous-access score be used as a screening tool to suggest when to apply near-infrared devices to children with difficult peripheral intravenous access in order to maximize efficacy of treatment.

[Efficacy of Ultrasound-Guided Peripheral Intravenous Access: A Systematic Review and Meta-Analysis]

BACKGROUND

Peripheral intravenous access is a common, invasive procedure that is performed in clinical practice. Difficult intravenous access may not only jeopardize patient safety but also increase staff stress, nursing hours, and material costs.

PURPOSE

To explore the efficacy of ultrasound-guided peripheral intravenous access in difficult intravenous-access patients and in the two subgroups of adult patients and pediatric patients using systematic review and meta-analysis.

METHODS

Six Chinese and English databases, including the Index to Taiwan Periodical Literature System, Airiti Library, CINAHL, Cochrane Library, PubMed/MEDLINE, and ProQuest, were searched for related articles that were published between the earliest year available and April 2016. The search was limited to studies that used randomized control trials (RCTs) or controlled clinical trials (CCTs) and the associated key words "ultrasound-guided" AND "peripheral intravenous access". The 12 articles that met these criteria were used in the analysis. The Joanna Briggs Institute (JBI) critical appraisal checklist was used to assess methodological quality and RevMan 5.3 software was used to conduct the meta-analysis.

RESULTS

The ultrasound-guided technique was found to improve the success rate of intravenous access significantly (OR = 3.00, p < .0001) and to decrease the number of attempts (MD = -0.61, p = .03) in the overall group of difficult intravenous-access patients. The subgroup analysis found a significantly improved success rate and decreased number of attempts in difficult intravenous-access adult patients and significantly decreased procedural times in difficult intravenous-access pediatric patients.

CONCLUSIONS / IMPLICATIONS FOR PRACTICE

The ultrasound-guided technique may improve the efficacy of intravenous access by helping health care professionals visualize the peripheral veins. We suggest that patient characteristics, ultrasound accessibility, and the feasibility of staff training be assessed in order to provide ultrasound guidance that improves the efficacy of intravenous access.

The effects of nursing preceptorship on new nurses' competence, professional socialization, job satisfaction and retention: A systematic review

AIMS

The aim of this study was to determine the effects of nursing preceptorship on the competence, job satisfaction, professional socialization and retention of new nurses.

BACKGROUND

Although studies have focused on the effects of nursing preceptorship on new nurses' competence and retention, a systematic review of the overall effects is lacking.

DESIGN

A quantitative systematic review.

DATA SOURCES

Five English/Chinese databases were searched for original articles published before June 2015 and only six articles published between 2001-2014 were included in the final analysis.

REVIEW METHODS

Joanna Briggs Methodology was used to process one randomization control trial, one quasi-experimental study and four observational studies. Two appraisers independently reviewed each study using the standardized critical appraisal tools from the Joanna Briggs Institute.

RESULTS

The most adopted preceptorship was a fixed preceptor/preceptee model and one-on-one for 1-3-month duration. It showed that new nurses' overall competence increased significantly due to preceptorship. Only a few studies explored the effects of preceptorship on the job satisfaction and professional socialization of new nurses. Clear conclusions regarding the effect of preceptorship on nurses' retention rate could not be made because of inconsistent time points for calculation and a lack of control groups in the study design.

CONCLUSIONS

Preceptorship can improve new nurses' nursing competence; however, more studies are needed to ascertain its effects on new nurses' retention rates, job satisfaction and professional socialization to promote nursing care quality and resolve nursing shortages.

Effectiveness of empowerment-based self-management interventions on patients with chronic metabolic diseases: a systematic review and meta-analysis

BACKGROUND

Management of chronic metabolic diseases has recently become an important global health issue. Extensive research on empowerment-based self-management interventions (EBSMIs) for patients with chronic metabolic diseases has been conducted, but no systematic review has evaluated their effects.

AIM

To evaluate the effects of EBSMIs on patients with chronic metabolic diseases.

METHODS

A systematic review and meta-analysis was conducted. Five electronic databases (Airiti Library, CINAHL, Cochrane Library, PubMed/ MEDLINE, and Index of Taiwan Periodical Literature System) were searched from the earliest year available to October 2012. Controlled trials about the effectiveness of interventions on patients with chronic metabolic diseases were included. Each study was appraised by three reviewers and assigned a level of evidence based on the modified Jadad scale. Extracted data were entered and analyzed using Review Manager 5.2.

FINDINGS

Nineteen studies were reviewed. Most studies showed that EBSMIs improved patients' hemoglobin A1c test (HbA1c) (p < .00001), waist circumference (p = .02), and empowerment level (p = .004). Four studies compared the effect on body weight and body mass index, but the overall effect was not significant (p = .33 and .73, respectively). Five studies compared the effect on self-efficacy, four of which indicated significant increase. However, the overall effect on self-efficacy was not compared because studies used different scales.

LINKING EVIDENCE TO ACTION

EBSMIs improved HbA1c test results, waist circumference, self-efficacy, and empowerment level in patients with chronic metabolic diseases. When implementing the EBSMIs, healthcare institutions need to provide training programs related to empowerment from which health professionals can acquire competence in patient empowerment. Moreover, healthcare leaders should assess and overcome barriers (e.g., time, manpower, cost, etc.) to implementing EBSMIs in clinical settings.

Analysis of microsatellites in the vulnerable orchid Gastrodia flavilabella: the development of microsatellite markers, and cross-species amplification in Gastrodia

BACKGROUND

Gastrodia flabilabella is a mycoheterotrophic orchid that obtains carbohydrates and nutrients from its symbiotic mycorrhizal fungi. The species is an endemic and vulnerable species enlisted in the "A Preliminary Red List of Taiwanese Vascular Plants" according to the IUCN Red List Categories and Criteria Version 3.1. G. flabilabella dwells the underground of broadleaf and coniferous forest with richness litter. Based on herbarium records, this species is distributed in central Taiwan. Twenty eight microsatellite loci were developed in G. flabilabella and were tested for cross-species amplification in additional taxa of G. confusoides, G. elata, and G. javanica. We estimated the genetic variation that is valuable for conservation management and the development of the molecular identification system for G. elata, a traditional Chinese medicine herb.

RESULTS

Microsatellite primer sets were developed from G. flabilabella using the modified AFLP and magnetic bead enrichment method. In total, 257 microsatellite loci were obtained from a magnetic bead enrichment SSR library. Of the 28 microsatellite loci, 16 were polymorphic, in which the number of alleles ranged from 2 to 15, with the observed heterozygosity ranging from 0.02 to 1.00. In total, 15, 13, and 7 of the loci were found to be interspecifically amplifiable to G. confusoides, G. elata, and G. javanica, respectively.

CONCLUSIONS

Amplifiable and transferable microsatellite loci are potentially useful for future studies in investigating intraspecific genetic variation, reconstructing phylogeographic patterns among closely related species, and establishing the standard operating system of molecular identification in Gastrodia.

[Appraisal of the application of empowerment elements and strategies: the example of chronic metabolic diseases]

BACKGROUND

The empowerment concept has been applied to chronic metabolic diseases. However, literature reviews to date are inadequate to assess their utilization status.

PURPOSE

This study was developed to assess the application of empowerment elements and strategies to chronic metabolic diseases and then propose suggestions for improvement.

METHODS

A literature review was conducted using five Chinese- and English-language electronic databases, including PubMed/MEDLINE. A total of 21 articles on randomized clinical trials related to the application of empowerment intervention program to chronic metabolic diseases were appraised to examine empowerment element and strategy usage.

RESULTS

The empowerment concept was applied mostly with diabetes groups (90.48%). Application rates for the six major elements were 95.24% in action, 47.62% in dialogue, 33.33% in feedback, 23.81% in building partnership, 23.81% in reflection, and 19.05% in listening. Application rates for the six major strategies were 95.24% in action planning and behavior change, 80.95% in goal-setting and plan, 52.38% in problem solving and obstacle overcoming, 47.62% in identifying concerns and problems, 33.33% in motivation and self-awareness, and 23.81% in review and continuous self-management. CONCLUSION / IMPLICATIONS FOR PRACTICE: Healthcare professionals are found generally lacking in the application of elements including "building partnership," "listening," and "reflection" and strategies including "motivation and self-awareness" and "review and continuous self-management" when applying empowerment programs to chronic metabolic disease patients. Therefore, the authors suggest that healthcare professionals fully apply the six major empowerment elements and strategies to clinical practice and studies to help thoroughly promote the spirit of empowerment and empower patients with chronic disease to take charge of their life and recovery.

Vertical-cavity and randomly scattered lasing from different thicknesses of epitaxial ZnO films grown on Y₂O₃-buffered Si (111)

Two different types of lasing modes, vertical Fabry-Perot cavity and random lasing, were observed in ZnO epi-films of different thicknesses grown on Si (111) substrates. Under optical excitation at room temperature by a frequency tripled Nd:YVO₄ laser with wavelength of 355 nm, the lasing thresholds are low due to high crystalline quality of the ZnO epitaxial films, which act as microresonators. For the thick ZnO layer (1,200 nm), its lasing action is originated from the random scattering due to the high density of crack networks developed in the thick ZnO film. However, the low crack density of the thin film (555 nm) fails to provide feedback loops essential for random scattering. Nevertheless, even the lower threshold lasing is achieved by the Fabry-Perot cavity formed by two interfaces of the thin ZnO film. The associated lasing modes of the thin ZnO film can be characterized as the transverse Gaussian modes attributed to the smooth curved surfaces.

Single domain m-plane ZnO grown on m-plane sapphire by radio frequency magnetron sputtering

High-quality m-plane orientated ZnO films have been successfully grown on m-plane sapphire by using radio frequency magnetron sputtering deposition. The introduction of a nanometer-thick, low-temperature-grown ZnO buffer layer effectively eliminates inclusions of other undesirable orientations. The structure characteristics of the ZnO epi-layers were thoroughly studied by synchrotron X-ray scattering and transmission electron microscopy (TEM). The in-plane epitaxial relationship between ZnO and sapphire follows (0002)(ZnO) [parallel] (112[overline]0)(sapphire) and (112[overline]0)(ZnO) [parallel] (0006)(sapphire) and the ZnO/sapphire interface structure can be described by the domain matching epitaxy along the [112[overline]0](ZnO) direction. The vibrational properties of the films were investigated by polarization dependent micro-Raman spectroscopy. Both XRD and micro-Raman results reveal that the obtained m-ZnO layers are under an anisotropic biaxial strain but still retains a hexagonal lattice.

Detection of Rickettsia spp. and host and habitat associations of fleas (Siphonaptera) in eastern Taiwan

Rickettsia typhi and Rickettsia felis (Rickettsiales: Rickettsiaceae) are two rickettsiae principally transmitted by fleas, but the detection of either pathogen has rarely been attempted in Taiwan. Of 2048 small mammals trapped in eastern Taiwan, Apodemus agrarius Pallas (24.5%) and Mus caroli Bonhote (24.4%) (both: Rodentia: Muridae) were the most abundant, and M. caroli hosted the highest proportion of fleas (63.9% of 330 fleas). Two flea species were identified: Stivalius aporus Jordan and Rothschild (Siphonaptera: Stivaliidae), and Acropsylla episema Rothschild (Siphonaptera: Leptopsyllidae). Nested polymerase chain reaction targeting parts of the ompB and gltA genes showed six fleas to be positive for Rickettsia spp. (3.8% of 160 samples), which showed the greatest similarity to R. felis, Rickettsia japonica, Rickettsia conorii or Rickettsia sp. TwKM01. Rickettsia typhi was not detected in the fleas and Rickettsia co-infection did not occur. Both flea species were more abundant during months with lower temperatures and less rainfall, and flea abundance on M. caroli was not related to soil hardness, vegetative height, ground cover by litter or by understory layer, or the abundance of M. caroli. Our study reveals the potential circulation of R. felis and other rickettsiae in eastern Taiwan, necessitating further surveillance of rickettsial diseases in this region. This is especially important because many novel rickettsioses are emerging worldwide.

Effect of phenethyl isothiocyanate on Ca2+ movement and viability in MDCK canine renal tubular cells

The effect of the natural compound phenethyl isothiocyanate (PEITC) on cytosolic Ca2+ concentrations ([Ca2+]i) and viability in MDCK renal cells is unknown. This study explored whether PEITC changed [Ca2+]i in MDCK cells using the Ca2+-sensitive fluorescent dye fura-2. PEITC at 200–700 μM increased [Ca2+]i in a concentration-dependent manner. The signal was reduced by removing extracellular Ca2+. PEITC-induced Ca2+ influx was inhibited by nifedipine, econazole, SK&F 96365 and protein kinase C modulators. In Ca2+-free medium, treatment with the endoplasmic reticulum Ca2+ pump inhibitor thapsigargin (TG) or 2,5-di- tert-butylhydroquinone (BHQ) inhibited PEITC-induced rise in [Ca2+]i. Incubation with PEITC also inhibited TG or BHQ-induced rise in [Ca2+]i. Inhibition of phospholipase C with U73122 abolished PEITC-induced rise in [Ca2+]i. At 15–75 μM, PEITC decreased viability. The cytotoxic effect of PEITC was enhanced by chelating cytosolic Ca2+ with 1,2-bis(2-aminophenoxy)ethane- N, N, N′, N′-tetraacetic acid/acetoxymethyl ester. Annexin V-FITC data suggest that 20 and 50 μM PEITC induced apoptosis. At 10 and 15 μM, PEITC did not increase reactive oxygen species (ROS) production. Together, in renal tubular cells, PEITC-induced rise in [Ca2+]i by inducing phospholipase C-dependent Ca2+ release from endoplasmic reticulum and Ca2+ entry via store-operated Ca2+ channels. PEITC induced apoptosis in a concentration-dependent, ROS/Ca2+-independent manner.

[Reflecting on nurse-patient relationships using core postmodernist concepts]

The task of defining, maintaining, and mutually adapting the nurse-patient relationship has been ongoing since modern nursing's earliest days. The nurse-patient relationship changes with social changes and paradigm shifts. Most medical centers today strive to incorporate the concept of partnership into the nurse-patient relationship in response to patient-centered medical care. What is the implication of this relationship? Is it suitable for all nurse-patient situations? What are the impacts on nurses and patients? How should nurses adapt to change in nurse-patient relationships? This article analyzes and reflects upon the nurse-patient relationship within a postmodernist framework guided by concepts of "deconstruction", "de-centralization", "multiplicity", and "inter-subjectivity." We derive a "dual-active" and "dual-expert" partnership between nurses and patients that centers on patient disease management. Core values of this partnership are respect and caring, and strategies include emancipation, enlightenment, and empowerment.

Identification of potential hosts and vectors of scrub typhus and tick-borne spotted fever group rickettsiae in eastern Taiwan

Scrub typhus and tick-borne spotted fever group (SFG) rickettsioses are transmitted by chiggers (larval trombiculid mites) and hard ticks, respectively. We assessed exposure to these disease vectors by extensively sampling both chiggers and ticks and their small mammal hosts in eastern Taiwan during 2007 and 2008. The striped field mouse Apodemus agrarius Pallas (Rodentia: Muridae) was the most common of the small mammals (36.1% of 1393 captures) and presented the highest rate of infestation with both chiggers (47.8% of 110 760) and ticks (78.1% of 1431). Leptotrombidium imphalum Vercammen-Grandjean & Langston (Trombidiformes: Trombiculidae) and immature Rhipicephalus haemaphysaloides Supino (Ixodida: Ixodidae) were the most abundant chiggers (84.5%) and ticks (>99%) identified, respectively. Immunofluorescent antibody assay revealed high seropositive rates of rodents against Orientia tsutsugamushi Hyashi (Rickettsiales: Rickettsiaceae), the aetiological agent of scrub typhus (70.0% of 437 rodents), and tick-borne SFG rickettsiae (91.9% of 418 rodents). The current study represents a first step towards elucidating the potential hosts and vectors in the enzootic transmission of O. tsutsugamushi and tick-borne SFG rickettsiae in Taiwan. Further studies should focus on characterizing pathogens in L. imphalum and R. haemaphysaloides, as well as the proclivity of both vectors to humans. Uncovering the main hosts of adult ticks is also critical for the prevention of SFG rickettsial infections.

Microsatellite primers in the native perennial cycad Cycas taitungensis (Cycadaceae)

PREMISE OF THE STUDY

Microsatellite primers were developed for the native perennial cycad Cycas taitungensis to evaluate the genetic variation of this endangered insular species.

METHODS AND RESULTS

Using a magnetic bead enrichment method and EST data, 16 primer sets were developed and identified for the native Taiwan cycad C. taitungensis. The primers amplified dinucleotide, trinucleotide, and complex repeats with 1-9 alleles per locus. Most primers also amplified DNA from C. revoluta and C. debaoensis.

CONCLUSIONS

These results indicate the utility of primers for future studies of the genetic structure of C. taitungensis. In addition, the primers are useful for further phylogeographic studies between C. taitungensis and C. revoluta, which is a closely related species.

A simplified method for immunological typing of trachoma-inclusion conjunctivitis-lymphogranuloma venereum organisms

Responding to the pressure of large numbers of trachoma-inclusion conjunctivitis (TRIC)-lymphogranuloma venereum (LGV) isolates from field studies requiring serotyping, we have developed a simplified, less-precise method that utilizes cell culture-grown organisms to produce mouse antisera which is tested agaist prototype TRIC-LGV antigens in the micro-immunofluorescence test. Cell cultures with as few as 5 to 15% of cells showing inclusions produced adequate antibody in mice 4 days after single injection. Knowledge of the reaction of prototype antisera with the antigens has allowed typing of most isolates tested from the pattern of cross-reaction of their antiserum.

Search for B+-->D*+pi0 decay

We report on a search for the doubly Cabibbo suppressed decay B+-->D*+pi0, based on a data sample of 657x10(6) BB pairs collected at the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric-energy e+e- collider. We find no significant signal and set an upper limit of B(B+-->D*+pi0)<3.6x10(-6) at the 90% confidence level. This limit can be used to constrain the ratio between suppressed and favored B-->D*pi decay amplitudes, r<0.051, at the 90% confidence level.

Observation of B{0}-->ppK*0 with a large K*0 polarization

Using a 492 fb{-1} data sample collected near the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric-energy e{+}e{-} collider, we observe the decay B{0}-->ppK*0 with a branching fraction of (1.18{-0.25}{+0.29}(stat)+/-0.11(syst))x10{-6}. We study the decay dynamics of B{0}-->ppK*0 and compare with B{+}-->ppK*+. The K*0 meson is found to be almost 100% polarized (with a fraction of (101+/-13+/-3)% in the helicity zero state), while the K*+ meson has a (32+/-17+/-9)% fraction in the helicity zero state. The direct CP asymmetries for B{0}-->ppK*0 and B{+}-->ppK*+ are measured to be -0.08+/-0.20+/-0.02 and -0.01+/-0.19+/-0.02, respectively. In addition, we report improved measurements of the branching fractions B(B{+}-->ppK*+)=(3.38{-0.60}{+0.73}+/-0.39)x10{-6} and B(B{0}-->ppK{0})=(2.51{-0.29}{+0.35}+/-0.21)x10{-6}, which supersede our previous measurements.

Measurement of B(Ds{+}-->mu+nu(mu))

We present a measurement of the branching fraction B(D{s}{+}-->mu{+}nu{mu}) using a 548 fb{-1} data sample collected by the Belle experiment at the KEKB e{+}e{-} collider. The D{s} momentum is determined by reconstruction of the system recoiling against DKgammaX in events of the type e{+}e{-}-->D{s}{*}DKX, D{s}{*}-->D{s}gamma, where X represents additional pions or photons from fragmentation. This full-reconstruction method provides high resolution in the neutrino momentum and thus good background separation, equivalent to that achieved by experiments at the tau-charm factories. We obtain the branching fraction B(D{s}{+}-->mu{+}nu{mu})=[6.44+/-0.76(stat)+/-0.57(syst)]x10{-3}, implying a D{s} decay constant of f{D{s}}=[275+/-16(stat)+/-12(syst)] MeV.

Production of new charmoniumlike states in e+e- -->J/psiD*D[over](*) at sqrt[s] approximately 10.6 GeV

We report a study of the processes e+e- -->J/psiD*D[over](*). In J/psiD*D[over]* we observe a significant enhancement in the D*D[over]* invariant mass spectrum, which we interpret as a new charmoniumlike state and denote X(4160). The X(4160) parameters are M=(4156(-20)+25+/-15) MeV/c2 and Gamma=(139(-61)+111+/-21) MeV. We also report a new measurement of the X(3940) mass and width: M=(3942(-6)+7+/-6) MeV/c2 and Gamma=(37(-15)+26+/-8) MeV. The analysis is based on a 693 fb(-1) data sample recorded near the Upsilon(4S) resonance by the Belle detector at the KEKB asymmetric-energy collider.

Observation of a resonancelike structure in the pi +- psi' mass distribution in exclusive B-->Kpi +- psi' decays

A distinct peak is observed in the pi +/- psi' invariant mass distribution near 4.43 GeV in B-->K pi +/- psi' decays. A fit using a Breit-Wigner resonance shape yields a peak mass and width of M=4433+/-4(stat)+/-2(syst) MeV and Gamma=45-13+18(stat)-13+30(syst) MeV. The product branching fraction is determined to be B(B 0-->K -/+Z+/-(4430)) x B(Z+/-(4430)-->pi+/-psi')=(4.1+/-1.0(stat)+/-1.4(syst)) x 10(-5), where Z+/-(4430) is used to denote the observed structure. The statistical significance of the observed peak is 6.5 sigma. These results are obtained from a 605 fb(-1) data sample that contains 657 x 10(6) BB pairs collected near the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric energy e+ e- collider.

Observation of B_(s)(0)-->phigamma and search for B_(s)(0)-->gammagamma decays at Belle

We search for the radiative penguin decays B_{s}{0}-->varphigamma and B_{s}{0}-->gammagamma in a 23.6 fb{-1} data sample collected at the Upsilon(5S) resonance with the Belle detector at the KEKB e{+}e{-} asymmetric-energy collider. We observe for the first time a radiative penguin decay of the B_{s}{0} meson in the B_{s}{0}-->varphigamma mode and we measure B(B_{s}{0}-->varphigamma)=(57_{-15}{+18}(stat)-11+12(syst))x10{-6}. No significant B_{s}{0}-->gammagamma signal is observed and we set a 90% confidence level upper limit of B(B_{s}{0}-->gammagamma)<8.7x10{-6}.

Measurement of time-dependent CP-violating parameters in B(0)-->K_(S)(0)K_(S)(0) decays

We report a measurement of the CP-violating parameters in B;{0}-->K_{S}{0}K_{S}{0} decays based on a data sample of 657x10{6} BB[over ] pairs collected at the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric-energy e;{+}e{-} collider. In this Letter, one neutral B meson is fully reconstructed in the B;{0}-->K_{S}{0}K_{S}{0} decay mode, and the flavor of the accompanying B meson is identified by its decay products. The CP-violating parameters are measured from the asymmetry in the distributions of the proper-time interval between the two B decays: S_K_{S}{0}K_{S}{0}}=-0.38_{-0.77}{+0.69}(stat)+/-0.09(syst) and A_{K_{S}{0}K_{S}{0}}=-0.38+/-0.38(stat)+/-0.05(syst).

Observation of anomalous upsilon(1S)pi+pi(-) and upsilon(2S)pi+pi(-) production near the upsilon(5S) resonance

We report the first observation of e;{+}e;{-}-->Upsilon(1S)pi;{+}pi;{-}, Upsilon(2S)pi;{+}pi;{-}, and first evidence for e;{+}e;{-}-->Upsilon(3S)pi;{+}pi;{-}, Upsilon(1S)K+K-, near the peak of the Upsilon(5S) resonance at sqrt[s] approximately 10.87 GeV. The results are based on a data sample of 21.7 fb;{-1} collected with the Belle detector at the KEKB e;{+}e;{-} collider. Attributing the signals to the Upsilon(5S) resonance, the partial widths Gamma(Upsilon(5S)-->Upsilon(1S)pi;{+}pi;{-})=0.59+/-0.04(stat)+/-0.09(syst) MeV and Gamma(Upsilon(5S)-->Upsilon(2S)pi;{+}pi;{-})=0.85+/-0.07(stat)+/-0.16(syst) MeV are obtained from the observed cross sections. These values exceed by more than 2 orders of magnitude the previously measured partial widths for dipion transitions between lower Upsilon resonances.

Observation of a new DsJ meson in B+-->D0D0K+ decays

We report the observation of a new DsJ meson produced in B+-->D0DsJ-->D0D0K+. This state has a mass of M=2708+/-9(-10)(+11) MeV/c2, a width Gamma=108+/-23(-31)(+36) MeV/c2 and a 1- spin-parity. The statistical significance of this observation is 8.4 sigma. The results are based on an analysis of 449 x 10(6) BB events collected at the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric-energy e+e- collider.

Observation of the psi(4415)-->DD2*(2460) decay using initial-state radiation

We report measurements of the exclusive cross section for e(+)e(-)-->D(0)D(-)pi(+) over the center-of-mass energy range 4.0 GeV to 5.0 GeV with initial-state radiation and the first observation of the decay psi(4415)-->D(0)D(-)pi(+). From a study of the resonant substructure in psi(4415) decay we conclude that the psi(4415)-->D(0)D(-)pi(+) decay is dominated by psi(4415)-->DD(2)(*)(2460). We obtain B(psi(4415)-->D(0)D(-)pi(nonresonant)(+))/B(psi(4415)-->DD(2)(*)(2460)-->D(0)D(-)pi(+))<0.22 at 90% C.L. The analysis is based on a data sample collected with the Belle detector with an integrated luminosity of 673 fb(-1).

Time-dependent CP-violating asymmetry in B0-->rho0gamma decays

We report the first measurement of CP-violation parameters in B0-->rho0gamma decays based on a data sample of 657x10(6)BB pairs collected with the Belle detector at the KEKB asymmetric-energy e+e- collider. We obtain the time-dependent and direct CP-violating parameters, Srho0gamma=-0.83+/-0.65(stat)+/-0.18(syst) and Arho0gamma=-0.44+/-0.49(stat)+/-0.14(syst), respectively.

Search for B --> h(*)nunu[over ] decays at Belle

We present a search for the rare decays B --> h(*)nunu[over ], where h(*) stands for a light meson. A data sample of 535 x 10{6} BB[over ] pairs collected with the Belle detector at the KEKB e{+}e{-} collider is used. Signal candidates are required to have an accompanying B meson fully reconstructed in a hadronic mode and signal side particles consistent with a single h(*) meson. No significant signal is observed and we set upper limits on the branching fractions at 90% confidence level. The limits on B{0} --> K{*0}nunu[over ] and B{+} --> K{+}nunu[over ] decays are more stringent than the previous constraints, while the first searches for B{0} --> K{0}nunu[over ], pi{0}nunu[over ], rho{0}nunu[over ], varphinunu[over ] and B{+} --> K{*+}nunu[over ], rho{+}nunu[over ] are reported.

Search for the CP-violating decays Upsilon(4S)-->B0B0-->J/psiKS0+J/psi(etac)KS0

We report the first search for CP-violating decays of the Upsilon(4S) using a data sample that contains 535 x 10(6) Upsilon(4S) mesons with the Belle detector at the KEKB asymmetric-energy e(+)e(-) collider. A partial reconstruction technique is employed to enhance the signal sensitivity. No significant signals were observed. We obtain an upper limit of 4 x 10(-7) at the 90% confidence level for the branching fractions of the CP violating modes, Upsilon(4S)-->B(0)B(0)-->J/psiK(S)(0)+J/psi(eta(c))K(S)(0). Extrapolating the result, we find that an observation with 5sigma significance is expected with a 30 ab(-1) data sample, which is within the reach of a future super B factory.