A Qualitative Study on the Care Experience of Emergency Department Nurses during the COVID-19 Pandemic

Background: The rapid spread of the disease has severely impacted healthcare systems around the world. There is a lack of evidence related to the care experience of emergency department nurses. Objective: To understand the care experience and thoughts of emergency department nurses during the COVID-19 epidemic. Methods: Purposive sampling was used to recruit 16 emergency department nurses from a medical center, and a semi-structured interview was used for data collection. The enrollment period was from 28 July 2021 to 30 October 2021. Thematic content analysis was used for data analysis. Results: The care experiences of emergency department nurses during the COVID-19 epidemic can be classified into three themes and six sub-themes. Theme 1: I am the gatekeeper; theme 2: Care and environment challenges: difficulties with equipment and environment, managing patient’s and family members’ emotions, insufficient manpower of care; theme 3: Conflicting emotions: worrying about being infected or transmitting the disease, needs of effective support and empathy, and lack of understanding and discrimination towards the occupation. Conclusion: Emergency department nurses adhered to professional awareness and responsibility during the epidemic and play a critical role in epidemic prevention.

An interesting case of recurrent temporomandibular joint dislocation

Acute temporomandibular joint dislocation is an infrequent presentation to the emergency department or to dental practitioners. It may be a rare complication of dental treatment. Recurrent temporomandibular joint dislocation occurs in individuals with certain anatomical abnormalities or systemic conditions. This paper reports an unusual presentation of recurrent temporomandibular joint dislocation and outlines some of the surgical techniques used in managing this condition.

Lifelong inorganic arsenic compounds consumption affected blood pressure in rats

Chronic arsenic exposure is a known risk factor for cardiovascular disease and has a strong correlation with hypertension. Oxidative stress may be one of the major contributors to arsenic-induced hypertension. To investigate the antioxidative and CYP systems through which inorganic arsenic compounds may contribute to blood pressure elevation in rats, we administered 50ppm arsenic (as arsenite and arsenate) in drinking water to Wistar rats for 200 successive days. Systolic blood pressure was determined every 20 days, and blood samples and tissues were collected at each time point for biological analysis. Compared to the control group, weight gain in the arsenic-exposed animals was slightly but significantly lower, whereas the relative weights of the various tissues was higher. Blood pressure was elevated until day 80 in both arsenic groups followed by a time-dependent change in the antioxidative enzyme system. The hypertensive effect remained until day 200 for arsenite when the change by arsenate was minimized. Patterns of antioxidative enzyme change differed between arsenite and arsenate. However, the most common marker of hypertension, the angiotensin-converting enzyme, showed no significant change in either arsenic group. CYP4A was highly expressed in both arsenic groups, particularly in the arsenite group. These results indicate that low but chronic arsenic exposure might cause elevated blood pressure and antioxidative interference. Furthermore, CYP4A might be more important than ACE in contributing to arsenic-induced hypertension.

Acute administration of red yeast rice (Monascus purpureus) depletes tissue coenzyme Q(10) levels in ICR mice

In this study, we attempted to evaluate the effect of administration of a high quantity of red yeast rice on coenzyme Q10 (CoQ10) synthesis in the tissues of ICR mice. Eighty-eight adult male ICR mice were housed and divided into control and experimental groups for red yeast rice treatment. Animals were gavaged with a low (1 g/kg body weight) or a high dose (5 g/kg body weight, approximately five times the typical recommended human dose) of red yeast rice dissolved in soyabean oil. After gavagement, animals of the control group were immediately killed; mice of the experimental groups (eight for each subgroup) were killed at different time intervals of 0.5, 1, 1.5, 4 and 24 h. The liver, heart and kidney were taken for analysis of monacolin K (liver only) and CoQ10 analysis. Liver and heart CoQ10 levels declined dramatically in both groups administered red yeast rice, especially in the high-dose group, within 30 min. After 24 h, the levels of hepatic and cardiac CoQ10 were still reduced. A similar trend was also observed in the heart, but the inhibitory effect began after 90 min. The higher dose of red yeast rice presented a greater suppressive effect than did the lower dose on tissue CoQ10 levels. In conclusion, acute red yeast rice gavage suppressed hepatic and cardiac CoQ10 levels in rodents; furthermore, the inhibitory effect was responsive to the doses administered.

Determination of diethanolamine and N-nitrosodiethanolamine in fatty acid diethanolamides

Diethanolamine (DEA) is a precursor of N-nitrosodiethanolamine (NDELA), an animal carcinogen. A gas chromatographic (GC) method was developed for determining DEA in fatty acid diethanolamides that are commonly used in cosmetic products. Methanolic solutions of the amides were analyzed by GC with flame ionization detection on either a wide-bore methyl silicone (Rtx-1) or 95% dimethyl--5% diphenyl polysiloxane (SPB-5) capillary column. Recovery of DEA from fatty acid dialkanolamides at fortification levels of 0.50, 1.00, and 5.00% ranged from 94 to 100%. In a survey of commercial fatty acid diethanolamides, DEA was found at levels ranging from 1.1 to 14.0%, and most were in good agreement with manufacturer's DEA specifications. Fatty acid diethanolamides also were anlayzed for NDELA by liquid chromatography interfaced to a thermal energy analyzer. Recovery of NDELA from fatty acid diethanolamides at fortification levels of 50, 100, and 200 ppb averaged 95%. No NDELA was found in any of the fatty acid diethanolamide samples analyzed.

A rapid and selective method for determining potential nitrosating agents in cosmetic products by chemiluminescence detection of nitric oxide

A method was developed for rapid and selective determination of potential nitrosating agents at the part-per-billion level in cosmetic products. These compounds are chemically reduced to nitric oxide, which is determined by its chemiluminescent reaction with ozone. Suspended materials and colors in cosmetic products do not interfere. Hence their removal before analysis is not required. A detection limit of 33 ppb, calculated as nitrite, was obtained. No false-positive interferences were observed from antifoaming agents, several N-nitroso compounds, and nitrate up to 20 ppm. Among cosmetic products surveyed, potential nitrosating agents were found at levels ranging from 113 to 5021 ppb. No consistent relationship was found between levels of potential nitrosating agents and N-nitrosamines in the same products. However, the highest levels of nitrosating agents were most often associated with the highest levels of N-nitrosamines known to be present in the products.

Generation of complement membrane attack complex in normal human corneas

PURPOSE

To determine whether complement-derived SC5b-9, the soluble nonlytic-fluid phase of the membrane attack complex, can be generated in normal human corneas when they are injured with lipopolysaccharide (LPS), ribitol teichoic acid (RTA) immune complexes, acid, or alkali.

METHODS

The experimental cornea of each donor pair was injected with 50 microliters of sterile saline containing 0.5 mg of LPS or 50 microliters of sterile saline containing 250 micrograms of RTA immune complexes. Other experimental corneas were treated topically for 35 seconds with either 200 microliters of 1N HCl or 2N NaOH. The control cornea of each donor pair was injected with 50 microliters of sterile saline or was treated topically for 35 seconds with 200 microliters of sterile saline. After injury, all corneas were incubated in medium 199 for 6 hours at 37 degrees C in 5% CO2, then eluted for 24 hours in phosphate-buffered saline with 10 mM ethylenediaminetetraacetic acid. Each corneal eluate was collected and stored at -70 degrees C until assayed for SC5b-9 by an enzyme immunoassay.

RESULTS

Compared with control corneas, SC5b-9 levels were increased significantly in corneas injected with LPS or RTA immune complexes. However, when compared with controls, SC5b-9 levels were decreased significantly in corneas treated with HCl or NaOH.

CONCLUSIONS

Normal human corneas injured immunologically with LPS or RTA immune complexes activate the classical or alternate pathway and generate SC5b-9. Corneas injured chemically with acid or alkali do not produce SC5b-9.

Determination of 2-ethylhexyl 4-(N-methyl-N-nitrosamino) benzoate in commercial sunscreens and cosmetic products

An analytical method has been developed for determination of 2-ethylhexyl 4-(N-methyl-N-nitrosamino) benzoate (NMPABAO), a nitrosamine contaminant in sunscreen products containing 2-ethylhexyl 4-(N,N-dimethylamino) benzoate (Padimate O). The method involves extraction of NMPABAO by column chromatography followed by liquid chromatographic separation and analysis wit a nitric oxide detector. To confirm the presence of NMPABAO in sunscreen products, the N-nitrosamine was synthesized and its structure was determined by infrared spectrophotometry, nuclear magnetic resonance spectrometry, and mass spectrometry (MS). For method validation, recovery studies were performed on a commercial suntan lotion, cream, and gel. Recoveries of NMPABAO added to representative test samples averaged 83%. The method has an estimated detection limit of 30 ppb. The method was used to analyze 25 commercial cosmetic and sunscreen products containing Padimate O. Eleven products contained NMPABAO at levels ranging from 160 to 21000 ppb. NMPABAO presence in 4 products was confirmed by MS at levels > or = 4000 ppb. The highest levels of NMPABAO were associated with products that contained the nitrite-releasing preservative 2-bromo-2-nitro-1,3-propanediol.

Complement system and host defense against staphylococcal endophthalmitis

PURPOSE

The authors studied the role of the complement system in host defense against Staphylococcus epidermidis and S. aureus endophthalmitis.

METHODS

Guinea pigs in the S. epidermidis model received an intravitreal injection of 7000 viable organisms, and guinea pigs in the S. aureus model received 50 viable organisms. The experimental animals in each model were decomplemented with intraperitoneal (IP) injections of cobra venom factor, whereas the control animals received IP injections of normal saline. Mean log bacterial counts in the vitreous and mean serum complement titers were compared in the experimental and control animals in each model on days 1, 2, 3, and 7.

RESULTS

In the S. epidermidis model, mean log bacterial counts in the vitreous were significantly higher in the experimental group than the control group on days 1 and 2 (P < 0.01) and on day 3 (P < 0.05). Mean serum complement titers were significantly lower in the experimental group at all days (P < 0.01). In the S. aureus model, mean log bacterial counts in the vitreous were significantly higher in the experimental group than the control group on day 2 (P < 0.05) and day 3 (P < 0.01). Mean serum complement titers were significantly lower in the experimental group on days 1, 2, and 3 (P < 0.01), but not on day 7.

CONCLUSION

These results suggest that decomplemented guinea pigs show impaired host defense to S. epidermidis and S. aureus endophthalmitis and that this defense is restored as complement levels approach normal.

Collagen shields impregnated with gentamicin-dexamethasone as a potential drug delivery device

We investigated the ability of collagen shields impregnated with gentamicin sulfate and dexamethasone to deliver medication into rabbit eyes. We compared the aqueous humor gentamicin and dexamethasone levels delivered by collagen shield and subconjunctival injection therapy at five time points over a ten-hour period, by using a fluorescence polarization immunoassay and high-pressure liquid chromatography. Our in vitro studies showed that impregnated collagen shields released most of the gentamicin within the first 30 minutes of elution, whereas dexamethasone was released gradually over a ten-hour period. The collagen shields impregnated with gentamicin and dexamethasone produced aqueous gentamicin levels that were significantly lower (P = .014) than those produced by subconjunctival injection therapy at 30 minutes and that were comparable to subconjunctival injection therapy at the other time points. Minimum inhibitory concentrations of gentamicin (approximately 4 micrograms) were observed in aqueous humor within 30 minutes in rabbits that received subconjunctival injections and at one hour in rabbits treated with impregnated collagen shields. The impregnated collagen shields produced aqueous dexamethasone levels that were significantly lower (P = .004) than those produced by subconjunctival injection therapy at one hour, significantly higher (P = .028) than subconjunctival injection therapy at six hours, and comparable to subconjunctival injection therapy at the other time points. Collagen shield delivery of gentamicin-dexamethasone may be comparable to subconjunctival injections and provide an alternative therapy after intraocular surgery.

Prolongation of corneal allograft survival with liposome-encapsulated cyclosporine in the rat eye

PURPOSE

To study the effects of different formulations of topical cyclosporine (Cyclosporin A [CsA]) on corneal allograft rejection in a rat model.

METHODS

Female Lewis rats received penetrating keratoplasties from female Wistar-Furth donors. A total of 78 allogeneic grafts were performed. An additional 15 syngeneic grafts (Lewis) were used as technical controls. Two CsA preparations with equivalent drug concentrations (2.1 mg/ml) were applied as drops: CsA encapsulated in large unilamellar liposomes (CsA-LIP) and CsA dissolved in olive oil (CsA-DR). Allogeneic grafts were randomly assigned to receive CsA-LIP or CsA-DR beginning on the day of surgery five times daily for 10 days. Animals without any treatment or receiving empty liposomes (EM-LIP) were used as treatment controls. Grafts were graded three times weekly and a rejection index was generated based on graft clarity, neovascularization, and vessel size.

RESULTS

All syngeneic grafts remained clear over the observation period of 60 days. Rejected allogeneic grafts without any treatment and those receiving EM-LIP or CsA-DR showed a mean survival time (+/- standard deviation) of 14 +/- 4, 14 +/- 5, and 14 +/- 4 days, respectively. There was no significant difference in mean survival time between the grafts without any treatment and those in CsA-DR or EM-LIP treatment groups. The mean survival time of rejected grafts in animals receiving CsA-LIP was prolonged to 20 +/- 4 days. There was a significant difference in the mean survival time between the CsA-LIP treatment group and groups receiving CsA-DR, EM-LIP, or no treatment (P < or = 0.05). The Kaplan-Meier survival curve of the CsA-LIP treatment group was significantly different from the other experimental groups. The graft survival rate in the CsA-LIP group was 77%, whereas the rate was 37% in the non-treated group, 45% in the CsA-DR group, and 36% in the EM-LIP group.

CONCLUSION

Encapsulation of CsA in liposomes might be a promising formulation for use in the prevention of corneal graft rejection.

Screening cosmetic products for N-nitroso compounds by chemiluminescent determination of nitric oxide

Cosmetic products were screened for total N-nitroso compounds by chemiluminescent measurement of nitric oxide liberated by the reductive cleavage of the N-nitroso group. The cosmetic was first partitioned between methylene chloride and water to separate polar and nonpolar N-nitroso compounds. Each extract was then examined for the presence of N-nitroso compounds by adding the cleavage reagent and sweeping the nitric oxide formed into a chemiluminescent analyzer. Although the method is not intended to be quantitative, recovery studies were conducted to determine measurable levels. Recovery studies of polar N-nitroso compounds were conducted by adding N-nitrosodiethanolamine (NDELA) to a cream, a shampoo, and a lotion at 3 levels, i.e., 80, 320, and 960 ppb, and then determining NDELA by the method. Recoveries ranged from 48 to 83% (mean 68%; SD = 11.9). For recoveries of nonpolar N-nitroso compounds, 100, 200, and 500 ppb of N-nitrosomethyltetradecylamine were added to the 3 cosmetic products. Recoveries ranged from 58 to 70% (mean 63%; SD = 5.3).

Pepstatin inhibition of proteinase-free human renin

The kinetics of inhibition of proteinase-free human renin and of pepsin by the carboxyl proteinase inhibitor pepstatin have been examined. Inhibition was of the tight-binding type with both enzymes. Inhibition of crude human renin was of the classical, freely reversible type, but most of the renin-like activity of the preparation was due to contaminating proteinases which could be separated chromatographically from the renin. These results clarify previous kinetic studies of pepstatin inhibition of human renin.

Proteinase activity of human renin preparations: the International Reference Preparation (Renin Standard 68/356)

1. Several commonly used preparations of human renin, including the International Reference Preparation (Renin Standard 68/356), were examined for the presence of contaminating proteinase activity by using a 14C-glycinated bovine haemoglobin substrate assay. 2. All of the human renin preparations tested cleaved haemoglobin even in the presence o di-isopropylfluorophosphate and ethylenediaminetetra-acetate (EDTA). For a given amount of renin activity, varying amounts of proteinase activity were seen. The pH optimum also varied between preparations. 3. Small peptide inhibitors of human renin were not able to inhibit the proteinase activity. Furthermore a diazoacyl reagent and pepstatin, both potent inhibitors of aspartic acid-active site proteinases, were only partially inhibitory. 4. These and other observations suggest that the proteinase activity of the human renin preparations is not due to renin itself, but to contaminating proteinases of different types. Since these enzymes may produce angiotensin I or peptides which may interfere in renin assays, crude preparations of renin which contain proteinase activity, including the International Reference Preparation, should be used with caution or replaced by proteinase-free human renin which can be easily prepared by use of suitable affinity chromatography.

Separation of human renal renin and pseudorenin by affinity chromatography on hemoglobin-Sepharose-2B

Human renal renin (EC 3.4.99.19) and pseudorenin were easily separated in a single step by affinity chromatography on hemoglobin-Sepharose-2B. Renin and pseudorenin were monitored by their actions on crude and partially purified hog protein renin substrates at neutral and acidic pH and on synthetic labelled polymeric renin substrate. Under the conditions employed (0.1 M sodium acetate (pH 3.5)/1 M sodium chloride at 4 degrees C) renin does not bind to the affinity adsorbent while pseudorenin is effectively bound and can be eluted only after raising the pH to 6.5. Pseudorenin-free renin prepared by this method is devoid of proteolytic activity toward hemoglobin. The chromatographic behaviour of renal pseudorenin on hemoglobin-Sepharose-2B is similar to that of cathepsin D.

Template specific inhibitors of E. coli RNA polymerase

Electroneutral analogs of polynucleotides, poly-9-vinyladenine and poly-1-vinyluracil inhibit E. coli RNA polymerase in all combinations where the single stranded polynucleotides are used as templates and the vinyl analogs are complementary to them. As templates both the ribo- and deoxyribopolynucleotides were tested; variation of the template concentration in the presence of vinyl analogs produced a competitive pattern of inhibition. The electroneutral analogs do not inhibit the enzyme activity when non-complementary single stranded polynucleotides or double stranded polynucleotides are used as templates; the latter fully supports transcription even when one of the strands is complementary to the analog.