Stretchable, Adhesive, and Biocompatible Hydrogel Based on Iron-Dopamine Complexes

Hydrogels' exceptional mechanical strength and skin-adhesion characteristics offer significant advantages for various applications, particularly in the fields of tissue adhesion and wearable sensors. Herein, we incorporated a combination of metal-coordination and hydrogen-bonding forces in the design of stretchable and adhesive hydrogels. We synthesized four hydrogels, namely PAID-0, PAID-1, PAID-2, and PAID-3, consisting of acrylamide (AAM), N,N'-methylene-bis-acrylamide (MBA), and methacrylic-modified dopamine (DA). The impact of different ratios of iron (III) ions to DA on each hydrogel's performance was investigated. Our results demonstrate that the incorporation of iron-dopamine complexes significantly enhances the mechanical strength of the hydrogel. Interestingly, as the DA content increased, we observed a continuous and substantial improvement in both the stretchability and skin adhesiveness of the hydrogel. Among the hydrogels tested, PAID-3, which exhibited optimal mechanical properties, was selected for adhesion testing on various materials. Impressively, PAID-3 demonstrated excellent adhesion to diverse materials and, combined with the low cytotoxicity of PAID hydrogel, holds great promise as an innovative option for biomedical engineering applications.

Self-Assembly of the Tetraphenylethylene-Capped Diserine through a Hierarchical Assembly Process

We report a new peptide-based urchin-shaped structure prepared through two-step self-assembly of tetraphenylethylene-diserine (TPE-SS). Hydrogelation generated nanobelts through the first stage of self-assembly of TPE-SS; these nanobelts further transformed on silicon wafers into urchin-like microstructures featuring nanosized spines. The presence of the TPE moiety in the hydrogelator resulted in aggregation-induced emission characteristics both in the solution and in the gel phases. TPE-SS has the lowest molecular weight of any TPE-capped hydrogelator with β-sheet-like structures under physiological pH. This new design strategy appears to be useful for generating three-dimensional self-assembled microstructures and multifunctional biomaterials. We found that TPE-SS is biocompatible with human mesenchymal stem cells and breast cancer cells, making them potential applications in tissue engineering and biomedical research.

Electroactive and Stretchable Hydrogels of 3,4-Ethylenedioxythiophene/thiophene Copolymers

Hydrogels are conductive and stretchable, allowing for their use in flexible electronic devices, such as electronic skins, sensors, human motion monitoring, brain-computer interface, and so on. Herein, we synthesized the copolymers having various molar ratios of 3,4-ethylenedioxythiophene (EDOT) to thiophene (Th), which served as conductive additives. With doping engineering and incorporation with P(EDOT-co-Th) copolymers, hydrogels have presented excellent physical/chemical/electrical properties. It was found that the mechanical strength, adhesion ability, and conductivity of hydrogels were highly dependent on the molar ratio of EDOT to Th of the copolymers. The more the EDOT, the stronger the tensile strength and the greater the conductivity, but the lower the elongation break tends to be. By comprehensively evaluating the physical/chemical/electrical properties and cost of material use, the hydrogel incorporated with a 7:3 molar ratio P(EDOT-co-Th) copolymer was an optimal formulation for soft electronic devices.

Cerebrovascular Reactivity Mapping Using Resting-State Functional MRI in Patients With Gliomas

BACKGROUND

Recently, a data-driven regression analysis method was developed to utilize the resting-state (rs) blood oxygenation level-dependent signal for cerebrovascular reactivity (CVR) mapping (rs-CVR), which was previously optimized by comparing with the CO₂ inhalation-based method in health subjects and patients with neurovascular diseases.

PURPOSE

To investigate the agreement of rs-CVR and the CVR mapping with breath-hold MRI (bh-CVR) in patients with gliomas.

STUDY TYPE

Retrospective.

POPULATION

Twenty-five patients (12 males, 13 females; mean age ± SD, 48 ± 13 years) with gliomas.

FIELD STRENGTH/SEQUENCE

Dynamic T2*-weighted gradient-echo echo-planar imaging during a breath-hold paradigm and during the rs on a 3-T scanner.

ASSESSMENT

rs-CVR with various frequency ranges and resting-state fluctuation amplitude (RSFA) were assessed. The agreement between each rs-based CVR measurement and bh-CVR was determined by voxel-wise correlation and Dice coefficient in the whole brain, gray matter, and the lesion region of interest (ROI).

STATISTICAL TESTS

Voxel-wise Pearson correlation, Dice coefficient, Fisher Z-transformation, repeated-measure analysis of variance and post hoc test with Bonferroni correction, and nonparametric repeated-measure Friedman test and post hoc test with Bonferroni correction were used. Significance was set at P < 0.05.

RESULTS

Compared with bh-CVR, the highest correlations were found at the frequency bands of 0.04-0.08 Hz and 0.02-0.04 Hz for rs-CVR in both whole brain and the lesion ROI. RSFA had significantly lower correlations than did rs-CVR of 0.02-0.04 Hz and a wider frequency range (0-0.1164 Hz). Significantly higher correlations and Dice coefficient were found in normal tissues than in the lesion ROI for all three methods.

DATA CONCLUSION

The optimal frequency ranges for rs-CVR are determined by comparing with bh-CVR in patients with gliomas. The rs-CVR method outperformed the RSFA. Significantly higher correlation and Dice coefficient between rs- and bh-CVR were found in normal tissue than in the lesion.

LEVEL OF EVIDENCE

3 TECHNICAL EFFICACY STAGE: 2.

Alkyl Chain Length Effects of Imidazolium Ionic Liquids on Electrical and Mechanical Performances of Polyacrylamide/Alginate-Based Hydrogels

Conductive hydrogels with stretchable, flexible and wearable properties have made significant contributions in the area of modern electronics. The polyacrylamide/alginate hydrogels are one of the potential emerging materials for application in a diverse range of fields because of their high stretch and toughness. However, most researchers focus on the investigation of their mechanical and swelling behaviors, and the adhesion and effects of the ionic liquids on the conductivities of polyacrylamide/alginate hydrogels are much less explored. Herein, methacrylated lysine and different alkyl chain substituted imidazole-based monomers (IMCx, x = 2, 4, 6 and 8) were introduced to prepare a series of novel pAMAL-IMCx-Ca hydrogels. We systematically investigated their macroscopic and microscopic properties through tensile tests, electrochemical impedance spectra and scanning electron microscopy, as well as Fourier transform infrared spectroscopy, and demonstrated that an alkyl chain length of the IMCx plays an important role in the designing of hydrogel strain sensors. The experiment result shows that the hexyl chains of IMC6 can effectively entangle with LysMA through hydrophobic and electrostatic interactions, which significantly enhance the mechanical strength of the hydrogels. Furthermore, the different strain rates and the durability of the pAMAL-IMC6-Ca hydrogel were investigated and the relative resistance responses remain almost the same in both conditions, making it a potential candidate for wearable strain sensors.

Intergenerational Narrative Learning to Bridge the Generation Gap in Humanistic Care Nursing Education

Background: The development of nursing students’ ability to practice humanistic care is extremely important. Methods: This study explored students’ learning experience when providing humanistic care for older adults with chronic diseases while employing intergenerational narrative learning. An exploratory descriptive qualitative study design was adopted. Results: We analyzed evaluations from 35 students who completed the course, in which intergenerational narrative learning was employed. Evaluations contained open-ended questions that asked students to reflect upon their experiences and describe their perceptions, thoughts, and feelings after the course. Three main themes were revealed by thematic analysis: direct interaction supersedes knowledge in books, the framework for improving humanistic caring, and internalization of the importance of humanistic care in nursing. Conclusion: An awareness of patients’ perspectives inspired the students in their development toward a more profound caring attitude. The intergenerational narrative learning teaching strategy could foster professional and humanistic-centered care in nursing students.

Preparation of conductive self-healing hydrogels via an interpenetrating polymer network method

Conductive self-healing hydrogels and related soft sensor devices are gaining extensive attention from academia to industry because of their impacts on the lifetime and ergonomic design of artificial skins and soft robotics, as well as health monitoring systems. However, so far the development of such a material has been limited considering performance and availability. In this work, we developed composite hydrogels of acrylamide, polyacrylamide, dialdehyde-functionalized poly(ethylene glycol) and conductive carbon black through an interpenetrating polymer network strategy. After optimizing the composition ratio, the resultant hydrogel exhibited self-healing reversibility mechanically and electrically when cut and self-healed. We used ¹H NMR and FT-IR spectroscopy to determine the self-healing mechanism of the system, thus demonstrating that the cooperative effect of the dynamic covalent and noncovalent interactions contributes to the self-healing capability of the gel. Rheology, scanning electron microscopy and light-emitting diode circuits were carried out to examine its macroscopic and microscopic properties, making it possible to apply in soft and conformable electronics.

A new type of conductive interpenetrating polymer network hydrogel exhibited self-healing reversibility mechanically and electrically when cut and self-healed, making it possible to apply in soft and conformable electronics.

Synthesis, photochemical isomerization and photophysical properties of hydrazide–hydrazone derivatives

The structure–property relationships for the hydrazide–hydrazone derivatives were investigated to provide new insights into the design of photo-responsive materials.

Synthesis and photophysical properties of benzoxazolyl-imidazole and benzothiazolyl-imidazole conjugates

Materials that have higher fluorescence emission in the solid state than molecules in solution have recently been paid more attention by the scientific community due to their potential applications in various fields. In this work, we newly synthesized benzoxazolyl-imidazole and benzothiazolyl-imidazole conjugates, which show aggregation-induced emission (AIE) features in their solid and aggregate states. It was found that oxygen and sulfur substitutions can dramatically influence the molecular structures and polarities of the dyes, leading to different degrees of the AIE phenomenon. The benzothiazolyl-imidazole molecule has lower polarity compared to that of benzoxazolyl-imidazole; therefore, the dye bearing a benzothiazolyl group shows higher emission intensity and dual emission in aqueous solution. Theoretical calculation results suggest that the benzothiazolyl-imidazole molecules might have electrostatic interactions between sulfur and nitrogen atoms, explaining the experimental observations of lower critical aggregation concentration and photophysical properties both in solution and in the solid state. The theoretical calculations agree with the experimental data, thus demonstrating a potent strategy to gain a deep understanding of the structure–property relationships to design solid-state fluorescent materials.

The effect of heteroatoms on the structural and photophysical properties of donor-π-acceptor molecules, comprising imidazole and benzoxazolyl as well as imidazole and benzothiazolyl units, was investigated.

Examining determinants of sexual behavior among indigenous adolescents in Taiwan

A recent Taiwanese government report indicated that there were an increased number of sexual encounters among 15- to 17-year-old adolescents. Among them, indigenous Taiwanese had a higher rate of sexual encounters than did the rest of the population. However, no prior study has surveyed indigenous Taiwanese adolescents' sexual behavior. Therefore, we examined the determinants of sexual behavior among indigenous adolescents in Taiwan.In this cross-sectional study, the researchers chose 16 high schools as the target research population; after 2-stage random sampling, 4 of the 16 high schools were recruited to participate in the research. Data were collected through a self-report questionnaire from the participants, with a total of 521 valid responses.Of the indigenous adolescents surveyed, 53% (N = 275) said they had touching, hugging, or kissing experiences, while 15.7% (N = 82) reported sexual behavior. The higher rate of sexual encounters among indigenous Taiwanese adolescents is associated with the gender, number of current or past romantic partners, drinking, and drug use before sexual intercourse. After adjustment for confounding factors, gender (male vs female, adjusted OR = 3.33, 95% CI: 1.83-6.07), number of heterosexual (≧1 vs no, OR = 1.67, 95% CI: 1.36-2.06), and heterosexual relationship (yes vs no, OR = 3.81, 95% CI: 1.94-7.48) appeared to be statistically significantly related sexual behaviors.This study found that the occurrence rate of sexual behavior for indigenous adolescents was higher than the past research results, and having initiated sexual intercourse in earlier age. The results also showed the indigenous adolescents whose drinking alcohol and drug use are more experiences on sexual behaviors. The results could be applied on sexual education program in campus.

Diffusion tensor imaging for assessment of microstructural changes associate with treatment outcome at one-year after radiofrequency Rhizotomy in trigeminal neuralgia

Background

Trigeminal neuralgia (TN) is characterized by facial pain that may be sudden, intense, and recurrent. Neurosurgical interventions, such as radiofrequency rhizotomy, can relieve TN pain, but their mechanisms and effects are unknown. The aim of the present study was to investigate the microstructural tissue changes of the trigeminal nerve (TGN) in patients with TN after they underwent radiofrequency rhizotomy.

Methods

Thirty-seven patients with TN were recruited, and diffusion tensor imaging was obtained before and two weeks after radiofrequency rhizotomy. By manually selecting the cisternal segment of the TGN, we measured the volume of the TGN, fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial diffusivity (AD), and radial diffusivity (RD). The TGN volume and mean value of the DTI metrics of the post-rhizotomy lesion side were compared with those of the normal side and those of the pre-rhizotomy lesion side, and they were correlated to the post-rhizotomy visual analogue scale (VAS) pain scores after a one-year follow-up.

Results

The alterations before and after rhizotomy showed a significantly increased TGN volume and FA, and a decreased ADC, AD, and RD. The post-rhizotomy lesion side showed a significantly decreased TGN volume, FA, and AD compared with the normal side; however, no significant difference in the ADC and RD were found between the groups. The TGN volume was significantly higher in the non-responders than in the responders (P = 0.016).

Conclusion

Our results may reflect that the effects of radiofrequency rhizotomy in TN patients include axonal damage with perineural edema and that prolonged swelling associated with recurrence might be predicted by MRI images. Further studies are necessary to understand how DTI metrics can quantitatively represent the pathophysiology of TN and to examine the application of DTI in the treatment of TN.

Tumor targeting with DGEA peptide ligands: a new aromatic peptide amphiphile for imaging cancers

A novel AIE-active self-assembled bioprobe TPE-FDGEA has been developed for selective cancer cell imaging.

Effects of Dehydration on Brain Perfusion and Infarct Core After Acute Middle Cerebral Artery Occlusion in Rats: Evidence From High-Field Magnetic Resonance Imaging

Background: Dehydration is common among ischemic stroke patients and is associated with early neurological deterioration and poor outcome. This study aimed to test the hypothesis that dehydration status is associated with decreased cerebral perfusion and aggravation of ischemic brain injury. Methods: Diffusion-weighted imaging and arterial spin labeling perfusion MR imaging were performed on rats with middle cerebral artery occlusion (MCAO) by using a 9.4T MR imaging scanner to measure the volume of infarction and relative cerebral blood flow (rCBF) after infarction. Twenty-five rats were assigned to either a dehydration group or normal hydration group, and dehydration status was achieved by water deprivation for 48 h prior to MCAO. Results: The volume of the infarction was significantly larger for the dehydration group at the 4th h after MCAO (p = 0.040). The progression in the infarct volume between the 1st and 4th h was also larger in the dehydration group (p = 0.021). The average rCBF values of the contralateral normal hemispheres at the 1st and the 4th h were significantly lower in the dehydration group (p = 0.027 and 0.040, respectively). Conclusions: Our findings suggested that dehydration status is associated with the progression of infarct volume and decreases in cerebral blood flow during the acute stage of ischemic stroke. This preliminary study provided an imaging clue that more intensive hydration therapies and reperfusion strategies are necessary for the management of acute ischemic stroke patients with dehydration status.

The correlation of asymmetrical functional connectivity with cognition and reperfusion in carotid stenosis patients

Objective

Neural disruption and cognitive impairment have been reported in patients with carotid stenosis (CS), but carotid artery stenting (CAS) may not contribute to the cognitive recovery. Although functional hyper-connectivity is one of the physiological over-compensation phenomena in neurological diseases, the literature on the cognitive influence of functional hyper-connectivity in CS patients is limited. We aimed to investigate the longitudinal changes of hyper-connectivity after CAS and its association with cognition in CS patients.

Methods

Thirteen patients with unilateral CS and 17 controls without CS were included. Cognitive function was evaluated at baseline, and resting-state functional MRI was performed 1 week before and 1 month and 1 year after CAS. Comparisons of functional connectivity (FC) between CS patients and controls in multiple brain networks were performed.

Results

In patients before CAS, FC in the cerebral hemispheres ipsilateral and contralateral to CS was mainly decreased and increased, respectively, compared with normal controls. Part of the FC alterations gradually recovered to the normal condition after CAS. The stronger FC abnormality (both hypo- and hyper-connectivity compared with normal controls) was associated with poorer cognitive performances, especially in memory and executive functions.

Conclusion

The study demonstrated the lateralization of hyper-connectivity and hypo-connectivity in patients with unilateral CS in contrast to the FC in normal controls. These FC alterations were associated with poor cognitive performances and tended to recover after CAS, implying that hyper-connectivity is served as a compensation for neural challenge.

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Cerebral hypoconnectivity on functional MRI is lateralized to carotid stenosis side.

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Cerebral hyperconnectivity is in regions contralateral to carotid stenosis side.

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Abnormal connectivity gradually returns back to normal after carotid stenting.

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Hypo- and hyper-connectivity associate with poor cognitive performances.

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Hyperconnectivity could be served as a compensation for neural challenge.

[Applying Game-Based Learning in Nursing Education: Empathy Board Game Learning]

Attending lectures and reading are two common approaches to acquiring knowledge, while repetitive practice is a common approach to acquiring skills. Nurturing proper attitudes in students is one of the greatest challenges for educators. Health professionals must incorporate empathy into their practice. Creative teaching strategies may offer a feasible approach to enhancing empathy-related competence. The present article focuses on analyzing current, empathy-related curriculums in nursing education in Taiwan, exploring the concepts of empathy and game-based learning, presenting the development of an empathy board game as a teaching aid, and, finally, evaluating the developed education application. Based on the learner-centered principle, this aid was designed with peer learning, allowing learners to influence the learning process, to simulate the various roles of clients, and to develop diverse interpersonal dialogues. The continuous learning loops were formed using the gamification mechanism and transformation, enabling students to connect and practice the three elements of empathy ability: emotion, cognition and expression. Via the game elements of competition, interaction, storytelling, real-time responses, concretizing feedback, integrated peer learning, and equality between teachers and students, students who play patient roles are able to perceive different levels of comfort, which encourages the development of insight into the meaning of empathy. Thereby, the goals of the empathy lesson is achievable within a creative game-based learning environment.

Alcohol use and problem drinking in Taiwanese adolescents: comparison of the Han and indigenous populations

The population of Taiwan is 98% Han and 2% indigenous. Taiwanese Hans are, ethnically, an immigrant Chinese population. Traditionally, indigenous families make wine and, just like tea to the Hans or coffee in Western social settings, wine is served to entertain the guests in the indigenous culture. Alcohol drinking is a way of delivering a message of their conviviality. It also has a central role in traditional harvest festivals, ancestor worship and wedding ceremonies (Historical Research Commission of Taiwan Province, 1996).

The relation between patient education, patient empowerment and patient satisfaction: A cross-sectional-comparison study

PURPOSE

Patient empowerment is a paradigm of clinical practice. The goal of patient empowerment is to lead patients' health and wellbeing. The aim of this study is to evaluate the relation between patient education, patient empowerment and patient satisfaction based on multi-hospital cross-sectional study design in Taiwan.

METHODS

In this cross-sectional survey, 609 inpatients in four teaching hospitals in northern Taiwan from August 2009 to July 2010 were recruited. Data were collected using Chinese version of the Patient Perceptions of Empowerment Scale (PPES), Sufficiency of Patient Education Questionnaire (SPEQ) and Patient Satisfaction Questionnaire (PSQ). The multiple linear regression model was used to assess the independent effects of relevant factors on patient empowerment after controlling for the covariates.

RESULTS

The overall mean empowerment scores was 44.80±5.94. There was a significant difference between the total scores and four dimensions of patient empowerment at different hospitals (t=5.44, p≤0.01). Sufficient patient education (β=0.568, 95%CI: 0.486-0.649) and patient satisfaction (β=0.317, 95%CI: 0.259-0.375) could significantly predict patient empowerment based on the multiple linear regression analysis, with a total variance was 54.4%.

CONCLUSIONS

In conclusion, both sufficient patient education and patient satisfaction were positively related to patient empowerment. Hospitals in Taiwan should try to improve their patients' active involvement toward empowerment.

Effectiveness of a psychoeducational programme in enhancing motivation to change alcohol-addictive behaviour

AIMS AND OBJECTIVES

To evaluate the effectiveness of a psychoeducational programme in enhancing motivation to change alcohol-addictive behaviour.

BACKGROUND

The prevalence of alcohol abuse has increased over the past 10 years, and the age of initial alcohol use has decreased gradually in Taiwan. Alcohol dependence is one of the leading causes of disability and has led to increases in the incidence of crime and violence, with alcohol abuse identified as a problem in society.

DESIGN

A quasi-experimental design with nonequivalent pre/post-testing was used.

METHODS

Alcohol-dependent inpatients undergoing alcohol treatment were selected from the psychiatric ward of a teaching hospital in northern Taiwan. The effectiveness of the psychoeducational programme in enhancing motivation to change alcohol-addictive behaviour was evaluated with the Severity of Alcohol Dependence Data Questionnaire and the Stages of Change Readiness and Treatment Eagerness Scale. In total, 24 and 51 participants were recruited to the experimental and control groups, respectively, for the baseline survey, and 14 and 17 were in the final survey, respectively.

RESULTS

After adjustment for baseline survey scores, the experimental group showed significantly greater increases in recognition and ambivalence relative to those observed in the control group.

CONCLUSIONS

The results not only showed that the psychoeducational programme was effective in reinforcing addicted inpatients' motivation for changing their drinking behaviour but also provided clinical nurses with practical methods via which to enhance patient motivation.

RELEVANCE TO CLINICAL PRACTICE

The psychoeducational programme could assist clinical nurses in helping alcohol-dependent patients to recognise the nature of their problematic drinking; increase participants' ambivalence towards their drinking behaviour, leading to the contemplation of change; and strengthen the possibility that they will change their addictive behaviour.

Reverse thermo-responsive hydrogels prepared from Pluronic F127 and gelatin composite materials

A series of F127–gelatin composite hydrogels with reverse thermo-responsive and tunable mechanical properties were developed.

Using Diffusion Tensor Imaging to Evaluate Microstructural Changes and Outcomes after Radiofrequency Rhizotomy of Trigeminal Nerves in Patients with Trigeminal Neuralgia

Trigeminal neuralgia is characterized by facial pain that may be sudden, intense, and recurrent. Our aim was to investigate microstructural tissue changes of the trigeminal nerve in patients with trigeminal neuralgia resulting from neurovascular compression by diffusion tensor imaging, and to test the predictive value of diffusion tensor imaging for determining outcomes after radiofrequency rhizotomy. Forty-three patients with trigeminal neuralgia were recruited, and diffusion tensor imaging was performed before radiofrequency rhizotomy. By selecting the cisternal segment of the trigeminal nerve manually, we measured the volume of trigeminal nerve, fractional anisotropy, apparent diffusion coefficient, axial diffusivity, and radial diffusivity. The apparent diffusion coefficient and mean value of fractional anisotropy, axial diffusivity, and radial diffusivity were compared between the affected and normal side in the same patient, and were correlated with pre-rhizotomy and post-rhizotomy visual analogue scale pain scores. The results showed the affected side had significantly decreased fractional anisotropy, increased apparent diffusion coefficient and radial diffusivity, and no significant change of axial diffusivity. The volume of the trigeminal nerve on affected side was also significantly smaller. There was a trend of fractional anisotropy reduction and visual analogue scale pain score reduction (P = 0.072). The results suggest that demyelination without axonal injury, and decreased size of the trigeminal nerve, are the microstructural abnormalities of the trigeminal nerve in patients with trigeminal neuralgia caused by neurovascular compression. The application of diffusion tensor imaging in understanding the pathophysiology of trigeminal neuralgia, and predicting the treatment effect has potential and warrants further study.

Self-Assembled Peptide-Based Hydrogels as Scaffolds for Proliferation and Multi-Differentiation of Mesenchymal Stem Cells

Fluorenyl-9-methoxycarbonyl (Fmoc)-diphenylalanine (Fmoc-FF) and Fmoc-arginine-glycine--aspartate (Fmoc-RGD) peptides self-assemble to form a 3D network of supramolecular hydrogel (Fmoc-FF/Fmoc-RGD), which provides a nanofibrous network that uniquely presents bioactive ligands at the fiber surface for cell attachment. In the present study, mesenchymal stem cells (MSCs) in Fmoc-FF/Fmoc-RGD hydrogel increase in proliferation and survival compared to those in Fmoc-FF/Fmoc-RGE hydrogel. Moreover, MSCs encapsulated in Fmoc-FF/Fmoc-RGD hydrogel and induced in each defined induction medium undergo in vitro osteogenic, adipogenic, and chondrogenic differentiation. For in vivo differentiation, MSCs encapsulated in hydrogel are induced in each defined medium for one week, followed by injection into gelatin sponges and transplantation into immunodeficient mice for four weeks. MSCs in Fmoc-FF/Fmoc-RGD hydrogel increase in differentiation into osteogenic, adipogenic, and chondrogenic differentiation, compared to those in Fmoc-FF/Fmoc-RGE hydrogel. This study concludes that nanofibers formed by the self-assembly of Fmoc-FF and Fmoc-RGD are suitable for the attachment, proliferation, and multi-differentiation of MSCs, and can be applied in musculoskeletal tissue engineering.

Functional Supramolecular Polymers: A Fluorescent Microfibrous Network in a Supramolecular Hydrogel for High-Contrast Live Cell-Material Imaging in 3D Environments

A new bottom-up strategy based on aromatic peptide amphiphile is developed for a high-contrast visualization of 3D live cell-material imaging-something that has been difficult to achieve previously because of the problems associated with the diffraction of light by the nanosized peptide materials and the aggregation-caused quenching of aggregated π-conjugated fluorophores in the nanostructures. This study reports an example of a novel supramolecular hydrogelator, naphthaleneimide-phenylalanine (NI-Phe), which forms a self-supporting hydrogel displaying a unique microfibrous network and promising aggregation-induced emission characteristics at pH 7.4. The storage modulus of the NI-Phe gel supports the mass of a cell for 3D cell culturing. This work illustrates a new dopant-free supramolecular approach, complementary to well-established doping procedures that should facilitate the development of live cell imaging in 3D scaffolding materials.

A novel nanostructured supramolecular hydrogel self-assembled from tetraphenylethylene-capped dipeptides

Herein, we report a tetraphenylethylene-diglycine (TPE-GG) hydrogelator from a systematic study of TPE-capped dipeptides with various amphiphilic properties. From a chemical design, we found that the hydrogelation of TPE-GG molecules can be utilized to generate supramolecular nanostructures with a large TPE-based nanobelt width (∼300 nm) and lateral dimension ratio (>30 fold). In addition, TPE-GG has the lowest molecular weight and minimum number of atoms compared to any TPE-capped peptide hydrogelator reported to date. This minimal self-assembled hydrogelator can fundamentally achieve the gel features compared with other TPE-capped peptides. A combined experimental and computational study indicates the π-π interactions, electrostatic interactions and hydrogen-bonding interactions are the major driving forces behind the formation of self-assembled nanobelts. This study demonstrates the importance of structure-property relationships and provides new insights into the design of supramolecular nanomaterials.

Effect of Peptide Sequences on Supramolecular Interactions of Naphthaleneimide/Tripeptide Conjugates

In this study, we reported a significant difference in the supramolecular hydrogelation of newly discovered NI-GFF (NI-Gly-l-Phe-l-Phe) and NI-FFG (NI-l-Phe-l-Phe-Gly) on the basis of their phase diagrams. With a small difference in the peptide chain between NI-GFF and NI-FFG, we observed a significant difference in their self-assembly properties; NI-GFF formed a stable gel at neutral pH, whereas NI-FFG did not, under the same conditions. From spectroscopic and computational studies, intermolecular π-π interactions and extended hydrogen bonding interactions might reinforce the intermolecular interactions of NI-GFF, which may facilitate the formation of the self-assembled nanostructures and the hydrogel. In addition, the aggregation-induced emission (AIE)-active NI-GFF reveals relatively good biocompatibility compared with that of NI-FFG for two commonly used cell lines, suggesting that it is a promising candidate for use as a supramolecular material in biomedical applications. Our results highlight the importance of tripeptide sequences in a self-assembling hydrogel system.

Nanofibrous hydrogels self-assembled from naphthalene diimide (NDI)/amino acid conjugates

A new approach is proposed for the design of NDI-capped supramolecular hydrogels.

Clinical predictors associated with full remission versus episode of major depressive disorder outpatients: the experience at a teaching hospital in Taiwan

BACKGROUND

When depressed patients are in remission, the clinical characteristics indicate that they are able to participate in social activities more regularly, and their impairment in daily functioning is improved. The present study examines the clinical characteristics associated with one- and two month clinical response in outpatients with Major Depressive Disorder (MDD) in Taiwan.

METHODS

A total of 160 outpatients were initially recruited from the medical centre in Taiwan. Of these participants, 151 MDD patients completed the baseline-assessment interview, 111 were interviewed and assessed again 4 weeks later, and 78 completed the final interview and assessment 8 weeks later. In the present study, asymptomatic was defined as scoring ≤ 7 on the Hamilton Depression Rating Scale (HAM-D); partially symptomatic was defined as scoring 8-14; fully symptomatic was defined as scoring ≥15. Finally, asymptomatic, partially symptomatic, and fully symptomatic were defined in patients with MDD respectively as in full remission, in persistent depressive symptom, and in episode.

RESULTS

Of the remaining 78 patients, a total of 21 (26.9%) were in full remission, 35 (44.9%) were in persistent depressive symptom, and 22 (28.2%) were in episode. Patients in full remission were older (p = 0.03), exhibited greater psychosocial functioning, (p < 0.001), held more-positive beliefs regarding antidepressant medication (p = 0.03), had higher self-efficacy (p = 0.001), and scored lower for neuroticism (p = 0.003), as compared to patients in episode. Younger patients were more prevalent in persistent depression. Repeated-measures ANOVA revealed that differences in four factors (psychosocial functioning, beliefs regarding antidepressant medication, self-efficacy in managing and preventing depression, and neuroticism) were significantly different between full remission and episode. Episode was significantly associated with psychosocial-functioning impairment (OR = 1.12, 95% CI: 1.00-1.26) and poorer self-efficacy (OR = 0.91, 95% CI: 0.82-1.00).

CONCLUSIONS

Our findings identify significant factors of full remission, persistent depressive symptom, and episode. We highlight the importance of enhancing patients' psychosocial functioning and self-efficacy until achieving full remission. Suggestions are provided for clinical health-care management services in Taiwan.

Reasons for middle-aged women in Taiwan to choose hysterectomy: a qualitative study using the bounded rationality perspective

AIMS AND OBJECTIVES

To explore women's perspectives on deciding to undergo hysterectomy for benign conditions based on physicians' recommendations and the women's own judgement.

BACKGROUND

Hysterectomy is the second most common surgical procedure worldwide. Although most hysterectomies are elective, physicians may recommend treatment that involves a loss of sexuality or ovary removal, creating a difficult choice for women.

DESIGN

Qualitative, in-depth interview

METHODS

A purposive sample of 17 women was recruited. The women had decided to undergo hysterectomy after the diagnosis of uterine fibroids. All these women had already decided not to have more children. Data were collected by in-depth interviewing, and content analysis was used to analyse the data.

RESULTS

Our study revealed five themes: release from stress, inescapable fate, positive support, hoping for peace of mind and sense of trust.

CONCLUSIONS

The participants felt that mental and physical health were the most important considerations, noting that when women no longer want children, a uterus is useless. The women believed that they retained their womanhood, even without a uterus, and were satisfied with the outcomes of their hysterectomy decisions.

RELEVANCE TO CLINICAL PRACTICE

Our findings might serve as educational and counselling reference materials for healthcare providers, ensuring that women receive appropriate care quality and have their needs met. Healthcare providers can then maximise women's empowerment, deepen their awareness of body image and their concept of self-care and help them to clearly perceive their own concerns and needs so that they can make suitable decisions.

Disruption of brain connectivity in acute stroke patients with early impairment in consciousness

Impairment in consciousness is common in acute stroke patients and is correlated with the clinical outcome after stroke. The underlying mechanism is not completely understood, with little known about brain activity and connectivity changes in acute stroke patients having impaired consciousness. In this study, we investigated changes in regional brain activity and brain networks of consciousness impaired stroke patients, as well as the amplitude of spontaneous low frequency fluctuation (ALFF) of each time series. Regional homogeneity (ReHo) of each voxel was measured, and resting state network analysis was consequently conducted. Results from this study demonstrate that, compared to normal subjects, the intensities of ALFF and ReHo, as well as the strength of the default mode network (DMN) connectivity, were significantly decreased in the precuneus and posterior cingulate cortex regions among stroke patients with impaired consciousness. Furthermore, the strength of the DMN was highly correlated with differences in the Glasgow Coma Scale (GCS) scores between the onset time and the scanning time. Results from this study suggest that the resting state fMRI is a feasible tool for the evaluation of acute stroke patients with an early impairment of consciousness. The detailed mechanisms, implications of these brain activities and networks exhibiting changes will require further investigation.

Comparison of arterial spin labeling and dynamic susceptibility contrast perfusion MRI in patients with acute stroke

Background

The aim of this study was to evaluate whether arterial spin labeling (ASL) perfusion magnetic resonance imaging (MRI) can reliably quantify perfusion deficit as compared to dynamic susceptibility contrast (DSC) perfusion MRI.

Methods

Thirty-nine patients with acute ischemic stroke in the anterior circulation territory were recruited. All underwent ASL and DSC MRI perfusion scans within 30 hours after stroke onset and 31 patients underwent follow-up MRI scans. ASL cerebral blood flow (CBF) and DSC time to maximum (T_max) maps were used to calculate the perfusion defects. The ASL CBF lesion volume was compared to the DSC T_max lesion volume by Pearson's correlation coefficient and likewise the ASL CBF and DSC T_max lesion volumes were compared to the final infarct sizes respectively. A repeated measures analysis of variance and least significant difference post hoc test was used to compare the mean lesion volumes among ASL CBF, DSC T_max >4–6 s and final infarct.

Results

Mean patient age was 72.6 years. The average time from stroke onset to MRI was 13.9 hours. The ASL lesion volume showed significant correlation with the DSC lesion volume for T_max >4, 5 and 6 s (r = 0.81, 0.82 and 0.80; p<0.001). However, the mean lesion volume of ASL (50.1 ml) was significantly larger than those for T_max >5 s (29.2 ml, p<0.01) and T_max >6 s (21.8 ml, p<0.001), while the mean lesion volumes for T_max >5 or 6 s were close to mean final infarct size.

Conclusion

Quantitative measurement of ASL perfusion is well correlated with DSC perfusion. However, ASL perfusion may overestimate the perfusion defects and therefore further refinement of the true penumbra threshold and improved ASL technique are necessary before applying ASL in therapeutic trials.

[The spirit of humanism should be cultivated in the nursing profession]

As nursing is an art that emphasizes the nature of caring it should have humanistic attributes. Humanistic education of a nursing professional should emphasize a person-centered perspective in order to foster cultivation of the humanities and infuse the spirit of humane care into medical practice. Cultivation of humanism refers to the emotional level of personal-affective experience that blends humanistic science and aesthetic experience to enhance nurse observational abilities. The ability generated by self-awareness and reflection can trigger deep empathy and empathetic performance, which is ideal humanistic-nursing behavior in nursing staff. Traditional nursing education focuses on acquiring professional knowledge and largely ignores the cultivation of a humanist spirit. To help nurses adjust to the rapidly changing environment of nursing care and demonstrate a professional and humane character, in addition to advocating for a humane medical environment, the six Es of humanistic-nursing education (Example, Explanation, Exhortation, Environment, Experience, Expectation) should be promoted. The six Es are essential to building a framework to cultivate humanistic education strategies and strengthen humanist content in nursing education. In order to instill deeply the spirit of humanistic care in nursing and make the nursing-care process more humane, these ideals must be emphasized in nursing education to raise the level of humanism.

Sleep quality and quality of life in female shift-working nurses

AIM

This paper is a report of a study of the factors that influence sleep quality and quality of life among shift-working nurses and the relationship between their sleep quality and quality of life.

BACKGROUND

Although shift-working nurses strive to adapt their life schedules to shift rotations, they tend to suffer from severe sleep disturbances and increased rates of cancer, cardiovascular diseases, digestive disease and irregular menstrual cycles. Poor sleep is also associated with medical errors and occupational injuries.

METHODS

A cross-sectional study was conducted in 2008 with a convenience sample of 435 female nurses from five regional hospitals in Taiwan. Data were collected on sleep quality and quality of life using the Pittsburgh Sleep Quality Index and World Health Organization Quality of Life Instrument-BREF Taiwan version respectively. Data were analysed using descriptive statistics, independent t-tests, analysis of variance and Pearson correlations.

FINDINGS

The majority of female shift workers (57%) had global sleep-quality scores > or = 5, indicating poor sleep and all mean scores in four domains of the quality-of-life measure were statistically significantly lower than those of females in Taiwan's general population. Scores for poor sleep quality and quality of life were related to premenstrual dysphoria, occupational injury, illness and medication use. In addition, the associations between scores on the sleep-quality and quality-of-life scales were statistically significantly inversely correlated.

CONCLUSION

Advice should be included in both undergraduate programmes and continuing education to help nurses to recognize and improve their own sleep quality and life quality managers should create a supportive environment to encourage shift-working nurses to engage in healthy behaviours.

Cultural and hierarchical influences: ethical issues faced by Taiwanese nursing students

OBJECTIVES Improving nurses' competence in resolving clinical ethical issues must start with ethics education in training and clinical practice. However, many students complain that they cannot apply classroom learning to actual clinical scenarios. This study explored ethical issues and dilemmas, and their impact experienced by student nurses in clinical practice. METHODS Focus groups were conducted with 44 first-year student nurses from a 2-year college course in northern Taiwan. Interviews were tape-recorded and verbatim transcripts were analysed using content analysis. RESULTS Students expressed and discussed their views in eight focus groups. Analysis of interviews revealed five themes: frustration at inability to help some patients; oppression caused by lower status; lack of honesty and ethical courage; powerlessness, and self-encouragement in adversity. CONCLUSIONS Taiwanese nurse ethics training was only recently introduced and the curriculum has not addressed the clinical reality in Taiwan. This reality includes limitations arising from the medical hierarchy and the socio-cultural role of families in medical decision making, which may inhibit ethical judgements and decision making. In clinical dilemmas, the most common problems faced by Taiwanese nursing students involved not knowing how to handle some situations, inability to abide by principles, and a lack of appropriate role models. Hence, we suggest that nursing ethics education should: (i) integrate scenarios involving ethical dilemmas into daily routines; (ii) give students opportunities to discuss their feelings about their experiences; (iii) allow teachers and students to talk about scenarios with ethical implications, and (iv) provide students with opportunities to reflect on clinical scenarios in order to clarify their values and learn how to respect the value of life.

An ongoing process: a qualitative study of how the alcohol-dependent free themselves of addiction through progressive abstinence

BACKGROUND

Most people being treated for alcoholism are unable to successfully quit drinking within their treatment programs. In few cases do we know the full picture of how abstinence is achieved in Taiwan. We tracked processes of abstinence in alcohol-dependency disorders, based on study evidence and results. This research explores the process of recovery from the viewpoint of the alcohol-dependent.

METHODS

Semi-structured interviews were conducted in two different settings, using purpose sampling, during 2003-2004. The data were analyzed using content analysis. Participants were 32 adults, purposefully selected from an Alcoholics Anonymous group and a psychiatric hospital in North Taiwan.

RESULTS

We found that the abstinence process is an ongoing process, in which the alcohol-dependent free themselves of addiction progressively. This process never ends or resolves in complete recovery. We have identified three stages in the struggle against alcoholism: the Indulgence, Ambivalence and Attempt (IAA) cycle, in which the sufferer is trapped in a cycle of attempting to give up and failing; the Turning Point, in which a Personal Nadir is reached, and the Ongoing Process of abstinence, in which a constant effort is made to remain sober through willpower and with the help of support groups. We also discuss Influencing Factors that can derail abstinence attempts, pushing the sufferer back into the IAA cycle.

CONCLUSION

This study provides important points of reference for alcohol and drug service workers and community healthcare professionals in Taiwan, casting light on the abstinence process and providing a basis for intervention or rehabilitation services.

A psychometric evaluation of the Chinese version of the stage of change-readiness and treatment-eagerness scale

AIMS

The present study analysed the psychometric properties of a Chinese version of the stage of change-readiness and treatment-eagerness scale among alcohol-dependent patients and investigated whether a three-factor structure fit the data.

BACKGROUND

The stage of change-readiness and treatment-eagerness scale is a 19-item instrument designed to measure alcohol-dependent patients' motivation for change. However, this instrument had not been translated and validated for use in Taiwan.

DESIGN

Survey.

METHODS

A sample of 161 alcohol-dependent patients receiving alcohol-related treatment in psychiatric hospital outpatient and inpatient units was included. Confirmatory factor analyses were conducted on three-factor measurement models of the stage of change-readiness and treatment-eagerness scale.

RESULTS

Confirmatory factor analyses supported the presence of a three-factor modified model (ambivalence, recognition and taking steps) among alcohol-dependent patients. Higher internal item consistency was found for the recognition and taking step factors, while the ambivalence factor was shown to have lower internal consistency. Convergent, discriminant and concurrent validity were obtained for the assessment of severity of alcohol dependence.

CONCLUSIONS

The results indicated that the 11-item, three-factor modified Chinese version of the stage of change readiness and treatment eagerness scale provided best goodness of fit for the data in this study. This study demonstrated that the Chinese version of the stage of change readiness and treatment eagerness scale is a reliable and valid self-report measure for the assessment of changing motivation in alcohol-dependent patients.

RELEVANCE TO CLINICAL PRACTICE

The Chinese version of stage of change readiness and treatment eagerness scale is applicable for use in clinical treatment and research, predicting motivation for change and evaluating intervention outcomes in Taiwan.

Measuring readiness to change and locus of control belief among male alcohol-dependent patients in Taiwan: comparison of the different degrees of alcohol dependence

AIMS

The purpose of the present study was to evaluate the Drinking-Related Health Locus of Control scale (DRIE) and the three aspects of readiness to change (i.e. ambivalence, recognition, and taking action), in response to the degree of dependence.

METHODS

This study was carried out based on data collected from 160 male alcohol-dependent patients, and the degree of alcohol dependence was divided into three categories: light, moderate, and severe, on the basis of the total scores of the short-form Severity Degree Alcohol Dependence Data questionnaire (SADD).

RESULTS

There were significant differences between the different degrees of dependence on drinking-related locus of control, feelings of ambivalence toward drinking, recognition of problematic drinking, and readiness to take action to change. Patients with more severe dependence usually had higher scores of drinking-related locus of control, indicating a tendency toward external locus of control, feelings of ambivalence, and recognition of their drinking problem; patients with light dependence usually had higher scores for taking action.

CONCLUSIONS

Clinicians can strengthen readiness to change problematic drinking if the importance of degree of dependence and drinking-related locus of control are taken into consideration when devising interventions.

Predictors of adherence to an antidepressant medication regimen among patients diagnosed with depression in Taiwan

This study explored the predictors of medication adherence among Taiwanese people with major depression and dysthymic disorder. Previous research indicates that depressed patients vary in compliance with their medication regimen. Poor compliance reduces the therapeutic effect of medication. Self-report questionnaires were used for this cross-sectional study conducted with 181 outpatients diagnosed with major depression or dysthymic disorder. About 50% of depressed patients reported good medication adherence. The predictors of adherence were patient income, treatment efficacy, and understanding the importance of continuing medication. Professionals should use collaborative communication and cultural values clarification with depressed patients and their families to improve the awareness of illness and to increase the likelihood of medication compliance.

An empowerment process: successful recovery from alcohol dependence

AIMS

The purpose of this study was to explore the concepts and processes for successful abstinence from alcohol for Taiwanese Alcoholics Anonymous members.

BACKGROUND

Attempting to identify the psychological and social influences upon alcohol consumption remission outside of alcoholism treatment could help professionals to engage in a broad array of community interventions in an informed fashion.

METHODS

Grounded theory method was utilized in this study. The study chose nine participants who had succeeded in abstinence, using theoretical sampling and conducted in-depth interviews by an open-ended questionnaire.

RESULTS

The results of this study indicated that the core of the process during which alcoholic individuals succeeded in abstaining from further alcohol consumption was an empowerment process for the involved individual. Alcoholics felt that their family, interpersonal relationships, jobs and personal finances all had been at 'rock-bottom' level following a long period of alcohol dependence. This feeling caused the individual to experience an emotion of a loss of control and provoked the arousal of an alcoholic's inner consciousness levels, this then resulting in the generation of a driving force for abstinence from alcohol for these individuals.

CONCLUSIONS

The expansion of an individual's internal awakening power helps the individual to obtain assistance and to resist the temptation of further alcohol consumption. Therefore, the power derived by individuals from the stages of repositioning, releasing, active sharing, resistance and assistance are the maintenance factors for an individual's empowerment process that help maintain the successful recovery from alcohol for the involved individual.

RELEVANCE TO CLINICAL PRACTICE

A good comprehension of the recovery processes for alcoholics, we believe, will trigger clinical professionals to pay appropriate attention to the specific problems and needs of alcoholic individuals, to build an effective resource network for treatment and to help solve alcoholics' physical and psychosocial problems.

Factors related to quality of life in depressive outpatients in Taiwan

Issues related to recovery of quality of life (QoL) in depressive outpatients have been raised. This descriptive correlation study investigated QoL in depressive outpatients in Taiwan. A total of 181 depressive outpatients participated in the study. Their QoL levels were measured using the Taiwanese version of the Short Form of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF). The results indicate that multiple predicting factors including marriage, less severity of depression, better social support, and better medical professional-patient interaction are associated with better QoL in depressive outpatients in the physical, psychological, social relationship, and environmental domains. QoL and its correlation with depressive outpatients must be emphasized in order to develop appropriate strategies to improve QoL and treatment efficacy.