Structural basis and synergism of ATP and Na+ activation in bacterial K+ uptake system KtrAB.

The K+ uptake system KtrAB is essential for bacterial survival in low K+ environments. The activity of KtrAB is regulated by nucleotides and Na+. Previous studies proposed a putative gating mechanism of KtrB regulated by KtrA upon binding to ATP or ADP. However, how Na+ activates KtrAB and the Na+ binding site remain unknown. Here we present the cryo-EM structures of ATP- and ADP-bound KtrAB from Bacillus subtilis (BsKtrAB) both solved at 2.8 Å. A cryo-EM density at the intra-dimer interface of ATP-KtrA was identified as Na+, as supported by X-ray crystallography and ICP-MS. Thermostability assays and functional studies demonstrated that Na+ binding stabilizes the ATP-bound BsKtrAB complex and enhances its K+ flux activity. Comparing ATP- and ADP-BsKtrAB structures suggests that BsKtrB Arg417 and Phe91 serve as a channel gate. The synergism of ATP and Na+ in activating BsKtrAB is likely applicable to Na+-activated K+ channels in central nervous system.

Increased Risk of Coronary Artery Disease in People with Diagnosis of Neuromuscular Disorders: A Nationwide Retrospective Population-Based Case-Control Study.

The existing literature has explored carpal tunnel syndrome (CTS) and determined that it could be a risk for coronary artery disease (CAD), but there has been little research comparing the relevance of CAD with other neuromuscular disorders (NMDs) to CTS. This case-control study explored the association between CTS, stenosing tenosynovitis (ST), and ulnar side NMDs and CAD. The study utilized data from Taiwan's National Health Insurance Research Database, focusing on health insurance claims. Between January 2000 and December 2011, we employed the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes to identify 64,025 CAD patients as the case group. The control group consisted of an equal number of individuals without CAD, matched for age, sex, and index year of CAD. Logistic regression analysis was employed to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for each variable. Multivariate analysis, after adjusting for sociodemographic factors and comorbidities, revealed a significantly higher likelihood of a previous diagnosis of CTS in the CAD group compared to the comparison control group. However, neither ST nor the ulnar side NMDs had any statistical significance. These results indicated that median nerve injury, rather than other NMDs, may uniquely serve as a predisposing factor of CAD.

The effects of laser acupuncture dosage at PC6 (Neiguan) on brain reactivity: a pilot resting-state fMRI study.

Previous studies indicated that laser acupuncture (LA) may effectively treat various medical conditions. However, brain responses associated with LA intervention have not been fully investigated. This study is focused on the effect of LA with different energy density (ED) in brain using resting-state functional magnetic resonance imaging (fMRI). We hypothesized that different ED would elicit various brain responses. We enrolled healthy adults participants and selected bilateral PC6 (Neiguan) as the intervention points. LA was applied, respectively, with ED of 0, 7.96, or 23.87 J/cm2. Two 500-s resting-state fMRI scans were acquired before and after intervention, respectively. The functional connectivity (FC) was calculated between autonomic nerve system-regulation associated brainstem structures and other brain regions. Compared to other dosages, the FC between rostral ventrolateral medulla and orbitofrontal cortex has more enhanced; the FC between caudal ventrolateral medulla, nucleus of the solitary tract/nucleus ambiguus, and dorsal motor nucleus of the vagus and somatosensory area has more weakened when ED was 23.87 J/cm2. Different dosages of LA have demonstrated varied regions of FC changes between regions of interest and other brain areas, which indicated that variations in EDs might influence the clinical efficacy and subsequent impacts through distinct neural pathways within the brain.

Analgesic Efficacy of Acupuncture on Chronic Pelvic Pain: A Systemic Review and Meta-Analysis Study.

Chronic pelvic pain (CPP) is the pain occurred in the pelvic region longer than six months. The monotherapy of medicine may not adequate for the pain management of CPP and multidisciplinary approaches have been more recommended. The aim of this study is to evaluate the pain management efficacy of acupuncture compared with a control group on CPP. The articles of randomized controlled trial on CPP in PubMed and Embase databases were screened between January 2011 and September 2022 without language restriction to evaluate the treatment efficacy of acupuncture. The visual analogue scale/numerical rating scale (VAS/NRS) and total pain scores of National Institutes of Health-chronic prostatitis symptom index (NIH-CPSI) were served as outcome variables. Post-intervention mean scores were extracted and pooled for meta-analysis. Seventeen studies including 1455 patients were selected for meta-analysis. Both total pain scores of NIH-CPSI and VAS/NAS data revealed significant lower pain level in the acupuncture group than in the control group. Moreover, monotherapy with acupuncture revealed a significantly lower pain level than in the control group in both total pain scores of NIH-CPSI and VAS/NRS. These results indicated that acupuncture may have beneficial effects on pain management for CPP, even when administrated as a monotherapy.

The Dosage Effect of Laser Acupuncture at PC6 (Neiguan) on Heart Rate Variability: A Pilot Study.

Laser acupuncture (LA) has been more applicated in the clinical practice with good responses, but the dosage and parameter settings are still inconsistent with the arguments. This study is focused on the effect of LA on heart rate variability (HRV) with different energy density (ED). Based on the Arndt-Schulz law, we hypothesized that the effective range should fall within 0.01 to 10 J/cm2 of ED, and settings above 10 J/cm2 would perform opposite or inhibitory results. We recruited healthy adults in both sexes as subjects and choose bilateral PC6 (Neiguan) as the intervention points to observe the HRV indexes changes by an external wrist autonomic nerve system (ANS) watch on the left forearm. The data from the ANS watch, including heart rate, blood pressure, and ANS activity indexes, such as low frequency (LF), high frequency (HF), LF%, HF%, LF/HF ratio, and so on, were analyzed by the one-way ANOVA method to test the possible effect. In this study, every subject received all three different EDs of LA in a randomized order. After analyzing the data of 20 subjects, the index of HF% was upward and LF/HF ratio was downward when the ED was 7.96 J/cm2. Otherwise, the strongest ED 23.87 J/cm2 performed the opposite reaction. Appropriately, LA intervention could affect the ANS activities, with the tendency to increase the ratio of parasympathetic and decrease the ratio of sympathetic nerve system activities with statistically significant results, and different ED interventions are consistent with Arndt-Schulz law with opposite performance below and above 10 J/cm2.

Trajectory of growth in Taiwanese nursing students' professional self-concept over two years and its association with critical thinking and class climate.

BACKGROUND: Nursing is a practice-oriented profession, and the goal of education is to cultivate confidence and assertiveness for future clinical practice. Nurturing a professional self-concept at school is expecting to help students to approach their success in the nursing profession. PURPOSE: Using a hierarchical model associated with critical thinking, academic achievement, class climate, and work experience, this longitudinal correlational study explored the growth trajectory of professional self-concept over two years in students attending 2- or 4-year baccalaureate nursing programs. METHOD: This was a longitudinal and correlational study with five repeated measurements. Questionnaire data were collected by using the Chinese version of the Nurses Self-Concept Instrument (NSCI-C) and the California Critical Thinking Disposition Inventory (CCTDI). RESULTS: Scores for overall professional self-concept ranged from 84.51 (standard deviation [SD] 12.34) when the students began this study to 89.28 (SD 11.23) at graduation. Hierarchical linear modeling yielded the growth trajectory of professional self-concept was significantly associated with time (ß = 0.93, p < .01), CCTIDI (ß = 0.13, p < .001), and class climate (ß = 5.20, p < .01). An intraclass correlation coefficient was 55.48%. CONCLUSION: This study confirmed the positive growth trajectory of the professional self-concept in the nursing students' two academic years. The continuous development of the professional self-concept of nursing students is encouraged. Development of critical thinking through their studies, feelings of belonging in their classes, and campus culture all contributed to this trend. To construct a comprehensive hierarchical model, future investigations should use large sample sizes from various classes and conduct multisite evaluations.

The effects of a virtual simulation-based, mobile technology application on nursing students' learning achievement and cognitive load: Randomized controlled trial.

BACKGROUND: The use of virtual simulation methods in nursing education offers potential advantages for students to experience and learn in a safe and realistic environment by acquiring skills and attitudes to prepare for clinical experiences. OBJECTIVE: The study's aim was to test the hypothesis that nursing students who used a mobile learning app would have significantly (1) higher levels of knowledge about medication administration and nasotracheal suctioning, (2) better development of skill performances on medication administration and nasotracheal suctioning, (3) higher satisfaction, and (4) lower cognitive load than a control group. DESIGN: A randomized experimental study with pretest and posttest design. SETTINGS AND PARTICIPANTS: One hundred nursing students were randomly assigned to an experimental or control group at a Southern Taiwan university's school of nursing. METHODS: The experimental group received the virtual simulation-based mobile learning app and the control group used traditional paper materials. Participants were assessed on knowledge before and after the intervention. Skill performance and intrinsic and extraneous cognitive load were measured after the intervention. RESULTS: The experimental group who used the mobile app had significantly higher knowledge scores, significantly lower intrinsic and extraneous cognitive load, better skill performance, and higher satisfaction than the control group. CONCLUSIONS: The implementation of a mobile app for simulation learning had a positive impact on nursing students' knowledge and skill performances as well as the reduction of learning cognitive loading. Nurse educators and researchers should collaborate in developing virtual learning resources to support clinical nursing education. Tweetable abstract: The mobile app for learning achieved higher knowledge and satisfaction scores, demonstrated better skill performance without increasing cognitive load.

Increased Risk of Coronary Artery Disease in People with a Previous Diagnosis of Carpal Tunnel Syndrome: A Nationwide Retrospective Population-Based Case-Control Study.

BACKGROUND: Existing literature suggests that an association exists between coronary artery disease (CAD) and carpal tunnel syndrome (CTS), but few researchers have explored whether CTS is a risk for CAD. MATERIALS AND METHODS: This large case-control study explored the association between CTS and CAD, using health insurance claims data from Taiwan's National Health Insurance Research Database (NHIRD) between January 2000 and December 2013. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes identified 70,622 patients with CAD (ICD-9-CM codes 410-414; cases); 70,622 patients without CAD were frequency-matched by age, sex, and index year of CAD and served as controls. RESULTS: The likelihood of a previous diagnosis of CTS (ICD-9-CM codes 354.0, 354.1) was significantly higher in the CAD group than in the comparison control group (crude OR: 1.75, 95% CI 1.63-1.89; p<0.0001; adjusted OR: 1.46, 95% CI 1.34-1.58; p<0.0001). CONCLUSION: A significant positive correlation was observed between CAD and a previous diagnosis of CTS.

Translation and validation of the Nurses Self-Concept Instrument for college-level nursing students in Taiwan.

Nurturing a professional nursing self-concept is crucial in nursing education. To determine whether it has been achieved, a reliable and valid measurement tool is necessary. This study therefore aimed to translate the Nurses Self-Concept Instrument (NSCI), and then ascertain the content and construct validity, and test-retest and internal consistency reliability in the Chinese version of the NSCI (NSCI-C). A methodological design was conducted with 1239 nursing students of a university recruited as the sample frame and 540 randomly selected. The results showed the content validity index of 0.81 overall, alpha of 0.92 overall, and correlation coefficient of 0.87. The mean score of the NSCI-C was significantly higher in freshman than in senior (p<.01). The hypothesized four-factor model did not fit the data well. After restructuring, two factors were explored, with 69.04% explained variance. The findings suggest that the NSCI-C is reliable and valid in nursing students.

Acupressure improves the postoperative comfort of gastric cancer patients: A randomised controlled trial.

OBJECTIVE: This pilot study evaluated whether acupressure affected the postoperative comfort of gastric cancer patients following a subtotal gastrectomy. METHODS: A randomised controlled trial was conducted. Sixty patients were recruited from 141-bed general surgery ward at a 3000-bed medical centre in Northern Taiwan. Participants were randomly assigned to either a control group receiving regular postoperative care or to the experimental group receiving additional acupressure at acupoints of Neiquan (P6) and Zusanli (ST36) for 3 consecutive days. RESULTS: The similarities between two groups were in postoperative pain and the onset of postoperative nausea and vomiting (PONV) at the baseline. Following acupressure, significant differences were found in postoperative pain (P=.03) and time of first flatus (P=.04); but not PONV (P=.49), nor the time of first defecation (P=.34). CONCLUSIONS: Acupressure is a simple, noninvasive, safe, and economical procedure for improving the comfort of patients who undergo surgery for gastric cancer. Acupressure at the P6 and ST36 acupoints can improve postoperative comfort by alleviating pain and decreasing the time until first flatus. However, additional research is necessary to elucidate how acupressure can improve postoperative outcomes.