Feasibility of Endotracheal Extubation Evaluation Form in Predicting Successful Extubation in Neonatal Intensive Care Units: A Retrospective Study.

Given the limited availability of evidence-based methods for assessing the timing of extubation in intubated preterm infants, we aimed to standardize the extubation protocol in this single-center, retrospective study. To accomplish this, we established an extubation evaluation form to assess the suitability of extubation in preterm infants. The form comprises six indicators: improved clinical condition, spontaneous breath rate ≥ 30 breaths per minute, peak inspiratory pressure (PIP) ≤ 15 cmH2O, fraction of inspired oxygen (FiO2) ≤ 30%, blood pH ≥ 7.2, and mixed venous carbon dioxide tension (PvCO2) < 70 mmHg. Each positive answer is given one point, indicating a maximum of six points. We enrolled 41 intubated preterm infants (gestational age < 32 weeks, birth weight < 1500 g) who were receiving mechanical ventilation support for over 24 h. Among them, 35 were successfully extubated, and 6 were not. After completing the extubation evaluation form and adjusting for birth weight and postextubation device, we observed that the total score of the form was significantly associated with successful extubation; the higher the score, the greater the chance of successful extubation. Thus, we infer that the extubation evaluation form may provide a more objective standard for extubation assessment in preterm infants.

Massive Distance Education: Barriers and Challenges in Shifting to a Complete Online Learning Environment.

The global pandemic has dramatically changed how the world functions and impacted all sectors of society including all educational institutions. Government and educators respond with immediate online teaching and learning for all students. Massive distance education has been drawn into the picture to provide non-stop learning in most countries worldwide. This study focuses on examining different orders of barriers educators have encountered during the Covid-19 pandemic. The barriers to massive online teaching and learning included the first-order barrier (technological or external barrier), the second-order barrier (internal barrier or teachers' and parents' beliefs), the third-order barrier (design thinking barrier), and the 2.5th order barrier (the classroom management barrier). Both teachers and students are suffering from unstable or limited internet connectivity and it directly hinders students' rights in the massive online education. Teachers are facing the need for sudden pedagogical redesign while parents are enduring the burden of providing all kinds of support for their children's online learning at home. Some learners are experiencing videoconferencing fatigue and struggling with overwhelming resources and an excessive amount of technology time. This study also identifies a group of forgotten learners, the videoconferencing refugees, who have limited access to the Internet and lost their learning opportunities. From a global perspective, shifting to massive online education may be possible with all four orders of barriers being overcome.

Amentoflavone Induces Apoptosis and Reduces Expression of Anti-apoptotic and Metastasis-associated Proteins in Bladder Cancer.

BACKGROUND/AIM: Amentoflavone has been shown to be effective against a variety of cancer cells, but its role in bladder cancer remains unclear. Thus, the aim of this study is to evaluate whether amentoflavone may induce toxicity effect of bladder cancer. MATERIALS AND METHODS: Herein, we evaluated amentoflavone effects in a human bladder cancer cell line TSGH8301 in vitro. RESULTS: Amentoflavone caused significant cytotoxicity in TSGH8301 cells at a concentration as low as 200 µM. FAS/FASL-dependent extrinsic apoptosis and mitochondria-dependent intrinsic apoptosis were observed in amentoflavone-treated cells in a dose-dependent manner. Levels of several proapoptotic proteins, such as FAS, FAS-ligand and BAX (B-cell lymphoma 2 associated X) were increased following amentoflavone treatment. Meanwhile, anti-apoptotic MCL-1 (myeloid cell leukemia sequence 1) and cellular FLICE-inhibitory protein (C-FLIP) protein levels were reduced. Additionally, angiogenesis and proliferation-related proteins, including matrix metalloproteinase (MMP)-2, -9, vascular endothelial growth factor (VEGF), urokinase-type plasminogen actvator (uPA) and cyclin D1 were diminished by amentoflavone. CONCLUSION: Amentoflavone induced toxicity of bladder cancer by inhibiting tumor progression and inducing apoptosis signaling transduction.

A Tai Chi exercise programme improved exercise behaviour and reduced blood pressure in outpatients with hypertension.

This two-group pretest and posttest quasi-experimental study aimed to evaluate the effects of a Tai Chi exercise programme on exercise behaviour and blood pressure (BP) in outpatients with hypertension. The experimental group (n = 27) received the Yang-style Tai Chi exercise programme three times a week for 8 weeks. The control group (n = 31) received routine care with no Tai Chi exercise. Exercise behaviour and exercise time using Routine Health Care Behaviour scale and BP were assessed at baseline and 8 weeks. The experimental group had a significant improvement on exercise behaviour (t = 2.11, P < 0.001) and exercise time (t = 1.44, P = 0.003), and a significant reduction in systolic BP (t = 2.57, P < 0.001) and diastolic BPs (t = 2.86, P < 0.001) compared with those of the control group. Tai Chi is an inexpensive and viable exercise and can improve exercise behaviour and BP control in outpatients with hypertension. Tai Chi exercise might offer outpatients with hypertension additional options, such as an adjunct to formal cardiac rehabilitation or as an exercise alternative in their management of hypertension. Nursing staff can easily learn and incorporate this exercise in patient education or care planning in the care of patients with hypertension in outpatient settings.