Infection Control and SARS Transmission among Healthcare Workers, Taiwan

This study found infrequent transmission of severe acute respiratory syndrome (SARS) coronavirus to healthcare workers involved in the care of the first five case-patients in Taiwan, despite a substantial number of unprotected exposures. Nonetheless, given that SARS has been highly transmissible on some occasions, we still recommend strict precautions

[[alternative]]Research of Quality Indicators for International Medical Service in Taiwan

[[abstract]]隨著全球化發展趨勢，世界各國皆積極發展國際醫療服務，以增加國內經濟發展效益，然而醫療服務機構必須具備相當程度之醫療服務品質，方能吸引外籍病患前來就醫。本研究希望藉由觀光醫療與國際醫療、影響國際醫療服務供需與發展之因素及醫療服務品質指標的文獻回顧，以服務品質測量量表（SERVQUAL量表）為基礎，探討國際醫療服務品質指標構面，並擬定國際醫療服務品質指標，藉由德菲法收集31位專家對台灣國際醫療服務品質指標的一致性意見，進行國際醫療服務品質指標之資料分析，篩選問卷中具有較高效度及信度之品質指標，以發展適合台灣的國際醫療服務品質指標，編製成「國際醫療服務品質指標」，作為醫院機構未來推行國際醫療服務時，提升服務品質之參考工具。研究結果顯示，「國際醫療服務品質指標」問卷經三回合德菲法專家評分後，83項醫療服務品質指標中，43項指標為重要且立即可行性服務品質指標，35項指標為重要但可行性較低，5項指標屬於不重要且不可行。其中以可靠性、保證性及文化為重要且可立即執行之構面，實體構面屬不重要但須執行構面，回應性及關懷性則屬低重要性且不易執行構面；就指標在各別構面內的重要及可行性進行分析，共計36項指標在構面內屬重要且可行指標。[[abstract]]Globalization makes the medical service been provided through all over the world and therefore causes the rapid development of medical tourism been developed from an economic standpoint. It has been realized that the patients’ perception for quality has played an important role and the quality strategies should be set according to the consumer’s standard in order to have a more competitive advantage and best practice in the healthcare industry.The aim of this research is to construct a questionnaire to develop quality indicators of international medical service for foreigner in Taiwan. A modified 3-round Delphi process is then conducted by a panel of 31 experts comprising mainly physicians, nurses and senior level managers from different hospitals, private medical clinics and academic researchers. It shows reliability, culture and assurance are the most important construct as a tool of evaluating medical service quality. There are 36 items can be used by medical institution as important and feasible indicators of medical service quality. Tangibility is a feasible by not important construct. Responsiveness and empathy are not only unimportant but also not easy to perform

The Synthetic β-Nitrostyrene Derivative CYT-Rx20 Inhibits Esophageal Tumor Growth and Metastasis via PI3K/AKT and STAT3 Pathways.

The β-nitrostyrene family have been implicated for anti-cancer property. However, the pharmacological role of β-nitrostyrene in esophageal cancer remain unclear. Here, a β-nitrostyrene derivative, CYT-Rx20, was synthesized and assessed for its anti-cancer activities and underlying mechanism in esophageal cancer. CYT-Rx20 induced cytotoxicity in esophageal cancer cells by promoting apoptosis through activation of caspase cascade and poly(ADP-ribose) polymerase (PARP) cleavage. Besides, CYT-Rx20 inhibited esophageal cancer cell migration and invasion by regulating the expression of epithelial to mesenchymal transition (EMT) markers. CYT-Rx20 decreased cell viability and migration through suppression of the PI3K/AKT and STAT3 pathways. Of note, the cytotoxicity and anti-migratory effect of CYT-Rx20 were enhanced by co-treatment with SC79 (AKT activator) or colivelin (STAT3 activator), suggesting the dependency of esophageal cancer cells on AKT and STAT3 for survival and migration, an oncogene addiction phenomenon. In xenograft tumor-bearing mice, CYT-Rx20 significantly reduced tumor growth of the implanted esophageal cancer cells accompanied by decreased Ki-67, phospho-AKT, and phospho-STAT3 expression. In orthotopic esophageal cancer mouse model, decreased tumor growth and lung metastasis with reduced Ki-67 and phospho-STAT3 expression were observed in mice treated with CYT-Rx20. Together, our results suggest that CYT-Rx20 is a potential β-nitrostyrene-based anticancer compound against the tumor growth and metastasis of esophageal cancer

Effect of CYT-Rx20 on cytotoxicity and cell apoptosis in esophageal cancer cells.

<p>(A) Chemical structure of CYT-Rx20. (B) Effects of CYT-Rx20 on KYSE70 and TE8 cell viability. KYSE70 and TE8 cells were treated with various concentrations of CYT-Rx20 for 48 h and assessed by XTT colorimetric assay. The representative results are repeated at least three times and five replicate wells per CYT-Rx20 concentration in each experiment. (C) KYSE70 and TE8 cells were treated with CYT-Rx20 for 48 h, and cell death was examined with Annexin V/PI staining followed by flow cytometric analysis. (D) Effect of CYT-Rx20 on KYSE70 and TE8 cell apoptosis. TUNEL staining of cells with CYT-Rx20 was analyzed at 48 hours. One-thousand cells were counted for positivity for each stain. (E) Caspase-associated proteins were analyzed by immunoblotting after KYSE70 and TE8 cells were treated with the indicated concentrations of CYT-Rx20 for 24 h. The expression of α-tubulin was used as the internal control. The representative results are from three separate experiments. Results are means ± SEM (n = 3–5). *<i>P</i> < 0.05, **<i>P</i> <0.01, ***<i>P</i> <0.001 compared with the control group.</p

Cytotoxicity^a of CYT-Rx20 on esophageal cancer cell lines.

<p>Cytotoxicity<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0166453#t001fn001" target="_blank">^a</a> of CYT-Rx20 on esophageal cancer cell lines.</p

CYT-Rx20 suppressed orthotopic esophageal tumor growth and metastasis in vivo.

<p>(A) Luciferase-expressing KYSE70 cells were inoculated into the abdominal esophagus of female nude mice as described in the Materials and methods section. The mice were intraperitoneally injected with 0 μg/g (control) or 5 μg/g of CYT-Rx20 three times a week (n = 4–5 per group). After 4 weeks, the mice were anesthetized and intraperitoneally injected with D-luciferin (150 mg/kg) for detection of bioluminescence by IVIS Spectrum in vivo imaging system. (B) Orthotopic esophageal tumor tissues were analyzed for the expression of Ki-67 and phospho-STAT3 by IHC staining. H-score was calculated as the product of percentage of stained cells and intensity of staining. The representative photographs are shown with ×40 (H&E), ×200 (IHC) magnification. (C) Metastatic lung tumor tissues from mice with or without orthotopic esophageal tumor cell injection were analyzed for the expression of Ki-67 and phospho-STAT3. Histograms show the H-score calculated as the product of percentage of stained cells and intensity of staining. The representative photographs are shown with ×100 (H&E), ×200 (IHC) magnification. Results are means ± SEM. *<i>P</i> < 0.05, **<i>P</i> <0.01 compared with the control group.</p

Involvement of PI3K/AKT and STAT3 in CYT-Rx20-inhibited KYSE70 and TE8 cell viability and migration.

<p>(A) Dose effect of CYT-Rx20 on p85, AKT, and STAT3 phosphorylation was performed was performed by using immunoblotting. KYSE70 and TE8 were incubated with CYT-Rx20, and cell viability was detected by using XTT colorimetric assay. In parallel cultures, cells were pre-treated with 4 μM SC79 (B) or 0.5 μM colivelin (C) for 1 h and were further co-incubated with CYT-Rx20 for another 72 h. All values are expressed as a percentage of the control group, which is set as 100%. Results are means ± SEM (n = 3–4). *<i>P</i> < 0.05, **<i>P</i> <0.01, ***<i>P</i> <0.001 compared with the indicated group. Using a modified Boyden chamber assay, KYSE70 and TE8 were pre-treated with 4 μM SC79 (D) or 0.5 μM colivelin (E) for 1 h and further treated with CYT-Rx20 for 48 h. Representative photographs are shown with ×40 magnification. Histograms show the average area of migrated cells compared with control. Results are presented as means ± SEM (n = 3). *<i>P</i> < 0.05, **<i>P</i> <0.01, ***<i>P</i> <0.001 compared with the indicated group.</p

CYT-Rx20 suppressed xenograft tumor growth and decreased phospho-AKT and phospho-STAT3 expression in vivo.

<p>(A) KYSE70 cells were treated with the indicated concentrations of CYT-Rx20, followed by evaluation of anchorage-independent colony formation using soft agar assay as described in the Materials and methods section. The representative photographs are shown with ×100 magnification. (B) Female nude mice subcutaneously xenografted with KYSE70 cells were intraperitoneally treated with 0.1% DMSO in normal saline (control), 5 μg/g CYT-Rx20, or 25 μg/g CYT-Rx20 three times per week (n = 10 for each group). Tumor volumes were measured every week for each group and calculated according to the formula of width²×length/2. (C) Tumor weight was measured after sacrifice of the mice at the end of the 4-week treatment period. (D) Xenograft tumor tissues were analyzed for the expression of Ki-67, phospho-AKT, and phospho-STAT3 by IHC staining. Negative control was performed in the same procedure but without addition of Ki-67, phospho-AKT, or phospho-STAT3 antibodies. H-score was calculated as the product of percentage of stained cells and intensity of staining. The representative photographs are shown with ×200 magnification. (E) Hematoxylin and eosin (H&E) staining of tissues sections from mouse organs in control and CYT-Rx20 (25 μg/g)-administered mice. The representative photographs are shown with ×100 (Esophagus, Lung, Spleen), ×200 (Heart, Liver, Kidney) magnification. Results are means ± SEM. *<i>P</i> < 0.05, **<i>P</i> <0.01, ***<i>P</i> <0.001 compared with the control group.</p