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CuO NWs boosted triboelectric microfluidic nanosensor functionalized by collagen-protein interactions for real-time platelet count monitoring

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Chemical engineering Journal 2024年 490卷

作者： Lin, Jia-Cheng Kaswan, Kuldeep Chatterjee, Subhodeep Wu, Yu-Wen Kumar Sharma, Manish Ranjan, Ashok Roy Barman, Snigdha Lin, Yu-Zih Burnouf, Thierry Boireau, Wilfrid Lu, Ming-Yen Tu, Yong-Kwang Su, I-Chang Wu, Ping-Hsiu Lin, Zong-Hong Fan, Yu-Jui School of Biomedical Engineering Taipei Medical University Taipei11031 Taiwan Taipei Neuroscience Institute Taipei Medical University Taipei11031 Taiwan Department of Biomedical Engineering National Taiwan University Taipei11031 Taiwan International Intercollegiate PhD Program National Tsing Hua University Hsinchu30013 Taiwan Department of Power Mechanical Engineering National Tsing Hua University Hsinchu30013 Taiwan Graduate Institute of Biomedical Materials and Tissue Engineering Taipei Medical University Taipei11031 Taiwan Department of Material Science and Engineering National Tsing Hua University Hsinchu30013 Taiwan Institute of Biomedical Engineering National Tsing Hua University Hsinchu30013 Taiwan International PhD Program in Biomedical Engineering Taipei Medical University Taipei11031 Taiwan Université de Franche-Comté CNRS Institut FEMTO-ST BesançonF-25030 France Department of Neurosurgery Shuang Ho Hospital Taipei Medical University New Taipei City23561 Taiwan Department of Surgery School of Medicine College of Medicine Taipei Medical University Taipei11031 Taiwan Department of Radiology School of Medicine College of Medicine Taipei Medical University Taipei11031 Taiwan Department of Radiation Oncology Taipei Medical University Hospital Taipei11031 Taiwan Center for Precision Health and Quantitative Sciences Taipei Medical University Hospital Taipei 11031 Taiwan

Blood platelet count significantly affects the development of severe conditions like myocardial infarction, peripheral arterial ischemia, respiratory compromise, stroke, diabetes, coronavirus disease 2019 (COVID-19), along with chemotherapy patients and those suffering cardiovascular diseases (CVDs). These conditions necessitate frequent monitoring of platelet counts to guide diagnostic and therapeutic decisions. However, existing techniques are relatively time-consuming, lack of accuracy and require precise operation. The emergence of these severe diseases underscored the need to develop advanced platelet count-monitoring techniques which are rapid, highly precise, and conveniently portable for point-of-care applications. In this study, we emphasized the development of a triboelectric microfluidic nanosensor (TMNS) for platelet quantification through the assessment of flow resistance. The functionality of TMNS device is based on immobilization of platelets on a collagen layer coated inside a microfluidic channel. The triboelectric voltage output is measured as a detection signal of the flow resistance and is enhanced by incorporating high surface area copper oxide nanowires (CuO NWs) on the interior of copper tubes. These copper tubes serve as terminal electrodes and for flow guiding. The flow resistance of plasma solutions is elevated when the platelet concentration increases due to heightened adherence of platelets onto the collagen layer. Variations in flow resistance induce alterations in contact electrification, causing changes in output voltage at load terminals. Fine-tuning of the TMNS device was achieved by optimizing the channel width and length, flowing liquid viscosity, and voltage measurement technique. Platelet quantification sensing data were acquired through the combination of platelet-rich plasma (PRP) and platelet-poor plasma (PPP) solutions. The described device exhibits promising capabilities for platelet-count monitoring in whole-blood samples c

关键词： Copper oxides

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Noncontact monitoring of the peripheral microcirculation using laser speckle contrast imaging to evaluate the skin perfusion pressure

Results in Engineering

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Results in engineering 2025年 26卷

作者： Hsieh, Meng-Che Lai, Rou-Zheng Hsu, Ching-Han Lin, Yan-Ren Hsieh, Pei-You Ching, Congo Tak Shing Liao, Lun-De Institute of Biomedical Engineering and Nanomedicine National Health Research Institutes 35 Keyan Road Zhunan Town Miaoli County350 Taiwan Doctoral Program in Tissue Engineering and Regenerative Medicine National Chung Hsing University 145 Xingda Road Taichung City South District402 Taiwan Department of Biomedical Engineering and Environmental Sciences National Tsing Hua University No. 101 Section 2 Kuang-Fu Road Hsinchu30013 Taiwan Department of Emergency and Critical Care Medicine Changhua Christian Hospital Changhua Taiwan Graduate Institute of Biomedical Engineering National Chung Hsing University 145 Xingda Road South District Taichung City402 Taiwan Department of Electrical Engineering National Chi Nan University Puli Township54561 Taiwan International Doctoral Program in Agriculture National Chung Hsing University Taichung 402 Taiwan Department of Post-Baccalaureate Medicine College of Medicine National Chung Hsing University 145 Xingda Road South District Taichung City402 Taiwan School of Medicine Chung Shan Medical University 110 Section 1 Jianguo North Road Taichung City402 Taiwan

The skin perfusion pressure (SPP) is traditionally measured with laser Doppler flowmetry (LDF), but this technique is limited by its single-point fiber optic probe, the need to contact the skin, and susceptibility to various factors, resulting in poor data consistency. Therefore, we developed a noncontact system for measuring the SPP over a large area based on laser speckle contrast imaging (LSCI). When it was paired with a pressure cuff device, the system accurately recorded blood flow changes during various pressure interventions, and the reperfusion pressure point could be calibrated to overcome traditional measurement limitations. Cross-comparison experiments revealed that the measurements obtained with the LSCI and LDF systems were highly correlated (r > 0.7), confirming the reliability of LSCI in assessing microcirculatory function. Since supine measurements are not always suitable in clinical environments, such as in space-constrained clinics or when the patient cannot lie flat, we compared SPP measurements obtained from individuals in sitting versus supine positions, revealing minimal differences (Cohen's d = 0.1, p > 0.05), which demonstrates the system's stability over different patient postures. Under cold water stimulation, which induces microvascular contraction, simulating poor circulation, the measured SPP was significantly lower than that measured under normal conditions (Cohen's d = 2.6, p © 2025

关键词： Laser Doppler velocimeters

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A Label-Free Droplet Sorting Platform Integrating Dielectrophoretic Separation for Estimating Bacterial Antimicrobial Resistance

Biosensors

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Biosensors 2024年第5期14卷 218页

作者： Yan, Jia-De Yang, Chiou-Ying Han, Arum Wu, Ching-Chou Doctoral Program in Tissue Engineering and Regenerative Medicine National Chung Hsing University Taichung City402 Taiwan Institute of Molecular Biology National Chung Hsing University Taichung City402 Taiwan Department of Electrical and Computer Engineering Texas AM University College StationTX77843 United States Department of Biomedical Engineering Texas AM University College StationTX77843 United States Department of Chemical Engineering Texas AM University College StationTX77843 United States Department of Bio-Industrial Mechatronics Engineering National Chung Hsing University Taichung City402 Taiwan Innovation and Development Center of Sustainable Agriculture National Chung Hsing University Taichung City402 Taiwan

Antimicrobial resistance (AMR) has become a crucial global health issue. Antibiotic-resistant bacteria can survive after antibiotic treatments, lowering drug efficacy and increasing lethal risks. A microfluidic water-in-oil emulsion droplet system can entrap microorganisms and antibiotics within the tiny bioreactor, separate from the surroundings, enabling independent assays that can be performed in a high-throughput manner. This study presents the development of a label-free dielectrophoresis (DEP)-based microfluidic platform to sort droplets that co-encapsulate Escherichia coli (E. coli) and ampicillin (Amp) and droplets that co-encapsulate Amp-resistant (AmpR) E. coli with Amp only based on the conductivity-dependent DEP force (FDEP) without the assistance of optical analyses. The 9.4% low conductivity (LC) Luria–Bertani (LB) broth diluted with 170 mM mannitol can maintain E. coli and AmpR E. coli growth for 3 h and allow Amp to kill almost all E. coli, which can significantly increase the LCLB conductivity by about 100 μS/cm. Therefore, the AmpR E. coli/9.4%LCLB/Amp where no cells are killed and the E. coli/9.4%LCLB/Amp-containing droplets where most of the cells are killed can be sorted based on this conductivity difference at an applied electric field of 2 MHz and 100 Vpp that generates positive FDEP. Moreover, the sorting ratio significantly decreased to about 50% when the population of AmpR E. coli was equal to or higher than 50% in droplets. The conductivity-dependent DEP-based sorting platform exhibits promising potential to probe the ratio of AmpR E. coli in an unknown bacterial sample by using the sorting ratio as an index. © 2024 by the authors.

关键词： Escherichia coli

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An Innovative Real-Time Cell Viability Analysis: A Cutting-Edge Flexible Bioimpedance Sensor

SSRN

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SSRN 2023年

作者： Chou, Hsin-Yu Ching, Congo Tak-Shing Huang, Hui-Xuan Phan, Thien Luan Wang, Hui-Min David Department of Materials Science and Engineering National Chung Hsing University Taichung40227 Taiwan Ph.D. Program in Tissue Engineering and Regenerative Medicine National Chung Hsing University Taichung402 Taiwan Graduate Institute of Biomedical Engineering National Chung Hsing University Taichung40227 Taiwan Department of Electrical Engineering National Chi Nan University Nantou54561 Taiwan Department of Physic and Electronic Engineering Faculty of Physic and Engineering Physic Vietnam National University Ho Chi Minh City University of Science Viet Nam Graduate Institute of Medicine College of Medicine Kaohsiung Medical University Kaohsiung807 Taiwan Department of Medical Laboratory Science and Biotechnology China Medical University Taichung City404 Taiwan

There are many compounds to be used to treat cancer but still only 20% of proposed anticancer agents have been commercialized after clinical trials due to serious side effects and unsatisfactory results. To screen potential drugs precisely and quickly, this study develops a flexible bioimpedance sensor. The sensor is positive to detect the half maximal inhibitory concentration (IC50) of drugs real-time by analyzing phase angle changes during cell mortality. The best results are achieved using a probe separation of A12B34 at logarithmic frequencies of 163 Hz and 77.87 kHz. At these two frequencies, there is a linear relationship with the phase angle at 0% and 50% of the dead cells. Dividing the phase angle at the two frequencies shows a 17.98% change in the phase angle, which allows self-correction and insensitivity to the number of cells. A custom phase angle measurement device is developed for detection at 163 Hz and 77.87 kHz, respectively. This study develops a novel sensor that is precise, fast and allows high throughput analysis to detect the inhibition of cancer in real-time. This sensor is an alternative to traditional chemical detection methods because it is faster, cheaper and more accurate. © 2023, The Authors. All rights reserved.

关键词： Chemical detection

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A biomimetic micropillar wound dressing with flavone and polyphenol control release in vitro and in vivo

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Journal of the Taiwan Institute of Chemical Engineers 2024年 160卷

作者： Cheng, Tien-Hsin Lin, Ruei-Hong Cheng, Yu-Shen Shih, Pin-Keng Show, Pau Loke Chen, Hsiao-Yi Nakmee, Pattarawadee Sumthong Chang, Jui-Jen Huang, Dong-Ming Wang, Hui-Min David Department of Chemical and Materials Engineering National Yunlin University of Science and Technology Yunlin Taiwan Graduate Institute of Biomedical Engineering National Chung Hsing University Xingda Rd. South Dist. Taichung402 China Department of Neurological Institute Taichung Veterans General Hospital Taichung China Doctoral Program in Tissue Engineering and Regenerative Medicine National Chung Hsing University Taichung China Department of Surgery China Medical University Hospital Taichung Taiwan School of Medicine China Medical University Taichung Taiwan Department of Chemical Engineering Khalifa University Abu Dhabi United Arab Emirates Faculty of Science at Sriracha Kasetsart University Sriracha Campus 199 Moo 6 Sukhumvit Rd. Chonburi Sriracha20230 Thailand Department of Medical Research China Medical University Hospital China Medical University Taichung China Institute of Biomedical Engineering and Nanomedicine National Health Research Institutes Miaoli County China Regenerative Medicine and Cell Therapy Research Center Graduate Institute of Medicine College of Medicine Kaohsiung Medical University Kaohsiung Taiwan Department of Medical Laboratory Science and Biotechnology China Medical University Taichung China

Background: Wound healing is a complex and dynamic process involving the replacement of devitalized and missing cellular structures and tissue layers. Methods: This study involved developing a drug-loaded biomimetic micropillar wound dressing based upon inspiration from witnessing the adhesive ability in a gecko's footpad. The conformal adhesion was set up by applying a soft elastomer thin film on the developed wound dressing surfaces. The results showed that the developed surfaces prepared based on polydimethylsiloxane (PDMS) had low surface free energy, high chemical stability, and good plasticity. Astaxanthin (AST) and curcumin were applied as the patch's bioactive compounds to help accelerate the wound healing process. Results: The results showed that the developed surfaces prepared based on polydimethylsiloxane (PDMS) had low surface free energy, high chemical stability, and good plasticity. Astaxanthin (AST) and curcumin were applied as the patch's bioactive compounds to help accelerate the wound healing process. The results indicate that the developed biomimetic micropillar patches could release the loaded drugs and significantly increase cell viability and collagen content to 20 % ∼ 25 % in vitro and in vivo. Conclusion: In summation, the primary purpose of this study has been to design a novel encapsulated carrier (micropillar patch) for use in adjustable drug release, while combining with the biomimetic microstructure to reach wound healing through percutaneous absorption. © 2024 Taiwan Institute of Chemical Engineers

关键词： Chemical stability

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Effects of a low-protein nutritional formula with dietary counseling in older adults with chronic kidney disease stages 3–5: a randomized controlled trial

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BMC Nephrology 2023年第1期24卷 372-372页

作者： Yang, Wen-Ching Hsieh, Hui-Min Chen, Jun-Peng Liu, Li-Chun Chen, Cheng-Hsu Department of Food and Nutrition Taichung Veterans General Hospital Taichung Taiwan Biostatistics Group Department of Medical Research Taichung Veterans General Hospital Taichung Taiwan Division of Nephrology Department of Internal Medicine Taichung Veterans General Hospital No. 1650 Sect. 4 Boulevard Taichung Taiwan Department of Post-Baccalaureate Medicine College of Medicine National Chung Hsing University School of Medicine Taichung Taiwan Department of Life Science Tunghai University Taichung Taiwan Program in Tissue Engineering and Regenerative Medicine College of Medicine National Chung-Hsing University Taichung Taiwan

Background: Although combining a low-protein diet (LPD) with oral nutritional supplements increases treatment adherence and nutritional status in patients with chronic kidney disease (CKD), the effect of this combination approach in older adults remains unclear. This study examined the impact of a 6% low-protein formula (6% LPF) with diet counseling in older adults with stage 3–5 CKD. Methods: In this three-month randomized controlled study, 66 patients (eGFR < 60 mL/min/1.73 m², non-dialysis, over 65 years of age) were randomly assigned to an intervention group (LPD plus a 6% LPF) or control group (LPD alone). The 6% LPF comprised 400 kcal, 6 g of protein, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and various micronutrients. All data were collected at baseline and after three months, including physical performance based on hand grip strength (HGS) and gait speed, nutritional status using Mini Nutritional Assessment-Short Form (MNA-SF) scores, body composition through bioelectrical impedance analysis, and dietary intake from 24-h dietary records. Results: This study incorporated 47 participants (median age, 73;median eGFR, 36 ml/min/1.73 m²;intervention group: 24;control group: 23). The intervention group exhibited significant differences in HGS and gait speed, and micronutrient analysis revealed significantly higher monounsaturated fatty acids (MUFA), EPA, DHA, calcium, iron, zinc, copper, thiamine, riboflavin, niacin, B6, B12, and folic acid intake than the control group. MNA-SF scores, macronutrient intake, and body composition did not differ significantly between the two groups. Conclusions: Compared to LPD counseling alone, an LPD prescription with 6% LPF in older adults with CKD stages 3–5 helped relieve physical deterioration and increased micronutrient intake after three months. Trial registration: *** NCT05318014 (retrospectively registered on 08/04/2022). © 2023, The Author(s).

关键词： Aging Chronic kidney disease Gait speed Hand grip strength Low-protein diet Nutritional status Oral nutritional supplements Physical performance

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The mitochondrial stress signaling tunes immunity from a view of systemic tumor microenvironment and ecosystem

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iScience 2024年第9期27卷

作者： Kuo, Cheng-Liang Lin, Ying-Chen Lo, Yu Kang Lu, Yu-Zhi Babuharisankar, Ananth Ponneri Lien, Hui-Wen Chou, Han-Yu Lee, Alan Yueh-Luen National Institute of Cancer Research National Health Research Institutes Miaoli Zhunan 35053 Taiwan Department of Life Sciences College of Health Sciences & Technology National Central University Taoyuan Zhongli 32001 Taiwan Ph.D. Program in Tissue Engineering and Regenerative Medicine College of Medicine National Chung Hsing University Taichung 40402 Taiwan Graduate Institute of Biomedical Sciences China Medical University Taichung 40402 Taiwan Department of Biotechnology College of Life Science Kaohsiung Medical University Kaohsiung 80708 Taiwan

Mitochondria play important roles in cell fate, calcium signaling, mitophagy, and the signaling through reactive oxygen species (ROS). Recently, mitochondria are considered as a signaling organelle in the cell and communicate with other organelles to constitute the mitochondrial information processing system (MIPS) that transduce input-to-output biological information. The success in immunotherapy, a concept of systemic therapy, has been proved to be dependent on paracrine interactions within the tumor microenvironment (TME) and distant organs including microbiota and immune components. We will adopt a broader view from the concept of TME to tumor micro- and macroenvironment (TM²E) or tumor-organ ecosystem (TOE). In this review, we will discuss the role of mitochondrial signaling by mitochondrial ROS, calcium flux, metabolites, mtDNA, vesicle transportation, and mitochondria-derived peptide in the TME and TOE, in particular immune regulation and effective cancer immunotherapy. © 2024 The Author(s)

关键词： Cancer Immune response Microenvironment

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Pioneering Astaxanthin-Tumor Cell Membrane Nanoparticles for Innovative Targeted Drug Delivery on Melanoma

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International journal of nanomedicine 2024年 19卷 2395-2407页

作者： Jui-Jen Chang Yi-Chen Wang Shu-Hui Yang Ju-Yu Wu Ming-Wei Chang Hui-Min David Wang Department of Medical Research China Medical University Hospital China Medical University Taichung 40447 Taiwan. Graduate Institute of Integrated Medicine China Medical University Taichung 40447 Taiwan. Division of Cardiology Department of Internal Medicine Kaohsiung Armed Forces General Hospital Kaohsiung City 802 Taiwan. Institute of Medical Science and Technology National Sun Yat-sen University Kaohsiung 807 Taiwan. Graduate Institute of Biomedical Engineering National Chung Hsing University Taichung 402 Taiwan. Bachelor Program of Biotechnology National Chung Hsing University Taichung 402 Taiwan. Doctoral Program in Tissue Engineering and Regenerative Medicine National Chung Hsing University Taichung 402 Taiwan. Nanotechnology and Integrated Bioengineering Centre University of Ulster Belfast BT15 1AB Northern Ireland UK. Graduate Institute of Medicine College of Medicine Kaohsiung Medical University Kaohsiung 807 Taiwan. Department of Medical Laboratory Science and Biotechnology China Medical University Taichung 404 Taiwan. Center of Applied Nanomedicine National Cheng Kung University Tainan 701 Taiwan.

Background:Recently, the use of the tumor or its secretions as drug carriers has gradually become popular, with the advantages of high biocompatibility and enhanced drug delivery to specific cells. Melanoma is the most malignant tumor of all skin cancers; it is the most metastatic and, therefore, the most difficult to treat. The main purpose of this study is to develop nanovesicles with tumor cell membrane secretion properties to encapsulate target substances to enhance the therapeutic effect of cancer. Methods:Astaxanthin was selected as an anticancer drug due to our previous research finding that astaxanthin has extremely high antioxidant, anti-ultraviolet damage, and anti-tumor properties. The manufacturing method of the astaxanthin nanovesicle carrier is to mix melanoma cells and astaxanthin in an appropriate ratio and then remove the genetic material and inflammatory factors of cancer cells by extrusion. Results:In terms of results, after the co-culture of astaxanthin nanovesicles and melanoma cancer cells, it was confirmed that the ability of astaxanthin nanovesicles to inhibit the growth and metastasis of melanoma cancer cells was significantly better than the same amount of astaxanthin alone, and it had no effect on normal Human cells are also effective. There was no apparent harm on normal cells, indicating the ability of the vesicles to be selectively transported. Conclusion:Our findings illustrated the potential of astaxanthin nanovesicles as an anticancer drug.

关键词： astaxanthin melanoma nanoparticle

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Enhancing safety with an AI-empowered assessment and monitoring system for BSL-3 facilities

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Heliyon 2025年第1期11卷 e40855页

作者： Fan, Yi-Ling Hsu, Ching-Han Wu, Ju-Yu Tsai, Ying-Ying Chen, Wei J. Lee, Min-Shi Hsu, Fang-Rong Liao, Lun-De Institute of Biomedical Engineering and Nanomedicine National Health Research Institutes 35 Keyan Road Miaoli County Zhunan Town 350 Taiwan Department of Biomedical Engineering & Environmental Sciences National Tsing-Hua University Hsinchu Taiwan Doctoral Program in Tissue Engineering and Regenerative Medicine National Chung Hsing University Taichung Taiwan Center for Neuropsychiatric Research National Health Research Institutes 35 Keyan Road Miaoli County Zhunan Town 350 Taiwan National Institute of Infectious Diseases and Vaccinology National Health Research Institutes 35 Keyan Road Miaoli County Zhunan Town 350 Taiwan Department of Information Engineering and Computer Science Feng Chia University Taichung 407 Taiwan

Introduction: The COVID-19 pandemic has created an urgent demand for research, which has spurred the development of enhanced biosafety protocols in biosafety level (BSL)-3 laboratories to safeguard against the risks associated with handling highly contagious pathogens. Laboratory management failures can pose significant hazards. Methods: An external system captured images of personnel entering a laboratory, which were then analyzed by an AI-based system to verify their compliance with personal protective equipment (PPE) regulations, thereby introducing an additional layer of protection. A deep learning model was trained to detect the presence of essential PPE items, such as clothing, masks, hoods, double-layer gloves, shoe covers, and respirators, ensuring adherence to World Health Organization (WHO) standards. The internal laboratory management system used a deep learning model to delineate alert zones and monitor compliance with the imposed safety protocols. Results: The external detection system was trained on a dataset consisting of 4112 images divided into 15 PPE compliance classes. The model achieved an accuracy of 97.52 % and a recall of 97.03 %. The identification results were presented in real time via a visual interface and simultaneously stored on the administrator's dashboard for future reference. We trained the internal management system on 3347 images, achieving 90 % accuracy and 85 % recall. The results were transmitted in JSON format to the internal monitoring system, which triggered alerts in response to violations of safe practices or alert zones. Real-time notifications were sent to the administrators when the safety thresholds were met. Conclusion: The BSL-3 laboratory monitoring system significantly reduces the risk of exposure to pathogens for personnel during laboratory operations. By ensuring the correct use of PPE and enhancing adherence to the imposed safety protocols, this system contributes to maintaining the integrity of BSL-3 facilities

关键词： Bioengineering Biomedical instrumentation Biomedical laboratory safety Biosafety level-3 laboratory

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Exploring knowledge, attitude, and intention towards advance care planning, advance directive, and the patient self-determination act among hemodialysis patients

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BMC Palliative Care 2023年第1期22卷 201-201页

作者： Tsai, Shang-Feng Chang, Ching-Yi Yang, Jia-Yi Ho, Yu-Ying Hsiao, Ching-Ching Hsu, Shu-Chuan Chen, Shih-Yun Lin, Huan-Yi Yeh, Te-Feng Chen, Cheng-Hsu Division of Nephrology Department of Internal Medicine Taichung Veterans General Hospital 160 Sec. 3 Boulevard Taichung 407 Taiwan Department of Life Science Tunghai University Taichung Taiwan Department of Post-Baccalaureate Medicine College of Medicine National Chung Hsing University Taichung Taiwan Department of Nursing Taichung Veterans General Hospital Taichung Taiwan Department of Ophthalmology Taichung Veterans General Hospital Taichung Taiwan Department of Healthcare Administration Central Taiwan University of Science and Technology Taichung Taiwan Ph.D. Program in Tissue Engineering and Regenerative Medicine College of Medicine National Chung Hsing University Taichung Taiwan

Background: Hemodialysis holds the highest incidence and prevalence rate in Taiwan globally. However, the implementation of advance care planning (ACP), advance directives (AD), and patient self-determination acts (PSDA) remains limited. Our objective was to examine the current status of ACP, AD and PSDA and potential opportunities for enhancement. Methods: We developed a novel questionnaire to assess individuals’ knowledge, attitudes, and intentions regarding ACP, AD, and PSDA. We also collected baseline characteristics and additional inquiries for correlation analysis to identify potential factors. Student’s t-test and Analysis of Variance were employed to assess significance. Results: Initially, a cohort of 241 patients was initially considered for inclusion in this study. Subsequently, 135 patients agreed to participate in the questionnaire study, resulting in 129 valid questionnaires. Among these respondents, 76 were male (59.9%), and 53 were female (41.1%). Only 13.2% had signed AD. A significant portion (85.3%) indicated that they had not discussed their dialysis prognosis with healthcare providers. Additionally, a mere 14% engaged in conversations about life-threatening decisions. Ninety percent believed that healthcare providers had not furnished information about ACP, and only 30% had discussed such choices with their families. The findings revealed that the average standardized score for ACP and AD goals was 84.97, while the attitude towards PSDA received a standardized score of 69.94. The intention score stood at 69.52 in standardized terms. Potential candidates for ACP initiation included individuals aged 50 to 64, possessing at least a college education, being unmarried, and having no history of diabetes. Conclusion: Patients undergoing hemodialysis exhibited a significant knowledge gap concerning ACP, AD, and the PSDA. Notably, a substantial number of dialytic patients had not received adequate information on these subjects. Nevertheless, they display

关键词： Advance care planning (ACP) Advance directive (AD) Attitude Hemodialysis Intention Knowledge Life-sustaining treatment Life-sustaining treatment (LST) Patient right to autonomy act Patient self-determination act (PSDA)

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