ABSTRACT BACKGROUND: The COVID-19 pandemic has instilled fear and stress among healthcare workers. OBJECTIVES: The aim of this study was to assess work stress and associated factors among healthcare workers during the COVID-19 outbreak and to evaluate whether prior experience of treating severe acute respiratory syndrome (SARS) had a positive or negative influence on healthcare workers’ stress levels during the COVID-19 pandemic. DESIGN AND SETTING: Cross-sectional survey in a tertiary hospital in Kaohsiung City, in southern Taiwan. METHODS: The survey was conducted using an online self-administered questionnaire to measure the stress levels among healthcare workers from March 20 to April 20, 2020. The stress scales were divided into four subscales: worry of social isolation; discomfort caused by the protective equipment; difficulties and anxiety regarding infection control; and workload of caring for patients. RESULTS: The total stress scores were significantly higher among healthcare workers who were aged 41 or above, female, married, parents and nurses. Those with experience of treating SARS reported having significantly higher stress scores on the subscale measuring the discomfort caused by protective equipment and the workload of caring for patients. During the COVID-19 outbreak, frontline healthcare workers with experience of treating SARS indicated having higher stress levels regarding the workload of caring for patients than did non-frontline healthcare workers with no experience of treating SARS. CONCLUSIONS: Work experience from dealing with the 2003 SARS virus may have had a negative psychological impact on healthcare workers amidst the COVID-19 outbreak.

OBJECTIVES: Esophageal leiomyoma is the most common benign tumor of the esophagus, and it originates from mesenchymal tissue. This study analyzed the clinicopathological characteristics of esophageal leiomyoma and aimed to evaluate the role of endoscopic ultrasonography in the diagnosis and treatment selection for these lesions. METHODS: Two hundred and twenty-five patients who had suspected esophageal leiomyomas in endoscopic ultrasonography were enrolled at the Endoscopy Center of The First Affiliated Hospital, Zhejiang University from January 1st, 2009 to May 31th, 2015. The main outcomes included the demographic and morphological characteristics, symptoms, comparisons of diagnosis and treatment methods, adverse events, and prognosis. RESULTS: One hundred and sixty-seven patients were diagnosed as having an esophageal leiomyoma by pathological examination. The mean patient age was 50.57±9.983 years. In total, 62.9% of the lesions originated from the muscularis mucosa, and the others originated from the muscularis propria. The median distance to the incisors was 30±12 cm. The median diameter was 0.72±0.99 cm. As determined by endoscopic ultrasonography, most existing leiomyomas were homogeneous, endophytic, and spherical. The leiomyomas from the muscularis mucosa were smaller than those from the muscularis propria and much closer to the incisors (p<0.05). SMA (smooth muscle antibody) (97.2%) and desmin (94.5%) were positive in the majority of patients. In terms of treatments, patients preferred endoscopic therapies, which led to less adverse events (e.g., intraoperative bleeding, local infection, pleural effusion) than surgical operations (p<0.05). The superficial leiomyomas presented less adverse events and better recovery (p<0.05) than deep leiomyomas. CONCLUSION: Endoscopic ultrasonography has demonstrated high accuracy in the diagnosis of esophageal leiomyomas and provides great support in selecting treatments; however, EUS cannot completely avoid misdiagnosis, so combining it with other examinations may be a good strategy to solve this problem.

Abstract The selection of suitable reference genes is crucial for accurate quantification of gene expression and can add to our understanding of host–pathogen interactions. To identify suitable reference genes in Pandora neoaphidis, an obligate aphid pathogenic fungus, the expression of three traditional candidate genes including 18S rRNA(18S), 28S rRNA(28S) and elongation factor 1 alpha-like protein (EF1), were measured by quantitative polymerase chain reaction at different developmental stages (conidia, conidia with germ tubes, short hyphae and elongated hyphae), and under different nutritional conditions. We calculated the expression stability of candidate reference genes using four algorithms including geNorm, NormFinder, BestKeeper and Delta Ct. The analysis results revealed that the comprehensive ranking of candidate reference genes from the most stable to the least stable was 18S (1.189), 28S (1.414) and EF1 (3). The 18S was, therefore, the most suitable reference gene for real-time RT-PCR analysis of gene expression under all conditions. These results will support further studies on gene expression in P. neoaphidis.

OBJECTIVE: To study the role of hepatitis B virus with A1762T/G1764A double mutation in liver cirrhosis and hepatocellular carcinoma, and create a sensitive, fast, accurate assay for detection of A1762T/G1764A double mutation.METHODS: We developed an accurate and fast real-time amplification refractory mutation system to detect A1762T/G1764A double mutation. Cloned hepatitis B virus genome was used as a control. Assay sensitivity was determined by serial dilution and mixed template experiments. Specificity was determined by cross experiments with wild and mutant hepatitis B virus. Fifty clinical samples were tested by the real-time amplification refractory mutation system and the results were compared with sequencing.RESULTS: The real-time amplification refractory mutation system had a sensitivity of 100 copies of virus with these mutations, and 0.1% weak population virus with double mutation could be found in mixtures. A total of 50 randomly collected clinical samples were detected by real-time amplification refractory mutation system, and the results were consistent with those by DNA sequencing. Hepatitis B virus genotype C was more prevalent in 39 of 50 samples than genotype B (11 samples), and about 75% of genotype C carried a double mutation compared to 45% of genotype B. However, the percentage of A1762T/G1764A double mutation in hepatitis B e antigen-negative (58.3%) samples was almost the same as in hepatitis B e antigen-positive (61%) samples.CONCLUSION: The real-time amplification refractory mutation system is sensitive and specific for detection of hepatitis B virus double mutation.

Background and Objectives: As part of UN peacekeeping operations in Liberia, China has sent a dozen of batches of peacekeeping force to Liberia for medical, engineering and transporting purposes from 2003 to 2012. This study aimed to explore the mental health of Chinese peacekeepers under the influence of stressful and traumatic events in Liberia. Methods: A total of 440 Chinese peacekeepers were selected by cluster sampling and surveyed by Chinese Military Mental Health Scale (CMMHS) before, during and after peacekeeping deployment. Results: The total CMMHS score (48.90 ± 21.15), depression factor (7.25 ± 3.43), interpersonal sensitivity (4.20 ± 2.15) of Chinese peacekeepers were significantly higher than the Chinese military norm (23.04 ± 14.70, 2.47 ± 2.46, 3.95 ± 2.97 respectively) (p<0.01). The total score and anxiety, somatization factor score of the transporting group were significantly higher than those of the medical group (P <0.05); All CMMHS factors in the transporting group and the medical group were higher than those of the engineering group (p<0.01). CMMHS factors score of the peacekeepers positively correlated with the age, military service duration, years of eudcation and military rank (r = 0.107 ~ 0.523, p<0.05); stepwise linear regression analysis revealed that years of eudcation was the main influence factor for peacekeepers' mental health (t = 2.288 ~ 4.358, p<0.05 ~ 0.01). Conclusions: The mental health status of Chinese peacekeepers was worse than average Chinese servicemen. Peacekeepers of different mission groups had different degree of mental damage, and the years of education was the main influence factor for peacekeepers' mental health, whereas age, military service duration as well as military rank were the secondary influence factors.

Objetivo: El objetivo del estudio fue comparar la seguridad, los resultados clínicos y el costo entre el procedimiento quirúrgico de suspensión de la mucosa y el manejo quirúrgico del prolapso para el tratamiento de las hemorroides. Métodos: Se incluyeron en el estudio 80 pacientes quienes presentaban hemorroides sintomáticas grado II y III; 40 (50%) recibieron como tratamiento el procedimiento quirúrgico de suspensión de la mucosa y 40 (50%) recibieron el manejo quirúrgico del prolapso. Resultados: Ambos tratamientos quirúrgicos fueron eficientes y seguros observando una menor proporción de persistencia del dolor y tenesmo con el procedimiento quirúrgico de suspensión de la mucosa con costos más bajos para este tipo de cirugía. Conclusión: La suspensión de la mucosa es un procedimiento eficaz, seguro y de bajo costo para los pacientes con enfermedad hemorroidal. Esta técnica debería usarse más ampliamente.

Objective: The aim of this study was to evaluate the effect of mucosa suspension procedure (MSP) by comparing procedure for prolapse and hemorrhoids (PPH). Methods: We compared the safety, clinical outcome, and cost between PPH and MSP for the surgical treatment of hemorrhoidal disease. A total of 80 patients with II and III degree hemorrhoids were included in the study. MSP group (n=40) and PPH group (n=40) were applied at random. Results: Both MSP and PPH are safe surgical treatments for patients with II and III degree hemorrhoids. Complications of the patients, such as persistent pain and tenesmus in the MSP group were less than the PPH group. Moreover, MSP had lower costs. Conclusion: MSP is a safe, effective, and inexpensive procedure for patients with hemorrhoidal disease. We consider that this technique should be widely used.