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High-altitude polycythemia (HAPC) affects individuals living at high altitudes, characterized by increased red blood cells (RBCs) production in response to hypoxic conditions. The exact mechanisms behind HAPC are not fully understood. We utilized a mouse model exposed to hypobaric hypoxia (HH), replicating the environmental conditions experienced at 6000 m above sea level, coupled with in vitro analysis of primary splenic macrophages under 1% O 2 to investigate these mechanisms. Our findings indicate that HH significantly boosts erythropoiesis, leading to erythrocytosis and splenic changes, including initial contraction to splenomegaly over 14 days. A notable decrease in red pulp macrophages (RPMs) in the spleen, essential for RBCs processing, was observed, correlating with increased iron release and signs of ferroptosis. Prolonged exposure to hypoxia further exacerbated these effects, mirrored in human peripheral blood mononuclear cells. Single-cell sequencing showed a marked reduction in macrophage populations, affecting the spleen’s ability to clear RBCs and contributing to splenomegaly. Our findings suggest splenic ferroptosis contributes to decreased RPMs, affecting erythrophagocytosis and potentially fostering continuous RBCs production in HAPC. These insights could guide the development of targeted therapies for HAPC, emphasizing the importance of splenic macrophages in disease pathology.

Labor issues related to the nursing profession have been gaining prominence in Taiwan as well as overseas. In 2016, the United Nations highlighted the importance of societies investing sufficient funds in their professional nurses to support and promote public health, gender equality, and economic growth. Good-quality care requires that nurses have good physical and mental health, while creating and maintaining a friendly nursing work environment rely on cooperation among the government, labor unions, and hospitals. Over the past decade, the Taiwan government has increasingly promoted relevant regulations and established a friendly platform to allow nursing staffs to identify problems and report labor rights violations. In addition, nurses have formed unions to defend and advocate for their professional rights. After the outbreak of COVID-19 in late 2019, the Department of Nursing and Health Care of the Ministry of Health and Welfare actively proposed policies related to creating and maintaining good nursing

The global outbreak of coronavirus disease (COVID-19) began in December 2019. The high levels of stress experienced by nurses during this pandemic may have immediate and long-term effects on their mental health. To explore the stress and psychological problems of nurses during this pandemic and to identify strategies used by these nurses to relieve stress. A cross-sectional online survey was conducted that included a basic information datasheet, stress of nursing staff during COVID-19 outbreak scale, psychological distress scale, and stress relief methods survey form. Convenience sampling was used and a total of 469 practicing nurses participated in this study. Most of the participants expressed concerns about living problems (72.7%). On the stress questionnaire, the facets of \"burden of taking care of patients\" and \"worries about social isolation\" earned the first and second highest scores, respectively. In terms of items, \"worrying about infecting family members and friends\" and \"worrying about being separa

Travelers are known to convey infectious diseases across international borders. After its experience with SARS, Taiwan established a comprehensive mechanism at its border to prevent the entry of infectious diseases. However, people with chronic infectious diseases, carriers with no symptoms, and those likely to be infected are not easy to identify during border screenings. Therefore, Taiwan must implement internal disease-containment measures in addition to stopping infectious disease at its borders. With increasing numbers of patients coming to Taiwan for medical examinations, medical aesthetic treatments, and medical treatments and care, the risk of acute, chronic, and contagious diseases originating from non-residents must be considered and addressed. This article was developed to discuss the role and importance of nurses in preventing transnational infectious diseases from the perspective of international medical care. In addition to showing rich nursing experience, sensitivity, and conducting the managem

To understand the gaps between current bioethics education and the requirements of practicing nurses, a semistructured questionnaire was used to invite the directors of nursing departments at all 82 teaching hospitals in Taiwan to participate in this survey. The response rate was 64.6%. Through content analysis we obtained information about previous bioethical training, required themes and content, recommended teaching strategies, and difficulties with education and its application. The results suggest that Taiwanese nursing personnel need to be instilled with both self-cultivation of morality and mental cultivation to acquire nursing virtues and the right attitudes toward bioethical issues. Good communication skills to prevent damage to the harmonious relationships between patients, their families and medical team members, policies that support the provision of systematic formal knowledge of ethics, small group training, and clarification of values were also shown to be important in bioethics education.

High-altitude polycythemia (HAPC) affects individuals living at high altitudes, characterized by increased red blood cells (RBCs) production in response to hypoxic conditions. The exact mechanisms behind HAPC are not fully understood. We utilized a mouse model exposed to hypobaric hypoxia (HH), replicating the environmental conditions experienced at 6000 m above sea level, coupled with in vitro analysis of primary splenic macrophages under 1% O 2 to investigate these mechanisms. Our findings indicate that HH significantly boosts erythropoiesis, leading to erythrocytosis and splenic changes, including initial contraction to splenomegaly over 14 days. A notable decrease in red pulp macrophages (RPMs) in the spleen, essential for RBCs processing, was observed, correlating with increased iron release and signs of ferroptosis. Prolonged exposure to hypoxia further exacerbated these effects, mirrored in human peripheral blood mononuclear cells. Single-cell sequencing showed a marked reduction in macrophage populations, affecting the spleen’s ability to clear RBCs and contributing to splenomegaly. Our findings suggest splenic ferroptosis contributes to decreased RPMs, affecting erythrophagocytosis and potentially fostering continuous RBCs production in HAPC. These insights could guide the development of targeted therapies for HAPC, emphasizing the importance of splenic macrophages in disease pathology.

High-altitude polycythemia (HAPC) is a chronic condition prevalent in individuals residing at high altitudes (HA), characterized by an augmented production of red blood cells (RBCs) due to hypoxic conditions. Despite its prevalence, the pathophysiological basis and molecular mechanisms driving HAPC remain largely unelucidated. In our study, we utilized a mouse model exposed to hypobaric hypoxia (HH), replicating the environmental conditions experienced at 6000 m above sea level, coupled with in vitro analysis of primary splenic macrophages under 1% O2 to investigate these mechanisms. Our findings revealed that HH exposure significantly stimulates erythropoiesis, leading to erythrocytosis. This was accompanied by a notable sequence of splenic changes, initially characterized by splenic contraction, which subsequently progressed to splenomegaly over 14 days. A key observation was the impairment on the capacity of spleen to process RBCs, primarily attributed to a reduction in splenic macrophages located in the red pulp. Extended HH treatment over 7 and 14 days precipitated increased iron mobilization and the onset of ferroptosis within the spleen. This was evidenced by altered expression levels of iron metabolism and ferroptosis-related proteins, paralleling gene expression patterns observed in human peripheral blood mononuclear cells. Single-cell sequencing of splenic tissue post-HH exposure demonstrated a marked decrease in macrophage populations after 7 days. Our study further disclosed a significant increase in RBCs retention in the spleen following HH exposure, likely a consequence of diminished red pulp macrophages (RPMs) and erythrophagocytosis. This hypothesis was corroborated through comprehensive analyses involving flow cytometry, histological staining, and immunostaining, which collectively provided a detailed understanding of RBCs dynamics under HH conditions. In vitro analyses substantiated the decline in primary splenic macrophages and induction of ferroptosis under hypoxic treatment, effects that were relieved by pre-treatment with the ferroptosis inhibitor ferrostatin-1. Collectively, our data suggest that HH exposure initiates splenic ferroptosis, leading primarily to a decrease in RPMs. This decrease potentially impacts erythrophagocytosis, contributing to increased RBCs retention and subsequent splenomegaly. Such changes could potentially foster continuous RBCs production and accelerate the progress of HAPC. In conclusion, our study highlights the important role of the spleen and splenic macrophages in the pathogenesis of HAPC, providing crucial insights into the disease progression and potential therapeutic targets.Competing Interest StatementThe authors have declared no competing interest.Footnotes* We have thoroughly revised our manuscript and incorporated additional experimental data （revised Figures 1-9 and added supplementary Figures 1-3) to further support and clarify our findings.

目標：家庭會議是促進醫療端與病家端的重要開放性溝通方式，藉此確認病人的意願，整合家屬意見，討論共識出適切的醫療抉擇。本研究目的為了解末期醫療抉擇的家庭會議中醫療端與病家端間的溝通模式。方法：以台灣南部一區域教學醫院，收集2009-2014年108位病人共125份的癌末醫療抉擇的家庭會議紀錄，進行病歷之回溯性分析。採內容分析歸納臨床上進行末期醫療抉擇家庭會議的常見溝通模式。結果：發現召開的家庭會議中，雖然有部分討論到以病人的意願與自主為最重要之考量，但實際上有病人參與共同討論的家庭會議為數不多，甚至有的會議家屬拒絕病人參與決策。質性分析歸納出家庭會議溝通模式包括了三主題九大類別：1.病主－尊重依循病人的自主決定；2.家主－由家屬代表發聲並代做決定；3.醫主－希望以醫師的經驗與建議為之。結論：期能以此研究結果為基礎，發展符合文化民情但具有效能的末期醫療抉擇與家庭會議溝通模式，進而深耕推動未來更尊重病人自主的醫病共享決策模式。

The steady and continued rise in medical-related disputes and lawsuits is one indicator of the myriad risks and challenges faced in todays nursing practice. When nurses become defendants, the lengthy litigation process and pressures that ensue greatly impact their professional and personal lives. Nursing practice dispute categories marked by particularly high severity and frequency over the past ten years include: (1) Failure to operate according to standard procedures, (2) Insufficient nursing sensitivity and negligent care, (3) Failure to communicate and deal with issues promptly and appropriately, (4) Beyond the scope of nursing practice, and (5) Falsification or alteration of nursing records. In this paper, the important duties of care in four major nursing practices are first summarized based on the relevant legal risks. Next, based on this, risk management procedures are prioritized, evidence-oriented nursing routine standards are set, and systematic analysis and management are conducted. In addition, t

在風險社會的現今，護理業務充滿著各種風險挑戰，糾紛與訴訟日漸增加，一旦護理人員成為被告，漫長的訴訟流程與壓力將造成巨大衝擊。近十年實務上嚴重度與頻率較高的護理糾紛包括：（一）未依標準作業流程操作、（二）敏感度不足，疏於照護、（三）未即時適切溝通與處理、（四）逾越護理法定業務範圍、（五）不實登載護理紀錄與作證。由這些嚴重度與可能性較高的法律風險，歸納出四大護理業務的重要注意義務。據此排定風險管理的優先順序，設定以實證為導向之護理常規標準，進行系統性的分析與管理。再者，強化護理工作中的法律意識培育，讓護理實務中的護理人員、所屬主管及機構清楚了解業務相關的民刑與行政責任三類法律責任。正視護理疏失恐造成的民事賠償責任、刑事過失傷害及過失致死之處罰、行政懲處等法律風險與不利後果，期能防患於未然，以減少訴訟與損失。