Purpose: The purpose of this study is to develop the Theory of Uncertainty on COVID-19 using the strategy of theory derivation. Methods: Theory derivation was carried out in the following steps: review the literature to explore the phenomena related to uncertainty on COVID-19; select a parent theory that provides valuable concepts and a useful structure for derivation, and identify the concepts and structure of the parent theory to use in derivation; modify and redefine the concepts and structure of the parent theory to create a derived theory. In the literature review process, relevant findings were synthesized to support the propositions of the derived theory. Results: The Theory of Uncertainty on COVID-19 was derived from the Uncertainty in Illness Theory to make it relevant and applicable to a specific aspect of uncertainty on COVID-19, health-related uncertainty perceived by a person who has not contracted COVID-19. It is a middle-range theory targeting the general population and consists of a linear and unidirectional model centered on three themes: antecedents of uncertainty, appraisal of uncertainty, and coping with uncertainty. Conclusion The Theory of Uncertainty on COVID-19 will be able to contribute to efforts to manage perceived uncertainty on pandemic diseases and improve individual biopsychosocial health in the future.

Purpose: The purpose of this study is to develop the Theory of Uncertainty on COVID-19 using the strategy of theory derivation. Methods: Theory derivation was carried out in the following steps: review the literature to explore the phenomena related to uncertainty on COVID-19; select a parent theory that provides valuable concepts and a useful structure for derivation, and identify the concepts and structure of the parent theory to use in derivation; modify and redefine the concepts and structure of the parent theory to create a derived theory. In the literature review process, relevant findings were synthesized to support the propositions of the derived theory. Results: The Theory of Uncertainty on COVID-19 was derived from the Uncertainty in Illness Theory to make it relevant and applicable to a specific aspect of uncertainty on COVID-19, health-related uncertainty perceived by a person who has not contracted COVID-19. It is a middle-range theory targeting the general population and consists of a linear and unidirectional model centered on three themes: antecedents of uncertainty, appraisal of uncertainty, and coping with uncertainty. Conclusion The Theory of Uncertainty on COVID-19 will be able to contribute to efforts to manage perceived uncertainty on pandemic diseases and improve individual biopsychosocial health in the future.

Purpose: The purpose of this study is to develop the Theory of Uncertainty on COVID-19 using the strategy of theory derivation. Methods: Theory derivation was carried out in the following steps: review the literature to explore the phenomena related to uncertainty on COVID-19; select a parent theory that provides valuable concepts and a useful structure for derivation, and identify the concepts and structure of the parent theory to use in derivation; modify and redefine the concepts and structure of the parent theory to create a derived theory. In the literature review process, relevant findings were synthesized to support the propositions of the derived theory. Results: The Theory of Uncertainty on COVID-19 was derived from the Uncertainty in Illness Theory to make it relevant and applicable to a specific aspect of uncertainty on COVID-19, health-related uncertainty perceived by a person who has not contracted COVID-19. It is a middle-range theory targeting the general population and consists of a linear and unidirectional model centered on three themes: antecedents of uncertainty, appraisal of uncertainty, and coping with uncertainty. Conclusion The Theory of Uncertainty on COVID-19 will be able to contribute to efforts to manage perceived uncertainty on pandemic diseases and improve individual biopsychosocial health in the future.

Purpose: The purpose of this study is to develop the Theory of Uncertainty on COVID-19 using the strategy of theory derivation. Methods: Theory derivation was carried out in the following steps: review the literature to explore the phenomena related to uncertainty on COVID-19; select a parent theory that provides valuable concepts and a useful structure for derivation, and identify the concepts and structure of the parent theory to use in derivation; modify and redefine the concepts and structure of the parent theory to create a derived theory. In the literature review process, relevant findings were synthesized to support the propositions of the derived theory. Results: The Theory of Uncertainty on COVID-19 was derived from the Uncertainty in Illness Theory to make it relevant and applicable to a specific aspect of uncertainty on COVID-19, health-related uncertainty perceived by a person who has not contracted COVID-19. It is a middle-range theory targeting the general population and consists of a linear and unidirectional model centered on three themes: antecedents of uncertainty, appraisal of uncertainty, and coping with uncertainty. Conclusion The Theory of Uncertainty on COVID-19 will be able to contribute to efforts to manage perceived uncertainty on pandemic diseases and improve individual biopsychosocial health in the future.

Purpose: The purpose of this study is to develop the Theory of Uncertainty on COVID-19 using the strategy of theory derivation. Methods: Theory derivation was carried out in the following steps: review the literature to explore the phenomena related to uncertainty on COVID-19; select a parent theory that provides valuable concepts and a useful structure for derivation, and identify the concepts and structure of the parent theory to use in derivation; modify and redefine the concepts and structure of the parent theory to create a derived theory. In the literature review process, relevant findings were synthesized to support the propositions of the derived theory. Results: The Theory of Uncertainty on COVID-19 was derived from the Uncertainty in Illness Theory to make it relevant and applicable to a specific aspect of uncertainty on COVID-19, health-related uncertainty perceived by a person who has not contracted COVID-19. It is a middle-range theory targeting the general population and consists of a linear and unidirectional model centered on three themes: antecedents of uncertainty, appraisal of uncertainty, and coping with uncertainty. Conclusion The Theory of Uncertainty on COVID-19 will be able to contribute to efforts to manage perceived uncertainty on pandemic diseases and improve individual biopsychosocial health in the future.

Background: Achieving a definitive genetic diagnosis of unexplained multiple congenital anomalies (MCAs) in neonatal intensive care units (NICUs) infants is challenging because of the limited diagnostic capabilities of conventional genetic tests. Although the implementation of whole genome sequencing (WGS) has commenced for diagnosing MCAs, due to constraints in resources and faculty, many NICUs continue to utilize chromosomal microarray (CMA) and/or karyotyping as the initial diagnostic approach. We aimed to evaluate the diagnostic efficacy of WGS in infants with MCAs who have received negative results from karyotyping and/or CMA. Methods: In this prospective study, we enrolled 80 infants with MCAs who were admitted to a NICU at a single center and had received negative results from CMA and/or karyotyping.The phenotypic characteristics were classified according to the International Classification of Diseases and the Human Phenotype Ontology. We assessed the diagnostic yield of trioWGS in infants with normal chromosomal result and explored the process of diagnosing by analyzing both phenotype and genotype. Also, we compared the phenotype and clinical outcomes between the groups diagnosed with WGS and the undiagnosed group. Results: The diagnostic yield of WGS was 26% (21/80), of which 76% were novel variants.There was a higher diagnostic yield in cases of craniofacial abnormalities, including those of the eye and ear, and a lower diagnostic yield in cases of gastrointestinal and genitourinary abnormalities. In addition, higher rates of rehabilitation therapy and gastrostomy were observed in WGS-diagnosed infants than in undiagnosed infants. Conclusion This prospective cohort study assessed the usefulness of trio-WGS following chromosomal analysis for diagnosing MCAs in the NICU and revealed improvements in the diagnostic yield and clinical utility of WGS.

Purpose: Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (ARBs) are frequently employed to counteract the detrimental effects of proteinuria on glomerular diseases. However, the effects of ARBs remain poorly examined in pediatric patients with immunoglobulin A (IgA) nephropathy. Herein, we evaluated the efficacy and safety of losartan, an ARB, in pediatric IgA nephropathy with proteinuria. Methods: This prospective, single-arm, multicenter study included children with IgA nephropathy exhibiting proteinuria. Changes in proteinuria, blood pressure, and kidney function were prospectively evaluated before and 4 and 24 weeks after losartan administration. The primary endpoint was the difference in proteinuria between baseline and 24 weeks. Results: In total, 29 patients were enrolled and received losartan treatment. The full analysis set included 28 patients who received losartan at least once and had pre- and post-urinary protein to creatinine ratio measurements (n=28). The per-protocol analysis group included 22 patients who completed all scheduled visits without any serious violations during the study period. In both groups, the mean log (urine protein to creatinine ratio) value decreased significantly at 6 months. After 24 weeks, the urinary protein to creatinine ratio decreased by more than 50% in approximately 40% of the patients. The glomerular filtration rate was not significantly altered during the observation period. Conclusions Losartan decreased proteinuria without decreasing kidney function in patients with IgA nephropathy over 24 weeks. Losartan could be safely employed to reduce proteinuria in this patient population. ClinicalTrials.gov trial registration (NCT0223277)

Objective: To compare the clinical and radiological features of various etiologies of chronic diffuse lacrimal gland enlargement. Materials and Methods: We retrospectively reviewed 91 consecutive patients who underwent surgical biopsy for chronic diffuse lacrimal gland enlargement and were diagnosed with non-specific dacryoadenitis (DA) (n = 42), immunoglobulin G4-related dacryoadenitis (IgG4-RD) (n = 33), and lymphoma (n = 16). Data on patient demographics, clinical presentation, and CT imaging findings (n = 73) and MRI (n = 43) were collected. The following radiologic features of lacrimal gland enlargement were evaluated: size, unilaterality, wedge sign, angle with the orbital wall, heterogeneity, signal intensity, degree of enhancement, patterns of dynamic contrast-enhanced, and apparent diffusion coefficient value. Radiological features outside the lacrimal glands, such as extra-lacrimal orbital involvement and extra-orbital head and neck involvement, were also evaluated. The clinical and radiological findings were compared among the three diseases. Results: Compared to the DA and IgG4-RD groups, the lymphoma group was significantly older (mean 59.9 vs. 46.0 and 49.4 years, respectively; p = 0.001) and had a higher frequency of unilateral involvement (62.5% vs. 31.0% and 15.2%, respectively;p = 0.004). Compared to the IgG4-RD and lymphoma groups, the DA group had significantly smaller lacrimal glands (2.3 vs. 2.8 and 3.3 cm, respectively; p < 0.001) and a lower proportion of cases with a wedge sign (54.8% vs. 84.8% and 87.5%, respectively; p = 0.005). The IgG4-RD group showed more frequent involvement of the extra-orbital head and neck structures, including the infraorbital nerve (36.4%), paranasal sinus (72.7%), and salivary gland (58.6%) compared to the DA and lymphoma groups (4.8%–28.6%) (all p < 0.005). Conclusion Patient age, unilaterality, lacrimal gland size, wedge sign, and extra-orbital head and neck involvement differed significantly different between lymphoma, DA, and IgG4-RD. Our results will be useful for the differential diagnosis and proper management of chronic lacrimal gland enlargement.