Use and impact of a novel nurse-led consultation model in a palliative care consultation service for terminally ill cancer patients in Taiwan: an 11-year observational study

PURPOSE

The early integration of palliative care for terminally ill cancer patients improves quality of life. We have developed a new nurse-led consultation model for use in a palliative care consultation service (PCCS) to initiate early palliative care for cancer patients.

METHODS

In this 11-year observational study, data were collected from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH). Terminally ill cancer patients who had received PCCS during the years 2011 to 2021 were enrolled. Trend analysis was performed in order to evaluate differences in outcomes seen within the categories of either a nurse-led consultation model or ordinary consultation model throughout the study period. Analysis included studying the duration of PCCS and DNR declaration, as well as awareness of disease by both patients and families before and after PCCS.

RESULTS

In total, 6923 cancer patients with an average age of 64.1 years received PCCS from 2011 to 2021, with the average duration of PCCS being 11.1 days. Three thousand four hundred twenty-one patients (49.4%) received both a nurse consultation and doctor consultation during PCCS. Being admitted to the Department of Hematology, a longer duration of hospitalization, a DNR declaration after PCCS, and having had a PCCS consultation by a nurse only or both with a nurse and a doctor were significant determinants of a PCCS duration of more than 7 days.

CONCLUSION

This 11-year observational study shows that the number of terminal cancer patients receiving a novel nurse-led consultation during PCCS has increased significantly during the past decade, while a nurse-led consultation model during PCCS was effective in improving the duration of PCCS among terminally ill cancer patients.

[Analysis of genotypes on 850 newborns with SLC26A4 single-allele mutation and the phenotypes of those with second variant]

Objective: To clarify the phenotypes of the newborns with SLC26A4 single-allele mutation in deafness genetic screening and second variant; to analyze the SLC26A4 genotype and hearing phenotype. Methods: 850 newborns born in Beijing from April 2015 to December 2019 were included and there were 468 males and 382 females. They received genetic deafness screening for 9 or 15 variants, with the result of SLC26A4 single-allele mutation. Firstly, three step deafness gene sequencing was adopted in this work, i.e., the first step was "SLC26A4 gene whole exons and splice sites" sequencing; the second step was "SLC26A4 gene promoter, FOXI1 gene and KCNJ10 gene whole exons" sequencing; and the third step was detection for "SLC26A4 gene copy number variation". Secondly, we collected the results of newborn hearing screening for all patients with the second mutation found in the three step test, and conducted audiological examinations, such as acoustic immittance, auditory brainstem response and auditory steady state response. Thirdly, for novel/VUS mutations, we searched the international deafness gene database or software, such as DVD, ClinVar and Mutation Taster, to predict the pathogenicity of mutations according to the ACMG guideline. Lastly, we analyzed the relationship between genotype and phenotype of newborns with SLC26A4 single allele mutation. Results: Among 850 cases, the median age of diagnosis was 4 months. In the first step, 850 cases were sequenced. A total of 32 cases (3.76%, 32/850) of a second variants were detected, including 18 cases (2.12%, 18/850) with identified pathogenic variants; 832 cases were sequenced and 8 cases of KCNJ10 gene missense variants were detected among the second step. No missense mutations in the FOXI1 gene and abnormal SLC26A4 gene promoter were detected; the third step sequencing results were all negative. Genotypes and hearing phenotypes included 18 cases combined with the second clear pathogenic variant, 16 cases (16/18) referred newborn hearing screening and 2 cases (2/18) passed in both ears; degree of hearing loss consisted of 18 profound ears (18/36), 13 severe ears (13/36) and 5 moderate ears (5/36); audiogram patterns comprised 17 high frequency drop ears (17/36), 14 flat ears (14/36), 3 undistinguished ears (3/36), and 2 U shaped ears (2/36); 11 cases underwent imaging examination, all of which were bilateral enlarged vestibular aqueduct. As for 22 cases of other genotypes, all passed neonatal hearing screening and the hearing diagnosis was normal, including 9 cases with VUS or possibly novel benign variants, 8 cases with KCNJ10 double gene heterozygous variants, and 5 cases with double heterozygous variants. Conclusions: The probability of individuals with SLC26A4 single-allele variant who merge with a second pathogenic variant is 2.12%, all of which are SNV, which can provide scientific basis for the genetic diagnosis and genetic counseling of SLC26A4 variants. Those who have merged with second pathogenic variant are all diagnosed with sensorineural hearing loss. Patients with KCNJ10 gene mutations do not manifest hearing loss during the infancy, suggesting the need for further follow-up.

[Acupuncture combined with repetitive transcranial magnetic stimulation for post-stroke depression: a randomized controlled trial]

OBJECTIVE

To observe the curative effect of Shugan Tiaoshen (soothing liver and regulating mind) acupuncture combined with repetitive transcranial magnetic stimulation (rTMS) in the treatment of post-stroke depression (PSD), and to explore its mechanism.

METHODS

Ninety patients of PSD were randomly divided into an acupuncture+rTMS combination group (30 cases), a rTMS combination group (30 cases, 1 case dropped off) and a western medication group (30 cases, 1 case dropped off). The western medication group was treated with escitalopram oxalate tablets, 10 mg orally each time, once a day; on the basis of the treatment in the western medication group, the rTMS combination group was additionally given rTMS, and the frequency was 20 Hz, 20 min each time, once a day, 5 times a week; on the basis of the treatment in the rTMS combination group, the acupuncture+rTMS combination group was additionally treated with Shugan Tiaoshen acupuncture at Baihui (GV 20), Sishencong (EX-HN 1), Yintang (GV 24⁺), Shenting (GV 24), etc. for 40 min each time, once a day, weekly 5 times, and each group was treated for 4 weeks. Before and after treatment, the scores of Hamilton depression scale-17 (HAMD-17), Montreal cognitive assessment scale (MoCA), Pittsburgh sleep quality index (PSQI) were observed, and serum levels of 5-hydroxytryptamine (5-HT) and brain-derived neurotrophic factor (BDNF) were detected in each group.

RESULTS

After treatment, the HAMD-17 scores in the three groups were lower than those before treatment (P<0.01), and the PSQI scores in the acupuncture+rTMS combination group and the rTMS combination group were lower than those before treatment (P<0.01); the above indexes in the acupuncture+rTMS combination group and the rTMS combination group were lower than those in the western medication group (P<0.05), and the PSQI score in the acupuncture+rTMS combination group was lower than that in the rTMS combination group (P<0.05). After treatment, the MoCA scores and serum BDNF levels in the acupuncture+rTMS combination group and the rTMS combination group were higher than those before treatment (P<0.01), and the serum 5-HT levels in the three groups were higher than those before treatment (P<0.01); and the above indexes in the acupuncture+rTMS combination group and the rTMS combination group were higher than those in the western medication group (P<0.05), and which in the acupuncture+rTMS combination group were higher than those in the rTMS combination group (P<0.05).

CONCLUSION

On the basis of western medication escitalopram oxalate, the addition of Shugan Tiaoshen acupuncture combined with rTMS therapy can effectively improve cognitive function and sleep quality in patients with PSD, and the effect is better than that of western medication alone or rTMS combined with western medication. Its mechanism of action may be related to the increase of peripheral serum 5-HT and BDNF levels.

Abnormal keratin expression pattern in prurigo nodularis epidermis

Background

Prurigo nodularis (PN) is a highly pruritic, chronic dermatosis and difficult to treat. PN lesions are characterized by existence of many hyperkeratotic, erosive papules and nodules. However, the pathogenesis of PN still remains unelucidated.

Aim

To clarify the keratin role in the epidermis hyperproliferation, the keratin expression pattern in the PN lesional skin.

Methods

In this study, we enrolled 24 patients with PN and 9 healthy control volunteers. K1/K10, K5/K14, K6/K16/K17 expression pattern were investigated by using immunohistochemical staining.

Results

The lesional skin consists of the thickened spinous layers, in which active cell division was found. K5/K14 were upregulated in PN lesional epidermis, the staining signal localized in the basal layer and lower suprabasal layers. Hyperproliferation‐associated K6 was found in all layers of epidermal lesional skin, especially in the spinous layers. In contrast, K16 was only detected in the basal and lower suprabasal layers, K17 was observed in the basal and spinous layers. Terminal differential keratins K1/K10 were upregulated, detected in the pan‐epidermis, but spared in the basal and low suprabasal layers.

Conclusion

The keratinocytes enter an alternative differentiation pathway, which are responsible for the activated keratinocyte phenotype, abnormal keratins expression potentially contributes to the keratinocytes proliferation, subsequently lead to increased lesional skin epidermis thickness, hyperkeratiosis and alteration of skin barrier properties.

Trend analysis of palliative care consultation service for terminally ill non-cancer patients in Taiwan: a 9-year observational study

Backgrounds

Early integration of palliative care for terminally ill non-cancer patients improves quality of life. However, there are scanty data on Palliative Care Consultation Service (PCCS) among non-cancer patients.

Methods

In this 9-year observational study Data were collected from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH). Terminally ill non-cancer patients with 9 categories of diagnoses who received PCCS during 2011 to 2019 were enrolled. Trend analysis was performed to evaluate differences in categories of diagnosis throughout study period, duration of PCCS, patient outcomes, DNR declaration, awareness of disease by patients and families before and after PCCS.

Results

In total, 536 non-cancer patients received PCCS from 2011 to 2019 with an average age of 70.7 years. The average duration of PCCS was 18.4 days. The distributions of age, gender, patient outcomes, family’s awareness of disease before PCCS, and patient’s awareness of disease after PCCS were significantly different among the diagnoses. Organic brain disease and Chronic kidney disease (CKD) were the most prevalent diagnoses in patients receiving PCCS in 2019. For DNR declaration, the percentage of patients signing DNR before PCCS remained high throughout the study period (92.8% in 2019). Patient outcomes varied according to the disease diagnoses.

Conclusion

This 9-year observational study showed that the trend of PCCS among non-cancer patients had changed over the duration of the study. An increasing number of terminally ill non-cancer patients received PCCS during late life, thereby increasing the awareness of disease for both patients and families, which would tend to better prepare terminally ill patients for end-of-life as they may consider DNR consent. Early integration of PCCS into ordinary care for terminally non-cancer patients is essential for better quality of life.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-021-00879-z.

[Risk assessment for thyroid (131)I exposure among nuclear medical staff]

Objective: To explore the main risk factors and to assess the risk of thyroid (131)I exposure among nuclear medical workers. Methods: From March to October in 2019, cluster sampling was adopted to collect the number of (131)I automatic packer and patients treated for thyroid cancer, hyperthyroidism and liven cancer used (131)I, the practicing categories, job rotation and (131)I operation condition of nuclear medical staff were also investegated in the 21 nuclear medicine hospitals in Fujian Province that carried out (131)I nuclide diagnosis and treatment in 2018. (131)I aerosol and personnel thyroid (131)I were measured in 20 hospitals using (131)I for thyroid cancer or hyperthyroidism. The main risk factors leading to thyroid (131)I exposure of nuclear medical staff were found and aninternal exposure risk assessment model was established. Results: The detection rate of (131)I aerosol and personnel thyroid (131)I were 80.0% (16/20) and 25.5% (62/243) in 20 hospitals. The situation of packaging and administration about (131)I in the nearly 10 effective half-life, the concentration of (131)I aerosol in the nuclear medicine workplace, the number of patients treated with (131)I for thyroid cancer or hyperthyroidism were the main risk factors leading to thyroid (131)I internal exposure (OR=5.857, 6.808, 1.983, 1.150, P<0.05) . Conclusion: (131)I exposure is common among nuclear medical workers, attention should be paid to the protection of internal radiation, strengthen the control of main risk factors, so as to reduce the risk of internal radiation.

Palliative Care Consultation Services on Terminally Ill Cancer Patients and Non-Cancer Patients: Trend Analysis from a 9-Year-Long Observational Study in Taiwan

Early integration of palliative care for terminally ill cancer and non-cancer patients improves quality of life. However, there are sparse data on results of palliative care consultation services (PCCS) between cancer and non-cancer patients. In this 9-year observational study, data were collected from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH). Terminally ill cancer and non-cancer patients who received PCCS during 2011 to 2019 were enrolled. Trend analysis was performed to evaluate differences in outcomes of PCCS, including duration of PCCS, the awareness of disease of patients and families before and after PCCS, status of PCCS termination, and DNR declaration before and after PCCS among cancer and non-cancer patients throughout study period. In total, 5223 cancer patients and 536 non-cancer patients received PCCS from 2011 to 2019. The number of people who received PCCS increased stably over the decade, both for cancer and non-cancer patients. The average duration of PCCS for cancer and non-cancer patients was 21.4 days and 18.4 days, respectively. Compared with non-cancer patients, cancer patients had longer duration of PCCS, less DNR declaration (82% vs. 98%, respectively), and more transfers to the palliative care unit (17% vs. 11%, respectively), or for palliative home care (12% vs.8%, respectively). Determinants of late referral to PCCS includes age (OR 0.992, 95% CI 0.987–0.996), DNR declaration after PCCS (OR 1.967, 95% CI 1.574–2.458), patients’ awareness after PCCS (OR 0.754, 95% CI 0.635–0.895), and status of PCCS termination. This 9-year observational study showed that the trend of PCCS among cancer and non-cancer patients had changed over the duration of the study, and early integration of PCCS to all patients is essential for both cancer and non-cancer patients.

[Clinical observation of dynamic scalp acupuncture combined with task-oriented mirror therapy for upper limbs function impairment in patients with hemiplegia after ischemic stroke]

OBJECTIVE

To explore the effect of dynamic scalp acupuncture combined with task-oriented mirror therapy (TOMT) for upper limb motor function and activity ability of daily living in patients with hemiplegia after ischemic stroke.

METHODS

Seventy-eight patients with hemiplegia after ischemic stroke were randomly divided into a dynamic scalp acupuncture group, a TOMT group, and a scalp acupuncture group, 26 cases in each group (1 case dropped off in the TOMT group and the scalp acupuncture group respectively). All three groups received routine rehabilitation training and medication treatment. The TOMT group was treated with TOMT for 40 min a day, 5 days a week for 8 weeks. The scalp acupuncture group was treated with TOMT after the scalp acupuncture, and the dynamic scalp acupuncture group was treated with TOMT during the scalp acupuncture treatment. The scalp acupuncture treatment was applied at ipsilateral up 1/5 and mid 2/5 of Dingnie Qianxiexian and Dingnie Houxiexian, and the needles were retained for 40 min. The scalp acupuncture treatment was given once a day, 5 days a week for 8 weeks. Before treatment and after 4 weeks and 8 weeks of treatment, the functions of upper limb and hand were evaluated by simplified Fugl-Meyer assessment (FMA) scale upper limb part and functional test for the hemiplegic upper extremity-Hong Kong version (FTHUE-HK) grade, the muscle tension of the upper extremity flexor elbow muscle group was assessed by modified Ashworth scale (MAS) and the activity ability of daily living was assessed by modified Barthel index (MBI).

RESULTS

After 4 weeks and 8 weeks of treatment, the FMA scores, FTHUE-HK grades and MBI scores in the three groups were better than those before treatment (P<0.01, P<0.05), and MAS scores after 4 weeks of treatment in the three groups were better than those before treatment (P<0.05). After 4 weeks and 8 weeks of treatment, the FMA scores, FTHUE-HK grades and MBI scores in the dynamic scalp acupuncture group were better than those in the TOMT group and the scalp acupuncture group (P<0.05), and these items in the scalp acupuncture group were better than those in the TOMT group (P<0.05).

CONCLUSION

The dynamic scalp acupuncture combined with TOMT treatment can effectively improve the upper limb function and the activities ability of daily living in patients with hemiplegia after ischemic stroke, which is better than TOMT after scalp acupuncture and simple TOMT treatment.

Roles of nurses and National Nurses Associations in combating COVID-19: Taiwan experience

As the COVID‐19 pandemic continues to expand worldwide, Taiwan has effectively contained the spread domestically and protected its citizens after registering its first case relatively early on 21 January 2020. Proactive preparedness and deployment by the national government, timely evidence and experience‐based judgements and decision‐making, information transparency, rapid response, and effective communication and measures have all been critical to combating COVID‐19 in Taiwan. Nurses play a pivotal role in providing direct health care as well as providing contact tracing and care for the quarantined clients and community care services. The Taiwan Nurses Association and other nurses’ associations serve a vital leadership role in advocating for nurses, raising public awareness, enhancing nursing’s professional profile, and sharing experiences via national and international platforms. The implications for nursing and health policy are that we need to well prepare for any unpredicted emerging pandemic in the future. Providing adequate personal protective equipment and safe staffing should be the highest priority for the governments and policymakers around the world to combat pandemic successfully.

Association of surgical margins with local recurrence in patients undergoing breast-conserving surgery after neoadjuvant chemotherapy

BACKGROUND

The aim of the current study was to report a single-institution experience using breast-conserving surgery after neoadjuvant chemotherapy (NACT), focusing on the association between microscopic resection margin status and locoregional recurrence (LRR).

METHODS

Our institutional prospectively maintained database was reviewed to identify patients who were treated with NACT between January 2008 and April 2018.

RESULTS

Among the main partial mastectomy specimens available for analysis (n = 161), 28 had margins < 1 mm, 21 had margin width of 1-2 mm and the remaining 112 had margins > 2 mm. LRR occurred in 16 patients (9.9%) and distant metastases were detected in 27 (16.8%) patients. There was no significant difference in the LRR between the > 2 mm margin group with a 60-month cumulative survival of 85.2% compared with 76.2% for the ≤2 mm group (P = 0.335) in the Kaplan-Meier analysis. When we stratified patients by margin widths of ≥1 mm or <  1 mm, there was no LRR-free survival benefit observed for the ≥1 mm pathologic excision margin group in the univariate analysis (hazard ratio = 0.443; 95% confidence interval = 0.142-1.383; P = 0.161) with a 60-month cumulative LRR-free survival of 84.9% compared with 69.5% for the < 1 mm margin cohort (P = 0.150).

CONCLUSIONS

In the absence of multiple scattered microscopic tumour foci, a negative margin of no ink on tumour maybe sufficient for stage I-III invasive breast cancer treated with NACT and breast-conserving surgery.

[Follow-up research on hearing progression of GJB2 mutation associated hearing loss in children]

Objective: To analyze the auditory follow-up alteration of GJB2 associated hearing loss children. Method: Forty three children aged 0-5 years with homozygous or heterozygous mutations of gene attach to the Children' s Hearing Diagnostic Center of our hospital were enrolled in this study. Distortion product otoacoustic emissions and acoustic immittance, auditory brainstem response, auditory steady state response, acoustic impedance, pediatric behavior audiometry and other audiological tests were performed. The subjects had at least two audiology diagnosis results at different time; follow-up time was at least three months. According to the genotype, the subjects were divided into two groups: 23 cases(53.49%) in the truncating mutation/truncating mutation (T/T) group and 20 cases(46.51%) in the nontruncating mutation/truncating mutation (NT/T) group. Hearing levels of the first and last diagnoses and progression rate were compared between the two groups, and the progression value and progression rate were analyzed. Result: The average follow-up time was(19.63 ± 16.76) months. The frequency of c. 235delC (56.98%) in GJB2 gene mutations sites was highest in this group, followed by c. 109G> A (22.09%). The first diagnosis of hearing loss, T/T group was mainly severe(60.87%), NT/T group was mainly mild (50.00%); The degree of final hearing loss in the T/T group was mainly severe(50.00%) while the NT/T group was mainly mild(42.50%), and the T/T group was both heavier than the NT/T group. The difference was both statistically significant. Follow-up research on 43 cases(86 ears) showed that 3 cases(4 ears) developed hearing progression, 1 of them were bilateral progression, two was unilateral progression; the overall rate of progression was 4.65%(4/86), and the rate of progression in the T/T group was 2.17%(1/46) while the NT/T group was 7.50%(3/40). There was no significant difference between the two groups. The average progression of 4 ears was 11.25 dB HL, the average progression speed was 0.5 dB HL/month. Conclusion: This study showed that the degree of hearing loss of associated hearing loss children was mild to profound, and those with truncating mutations/truncating mutations were severer than those with nontruncating mutations/truncating mutations. Hearing progression was seen in both groups, it is suggested that children with GJB2 gene mutations hearing progression may occur during growth and development, therefore, they should be followed up regularly. .

[Analysis of genotypes and audiological characteristics of children with SLC26A4 gene pathogenic mutations]

Objective:To explore the correlation of SLC26A4 genotype and audiology.Method:The subjects were 70 children aged 0 to 7 years old, who were admitted to otological outpatient department.All subjects received nine crystal hereditary deafness gene chip and confirmed by (or)SLC26A4 gene full coding region detection.The patients were diagnosed as homozygous or compound heterozygous mutations.At the same time,acoustic immittance,auditory brainstem response, auditory steady state response and pediatric behavior audiometry, newborn hearing screening and other audiological tests were displayed. According to the genotype, the subjects were divided into two groups: group A (SLC26A4 gene homozygous mutation) in 40 cases, group B (SLC26A4 gene compound heterozygous mutation) in 30 cases. The frequency of SLC26A4 gene mutation, the two groups of genotypes and hearing screening results,the degree of hearing loss and audiometric configurations were analyzed statistically. Result: In 70 patients, the top 4 of the 70 patients with high frequency of mutations were IVS7-2A> G(76.43%), 2168A> G(15.00%), 1226G> A(2.86%) and 2000T> C(2.16%), respectively. 34.29% of newborns passed hearing screening with single or double ears, among which group A and group B were 32.50% and 36.67%,respectively. There was no statistically significant difference between two groups in hearing screening. The degree of hearing loss in group A(56.25%) and group B(48.33%) were mainly profound and there was no significant difference between them. The audiometric configurations: group A(60.00%) was mainly high frequency loss type, while group B(55.00%) was mainly flat type. The difference between them was statistically significant.Conclusion:The mutation sites of SLC26A4 gene were mainly IVS7-2A> G, and the degree of hearing loss was mostly profound. To the audiometric configurations,SLC26A4 gene homozygous mutant were mainly high frequency loss type, while SLC26A4 gene compound heterozygous mutant were mainly flat type. 34.29% children passed universal newborn hearing screening with one ear at least, which indicates SLC26A4 gene mutations can result in late-onset hearing loss, so those patients should be attached great importance..

Hexane fraction of adlay (Coix lachryma-jobi L.) testa ethanolic extract inhibits human uterine sarcoma cancer cells growth and chemosensitizes human uterine sarcoma cells to doxorubicin

BACKGROUND

Cancer has remained among the top ten causes of death in Taiwan since 1982. Uterine sarcoma is a rare gynecologic cancer, and chemotherapy is one type of cancer treatment. Doxorubicin (Dox) is widely used for treating several cancers, including uterine sarcoma, however, multidrug resistance (MDR) is a major clinical problem and a critical cause of treatment failure. The ethanolic extracts of adlay testa (ATE) exhibited significant anticancer activities against many cancer types.

PURPOSE

In this study we investigated the antitumor effects of the hexane fraction of the adlay testa ethanolic extracts (ATE-Hex) on the human uterine sarcoma cancer cell line MES-SA, as well as on the multidrug-resistant human uterine sarcoma cancer cell line MES-SA/Dx5.

METHODS

The MTT assay was performed to assess the effects of the extracts of different parts of the adlay on the proliferation of human uterine sarcoma cells (MES-SA and MES-SA/Dx5) and human uterine smooth muscle cells (HUtSMCs). To determine whether ATE-Hex has a chemosensitizing effect on drug-resistant uterine sarcoma cells, the MTT assay was performed to examine the synergistic effects of ATE-Hex, the chemotherapeutic drug Dox alone, and in combination. Rhodamine accumulation was analyzed using fluorescence detection. Apoptotic cells were analyzed via flow cytometry. In addition, employing a flame ionization detector (GC/FID) gas chromatography was also developed as the analysis platform for ATE-Hex.

RESULTS

The results demonstrated that ATE-Hex exhibited the best effects of inhibition on MES-SA and MES-SA/Dx5 cells. Co-treatment of ATE-Hex and Dox could synergistically inhibit the proliferation of cancer cells. ATE-Hex reduced the rhodamine efflux in MES-SA/Dx5 cells, indicating that ATE-Hex could reduce the expression of P-gp. In addition, our results showed that treatment with ATE-Hex alone or in combination with Dox significantly inhibited the growth of cancer cells and induced apoptosis by increasing the sub-G1 phase and poly(ADP-ribose) polymerase (PARP) being cleaved. Flow cytometry revealed that ATE-Hex induced apoptosis.

CONCLUSION

These results suggest that ATE-Hex can inhibit human uterine sarcoma cancer cells by inducing apoptosis and increasing the chemosensitivity of the multidrug-resistant human uterine sarcoma cancer cell MES-SA/Dx5 to Dox. Furthermore, the combination of ATE-Hex and Dox could decrease MDR and increase the synergistic effect.

[Analysis of clinical audiology and etiology in 72 twins aged 0-4 years]

Objective:To investigate the clinical audiological characteristics of twins and analyze the risk factors for hearing loss. Method：The subjects were 72 cases,selected from our hospital otological outpatient of 0 to 4 years old twins. All subjects underwent universal newborn hearing screening and had definite results. At the same time, acoustic immittance,auditory brainstem response, auditory steady-state response, pediatric behavior audiometry and other audiological tests were carried out. Subjects were divided into two groups according to whether with high risk factors for hearing loss: 42 patients(58.33%) in group A(risk factor group) and 30 patients(41.67%) in group B (no risk factor group).The results of universal newborn hearing screening(UNHS),hearing diagnosis, degree of hearing loss, type of hearing curve and risk factors categories of hearing loss were analyzed for both groups of subjects.Result:In 72 cases,41 were males and 31 were females. Thirty-one were the first born and 41 were the second born. Age distribution of first visit:3 to 40 months, median age: 4-6 months.Forty-seven(65.27%) failed in the UNHS. The failing rate was higher in group A(76.19%) than in group B(50.00%).Fifty(69.44%) were diagnosed with hearing loss.78.57% of hearing loss was diagnosed in group A, which was higher than that in group B(56.67%).The degree of hearing loss in group A was mainly profound(43.55%) and group B was moderate(48.00%).The differences above all was statistically significant.For the hearing curve type, group A(35.48%) and group B(40.00%) were both mainly flat-type, the difference was not statistically significant. In 72 cases, there were 42 cases(58.33%) with risk factors for hearing loss, of which 38.1% had two or more kinds of risk factors and 61.9% had one kind of risk factor.Hyperbilirubinemia was the major risk factor(34.92%).Conclusion:69.44% of twins had a confirmed hearing loss. Those with risk factors had higher failing rate of UNHS and more serious hearing loss.58.33% of twins had risk factors for hearing loss, and individuals with two or more kinds of risk factors were much more. Hyperbilirubinemia takes the first place and should be paid enough attention by clinicians.

[Research progress on the etiology of delayed-onset hearing loss in children]

Newborn hearing screening is an effective method for early detection of hearing loss, however, it is not able to detect delayed-onset hearing loss. By exploring the etiology of delayed-onset hearing loss in children, it can provide a clinical basis for early detection of delayed-onset hearing loss. Mutations in SLC26A4, mitochondrial, GJB2 and other genes, enlarged vestibular aqueduct, congenital cytomegalovirus infection, extracorporeal membrane oxygenation, and auditory neuropathy et al were more commonly reported risk factors. In this paper, the risk factors related to delayed-onset hearing loss, which are divided into 5 categories: genetic mutation, abnormal inner ear malformation, perinatal factors, auditory neuropathy and no identifiable cause, are reviewed and analyzed.

A comparison of the cost-utility of ultrasound-guided high-intensity focused ultrasound and hysterectomy for adenomyosis: a retrospective study

OBJECTIVE

To evaluate cost-effectiveness of ultrasound-guided high-intensity focused ultrasound (USgHIFU) and open hysterectomy for adenomyosis.

DESIGN

A retrospective analysis.

SETTING

Gynaecological department in a single centre in China.

POPULATION

Patients with symptomatic adenomyosis.

MAIN OUTCOME MEASURES

Cost difference between patients with adenomyosis treated with USgHIFU and open hysterectomy.

METHODS

Three hundred and sixty-eight patients with adenomyosis were retrospectively reviewed. Among them, 302 patients were treated with USgHIFU and 66 patients with open hysterectomy. All of them had 1-, 3-, 6- and 12-month follow ups. The patients' quality of life (QOL) was evaluated and the utility scores were obtained from a rating scale to conduct a cost-utility analysis (CUA).

RESULTS

No significant differences were found at any follow-up time point in the QOL between the two groups (P > 0.05). After treatment, the QOL scores significantly increased in both groups (P < 0.05): the quality adjusted life year (QALY) for patients treated with USgHIFU was USUS$5256.48, whereas it was USUS$7510.03 for patients treated with open hysterectomy. Both incremental cost and sensitivity analysis showed that USgHIFU was less costly than open hysterectomy.

CONCLUSIONS

The QOL of patients with adenomyosis can be significantly improved by either USgHIFU or open hysterectomy, but USgHIFU is less costly.

TWEETABLE ABSTRACT

USgHIFU can safely be used to treat patients with adenomyosis and significantly improved the quality of life of patients after treatment. The cost of USgHIFU is less than that of surgical treatment.

[The effect of liraglutide in combination with human umbilical cord mesenchymal stem cells treatment on glucose metabolism and β cell function in type 2 diabetes mellitus]

OBJECTIVE

To observe the effect of liraglutide (LIRA) in combination of umbilical cord mesenchymal stem cells (hUC-MSCs) in treating type 2 diabetes mellitus.

METHODS

Eligibility criteria for subjects includes: type 2 diabetes mellitus with more than 10 years duration; having been treated with secretagogues, metformin and insulin in combination with LIRA for at least 6 months; poor glycemic control [glycosylated hemoglobin A1c(HbA1c) 7%-10%]. Totally, twelve patients were enrolled and randomly divided into two groups: the group A (LIRA group, n=6) and the group B (LIRA+ hUC-MSCs group, n=6). The hUC-MSCs were transplanted through infusing of 1×10(6) cells /kg via pancreatic artery directed by interventional radiology on the first day, and followed by infusing 1×10(6) cells /kg through peripheral vein on the eighth, the fifteenth and the twenty-second day sequentially. The control subjects were infused with saline. Both groups were treated with LIRA for 24 weeks at the same period. Fasting plasma glucose(FPG), 2h postprandial plasma glucose(2hPG) and HbA1c were measured. A 75 g oral glucose tolerance test(OGTT)was performed. The early phase of C peptide(CP) secretion function(ΔCP30/ΔG30), the total amount of C peptide secretion function(AUCCP180)and Homeostasis model assessment of insulin resistance (HOMA-IR) were calculated.

RESULTS

(1) The baseline FPG, 2hPG, HbA1c, ΔCP30/ΔG30, AUCCP180 and HOMA-IR were comparable between the two groups(P>0.05). (2) Compared with subjects in group A, FPG, 2hPG and HbA1c levels were significantly decreased in subjects in group B [(8.33±0.99) mmol/L vs (6.64±0.79)mmol/L, (13.85±0.86) mmol/L vs (8.65±1.12) mmol/L, (7.82±0.31)% vs (6.82±0.53)%, P<0.05]. (3) Compared with group A, ΔCP30/ΔG30 and AUCCP180 were significantly increased, and HOMA-IR was significantly decreased in group B(0.22±0.13 vs 0.70±0.38, 12.52±5.30 vs 21.16±3.17, 9.46±4.88 vs 4.30±2.68, P<0.05).

CONCLUSION

LIRA treatment in combination with hUC-MSCs improves glucose metabolism and the β cell function in type 2 diabetic patients. (ClinicalTrials.gov NCT01954147).

[The audiological characteristics of large vestibular aqueduct syndrome in infants and young children]

Objective:To investigate the audiological characteristics of large vestibular aqueduct syndrome(LVAS) in infants and young children, and to provide suggestion for the early diagnosis and early intervention.Method:One hundred and twenty-four cases diagnosed as LVAS were enrolled in our study. Acoustic immittance, pediatric audiometry and(or) auditory steady state responses and auditory brainstem response test were tested to analyze the degree and configuration of hearing loss, and air-bone threshold difference and short latency negative response in auditory brainstem response.Result:The configuration of the hearing loss, includes 44.8%(111/248) of high frequency loss, 19.0%(47/248) of flat, 13.7%(34/248) of rising, 3.6%(9/248) of U type, and 19.0%(47/248) of the configuration which cannot be distinguished. The distribution of the degree of the hearing loss in total 124 cases (248 ears) includes 73.4%(182/248) of profound hearing loss, 16.9%(42/248) of severe hearing loss, 6.9%(17/248) of moderate hearing loss, and 2.8%(7/248)of mild hearing loss. The acoustically evoked short latency negative response in ABR accounted for 27.4%(68/248). The emergence of ABR air-bone threshold difference accounted for 24.6%(61/248), and the mean difference was(19.3±14.2) dB nHL.Conclusion:Infants and young children with large vestibular aqueduct syndrome mostly has the characteristics of high frequency hearing loss curve, acoustically evoked short latency negative response in ABR and ABR bone-air threshold difference, that will remind clinicians of LVAS.