Analysis of trajectory changes and predictive factors of sense of coherence in patients after colorectal cancer surgery

OBJECTIVE

To investigate the trajectories and potential categories of changes in the sense of coherence (SOC) in patients after colorectal cancer surgery and to analyze predictive factors.

METHODS

From January to July 2023, 175 patients with colorectal cancer treated at a tertiary Grade A oncology hospital in Jiangsu Province were selected as the study subjects. Prior to surgery, SOC-13 scale, Patient-Generated Subjective Global Assessment (PG-SGA), Brief Illness Perception Questionnaire (BIPQ), and Social Support Rating Scale (SSRS) were used to survey the patients. SOC levels were measured multiple times at 1 week, 1 month, and 3 months post-surgery. Growth Mixture Modeling (GMM) was applied to fit the trajectory changes of SOC in patients after colorectal cancer surgery. Multinomial logistic regression was used to analyze the predictive factors of SOC trajectory changes.

RESULTS

The SOC scores of patients at points T1-T4 were (65.27 ± 9.20), (63.65 ± 10.41), (63.85 ± 11.84), and (61.56 ± 12.65), respectively. Multinomial logistic regression results indicated that gender, employment status, disease stage, household monthly income, intestinal stoma, nutritional status, illness perception, and social support were predictors of SOC trajectory changes (P < 0.05).

CONCLUSION

There is heterogeneity in the trajectory changes of SOC in patients after colorectal cancer surgery. Healthcare professionals should implement early precision interventions based on the patterns of changes and predictive factors in each trajectory category.

Reflections of nurses in the fight against COVID-19 in Hubei: a qualitative study

OBJECTIVES

To explore the reflections and experiences of nurses who were deployed to the frontline to combat COVID-19 in Wuhan, China. In order to gain insights that can be useful in developing cultivating positive professional values and attitudes towards future public health emergencies.

DESIGN

Qualitative study using semistructured interviews. Data were transcribed and analysed using the Colaizzi's 7-step method. The study is reported in accordance with the consolidated Standards for Reporting Qualitative Research.

SETTING

Telephonic interviews with nine participants who were deployed from Nanjing to Hubei Province for the fight against COVID-19.

PARTICIPANTS

Of 11 volunteer nurses deployed to Hubei Province for the fight against COVID-19, two nurses did not finish the interview because of their working hours. The remaining nine were recruited through purposive sampling using the following criteria: nurses who were deployed at the first stage and those who verbally agreed and signed an informed consent form to participate in the study.

RESULTS

Three thematic categories and subthemes that were identified from the analysis were as follows: (1) 'Assertive attitude to fight against the pandemic', included three subthemes: 'Inner calling towards professional accountability for saving lives', 'Extrinsic support that facilitates the commitment to the nursing profession' and 'Holistic value ascribed to the nursing profession'. (2) 'Challenges associated with the anti-pandemic mission', included 'overcoming challenges around the strict requirements for personal protection' and 'Fear and uncertainty over the rapid progression of the disease'. (3) 'Unbearable heaviness and lightness of being a nurse', with two subthemes: 'the heavy crown of the anti-pandemic hero' and 'eternal reverence without regrets'.

CONCLUSIONS

As reflected by the nurses on frontline combating COVID-19, it was necessary to inculcate professional nursing values in them, as only their dedication and selflessness could improve humanity's chances against the disease.

Risk factors for the development of a parastomal hernia in patients with enterostomy: a systematic review and meta-analysis

PURPOSE

Parastomal hernia (PSH) is a common and serious complication in patients with enterostomy, but there is no current consensus for the risk factors for PSH from previous studies. Therefore, this study systematically analyzed the risk factors for PSH to provide a reference for prevention and treatment of this condition.

METHODS

Seven databases and 3 registers were systematically searched from database inception to January, 2021. Study quality was assessed by Newcastle-Ottawa Scale. Review Manager 5.3 software was used for statistical analysis. The data that could not be combined quantitatively were only analyzed qualitatively.

RESULTS

Sixteen studies with 2031 patients were included. Higher BMI (OR, 1.29; 95% CI,1.02-1.63), older age (OR, 1.04; 95% CI, 1.02-1.07), female (OR, 2.55; 95% CI,1.39-4.67), lager aperture size (OR, 2.8; 95%CI, 1.78-4.42), transperitoneal stoma creation (OR, 2.4; 95% CI, 1.33-4.35), and lager waist circumference (OR, 1.01; 95% CI,1.0-1.01) were significant risk factors for PSH. The laparoscopic approach was not a risk factor for PSH (OR, 2.09; 95% CI, 0.83-5.27). Other risk factors, including the thickness of abdominal subcutaneous fat, no mesh, a stoma not through the middle of the rectus abdominis, atrophy of left lower medial part of rectus abdominis, α1(III) procollagen expression level, emergency surgery, no preoperative stoma site marking, end colostomy, smoking, diabetes, peristomal infection, severe abdominal distention, severe cough, chronic obstructive pulmonary disease, operation time and hypertension, were significant on the multivariate analysis of each individual study.

CONCLUSIONS

The current available evidence showed that higher BMI, older age, female, larger aperture size, the creation of a transperitoneal stoma, and a larger waist circumference were independent risk factors for PSH. For factors without exact cutoff value, further explorations are needed in the future. In addition, reference to the limited number of studies in the pooled analysis, these factors still need to be interpreted carefully.

POS0224 SELECTIVITY OF CLINICAL JAK INHIBITORS AND THE IMPACT ON NATURAL KILLER (NK) CELL FUNCTIONAL RESPONSES

Background:

Janus kinase (JAK) inhibitors (JAKinibs) show similar efficacy in rheumatoid arthritis (RA). However, in vitro studies have shown differences in JAK selectivity profiles for baricitinib (BARI), tofacitinib (TOFA), upadacitinib (UPA) and filgotinib (FIL).1,2 These lead to distinct pharmacologic profiles in cellular signaling assays that may impact clinical efficacy or safety1. NK cells are innate lymphocytes important in anti-pathogen responses and immune surveillance, which function via production of cytokines and cell killing3. NK cell proliferation and IFNγ production are JAK-dependent pathways and may be modulated by JAKinibs. Clinical findings show transient decreases in NK cell numbers in patients treated with JAKinibs, but the link to safety is unclear4

Objectives:

To extend upon findings in proximal cell signaling assays, we compared the selectivity and potency of clinical JAKinibs on NK cell function by assessing proliferation mediated by IL-15 (JAK1/3) and IFN-γ production driven by IL-12 (JAK2/TYK2)+IL-18.

Methods:

NK cells were isolated from healthy donor PBMC, incubated in vitro with 8 concentrations of each evaluated JAKinib (TOFA, BARI, FIL, FIL metabolite, UPA) and stimulated with IL-15 for proliferation or IL-12/18 for IFNγ production. Proliferation was assessed by Cell Trace dye dilution after 6 days and IFNγ production by intracellular flow cytometry 4hrs post-stimulation. Half maximal inhibitory concentration (IC50) values were calculated for CD56bright, CD56dim, and total NK cells. Steady-state pharmacologic profile over a clinical dosing interval was modeled using concentration-time profiles from JAKinib population pharmacokinetic data in RA subjects under the therapeutic dose5-7. For each JAKinib, the time above IC50 and average daily inhibition of IFNγ or proliferation were calculated for each NK cell population in each donor.

Results:

Cellular assays in purified NK cells showed dose-dependent inhibition of IL-15-induced proliferation by all JAKinibs with TOFA showing the highest average inhibition and time above IC50 (35-60% inhibition for 8-15 hrs; TOFA>UPA>BARI≈FIL). The differences between JAKinibs are in line with differences in pSTAT inhibition downstream of IL-151. Interestingly, IL-12/18-induced production of IFNγ, which is mediated via JAK2/TYK2 (IL-12) and non-JAK dependent pathways (IL-18), showed weaker inhibition for all compounds. Moreover, all JAKinibs showed <25% average inhibition of IFNγ production over 24hrs and did not show any time above IC50 for IFNγ production or pSTAT4 inhibition at clinical doses. CD56dim and CD56bright sub-populations of NK cells are proposed to have distinct functions and unique expression of surface receptors. Analysis of the IC50 for pSTAT4 and IFNγ production showed ~2-10-fold weaker inhibition by JAKinibs in CD56bright NK cells, suggesting less dependence on JAK-dependent signals in CD56bright NK cells than CD56dim NK cells.

Conclusion:

NK cell proliferation depends on JAK1 and JAK3-mediated signaling and is differentially inhibited at clinical doses of distinct JAKinibs. In contrast, functional responses downstream of JAK2/TYK2-dependent IL-12/18 were not substantially inhibited by any of the JAKinibs studied. Inhibition of functional and proliferative responses in purified NK cells aligned well with proximal pSTAT inhibition. JAKinib modulation of NK cell proliferation, but not response to IL-12, reflects unique pharmacologic profiles of the drugs studied and could be one component underlying clinical safety observations, including increased risk of viral infections or malignancy4.

References:

[1]Traves PG et al. Ann Rheum Dis 2021 (in press)

[2]McInnes IB, et al. Arthritis Res Ther 2019;21:183.

[3]Cooper MA, Fehniger TA, Caligiuri MA. Trends Immunol 2001 Nov;22(11):633-40.

[4]Winthrop KL. Nat Rev Rheumatol 2017; 13(4):234-243

[5]Zhang X, et al. CPT Pharmacometrics Syst Pharmacol 2017;6(12):804-13.

[6]CDER. Application Number: 203214Orig1s000. NDA 203214: Tofacitinib.

[7]Klunder B et al. Clin Pharmacokinet 2019;58(8):1045-58.

Disclosure of Interests:

Paqui Gonzalez-Traves Shareholder of: Gilead Sciences, Employee of: Gilead Sciences, Laura Simpson Shareholder of: Gilead Sciences, Employee of: Gilead Sciences, Bernard Murray Shareholder of: Gilead Sciences, Employee of: Gilead Sciences, Amy Meng Shareholder of: Gilead Sciences, Employee of: Gilead Sciences, Julie A. Di Paolo Shareholder of: Gilead Sciences, Employee of: Gilead Sciences, Ethan Grant Shareholder of: Gilead Sciences, Employee of: Gilead Sciences, Gundula Min-Oo Shareholder of: Gilead Sciences, Employee of: Gilead Sciences

Adverse drug reactions and nursing interventions in the treatment of non-Hodgkin's lymphoma by Aidi injection

BACKGROUND

To explore adverse drug reactions (ADRs) and the effects of nursing interventions after Aidi injection for the treatment of non-Hodgkin's lymphoma (NHL).

METHODS

A total of 104 NHL patients treated in our hospital from March 2019 to March 2020 were selected. All patients underwent conventional chemotherapy, with a concomitant Aidi injection administered at different doses (40, 60, 80, and 100 mL). ADRs were analyzed for all patients, and the clinical outcomes of ADRs were recorded after specific nursing interventions were performed.

RESULTS

A total of 17 NHL patients had ADRs, with a total incidence rate of 15.89% (total of 30 ADRs). In terms of different types of ADRs, inappetence accounted for the largest proportion, followed by skin pruritus and fever, phlebitis, nausea and vomiting, and chest distress and/or palpitation, the last of which shared the same proportion as chills and/or low fever and urticaria. The incidence rate of ADRs (total of 18 ADRs, 60.00%) was higher in NHL patients who were given 100 mL of Aidi injection. In terms of age and gender distribution of ADRs, there were 10 males (55.56%) and 7 females (44.44%), and ADRs were more common in patients aged 46-60 years old (total of 6 ADRs, 35.29%). Aidi injection mainly induced mild ADRs (total of 22 ADRs, 73.33%), and the resulting ADRs mostly occurred for <2 hours (total of 19 ADRs, 60.00%). After the specific nursing interventions were performed, no deaths due to ADRs occurred, and 12 (64.71%) cases were cured, 5 (29.41%) cases improved, and 1 (5.88%) case had no progression.

CONCLUSIONS

Particular attention should be paid to ADRs in the treatment of NHL patients with Aidi injection. After ADRs occur, specific nursing interventions can aid in recovery and lead to improvements in prognosis.

An ECG method for positioning the tip of a PICC in "mirror people" with dextrocardia: A case report

Intracavitary electrocardiogram (ECG) has been widely used for PICC tip positioning in patients with a normal left heart. However, there is little information about using ECG for PICC insertion in patients with mirror dextrocardia. We report a 70-year-old stomach cancer patient with mirror dextrocardia admitted to our vascular access center for four Fr silicon Groshong PICC insertion. We successfully performed an ultrasound-guided modified Seldinger technique for insertion. First, the usual standardized ECG technique was used for tip positioning, and it failed. Then, we changed the procedure slightly, using the opposite electrode connections (RA: the first intercostal space of the midline of the left clavicle; LA: the first intercostal space of the midline of the right clavicle; and LL: the inferior margin of the right costal arch) to obtain an evident P-wave change to guide catheter placement in this case. We confirm that we can use the opposite electrodes to obtain an apparent P-wave for locating the catheter tip in patients with mirror dextrocardia.

Factors associated with nurses' willingness to participate in care of patients with COVID-19: A survey in China

Aim

The research aims to assess nurses’ willingness to participate in care of patients with coronavirus disease 2019 (COVID‐19) in China and to identify its associated factors.

Background

Along with the increasing number of infections, the world has paid widespread attention to COVID‐19.

Methods

This cross‐sectional study used a convenience sampling method that included a demographics questionnaire and the Nurses' Perceived Professional Benefits Questionnaire. The survey was distributed to 1,787 nurses from 36 hospitals in China.

Results

In total, 1,176 questionnaires were usable for this research. 92.79% of nurses were willing to participate in care of patients with COVID‐19. Intensive care unit (ICU) nurses were less willing to participate, while surgical nurses were more willing to participate. In addition, nurses with high positive professional perception scores were more willing to participate than those with low scores.

Conclusion

The vast majority of nurses were willing to participate in care of patients with COVID‐19 in China. Surgical nurses and nurses with positive professional perceptions are more likely to be willing to participate in treatment.

Implications for nursing management

To increase nurses’ willingness to participate in care of patients with COVID‐19, improving the sense of perceived professional benefits, offering salary and offering paid sick leave for nursing staff are effective ways. In addition, raising the awareness of infectious diseases and increased pre‐disaster training during infectious diseases is critical.

THU0067 JAK SELECTIVITY AND THE IMPACT ON CYTOKINE SIGNALING INHIBITION AT CLINICAL RHEUMATOID ARTHRITIS DOSES

Background:

Janus kinase 1 (JAK1) inhibitors are efficacious in rheumatoid arthritis (RA). Despite having similar efficacy, in vitro studies have shown differences in JAK selectivity profiles for the small-molecule JAK inhibitors (JAKi) baricitinib (BARI), tofacitinib (TOFA), and upadacitinib (UPA).1For example, BARI and UPA are JAK1/JAK2 selective, while TOFA is JAK1/JAK3 selective, but each JAKi has some activity against other JAKs. As JAKs form signaling pairs, differences in selectivity could lead to distinct pharmacologic profiles that may impact clinical efficacy and safety.

Objectives:

As a first step to understand the basis of potential differences at therapeutic doses, we compared the selectivity and potency of filgotinib (FIL) and its major metabolite (MET) to those of BARI, TOFA, and UPA in cytokine-stimulated peripheral blood mononuclear cells (PBMCs) and whole blood (WB).

Methods:

PBMCs and WB from healthy donors were incubated in vitro with 8 doses of each JAKi, and levels of signal transducer and activator of transcription phosphorylation (pSTAT) were measured following cytokine stimulation. Half maximal inhibitory concentration (IC50) values were calculated in phenotypically sorted leukocyte populations by flow cytometry. Therapeutic dose relevance of the in vitro analyses was assessed using calculated mean concentration-time profiles from JAKi population pharmacokinetic data in RA subjects. For each JAKi, the time above IC50and average daily pSTAT inhibition were calculated for each cytokine/STAT pair in B cells, CD4+ T cells, CD8+ T cells, monocytes, and/or NK cells.

Results:

Cellular assays in PBMCs and WB showed dose-dependent inhibition of cytokine-induced pSTATs with all JAKi (correlation between the protein-adjusted IC50values from PBMCs and IC50values from WB, r2=0.98). Among the most potently inhibited pathways were JAK1/TYK2-dependent cytokine, interferon alpha (IFNα), and the JAK1/2-dependent cytokine, interleukin (IL)-6. FIL and MET had weaker potencies against JAK2/TYK2 (G-CSF/pSTAT3), JAK1/2 (IFNƴ/pSTAT1), and JAK2/2 (granulocyte-macrophage colony-stimulating factor [GM-CSF])-dependent pathways compared to JAK1/TYK2 (IFNα/pSTAT5). FIL and MET showed the greatest selectivity vs the JAK2/2 pathway (GM-CSF/pSTAT3) in monocytes.

The mean concentration-time profiles and time above IC50over 24 hr for each cytokine/STAT pathway showed that JAK1/2 (IL-6/pSTAT1) and JAK1/TYK2 (IFNα/pSTAT1) pathways were strongly modulated with all tested JAKi. FIL (200 mg) showed similar activity in average target coverage and time above IC50to the approved low doses of TOFA (5 mg) and UPA (15 mg); conversely, FIL had reduced mean average inhibition and time above IC50levels against JAK1/2 (IFNƴ/pSTAT1), JAK1/3-dependent cytokines (IL-2, -4, and -15), JAK2/TYK2 (G-CSF/pSTAT3), and JAK2/2 (GM-CSF/pSTAT5)-dependent pathways compared to TOFA and UPA, and in certain cases to BARI (2 mg).

Conclusion:

Different JAKi modulate distinct cytokine pathways to varying degrees, and no agent potently and continuously inhibited an individual cytokine signaling pathway throughout the dosing interval. FIL (200 mg) showed a similar inhibition profile to TOFA, BARI, and UPA against the JAK1/TYK2- (IFNα/pSTAT1) or JAK1/2-dependent (IL-6/pSTAT1) responses, consistent with the role of these pathways in clinical efficacy.2However, FIL displayed a differentiated pharmacologic profile from the other JAKi, showing biologically reduced activity on the JAK1/2 (IFNγ)-, JAK1/3 (IL-2, -4 and -15)-, JAK2/TYK2 (G-CSF)-, and JAK2/2 (GM-CSF)-dependent pathways, which play important roles in hematopoiesis and immune function. These data suggest that FIL (200 mg) may have less impact on a subset of homeostatic immune functions signaling via JAK2 and JAK3 than those observed at the clinically approved doses of TOFA (5 mg and 10 mg), UPA (15 mg), and BARI (4 mg).

References:

[1]McInnes IB, et al. Arthritis Res Ther. 2019;21:183.

[2]Banerjee S, et al. Drugs. 2017;77:521-546.

Disclosure of Interests:

Paqui Gonzalez-Traves Employee of: Gilead, Bernard Murray Employee of: Gilead, Federico Campigotto Employee of: Gilead, Amy Meng Shareholder of: Gilead Sciences, Employee of: Gilead, Julie A. Di Paolo Employee of: Gilead

SAT0149 EXPOSURE-RESPONSE RELATIONSHIPS FOR EFFICACY AND SAFETY OF FILGOTINIB AND ITS METABOLITE GS-829845 IN SUBJECTS WITH RHEUMATOID ARTHRITIS BASED ON PHASE 2 AND PHASE 3 STUDIES

Background:

Filgotinib is an orally administered small molecule that provides selective inhibition of JAK1, a signaling molecule that helps drive inflammatory pathways underlying rheumatoid arthritis (RA).

Objectives:

Exposure-response (ER) analyses were performed for efficacy following completion of Phase 2 studies over a wide range of doses to support evaluation of 200mg and 100 mg once daily in Phase 3 studies. ER analyses were subsequently performed by using Phase 3 efficacy data to support selection of the proposed registrational dose. ER analyses for safety based on pooled Phase 2 and Phase 3 studies were conducted to examine the safety of evaluated doses.

Methods:

Population PK analyses were conducted to estimate plasma exposures of filgotinib and GS-829845 (major circulating active metabolite of filgotinib) in both Phase 2 (DARWIN 1 and DARWIN 2) and Phase 3 studies (FINCH 1, FINCH 2, and FINCH 3) encompassing a dose range of 25 to 100 mg twice daily and 50 to 200 mg once daily. As both filgotinib and GS-829845 contribute to efficacy via JAK1 inhibition, their exposures were combined into single parameters, AUCeff and Ctau-eff (effective area under the curve and effective concentration at trough, by accounting for relative inhibition potency and molecular weight) in the ER analyses for various efficacy endpoints (e.g ACR20/50/70 responses) at Week 12 and Week 24. The ER analyses for safety endpoints (the 5 most frequent treatment-emergent adverse events [TEAEs] and Grade 3 or 4 laboratory abnormalities, serious TEAEs, and serious infections) were performed separately for filgotinib and GS-829845 exposures to characterize the individual safety profile of each analyte. The 5 evaluated TEAEs were nausea, nasopharyngitis, upper respiratory tract infection, headache, and hypertension; the 5 Grade 3/4 laboratory abnormalities included lymphocytes decrease, glucose increase, phosphate decrease, triacylglycerol lipase increase, and creatine kinase increase.

Results:

In the ER analyses for efficacy based on Phase 2 studies, high response rates were demonstrated in ACR20/50/70 across all octile groups in subjects with RA receiving filgotinib and the ER supported further evaluation of both 200 mg and 100 mg once daily doses in Phase 3 clinical studies. Similarly, ER relationships based on pooled Phase 3 studies across various endpoints (e.g ACR20/50/70) consistently revealed high response rates across the exposure range for both the filgotinib 200 mg and 100 mg doses. A trend of increasing response with increasing exposure was observed over the exposure range for multiple secondary efficacy endpoints including ACR50 and ACR70 with the effective exposures at filgotinib 200 mg primarily residing on the plateau of the ER curves.

Filgotinib was generally well-tolerated with no individual TEAE or Grade 3 or 4 laboratory abnormality > 5% in the filgotinib 200 mg once daily group up to Week 12. No relationships were observed between filgotinib and GS-829845 exposures (AUC0-24 and Cmax) and the most frequent TEAEs, Grade 3/4 laboratory abnormalities, serious TEAEs, or serious infections up to Week 52.

Conclusion:

ER analyses demonstrate that both the 200 mg and 100 mg once daily filgotinib doses are efficacious in subjects with moderately to severely active RA without clear dose-dependent effects on safety. The trend towards greater efficacy with higher exposures for some secondary endpoints (ACR50 and ACR70) and a lack of exposure-safety relationship supports a dose of 200 mg once daily over 100 mg once daily since it presents the best benefit/risk ratio among the doses tested.

Disclosure of Interests: :

Amy Meng Shareholder of: Gilead Sciences, Employee of: Gilead, Kacey Anderson Shareholder of: Gilead Sciences, Employee of: Sciences, Cara Nelson Shareholder of: Gilead, Employee of: Gilead, Brian Kirby Shareholder of: Gilead, Employee of: Gilead, Liyun Ni Shareholder of: Gilead, Employee of: Gilead, Shu-Min Chuang Shareholder of: Gilead, Employee of: Gilead, Brian Kearney Shareholder of: Gilead, Employee of: Gilead, Anita Mathias Shareholder of: Gilead, Employee of: Gilead

0837 Well-Being Predicts Sleep Disturbance in a Prospective Cohort of Older Adults

Introduction

Lower well-being negatively impacts health among older adults. Optimal sleep - a determinant of health - has been associated with higher well-being. Several domains of well-being, e.g., mindfulness and purpose in life have been shown to improve sleep. But, whether well-being impacts sleep remains unclear. This study examined associations between well-being and sleep duration, sleep quality, and incident insomnia symptoms among a nationally representative sample of older US adults.

Methods

This study analyzed data from the 2011-2013 National Health and Aging Trends Study (NHATS), a longitudinal, annual survey of community-dwelling Medicare beneficiaries. The exposure, a validated scale of well-being used questions on purpose, emotion, and self-satisfaction and divided responses into quartiles. Sleep outcomes included sleep duration, sleep quality, and insomnia symptoms. Unadjusted and adjusted linear and logistic regression models examined relationships between the health characteristics and well-being score in 2012 and sleep outcomes in 2013. Covariates included demographics and health characteristics.

Results

Half of study participants (n=2,000) were women. The mean sleep duration was 7.2 and 7.3 (standard error(SE) ±0.1) for men and women. Poor sleep quality was reported by 30% of subjects and more frequently among Hispanic subjects, older adults, and those with less education. The mean well-being score was 17.2 (SE ±0.07). Higher well-being scores correlated with male gender, younger age, higher education, marriage, and increased physical activity. Well-being scores in the 2nd - 4th quartile had lower odds of poor sleep quality (4th quartile adjusted odd ratio 0.24 (95% CI 0.15, 0.38). The highest well-being quartile had a 4-fold lower incidence of insomnia symptoms. Well-being scores were not associated with sleep duration

Conclusion

Higher well-being may protect older adults against the development of insomnia and poor sleep quality. Strategies to improve well-being could offer an innovative way to improve the health of older Americans though better sleep.

Support

none

Impact of body posture change on peripherally inserted central catheter tip position in Chinese cancer patients

PURPOSE

To evaluate the influence of body posture change on the peripherally inserted central catheter tip position in Chinese cancer patients.

METHODS

A prospective observational trial was conducted in a tertiary cancer hospital from August to September 2018. After the insertion of peripherally inserted central catheter, chest X-ray films were taken to check the catheter tip in the upright and supine positions, respectively. The distance from the carina to the catheter tip was separately measured on both chest films by nurses. The primary study outcome was the distance and direction of the catheter tip movement. The secondary study outcome was to analyze the influence factors on the catheter tip movement. The third study outcome was to observe the related adverse events caused by the catheter tip movement.

RESULTS

A total of 79 patients were included, the results showed that 61 moved cephalad, 14 moved caudally, and 4 did not move with body change from the supine to the upright position. When moved cephalad, the mean distance was 19.34 ± 11.95 mm; when moved caudally, the mean distance was -15.83 ± 8.97 mm. The difference between the two positions was statistically significant (p < 0.001). There was also a statistically significant difference between catheter tip movement direction and body mass index (p = 0.009) and height (p = 0.015). Two patients developed arrhythmias; no cardiac tamponade was found due to body posture change.

CONCLUSION

The results of this work implied that the tips of the catheter tend to shift toward the cephalad with body change from the supine to the upright position. A study involving a larger sample size is needed to find more information in the future.

Gastric juice piR-1245: A promising prognostic biomarker for gastric cancer

Background

Emerging reports demonstrated that PIWI‐interacting RNAs (piRNAs) played an indispensable role in tumorigenesis. However, it still remains elusive whether piR‐1245 in gastric juice specific in stomach could be employed as a biomarker for gastric cancer (GC). The present work is aiming at exploring the possibility of piR‐1245 in gastric juice as a potential marker to judge for diagnosis and prognosis of gastric cancer.

Methods

Gastric juice was collected from 66 GC patients and 66 healthy individuals. Quantitative real‐time reverse transcriptase polymerase chain reaction (qRT‐PCR) was employed to measure the levels of piR‐1245 expression. Then, the pattern of piR‐1245 expression in gastric juice was determined between GC patients and healthy individuals. A receiver operating characteristic (ROC) curve was constructed for distinguishing GC from healthy individuals.

Results

Gastric juice piR‐1245 levels in GC were higher than those of controls (P < .0001). The value of area under ROC (AUC) was 0.885 (sensitivity, 90.9%; specificity, 74.2%; 95% confidence interval, 0.8286 to 0.9414). High gastric juice piR‐1245 expression was signally correlated with tumor size (P = .013) and TNM stage (P = .001). GC patients with high piR‐1245 expression in gastric juice exerted a poorer overall survival (OS) (P = .0152) and progression‐free survival (PFS) (P = .013). COX regression analysis verified that gastric juice piR‐1245 expression was an independent prognostic risk variable for OS (P < .05).

Conclusions

The current study suggested that piR‐1245 in gastric juice had the potential to be a useful biomarker for GC detection and prognosis prediction.

Effectiveness of pulmonary rehabilitation in elderly patients with COPD: A systematic review and meta-analysis of randomized controlled trials

AIM

The review aimed to evaluate the effects of pulmonary rehabilitation in elderly patients with chronic obstructive pulmonary disease (COPD).

BACKGROUND

With an increase in published reports on pulmonary rehabilitation, there is a need for a meta-analysis to measure the effects of pulmonary rehabilitation in elderly COPD patients.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

The Cochrane library (Issue 4, 2018), Web of Science (1975 to April 2018), Embase (1974 to April 2018), Pubmed (1966 to April 2018), CINAHL (1982 to April 2018), JBI (The Joanna Briggs Institute) (1996 to April 2018), CNKI (China National Knowledge Infrastructure) (1979 to April 2018), CBM (SinoMed) (1982 to April 2018), and Wanfang Data (1900 to April 2018) were searched.

REVIEW METHODS

Six outcome indicators were utilized for the effects of pulmonary rehabilitation. Two reviewers selected trials, evaluated the quality, and extracted data. Meta-analysis was performed by using the RevMan 5.3 software.

RESULTS

Eight studies recruited 414 elderly patients. Pulmonary rehabilitation resulted in significantly improved exercise capacity and quality of life in elderly people but with no influence on oxygen saturation compared with the control group.

CONCLUSION

There is a need to provide more detailed pulmonary rehabilitation programs for elderly patients with COPD.

Superior success rate of intracavitary electrocardiogram guidance for peripherally inserted central catheter placement in patients with cancer: A randomized open-label controlled multicenter study

Background

Intracavitary electrocardiogram (IC ECG) guidance emerges as a new technique for peripherally inserted central catheters (PICCs) placement and demonstrates many potential advantages in recent observational studies.

Aims

To determine whether IC ECG-guided PICCs provide more accurate positioning of catheter tips compared to conventional anatomical landmarks in patients with cancer undergoing chemotherapy.

Methods

In this multicenter, open-label, randomized controlled study (ClinicalTrials.gov number, NCT02409589), a total of 1,007 adult patients were assigned to receive either IC ECG guidance (n = 500) or anatomical landmark guidance (n = 507) for PICC positioning. The confirmative catheter tip positioning x-ray data were centrally interpreted by independent radiologists. All reported analyses in the overall population were performed on an intention-to-treat basis. Analyses of pre-specified subgroups and a selected large subpopulation were conducted to explore consistency and accuracy.

Results

In the IC ECG-guided group, the first-attempt success rate was 89.2% (95% confidence interval [CI], 86.5% to 91.9%), which was significantly higher than 77.4% (95% CI, 73.7% to 81.0%) in the anatomical landmark group (P < 0.0001). This trend of superiority of IC ECG guidance was consistently noted in almost all prespecified patient subgroups and two selected large subpopulations, even when using optimal target rates for measurement. In contrast, the superiority nearly disappeared when PICCs were used via the left instead of right arms (interaction P-value = 0.021). No catheter-related adverse events were reported during the PICC intra-procedures in either group.

Conclusions

Our findings indicated that the IC ECG-guided method had a more favorable positioning accuracy versus traditional anatomical landmarks for PICC placement in adult patients with cancer undergoing chemotherapy. Furthermore, there were no significant safety concerns reported for catheterization using the two techniques.

Proliferating cell nuclear antigen (PCNA) as a proliferative marker during embryonic and adult zebrafish hematopoiesis

We investigated the expression of proliferative cell nuclear antigen (PCNA) in zebrafish to delineate the proliferative hematopoietic component during adult and embryonic hematopoiesis. Immunostaining for PCNA and enhanced green fluorescence protein (eGFP) was performed in wild-type and fli1-eGFP (endothelial marker) and gata1-eGFP (erythroid cell marker) transgenic fish. Expression of PCNA mRNA was examined in wild-type and chordin morphant embryos. In adult zebrafish kidney, the renal tubules are surrounded by endothelial cells and it is separated into hematopoietic and excretory compartments. PCNA was expressed in hematopoietic progenitor cells but not in mature neutrophils, eosinophils or erythroid cells. Some PCNA+ cells are scattered in the hematopoietic compartment of the kidney while others are closely associated with renal tubular cells. PCNA was also expressed in spermatogonial stem cells and intestine crypts, consistent with its role in cell proliferation and DNA synthesis. In embryos, PCNA is expressed in the brain, spinal cord and intermediate cell mass (ICM) at 24 h-post fertilization. In chordin morphants, PCNA is significantly upregulated in the expanded ICM. Therefore, PCNA can be used to mark cell proliferation in zebrafish hematopoietic tissues and to identify a population of progenitor cells whose significance would have to be further investigated.

Cellular origin of ionizing radiation-induced NF-kappaB activation in vivo and role of NF-kappaB in ionizing radiation-induced lymphocyte apoptosis

PURPOSE

To investigate the cellular origin of ionizing radiation (IR)-induced NF-kappaB activation in vivo and the role of NF-kappaB in IR-induced lymphocyte apoptosis.

MATERIALS AND METHODS

NF-kappaB activities were analysed by gel shift/supershift assay in isolated murine T- and B-cells, macrophages (MPhi) and tissues from normal and T- and B-cell-deficient Rag1 mice with or without exposure to IR. IR-induced lymphocyte apoptosis was determined by analysis of 3,3'-dihexyloxacarbocyanine iodide (DiOC(6)) uptake, annexin-V staining and the sub-G0/1 population, or by TUNEL assay.

RESULTS

The results showed that IR activated NF-kappaB in lymphocytes, including both T- and B-cells, but failed to do so in MPhi. Furthermore, T- and B-cell-deficient Rag1 mice exposed to IR exhibited a significant reduction in NF-kappaB activation as compared with normal mice. Although NF-kappaB1 (p50) gene knockout or NF-kappaB decoy oligonucleotide treatment specifically inhibited IR-induced lymphocyte NF-kappaB activation, they had no significant effect on IR-induced lymphocyte apoptosis.

CONCLUSIONS

This finding suggests that lymphocytes are the main cellular origin of IR-induced NF-kappaB activation in vivo. However, NF-kappaB activation has no significant effect on IR-induced lymphocyte apoptosis.

Cell death in irradiated prostate epithelial cells: role of apoptotic and clonogenic cell kill

Dose-escalated conformal radiotherapy is increasingly being used to radically treat prostate cancer with encouraging results and minimal long-term toxicity, yet little is known regarding the response of normal or malignant prostate cells to ionizing radiation (IR). To clarify the basis for cell killing during prostate cancer radiotherapy, we determined the IR-induced expression of several apoptotic- (bax, bcl-2, survivin and PARP) and G1-cell cycle checkpoint- (p53 and p21(WAF1/Cip1)) related proteins, in both normal (PrEC-epithelial and PrSC-stromal) and malignant (LNCaP, DU-145 and PC-3; all epithelial) prostate cells. For these experiments, we chose doses ranging from 2 to 10 Gy, to be representative of the 1.8-2 Gy daily clinical fractions given during curative radiotherapy and the 8-10 Gy single doses given in palliative radiotherapy. We observed that IR-induced bax and p21(WAF1/Cip1) protein expression were attenuated selectively in normal stromal and epithelial cell cultures, yet maintained their p53-dependency in malignant cell lines. For each cell culture, we also determined total apoptotic and overall radiation cell kill using a short-term nuclear morphologic assay and a long-term clonogenic survival assay, respectively. Clonogenic survival, as measured by the surviving fraction at 2 Gy (SF2), ranged from 0.05 (PrEC) to 0.55 (DU-145), suggesting that malignant prostate cells are more radioresistant than normal prostate cells, for this series. IR-induced apoptotic cell kill was minimal (less than 6% cell after a dose of 10 Gy at times of 24-96 h) and was not dose-dependent. Furthermore, apoptotic kill was not correlated with either molecular apoptotic response or clonogenic cell kill. Using a flow cytometric proliferation assay with the PrSC (stromal) and DU-145 (epithelial) representative cultures, we observed that a senescent-like phenotype (SLP) emerges within a sub-population of cells post-irradiation that is non-clonogenic. Terminal growth arrest was dose-responsive at 96 h following irradiation and associated with long-term expression of both p21(WAF1/Cip1) and p16(INK4a) genes. Future strategies for prostate radiotherapy prediction or novel treatments should additionally focus on terminal growth arrest as an important endpoint in prostate cancer therapy.

The zygotic expression of zebrafish trebf during embryogenesis is restricted to the embryonic shield and its derivatives

We have identified a zebrafish gene trebf that shows an overall similarity of 51.5% and 55.1% in amino acid sequence with human and mouse TREB5/hXBP-1/HTF, respectively. Northern hybridization reveals that trebf mRNA is expressed throughout the life cycle of zebrafish. Whole-mount in situ hybridization detects an expression pattern of trebf in zebrafish that is very different from that of mammalian TREB5. Just before the onset of gastrulation, trebf transcripts are accumulated in the dorsal blastoderm margin and subsequently in the forming organizer. During gastrulation, the trebf-positive cells in the organizer migrate toward the animal pole and form two distinct domains. The cells in the anterior leading expression domain ultimately differentiate into hatching gland, whereas those in the following domain form the notochord.

The nuclear localization signal of zebrafish terra is located within the DM domain

Zebrafish Terra is a member of the DM domain-containing transcription factor family and is involved in somitogenesis. The other known members of this family play a role in sex differentiation across species from Caenorhabditis elegans to human. Using the green fluorescence protein-Terra fusion constructs, we have identified the nuclear localization signal (NLS) of terra by transfecting human HeLa cells. The terra NLS is located between the two intertwined zinc-binding sites of the DNA-binding domain. However, the nuclear translocation of terra is independent of the structure required for DNA binding. Mutational analysis demonstrates that basic residues K77 and R78 within the DM domain are absolutely required for the translocation of Terra into the nuclei. Sequence comparison discloses that the NLS of Terra is also present in the other known members of the DM family, indicating the conservative nature of the NLS of this family during evolution.

DNA methyltransferases of the cyanobacterium Anabaena PCC 7120

From the characterization of enzyme activities and the analysis of genomic sequences, the complement of DNA methyltransferases (MTases) possessed by the cyanobacterium ANABAENA PCC 7120 has been deduced. ANABAENA has nine DNA MTases. Four are associated with Type II restriction enzymes (AVAI, AVAII, AVAIII and the newly recognized inactive AVAIV), and five are not. Of the latter, four may be classified as solitary MTases, those whose function lies outside of a restriction/modification system. The group is defined here based on biochemical and genetic characteristics. The four solitary MTases, DmtA/M.AVAVI, DmtB/M.AVAVII, DmtC/M. AVAVIII and DmtD/M.AVAIX, methylate at GATC, GGCC, CGATCG and rCCGGy, respectively. DmtB methylates cytosines at the N4 position, but its sequence is more similar to N6-adenine MTases than to cytosine-specific enzymes, indicating that it may have evolved from the former. The solitary MTases, appear to be of ancient origin within cyanobacteria, while the restriction MTases appear to have arrived by recent horizontal transfer as did five now inactive Type I restriction systems. One Mtase, M.AVAV, cannot reliably be classified as either a solitary or restriction MTase. It is structurally unusual and along with a few proteins of prokaryotic and eukaryotic origin defines a structural class of MTases distinct from all previously described.

[Principles of traditional Chinese medicine]

The beginnings of traditional Chinese medicine (TCM) can be related to the three most important philosophic and religious personalities. Modern Western medicine (MM), which was already sensationally successful at that time, was brought to China by business men, missionaries and soldiers. Compared to MM, the theories of TCM seem abstract, its concept unusual. Historical hallmarks of TCM influenced by culture are the following: the medical system is philosophical, oriented towards humanism. TCM is a medical system without strict structural relationships (without anatomy).

[Acupuncture in neurology]

Acupuncture is a reflex therapy with the aim of rearranging an imbalance of the organism. Acupuncture is a regulatory therapy. At first, there have to be diagnosis and indication according to the rules of western modern medicine. With that, we carry on with a standard program and standard exciting needle technique. We will report about acupuncture in neurology in three chapters: neuro-orthopedics, neuropsychiatry and somatopsychic diseases.

Double-stranded RNA injection produces nonspecific defects in zebrafish

We have investigated the ability of dsRNA to inhibit gene functions in zebrafish using sequences targeted to the maternal gene pouII-1, the transgene GFP, and an intron of the zebrafish gene terra. We found that embryos injected with all of these dsRNAs at approximately 7.5 pg/embryo or higher had general growth arrest during gastrulation and displayed various nonspecific defects at 24 h postfertilization, although embryonic development was unaffected before the midblastula stage. Reducing dsRNA concentration could alleviate the global defects. Injection of GFP dsRNA (7.5-30 pg/embryo) did not inhibit GFP expression in transgenic fish, although abnormal embryos were induced. Co-injection of GFP mRNA with either GFP or non-GFP dsRNA caused reduction of GFP expression. Whole-mount in situ hybridization clearly showed that embryos injected with dsRNA degraded co-injected and endogenous mRNA without sequence specificity, indicating that dsRNA has a nonspecific effect at the posttranscriptional level. It appears that RNAi is not a viable technique for studying gene function in zebrafish embryos.

[Cytocompatible evaluation for skin reproducing membrane of medical fibroin]

This study was intended to evaluate the cytocompatibility of skin reproducing membrane of medical fibroin. Cell growth rate test and hemolysis test were conducted to investigate the cytotoxicity and hemolysis reaction for skin reproducing membrane. The results showed there was no obvious cytotoxicity for this kind of membrance. The hemolysis rate was 1.15%. In conclusion, skin reproducing membrane is a material of good cytocompatibility.

Activation of peroxisome proliferator-activated receptor-gamma pathway inhibits osteoclast differentiation

The nuclear receptor and transcription factor, peroxisome proliferator-activated receptor-gamma (PPAR-gamma), regulates the activity of other transcription factors in the adipogenic differentiation and inflammatory response pathways. We examined the possible function of the PPAR-gamma pathway in osteoclast (Ocl) formation from CD34(+) hematopoietic stem cells (CD34(+) HSCs), using a co-culture system comprised of human mesenchymal stem cells (hMSCs) and CD34(+) HSCs, both derived from bone marrow. Ocl formation in this co-culture system is enhanced by the addition of exogenous osteoprotegerin ligand (OPGL), an essential Ocl differentiation factor, and macrophage-colony stimulating factor (M-CSF). The data indicate that soluble OPGL (sOPGL) and M-CSF stimulate Ocl formation in the co-cultures up to 4-fold compared with CD34(+) HSCs alone treated with sOPGL and M-CSF. CD34(+) HSCs, but not hMSCs, express PPAR-gamma, and 15-deoxy-Delta(12, 14)-prostaglandin-J2 (15d-PG-J2), a PPAR-gamma agonist, completely blocked the effects of sOPGL and M-CSF on Ocl formation and activity. The inhibitory effect of 15d-PG-J2 is specific to the Ocl lineage in both human and mouse models of osteoclastogenesis. Accordingly, parallel experiments demonstrate that sOPGL activates the NF-kappaB pathway within mouse Ocl progenitors, and this effect was abolished by 15d-PG-J2. These data establish a link between PPAR-gamma and OPGL signaling within Ocl progenitors, and support a role for PPAR-gamma pathway in the modulation of osteoclastogenesis.

A school-based asthma clinic: a partnership model for managing childhood asthma

Childhood asthma is a major public health problem. It is the leading cause of childhood hospitalizations and school absences despite recent advances in management. Current standards of care call for client education as partners in disease management. In pediatrics, this calls for shared decision making between health care provider, parent, and child. Traditional care delivery systems often fall short of meeting this standard. This article describes a nurse practitioner-run school-based asthma clinic, designed as a pilot study, to fill these gaps. Characteristics of the community that affected outcomes are described.

[Study on correlation between in vivo and in vitro tests of biomaterials--correlation between leukocyte chemotaxis test and muscular implant test in rabbits]

The purpose of this study was to investigate the correlation between the results of in vivo and in vitro tests of biomaterials. With muscular implant test and leukocyte chemotaxis test, the levels of tissue toxicity of seven biomaterials were evaluated. The samples with high-level toxicity showed weak leukocyte chemotaxis, which would influence the anti-inflammatory reaction to foreign bodies. By the method of Spearman rank correlation, the coefficient was between 0.89286-0.98198 indicating that the correlation of the two tests is excellent.

Human mesenchymal stem cells promote human osteoclast differentiation from CD34+ bone marrow hematopoietic progenitors

Interactions between osteoclast progenitors and stromal cells derived from mesenchymal stem cells (MSCs) within the bone marrow are important for osteoclast differentiation. In vitro models of osteoclastogenesis are well established in animal species; however, such assays do not necessarily reflect human osteoclastogenesis. We sought to establish a reproducible coculture model of human osteoclastogenesis using highly purified human marrow-derived MSCs (hMSCs) and CD34+ hematopoietic stem cells (HSCs). After 3 weeks, coculture of hMSCs and HSCs resulted in an increase in hematopoietic cell number with formation of multinucleated osteoclast-like cells (Ocls). Coculture of hMSCs with HSCs, transduced with a retroviral vector that expresses enhanced green fluorescent protein, produced enhanced green fluorescent protein+ Ocls, further demonstrating that Ocls arise from HSCs. These Ocls express calcitonin and vitronectin receptors and tartrate-resistant acid phosphatase and possess the ability to resorb bone. Ocl formation in this assay is cell contact dependent and is independent of added exogenous factors. Conditioned medium from the coculture contained high levels of interleukin (IL)-6, IL-11, leukemia inhibitory factor (LIF), and macrophage-colony stimulating factor. IL-6 and LIF were present at low levels in cultures of hMSCs but undetectable in cultures of HSCs alone. These data suggest that coculture with HSCs induce hMSCs to secrete cytokines involved in Ocl formation. Addition of neutralizing anti-IL-6, IL-11, LIF, or macrophage-colony stimulating factor antibodies to the coculture inhibited Ocl formation. hMSCs seem to support Ocl formation as undifferentiated progenitor cells, because treatment of hMSCs with dexamethasone, ascorbic acid, and beta-glycerophosphate (to induce osteogenic differentiation) actually inhibited osteoclastogenesis in this coculture model. In conclusion, we have developed a simple and reproducible assay using culture-expanded hMSCs and purified HSCs with which to study the mechanisms of human osteoclastogenesis.

A Drosophila doublesex-related gene, terra, is involved in somitogenesis in vertebrates

The Drosophila doublesex (dsx) gene encodes a transcription factor that mediates sex determination. We describe the characterization of a novel zebrafish zinc-finger gene, terra, which contains a DNA binding domain similar to that of the Drosophila dsx gene. However, unlike dsx, terra is transiently expressed in the presomitic mesoderm and newly formed somites. Expression of terra in presomitic mesoderm is restricted to cells that lack expression of MyoD. In vivo, terra expression is reduced by hedgehog but enhanced by BMP signals. Overexpression of terra induces rapid apoptosis both in vitro and in vivo, suggesting that a tight regulation of terra expression is required during embryogenesis. Terra has both human and mouse homologs and is specifically expressed in mouse somites. Taken together, our findings suggest that terra is a highly conserved protein that plays specific roles in early somitogenesis of vertebrates.

[A comparative study on cytocompatibility of medical PVA and intelligent PVA-g-NIPAAm hydrogels]

"Intelligent" Polymers which resonse with large property changes to small physical or chemical stimuli are attracting more and more attention in the field of medical science. One trend in the area is to modify some conventional medical polymers to form intelligent biomaterials. This investigation was designed to evaluate and compare in vitro cytocompatibility of PVA hydrogel, which could be used as a kind of solid support with good biomcompatibility, and PVA-g-NIPAAm, which was produced by irradiation grafting of NIPAAm onto the said PVA hydrogel support. Cytotoxicity test was carried out with a modified Cell Relative Growth Rate test (RGR test). On the day 2, day 4 and day 7, the RGRs of the PVA hydrogel were 82%, 90% and 102% respectively while the RGRs of the PVA-g-NIPAAm were 77%, 86% and 100%. The grades of the cytotoxicity of the PVA and PVA-g-NIPAAm hydrogels were 0, so they had no cytotoxicity as judged by our tests. After 24 hours, cells in direct contact with the two kinds of samples were observed morphologically through the Olympus inverted microscope and had a normal development. The conclusion suggests that irradiation grafting is a good way to modify conventional medical polymers to produce intelligent biomaterials.

[Evaluation on cytotoxicity of gallium alloy]

Cytotoxicity is an important indicator to the biocompatibility of biomaterials. In this study, the cytotoxicity of Gallium alloy was evaluated by the method of cell relative growth rate in vitrousing L-929 mouse fibroblast. The cell relative growth rate of Gallium alloy was the absorbency ratio between the solution of Gallium alloy and negative control. The relative growth rates of Gallium aloy were converted into the scores of cytotoxicity. It was found from the results that Gallium alloy had no cytotoxicity.

[Acupuncture therapy with TENS in chronic pain at the Neurologic Pain-Acupuncture Ambulatory Care Clinic of the Vienna Lainz Hospital]

TENS therapy represents a good completion of chronic pain treatment, prolonging the effects of acupuncture and helping to overcome therapy resistance. Application for patients who are under Warfarin treatment and anxious of needles is obvious. Under the careful control of physicians TENS therapy is harmless. This report should be stimulating and enlarge knowledge of physicians specialized on pain treatment.