Knowledge, attitude and practice of registered nurses toward ICU patients' transfer anxiety in China: A cross-sectional study

Introduction

Transfer anxiety has effect many critically ill patients in ICU around the world. Nurses must take care of the psychological adjustments that patients and families face when ICU patients transferred to general ward. During this period, basic knowledge, positive attitude, and correct practice are necessary for nurses to address the issue of transfer anxiety and seek to reduce it whenever possible. However, there were few investigations have been performed the knowledge, attitudes, and practice of registered nurses toward ICU patients' transfer anxiety.

Aim

The purpose of the paper is to explore the level and influencing factors of knowledge, attitude and practice of registered nurses toward ICU patients' transfer anxiety in China.

Methods

From February 1 to March 17, 2023, a cross-sectional study was adopted in China. An electronic questionnaire was used to collect data. Registered nurses' knowledge, attitudes and practice toward ICU patients' transfer anxiety were assessed using The Knowledge, Attitude and Practice Questionnaire for Chinese Registered nurses in ICU regarding the prevention of transfer anxiety. In the end, in this study involved 381 registered nurses from Lanzhou University Second Hospitals in China. SPSS 26.0 for mac, independent T-test, one-way ANOVA test, Scheffe's test, Pearson correlation coefficient and multiple linear regression tests were used for data analysis.

Results

The scores of total KAP, knowledge, attitude, and practice are 135.21 ± 24.504, 45.58 ± 13.903, 56.94 ± 10.690 and 32.87 ± 6.393 separately. Study results show that there was a statistically significant correlation among the three variables. According to the results of independent t-test or one-way ANOVA test, there is a correlation between gender(P = 0.001), highest educational attainment (P = 0.005) and knowledge; type of department(P = 0.003) and attitude; gender (P = 0.003), marital status (P = 0.002), clinical work experience (P = 0.002), type of department (P = 0.005) and practice. According to the results of linear regression analysis in this study, the variables of gender (P = 0.006), highest educational attainment (P = 0.032), scores of attitudes (P = 0.006), and scores of practice (P = 0.000) were associated with the scores of knowledge; the variables of scores of knowledge (P = 0.004), and scores of practice (P = 0.000) were associated with the scores of attitudes; the variables of scores of knowledge (P = 0.000), and scores of attitudes (P = 0.000) were associated with the scores of practice.

Conclusion

The findings of the study emphasize that comprehensive measures of knowledge, attitude and practice should be taken to improve nurses' knowledge, attitudes, and practices regarding transfer anxiety in intensive care unit patients in order to reduce its adverse effects on ICU patients.

The level of life space mobility among community-dwelling elderly: A systematic review and meta-analysis

BACKGROUND

Multiple countries have conducted surveys on the level of life space mobility for community-dwelling elderly through the Life-Space Assessment, the results vary greatly, from 41.7 to 88.6. However, there is no meta-analysis on the current situation of community-dwelling elderly life space mobility.

OBJECTIVE

To systematically assess the global level of life space mobility for community-dwelling elderly, to identify potential covariates such as geographical regions, survey years, gender, and age that contribute to the heterogeneity between the studies, and to identify the dynamic trend based on survey years.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Two reviewers searched the following 8 electronic bibliographic databases from inception until May 28, 2023: PubMed, The Cochrane Library, Web of Science, Embase, Chinese Biomedical Database, China Knowledge Resource Integrated Database, WanFang, and Weipu Database.

REVIEW METHODS

This review was conducted using the Stata 14.1 and R 4.3.1. The Cochrane's Q statistical and I2 index were used to test for heterogenicity and assess the degree of heterogenicity, respectively. Studies were appraised using the Agency for Healthcare Research and Quality tool, the Newcastle-Ottawa Scale for the quality of cross-sectional studies, cohort studies, respectively.

RESULTS

A total of 29 studies were selected from databases and reference lists. The pooled score of Life-Space Assessment was 66.84 (95% CI: 63.30-70.39) and the prevalence of restricted life space was 42% (95% CI: 0.27-0.57). The geographical regions, survey years, gender were found to be a significant covariate of the pooled score of life space mobility estimate in the subgroup analysis. The mean score of Life-Space Assessment gradually achieved stability after 2017.

CONCLUSIONS

The life space mobility of community-dwelling elderly in the global is at a moderate level, with 42% of them experiencing restricted life space. South America, females and earlier survey years have a lower level of life space mobility. In the future, the government should identify vulnerable groups for targeted intervention to promote the level of LSM in the community-dwelling elderly.

REGISTRATION

PROSPERO [CRD42023443054].

Whole-course care in photodynamic therapy of colorectal cancer: A short communication

Photodynamic therapy is now widely used in different oncologic fields. It is feasible for the treatment of early, non-surgical and non-obstructive cancers. Also, in gastroenterology, where it was a few attempts to treat both the premalignant lesion and advanced colorectal cancer. Photodynamic therapy provides a new treatment option for advanced colon cancer patients with severe obstruction and elderly patients whose cardiopulmonary function cannot tolerate surgery, and effective nursing support throughout the treatment is the key to ensure successful treatment. This study reported the effect of whole-course care for colorectal cancer patients undergoing photodynamic therapy in the Department of Surgical Oncology, Lanzhou University Second Hospital, Lanzhou, China.

Camrelizumab with Chemoradiotherapy for Locally Advanced Biliary Tract Cancer: Preliminary Results from A Phase II Study

PURPOSE/OBJECTIVE(S)

For locally advanced biliary tract cancer (BTC), capecitabine-based chemoradiotherapy (CRT) is commonly used but has limited benefits. Immunotherapy is potentially effective for BTC and may be synergized with CRT. Followed by gemcitabine and cisplatin (GP) consolidation chemotherapy (CT), we evaluated the safety and efficacy of combined camrelizumab and capecitabine-based CRT for locally advanced BTC.

MATERIALS/METHODS

Patients had stage II-III (T4N0M0, T1-4N+M0) BTC (per the 7th [2010] edition of the American Joint Committee on Cancer staging system) were eligible for CRT (capecitabine plus [50-60 Gy] radiotherapy), to be followed by GP CT. Camrelizumab was given concurrently with CRT. Safety was defined as the incidence and severity of adverse events (AEs), while efficacy was defined as overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and disease control rate (DCR).

RESULTS

Ten patients completed the planned treatment. None experienced grade ≥3 treatment-related AEs during CRT. Grade ≥3 immune-related AEs occurred in 2 of 10 patients (20%) only during GP CT. The mean OS time was 18.2 months (95% confidence interval [CI] 12.9m-23.5m) while the median OS time was 14.1 months (95% CI 10.1m-18.1m). OS rates were 100%, 59%, 44% at 6 months, 1 year and 2 years, respectively. The ORR was 30% while the DCR was 90%. Two patients (20%) obtained OS over 2 years with partial response (25.9m, 29.1m). Median PFS time was 14.1 months (95% CI 9.3m-18.9m).

CONCLUSION

Camrelizumab in combination with concurrent CRT was well tolerated and did not impair delivery of CRT in patients with locally advanced BTC.

[Persistence follow-up of immune memory to hepatitis B vaccine among infants with non- and low-response to primary vaccination after revaccination with three doses]

This study followed up the immune memory after 3-dose revaccination among infants with non-and low-response following primary hepatitis B (HepB) vaccination. About 120 children without self-booster doses were finally included who had anti-HBs<10 mIU/ml (anti-HBs negative) at the time of follow-up, of whom 86 children completed blood sampling and anti-HBs testing. Before the challenge dose, all 86 children were negative for anti-HBs, and the GMC of anti-HBs was<10 mIU/ml. The seropositive conversion rate of anti-HBs was 100% and the GMC of anti-HBs was 886.11 (95%CI: 678.15-1 157.84) mIU/ml after the challenge dose. Compared with those with GMC<7 mIU/ml before the challenge dose, infants with GMC>7 mIU/ml had a higher anti-HBs level after the challenge dose. The β value (95%CI) was 0.82 (0.18-1.46) (P=0.012). Compared with those with GMC<1 000 mIU/ml at primary vaccination, infants with GMC≥1 000 mIU/ml had a higher anti-HBs level after the challenge dose. The β value (95%CI) was 0.78 (0.18-1.38)(P=0.012). The results showed a stronger immune memory was found at 9 years after revaccination among infants with non-and low-response to HepB.

Prevalence and associated factors of alexithymia in intensive care unit nurses

AIMS

The aim of this study was to investigate the incidence of alexithymia in intensive care unit nurses and determine the associated factors.

DESIGN

A multi-center, cross-sectional study.

METHODS

In total, 485 nurses in intensive care unit were recruited from 53 hospitals in China. Data collection tools used in the study included demographic characteristics, the Social Support Rating Scale (SSRS), Emotional Intelligence Scale (EIS), and the 20-item Toronto Alexithymia Scale (TAS-20). SPSS 25.0 software (Corp., Armonk, NY, USA) was used to preform data analysis.

RESULTS

About 43.7% of intensive care unit nurses were classified as alexithymia in the whole sample (males: 50%, females: 43%). The median TAS-20 score was 60 (interquartile range = 9). The study found that alexithymia was significantly associated with marital status, whether living alone, working years, and social support (Adjusted R Squared = 0.194, F = 6.466, p < 0.01), while emotional intelligence was not statistically significant with alexithymia.

CONCLUSIONS

Alexithymia is a psychological problem with high incidence in intensive care unit nurses. In this study, being unmarried or divorced, living alone, and having fewer years of work (≤5 years) were associated with a higher risk of alexithymia. Interventions that strengthen social support may also help improve the mental health of ICU nurses.

Alexithymia in a Chinese Patient with Chronic Pain and Associated Factors: A Cross-Sectional Study

BACKGROUND

Alexithymia is more prevalent among those with patients living with chronic pain. Information on the prevalence of alexithymia in Chinese patients with chronic pain and associated factors is limited.

AIM

The primary objective of this study was to determine the prevalence of alexithymia, as defined by a score of 61 or greater in the 20-item Toronto Alexithymia Scale (TAS-20), in a Chinese patient with chronic pain. The secondary objective was to investigate the relationship between alexithymia and the clinical and psychological aspects of chronic pain.

METHODS

A cross-sectional observational study used the TAS-20 to assess alexithymia of Chinese patients with chronic pain. Sociodemographic and clinical information were obtained and participants filled in the Fear Avoidance Beliefs Questionnaire, Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, and General Self-efficacy Scale.

RESULTS

Of the 346 patients screened, 321 patients living with chronic pain were enrolled into the study. The prevalence of alexithymia among the study population (TAS-20 score ≥61) was 19.6% (95% confidence interval [CI]: 15.3-24.0). The findings showed anxiety (odds ratio [OR] = 2.474; 95% CI, 1.241-4.935), pain catastrophizing (2.649; 1.014-6.921), and self-efficacy (0.952; 0.908-0.988) as independent predictors of alexithymia in patients living with chronic pain.

CONCLUSIONS

Patients with chronic pain exhibiting alexithymia were at higher risk of pain catastrophizing, anxiety, and lower self-efficacy, compared with patients without alexithymia. It is important to identify and pay a special attention in clinical practice to patients with chronic pain exhibiting alexithymia, as these individuals are unable to properly express their emotions.

Characteristics and risk factors of nasal mucosal pressure injury in intensive care units

AIMS AND OBJECTIVES

This study aimed to understand the risk factors that contribute to medical device-related (MDR) nasal mucosal membrane pressure injuries (MM PI) in ICU patients.

BACKGROUND

ICU patients require substantial tube-based life support such as oxygen tubes, tracheal intubation and indwelling gastric tubes. As a result, there is an increased risk of PI occurrence; however, few studies have assessed the risk factors associated with nasal mucosal MDR-MMPI in ICU patients.

DESIGN

A cross-sectional study design was performed.

METHODS

From January 2019 to June 2020, data from 912 patients treated in the ICU of a tertiary first-class a hospital in China were collected. The occurrence of PI of the nasal mucosa was obtained by nasopharyngoscope when replacing the nasal catheter fixation patch every day. The study methods were followed by the STROBE guidelines.

RESULTS

The incidence of nasal mucosal MDR-MM PI was 10.9%. The degree of nasal mucosal MM PI was mainly grade 1 (62cases, 62.6%), and no grade 4 were observed. The columella (58 cases, 58.6%) was the most common site of nasal mucosal MM PI followed by the anterior septum (18 cases, 18.2%). A high patient APACHE-Ⅱ score, the disturbance of consciousness, a history of diabetes, days of gastric tube indwelling, hypoproteinemia, fever (T > 37.5℃) and the use of vasoconstrictors were identified as significant influencing factors of nasal MM PI in ICU patients (p < .05).

CONCLUSIONS

A high APACHE-Ⅱ score, disturbance of consciousness, history of diabetes, days of gastric tube indwelling, hypoproteinemia, fever (T > 37.5℃) and use of vasoconstrictive drugs were risk factors for nasal mucosal MDR-MM PI in ICU patients. This study informs on the risk factors of nasal mucosal MM PI that will allow medical support staff to carry out key interventional measures to prevent nasal mucosal MM PI.

RELEVANCE TO CLINICAL PRACTICE

This study illustrates the characteristics and risk factors of nasal mucosal pressure injury in intensive care units, potentially contributing to the prevention of the incidence of nasal mucosal MDR-PI in ICU patients.

Treatment of Severe Congenital Scoliosis with Type ІI Respiratory Failure

We report a case of a 14-year girl with severe congenital scoliosis (CS) and type ІІ respiratory failure (RF), who underwent preoperative halo-gravity traction in combination with intraoperative orthopaedic surgery on the spine based on the results of physical examination, pulmonary function tests (PFTs), computed tomography (CT), and blood gas analysis. The patient's coronal and sagittal Cobb's angles changed from 100° to 45° and 40°, respectively, and RF changed from type ІІ to type І after treatment. Scoliosis was corrected well, and RF was improved. During follow-up for nearly 3 years, no loss of deformity correction and no serious complications occurred, and the patient showed a good clinical outcome and balanced spine. Key Words: Congenital scoliosis, Halo-gravity traction, Respiratory failure.

Prevalence and risk factors of ischemic stroke-related headache in China: a systematic review and meta-analysis

Background

Headache accompanying ischemic stroke is considered an independent predictor of neurological deterioration. This meta-analysis aims to estimate the prevalence of ischemic stroke-related headaches and identify its risk factors in China.

Methods

PubMed, Embase, Cochrane Library database, Web of Science, PsycINFO, and four Chinese databases for the related publications were searched. Two researchers independently selected the literature, extracted the relevant data, and assessed its methodological quality. The meta-analysis applied a random-effects model with R software to calculate the pooled prevalence of ischemic stroke-related headaches in Chinese patients, and to merge the odds ratio (OR) of risk factors. Subgroup analysis, sensitivity analysis, and meta-regression analysis were conducted. Publication bias was assessed by a funnel plot and Egger test.

Results

Ninety-eight studies were eligible for inclusion. The overall pooled prevalence of ischemic stroke-related headache was 18.9%. Subgroup analysis showed that the prevalence of ischemic stroke related-headaches was higher among studies using self-report to diagnosis headache (18.9%; 95%CI, 8.9% to 40.2%), and those focused on age ≥ 55 years (19.7%; 95%CI, 14.9% to 25.9%), rural settings (24.9%; 95%CI, 19.7% to 31.6%). There were no significant differences in the headache prevalence between studies in the south and north, and inland and coastal studies. The prevalence of pre onset headache (13.9%) and tension-type headache (15.5%) and was higher compared with other types. History of headache (OR = 3.24; 95%CI, 2.26 to 4.65.), female gender (OR = 2.06; 95%CI, 1.44 to 2.96.), midbrain lesions (OR = 3.56; 95%CI, 1.86 to 6.83.), and posterior circulation stroke (OR = 2.13; 95%CI, 1.14 to 4.32) were major risk factors.

Conclusion

The prevalence of ischemic stroke-associated headache is high in China. In addition, women, presence of midbrain lesions, posterior circulation stroke and a history of migraine were high-risk factors for ischemic stroke-related headaches. Designing effective interventions to prevent or alleviated headaches is necessary to promote patients’ neurological recovery and quality of life.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13917-z.

Risk factors for fear of falling in stroke patients: a systematic review and meta-analysis

OBJECTIVE

Even though 32%-83% for fear of falling (FoF) in patients with stroke, very little is known about the predictors of the problems. Therefore, we systematically reviewed the literature on risk factors for FoF in patients with stroke.

DESIGN

A systematic review and meta-analysis DATA SOURCES: PubMed, Embase, Cochrane Library database, Web of Science, CINAHL, PsycINFO, Grey literature and other relevant databases for related publications were searched (from inception to 17 July 2021).

RESULTS

Eight studies involving 1597 participants were selected to analyse risk factors for patients with stroke with FoF. The quality of all included studies was assessed and categorised as medium or high quality. Review Manager V.5.3 merged the OR value and 95% CI of the potential risk factors. Meta-regression and Egger's test were performed by Stata V.15.1. The risk factors for FoF in patients with stroke were women (OR=2.13, 95% CI 1.47 to 3.09), impaired balance ability (OR=5.54; 95% CI 3.48 to 8.81), lower mobility (OR=1.12; 95% CI 1.05 to 1.19), history of falls (OR=2.33; 95% CI 1.54 to 3.53) and walking aid (OR=1.98; 95% CI 1.37 to 2.88), anxiety (OR=2.29; 95% CI 1.43 to 3.67), depression (OR=1.80; 95% CI 1.22 to 2.67), poor lower limb motor function (OR=1.14; 95% CI 1.00 to 1.29) and physically inactiveness (OR=2.04; 95% CI 1.01 to 4.12). Measurement of heterogeneity between studies was high for all outcomes (I² =0%-93%), indicating that the substantial interstudy heterogeneity in estimated proportions was not attributed to the sampling error. Sensitivity analysis (leave-one-out method) showed that the pooled estimate was stable.

CONCLUSION

This meta-analysis indicated that female population, impaired balance ability, lower mobility, history of falls and walking aid in patients with stroke might be at greater risk for FoF. Future studies are recommended to determine other risk factors specific to patients with stroke.

[Anti-HBs persistence after primary vaccination with three doses of 5 μg recombinant hepatitis B vaccine among normal and high-responder infants: 10-year of follow-up]

Objective: Assess the 10-year Immune persistence and the predictors after primary vaccination hepatitis B vaccine (HepB) among normal and high-responder infants. Methods: A total of 1 838 Infants of 7-12 months old located in Jinan, Weifang, Yantai and Weihai of Shandong Province who were induced normal or high antibody response (anti-HBs titer ≥ 100 mIU/ml) after primary vaccination (three dose with 0-1-6 procedure) with 5 μg recombinant HepB among newborns were included in the study, in 2009. 3 ml of venous blood samples were collected at baseline survey (T₀) and antibodies against hepatitis B surface antigen (anti-HBs), antibody against hepatitis B core antigen (anti-HBc) and hepatitis B surface antigen (HBsAg) were detected using chemiluminescence microparticle immunoassay (CMIA) method. A self-designed questionnaire was used to collect information including the infant's age, sex, birth weight, premature birth, birth number, delivery location and mother's HBV infection status. In 2014 (followed up for 5 years) and in 2019 (followed up for 10 years) (T₁), 2 ml of venous blood samples were collected. Anti HBS and anti HBC were detected by CMIA method. Those with anti HBS<10 mIU/ml were detected by CMIA method. Multivariate unconditional logistic and linear regression models were used to analyze the influencing factors of anti-HBs positive rate and geometric mean concentration (GMC) at T₁. Results: After 10 years follow-up, 73.94% of the subjects (1 359/1 835) finished the follow-up. 51.15% of the subjects, a total of 625 were boys. The positive rate of anti-HBs was 100% at T₀ and decreased to 53.44% (95%CI: 50.59%-56.26%) at T₁. The average annual decline rate of anti-HBs positive rate from T₀ to T₁ was 6.07%. The GMC of anti-HBs decreased from 607.89 (95%CI: 579.01-642.62) mIU/ml to 16.44 (95%CI: 15.06-18.00) mIU/ml. The average annual decline rate of anti-HBs GMC in 10-year follow-up was 30.30%. Multivariate logistic analysis showed that the positive rate of anti-HBs at T₁ was lower in those who did not vaccinate the first dose in time (OR=0.25, 95%CI:0.07-0.71). Compared with those with GMC<1 000 mIU/ml at T₀, those with GMC ≥ 1 000 mIU/ml had a higher positive rate of anti-HBs at T₁ (OR=2.29, 95%CI:1.76-2.97). Multivariate regression analysis showed that the GMC of anti-HBs at T₁ was lower in those who did not vaccinate the first dose in time (β=-0.50, 95%CI:-1.24-0.24). Compared with those with GMC<1 000 mIU/ml at T₀, those with GMC ≥ 1 000 mIU/ml had a higher GMC of anti-HBs at T₁ (β=0.81, 95%CI: 0.62-1.05). Conclusion: Anti-HBs GMC decreased in 10 years after primary vaccination of 5 μg recombinant hepatitis B vaccine among normal and high-responders. The anti-HBs persistence was mainly associated with whether the first dose was vaccinated in time and the level of anti-HBs at the end of primary vaccination.

Pain catastrophizing and associated factors in preoperative total knee arthroplasty in Lanzhou, China: a cross-sectional study

Background

Pain catastrophizing in preoperative total knee arthroplasty (TKA) patients is associated with several poorly characterised factors in the literature. This study investigated the current state and associated factors of preoperative pain catastrophizing in patients undergoing TKA.

Methods

This descriptive cross-sectional study was conducted at the orthopedics ward of two tertiary hospitals in Lanzhou, China. Pain catastrophizing was measured using the Chinese versions of the Pain Catastrophizing Scale, Short Form-36 (physical function domain), Numerical Rating Scale, Oxford Knee Score, Hospital Anxiety and Depression Scale, and Life Orientation Test-Revised.

Results

The study included 360 participants. Preoperative TKA pain catastrophizing in all patients was high, with a mean score of 24.92 (SD: 12.38). The stepwise multiple linear regression analysis revealed anxiety (β = 0.548, P < 0.01), education level (β =  − 0.179, P < 0.01), physical function (β =  − 0.156, P < 0.01), and pain intensity during activity (β = 0.105, P = 0.015) as associated factors for pain catastrophizing, possibly explaining 51.2% of the total variation (F = 95.149, P < 0.01).

Conclusion

Anxiety was the most relevant factor for pain catastrophizing in patients with preoperative TKA. Lower education levels, poor physical function, and stronger pain intensity during the activity were also associated with pain catastrophizing.

Alexithymia, social support, depression, and burnout among emergency nurses in China: a structural equation model analysis

Background

Several factors are associated with the incidence of burnout, including alexithymia, social support, and depression. The relative importance of these three key parameters as mediators of burnout, however, is not well understood. In addition, there have been few studies to date specifically examining the association between alexithymia and burnout among nurses in China.

Purpose

To evaluate the relationship of burnout with alexithymia, social support, and depression across emergency department nurses in China.

Methods

This descriptive, cross-sectional survey was conducted using a convenience sampling methodology to survey nurses responsible for direct emergency care (n = 413) from 18 tertiary hospitals in Western, Eastern, Northern, and Southern China between May 2020 and June 2020. A structural equation modeling approach was then used to assess a hypothetical model wherein alexithymia both directly and indirectly affects burnout among emergency nurses via impacting the incidence of depression and perceived social support.

Results

Results supported all driving hypotheses. Alexithymia was positive direct correlated with burnout (β = 0.35; P < 0.001) and depression (β = 0.50; P < 0.001), and exhibited a negative direct effect on social support (β = − 0.14; P = 0.041). Depression was associated with burnout, both directly (β = 0.24; P < 0.001) and indirectly (β = 0.15; P < 0.001) through its relationship with social support. Alexithymia was the factor most strongly associated with burnout, and it was able to affect burnout indirectly through depression and social support.

Conclusions

We found that among emergency nurses in China, alexithymia was correlated with burnout, depression, and social support. Alexithymia was the factor most strongly associated with burnout. These data suggest that providing better social support and alleviating alexithymia may decrease rates of burnout among emergency nurses.

[Rates and characteristics for hepatitis B reactivation of inactive hepatitis B carriers in rural communities]

Objective: To analyze the intensity and epidemiological characteristics of hepatitis B virus (HBV) reactivation among inactive HBsAg carriers (IHC) of rural areas in Ji'nan. Methods: In 2018 and 2020, follow-up investigations were conducted on IHC identified in the population physical examination in Zhangqiu district of Ji'nan. The results of the two follow-up visits were compared to analyze the incidence and distribution characteristics of HBV reactivation in IHC at the community level. Results: A total of 424 IHC completed two follow-up visits, and 47 cases of HBV reactivation were found, the cumulative reactivation rate was 11.08%, and the incidence density was 5.46/100 person-years. Multivariate analysis showed that gender, age, smoking, drinking , family history of liver disease and chronic diseases were not associated with HBV reactivation (P>0.05), and baseline HBV DNA load was associated with reactivation (P<0.05), in the HBV DNA level ≥1 000 IU/ml group, the reactivation rate could reach 18.92%. After reactivation, the mean level of ALT increased from baseline and the abnormal rate increased, liver function tended to be abnormal in reactivated patients. 4 (8.51%) reactivators had hepatitis, and 1 (2.13%) had jaundice hepatitis. Conclusions: The incidence of HBV reactivation was higher among IHC in rural communities in Ji'nan. Most of the reactivators were asymptomatic or mildly reactivated. Follow-up of inactive HBsAg patients should be strengthened and changes in ALT and HBV DNA levels should be closely monitored.

[Analysis of capability to pertussis etiology and serological diagnosis for GradeⅡ and Ⅲmedical institutions in Shandong Province in 2018]

Objective: Investigate and analyze the etiology and serological diagnosis capabilities of pertussis in medical institutions in Shandong Province in 2018. Methods: Using the census method, a questionnaire survey was conducted among 603 second and above level medical institutions in Shandong Province. The deadline for the survey was December 2018, and a total of 543 questionnaires have been recovered, and the validity rate of the questionnaires was 90%. Surveyed the pertussis etiology and serology test items (pertussis IgM and IgG, pertussis nucleic acid and pertussis bacterial culture) and the start time of each test item by questionnaire. The reported cases (confirmed cases and clinically diagnosed cases) between January 1, 2012 and December 31, 2018 were derived from the Chinese Disease Control and Prevention Information System according to the onset date. We used indicators such as fixed-base development speed, chain development speed, and chain growth speed for analysis. The chi test was used to analyze the differences in the composition ratio of medical institutions with detection ability in different levels and regions, and analyze the changes in the number of reported cases before and after the development of pertussis etiology and serology testing. Results: A total of 543 medical institutions accounted for 90.0% (543/603) of all secondary and above level medical institutions in the province, 356 secondary medical institutions (65.6%), and 187 tertiary medical institutions (34.4%). There were 10 medical institutions that carry out pertussis IgM, IgG and nucleic acid testing, accounting for 1.8% (10/543) of the surveyed medical institutions respectively. 2 medical institutions that carried out bacterial culture, accounting for 0.4% of the surveyed medical institutions (2/543). 20 medical institutions have carried out the above tests (8 secondary medical institutions and 12 tertiary medical institutions), accounting for 3.7% (20/543). The proportion of tertiary medical institutions with pertussis IgM, IgG detection and nucleic acid detection capabilities [6.42% (12/187)] was significantly higher than that of secondary medical institutions [2.25% (8/356)] (χ²=6.01, P=0.014). From 2012 to 2018, the fixed base ratio development speed of reported cases was 3 834.69% in Shandong Province, among which medical institutions with etiology and serological testing capabilities reached 4 533.33%. In 13 medical institutions, the average annual number of reported cases after pertussis etiology and serological testing were higher than that of reported cases before testing. Conclusion: The ability of pertussis etiology and serology diagnosis of secondary and above medical institutions in Shandong Province needs to be improved.

Involvement of TNF-alpha and IL-10 in breast cancer and patient survival

Purpose: To investigate the involvement of tumor necrosis factor α (TNF-α) and interleukin 10 (IL-10) in the pathogenesis of breast cancer in vivo as well as the activity of ten Chinese herbal compounds in human breast cancer (MCF-7) cell proliferation in vitro.Methods: In the in vivo study, the association of serum TNF-α and IL-10 with breast cancer cell invasiveness and prognosis was determined in female patients (n = 192) with breast cancer, while in the in vitro study, ten herbal Chinese compounds were screened for their effectiveness against MCF-7 cells. The levels of TNF-α, IL-10, estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor-2 (HER2/neu) were assayed using their respective enzyme-linked immunosorbent assay (ELISA) kits. Molecular docking was used to determine the lead compound(s) that can effectively inhibit TNF-α and IL-10.Results: Raised serum levels of TNF-α and IL-10 were significantly associated with breast cancer cell invasiveness and poor prognosis (p < 0.05). Moreover, there was a strong association between breast cancer prognosis and the expression levels of ER, PR and HER2/neu. Serum TNF-α and IL-10 levels were significantly elevated in stages II and III patients and in those with lymph node metastasis. Treatment of MCF-7 cells with the herbal compounds significantly reduced the synthesis and release of TNF-α and IL-10 (p < 0.05). The results of molecular docking showed that baicalein and oridonin significantly inhibited TNF- α and IL-10. The two herbal compounds had the highest docking scores for inhibition of cytokines, as well as favorable interaction energies.Conclusion: These results indicate that TNF-α and IL-10 are involved in the pathogenesis of breast cancer, and that baicalein and oridonin effectively inhibit the proliferation of the cells. Keywords: Baicalein, Breast cancer, Interleukin 10, Oridonin, Tumor necrosis factor alpha

Association of digestive symptoms with severity and mortality of COVID-19: A protocol for systematic review and meta-analysis

BACKGROUND

Gastrointestinal manifestations are common in patients with COVID-19, but the association between specific digestive symptoms and COVID-19 prognosis remains unclear. This study aims to assess whether digestive symptoms are associated with COVID-19 severity and mortality.

METHODS

We will search PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials up to September, 2020, to identify studies that compared the prevalence of at least one specific digestive symptom between severe and non-severe COVID-19 patients or between non-survivors and survivors. Two independent reviewers will assess the risk of bias of the included cohort studies using the modified Newcastle-Ottawa Scale. Meta-analyses will be conducted to estimate the pooled prevalence of individual symptoms using the inverse variance method with the random-effects model. We will conduct subgroup analyses, sensitivity analyses, and meta-regression analyses to explore the sources of heterogeneity. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will be used to assess the quality of the evidence.

RESULTS

The results of this study will be published in a peer-reviewed journal.

CONCLUSION

Our meta-analysis will comprehensively evaluate the association between different digestive symptoms and the severity and mortality of patients infected with COVID-19. This study will provide evidence to help determine whether special protective measures and treatment options are needed for patients with digestive system comorbidities during the COVID-19 pandemic.

INPLASY REGISTRATION NUMBER

INPLASY202090055.

Balanced crystalloids for intravenous fluid therapy in critically ill and non-critically ill patients: A protocol for systematic review and network meta-analyses

BACKGROUND

The balanced crystalloids have become a substitute for saline for fluid resuscitation. Some studies have investigated the clinical effect and adverse event of differently balanced crystalloids, but they have no consistent conclusions. This study aims to assess and compare the effect of differently balanced crystalloids for intravenous fluid therapy in critically ill and non-critically ill patients using network meta-analysis (NMA).

METHODS

Electronic databases including PubMed, EMBASE, Cochrane Library, Web of Science, Clinical Trials.gov, and the International Clinical Trials Registry Platform (ICTRP) will be searched from inception to April 2018. We will include randomized controlled trials (RCTs) that reported the effect and adverse event of balanced crystalloids. Risk of bias assessment of the included RCTs will be conducted according to the Cochrane Handbook 5.1.0. A Bayesian NMA will be performed using R software. GRADE will be used to explore the quality of evidence.

RESULTS

The results of this NMA will be published in a peer-reviewed journal.

CONCLUSION

This NMA will summarize the direct and indirect evidence to assess the effect of differently balanced crystalloids.

ETHICS AND DISSEMINATION

Ethics approval and patient consent are not required as this study is an NMA based on published studies.

PROSPERO REGISTRATION NUMBER

CRD42018093818.

Aryl hydrocarbon receptor polymorphisms are associated with dry skin phenotypes in Chinese patients with atopic dermatitis

BACKGROUND

Epidermal barrier dysfunction is the initial event in the development of atopic dermatitis (AD). Recent studies have identified a crucial role for the aryl hydrocarbon receptor (AHR) in controlling the gene expression of filaggrin and other skin barrier proteins, suggesting an underlying association between AHR and AD pathogenesis.

AIM

To investigate the role of AHR gene polymorphisms in the susceptibility to AD and in AD-associated phenotypes.

METHODS

We enrolled 487 patients with AD, 210 patients with psoriasis and 226 healthy controls (HCs) from the Han Chinese population, and genotyped two AHR single-nucleotide polymorphisms (rs10249788 and rs2066853) by PCR and subsequent DNA sequencing.

RESULTS

The AHR rs10249788 and rs2066853 polymorphisms were found in both sets of patients (AD and psoriasis) and in HCs, but no significant differences were detected in genotype or allele frequencies between the three groups. However, patients with AD with the rs10249788 (CT/TT) or rs2066853 (AG + AA) genotype were more likely to have severe dry skin scores. In the stratification analysis, the AHR rs2066853 (AG + AA) and rs10249788 (CT + TT) genotypes could predict a higher risk of severe dry skin phenotypes in the male, early-onset and allergic rhinitis subgroups. Furthermore, the combined rs10249788 (CT + TT) and rs2066853 (AG + AA) genotypes led to a higher risk for severe dry skin in patients with AD.

CONCLUSION

AHR polymorphisms are not associated with the risk of AD; however, they may predict a dry skin phenotype in patients with AD.

Interpretation of liver stiffness measurement-based approach for the monitoring of hepatitis B patients with antiviral therapy: A 2-year prospective study

Liver biopsy is not routinely performed in treated chronic hepatitis B. Liver stiffness measurement has been validated for noninvasive liver fibrosis assessment in pretreatment chronic hepatitis B but has not been assessed for fibrosis monitoring during antiviral therapy. Liver stiffness was systemically monitored by Fibroscan^® every 6 months in a cohort of patients with hepatitis B receiving antiviral therapy and compared with liver biopsies at baseline and week 104. A total of 534 hepatitis B e antigen-positive treatment-naive patients receiving telbivudine-based therapy with qualified liver stiffness measurement at baseline and week 104 were analyzed, 164 of which had adequate paired liver biopsies. Liver stiffness decreased rapidly (-2.2 kPa/24 weeks) in parallel with alanine aminotransferase (ALT) from 8.6 (2.6-49.5) kPa at baseline to 6.1 (2.2-37.4) kPa at week 24. Interestingly, liver stiffness decreased slowly (-0.3 kPa/24 weeks) but continually from week 24 to week 104 (6.1 vs 5.3 kPa, P < .001) while ALT levels remained stable within the normal range. More importantly, liver stiffness declined significantly irrespective of baseline ALT levels and liver necroinflammation grades. From baseline to week 104, the proportion of patients with no or mild fibrosis (Ishak, 0-2) increased from 74.4% (122/164) to 93.9% (154/164). Multivariate analysis revealed that percentage decline of 52-week liver stiffness from baseline was independently associated with 104-week liver fibrosis regression (odds ratio, 3.742; P = .016). Early decline of 52-week liver stiffness from baseline may reflect the remission of both liver inflammation and fibrosis and was predictive of 104-week fibrosis regression in treated patients with chronic hepatitis B.

The role of peginterferon in nucleos(t)ide-analogue-treated chronic hepatitis B patients: A review of published literature

Chronic hepatitis B infection (CHB) causes up to 1.0 million deaths annually. Currently, more than 90% of CHB patients worldwide are receiving indefinite nucleos(t)ide analogue (NA) therapy. New strategies for optimizing hepatitis B surface antigen (HBsAg) loss are required for NA-treated patients as the majority are unable to achieve HBsAg loss and may require lifelong therapy. In hepatitis B e antigen (HBeAg)-positive patients, switching from NAs to finite peginterferon (PegIFN) therapy can double HBeAg seroconversion rates. One in five patients who switch to PegIFN can achieve HBsAg loss, whereas patients who continue NA therapy typically do not. In HBeAg-negative NA-treated patients, add-on PegIFN therapy achieves higher, albeit modest, HBsAg loss rates compared with continued NA monotherapy and offers the opportunity for NA-treated patients to achieve the inactive carrier state. In the absence of curative therapies, PegIFN represents a valuable, finite option for NA-treated patients who would otherwise require potentially lifelong therapy.

Dosimetric and clinical toxicity comparison of critical organ preservation with three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and RapidArc for the treatment of locally advanced cancer of the pancreatic head

PURPOSE

We compared dosimetry and clinical toxicity for 3-dimensional conformal radiotherapy (3D-crt), intensity-modulated radiotherapy (imrt), and RapidArc (Varian Medical Systems, Palo Alto, CA, U.S.A.) in locally advanced pancreatic cancer (lapcc). We hypothesized that the technique with better sparing of organs at risk (oars) and better target dose distributions could lead to decreased clinical toxicity.

METHODS

The study analyzed 280 patients with lapcc who had undergone radiotherapy. The dosimetry comparison was performed using 20 of those patients. Dose-volume histograms for the target volume and the oars were compared. The clinical toxicity comparison used the 280 patients who received radiation with 3D-crt, imrt, or RapidArc.

RESULTS

Compared with 3D-crt, RapidArc and imrt both achieved a better conformal index, homogeneity index, V95%, and V110%. Compared with 3D-crt or imrt, RapidArc reduced the V10, V20, and mean dose to duodenum, the V20 of the right kidney, and the liver mean dose. Compared with 3D-crt, RapidArc reduced the V35, and V45 of duodenum, the mean dose to small bowel, and the V15 of right kidney. The incidences of grades 3 and 4 diarrhea (p = 0.037) and anorexia (p = 0.042) were lower with RapidArc than with 3D-crt, and the incidences of grades 3 and 4 diarrhea (p = 0.027) were lower with RapidArc than with imrt.

CONCLUSIONS

Compared with 3D-crt or imrt, RapidArc showed better sparing of oars, especially duodenum, small bowel, and right kidney. Also, fewer acute grades 3 and 4 gastrointestinal toxicities were seen with RapidArc than with 3D-crt or imrt. A technique with better sparing of oars and better target dose distributions could result in decreased clinical toxicities during radiation treatment for lapcc.

Histamine H4 Receptor mediates interleukin-8 and TNF-α release in human mast cells via multiple signaling pathways

Histamine, mainly produced by mast cells, is an important inflammatory mediator in immune response. Recently Histamine H4 Receptor (H4R) was also identified in mast cells, from which pro-inflammatory cytokines and chemokines are released. However, the mechanism of how H4R mediates these cytokines and chemokines release in mast cells was still unclear. To further explore the role of H4R in the immune inflammatory response in mast cells, we tested the release of inflammatory cytokine tumor necrosis factor-α (TNF-α), chemokine interleukin-8 (IL-8) and the relevant signaling pathways activated by H4R on LAD2 cells (a human mast cell line). We found that the release of IL-8 and TNF-α were blocked by inhibitors of PI3K, ERK and Ca2+-Calcineurin-NFAT signaling pathways, while the release of these cytokines and chemokines were enhanced by the inhibitor of P38 signaling pathway. However, inhibitors of the JNK and NF-κB signaling pathways had little effect on the expression of the pro-inflammatory mediators. Moreover, activation of the H4R could induce phosphorylation of ERK, p38 and AKT in mast cells. In conclusion, we found that H4R mediates the release of inflammatory cytokine TNF-α and chemokine IL-8 in human mast cells via PI3K, Ca2+-Calcineurin-NFAT and MAPKs signaling pathways.

Effects of ApoE on intracellular calcium levels and apoptosis of neurons after mechanical injury

OBJECTIVE

The current study aimed to explore the effects of apolipoprotein e (ApoE) on intracellular calcium ([Ca(2+)]i) and apoptosis of neurons after mechanical injury in vitro.

METHODS

A neuron mechanical injury model was established after primary neurons obtained from APOE knockout and wild-type (WT) mice, and four experimental groups were generated: Group-ApoE4, Group-ApoE3, Group-ApoE(-) and Group-WT. Recombinant ApoE4 and ApoE3 were added to Group-ApoE4 and Group-ApoE3 respectively, and Group-ApoE(-) and Group-WT were control groups. Intracellular calcium was labeled by fluo-3/AM and examined using laser scanning confocal microscope and flow cytometry, and the apoptosis of neurons was also evaluated.

RESULTS

The intracellular calcium levels and apoptosis rates of mice neurons were significantly higher in Group-ApoE4 than in Group-ApoE3 and Group-WT after mechanical injury. However, without mechanical injury on neurons, no significant differences in intracellular calcium levels and apoptosis rates were found among all four experimental groups. The effects of ApoE4 on intracellular calcium levels and apoptosis rates of injured neurons were partly decreased by EGTA treatment.

CONCLUSION

Compared with ApoE3-treatment and WT neurons, ApoE4 caused higher intracellular calcium levels and apoptosis rates of neurons after mechanical injury. This suggested APOE polymorphisms may affect neuron apoptosis after mechanical injury through different influences on intracellular calcium levels.

A recombined fusion protein SP5.2/tTF induce thrombosis in tumor blood vessel

Tumor vascular targeting is one of the most promising strategies in tumor therapy. Here we used E.coli to express a recombinant SP5.2/tTF fusion protein, which, as a tumor vascular targeting agent, consists of SP5.2 (a peptide selectively binding and targeting VEGFR-1 on tumor endothelial cells) and truncated tissue factor (tTF)and aimed to explore its anti-tumor activities.The SP5.2/tTF expression construct was synthesized by polymerase chain reaction (PCR) and recombined into plasmid pET22b(+). The fusion gene was verified by restriction mapping and sequencing. SP5.2/tTF was expressed in E. coli and then purified on a nickel-affinity chromatography column. The purified product was detected by SDS-PAGE. The pro-coagulant activity and binding of SP5.2/tTF to human umbilical vein endothelial cells (HUVECs) were monitored by FX activation analysis and fluorescent scanning confocal microscopy, respectively. The effect of SP5.2/tTF on tumor growth was analyzed in BALB/c mice bearing sarcoma 180 (S180) tumor. The tissue localization of SP5.2/tTF and its effect on tumor vessel thrombosis were observed by in vivo fluorescence imaging and histological studies, respectively. The fusion gene was successfully cloned into pET22b(+). SP5.2/tTF was abundantly expressed in bacterial cells and efficiently purified by nickel-affinity chromatography. Functional studies showed that the protein retained both the coagulation activity of tTF and the binding capacity of SP5.2 to HUVECs. In tumor xenograft studies, SP5.2/tTF selectively targeted the tumor, induced thrombosis, and led to retardation and even regression of tumor growth (growth inhibition ratio = 70%, P< 0.05). The recombinant fusion protein SP5.2/tTF inhibited tumor growth by selectively inducing thrombosis in tumor blood vessels.

[A study on loneliness among people who lost their children in disaster area of 5.12 Earthquake]

OBJECTIVE

To evaluate the status of loneliness, the influential factors and the relationship between loneliness and family function among bereaved parents in disaster area of 5.12 Earthquake and to provide basis for mental and family reconstruction for those people suffering from the Earthquake.

METHODS

A total 190 bereaved parents in disaster area of 5.12 Earthquake were enrolled for an across-sectional study. A face-to-face survey was conducted by following scales: General Data Scale, University of California at Los Angels Loneliness Scale, Emotional and Social Loneliness Scale and Family APGAR Index.

RESULTS

The score of loneliness ranged from 24 to 69 (mean=43.58, SD=9.61), the score of emotional loneliness ranged from 5 to 24 (mean=11.95, SD=3.60) while the social loneliness ranged from 6 to 24 (mean=13.99, SD=3.69). The scores of loneliness, social loneliness and emotional loneliness were all increased among bereaved parents compared to people without loss of their child. The results of multivariate analysis showed that family function and status of fertility significantly impacted the loneliness (P< 0.05). Furthermore, there was negative correlation between family function and the loneliness, social loneliness and emotional loneliness (P< 0.05).

CONCLUSION

The bereaved parents in disaster area of 5.12 Earthquake showed higher level of loneliness. The better of family function indicated the less of loneliness in bereaved parents. Measures should be taken to promote mental and family reconstruction for such people, including providing effective skills to improve emotional communication and family function and offering technical support for having another baby.

[A systematic review of clinical application of Percu Twist tracheostomy in intensive care unit]

OBJECTIVE

To evaluate the effectiveness of Percu Twist (PT) tracheostomy comparing with that of operative tracheostomy (OT) in intensive care unit (ICU).

METHODS

Related data were retrieved from CBM, CNKI, Wanfang Data, VIP, PubMed, EMBASE, CENTRAL, and Web of Science from the time of their establishment to May 15th 2014, and the data of randomized controlled trials (RCTs) concerning PT and OT were selected. The risk of bias assessment and data extraction were performed by two independent reviewers. Meta analysis was conducted using RevMan 5.2 software.

RESULTS

A total of 12 RCTs were identified, and 893 patients in ICU were involved. The results of Meta-analysis showed that PT could significantly shorten the operation time [mean difference (MD)=-15.11, 95% confidence interval (95% CI)=-17.14 to -13.07, P<0.000 01], reduce the volume of blood loss (MD=-17.59, 95% CI=-21.90 to -13.28, P<0.000 01), reduce the size of incision (MD=-2.20, 95% CI=-2.57 to -1.82, P<0.000 01), shor ten the time of healing (MD=-3.60, 95% CI=-4.15 to -3.05, P<0.000 01), and reduce complications such as infection of the wound [odds ratio (OR)=0.20, 95%CI=0.10-0.44, P<0.000 1] and cutaneous emphysema/mediastinal emphysema (OR=0.22, 95% CI=0.10-0.47, P<0.000 1) compared with OT group. The funnel plot suggested that publication bias might be found among 12 researches.

CONCLUSIONS

PT was shown to be more effective than OT in ICU with lower incidence of complications. As number of RCT cases is still small with unsatis factory quality, further clinical use is warranted for a better assessment.

Detection of Salmonella spp. by a loop-mediated isothermal amplification (LAMP) method targeting bcfD gene

In this study, we developed and validated a loop-mediated isothermal amplification (LAMP) assay for Salmonella detection targeting bcfD gene, a conserved fimbrial operon gene existing in Salmonella. The Salmonella LAMP assay we developed successfully amplified 44 Salmonella strains (14 standard strains and 30 clinical isolates), but none of 9 non-Salmonella standard strains (Proteus mirabilis, Listeria monocytogenes, Escherichia coli, Pseudomonas aeruginosa, Shigella flexneri, Shigella sonnei, Klebsiella pneumoniae, Campylobacter jejuni and Vibrio parahemolyticus). The detection limit was 5 CFU of Salmonella pure culture or 200 CFU of artificially spiked faeces per reaction system (equivalent to 5000 CFU g(-1) of faeces), and this method could directly detect Salmonella in chicken faeces free of pre-enrichment in a reaction time of 25 min. Our experiments show that the LAMP method we developed is a rapid, sensitive, specific and practical method for Salmonella detection. The Salmonella LAMP assay can potentially serve as new on-site diagnostics in the food and agricultural industries.

SIGNIFICANCE AND IMPACT OF THE STUDY

A loop-mediated isothermal amplification (LAMP) assay was established to detect Salmonella targeting bcfD gene, a conserved fimbrial operon gene. The detection limit was 5 CFU of Salmonella pure culture or 200 CFU of artificially spiked faeces per reaction system (equivalent to 5000 CFU g(-1) of faeces), and this method could directly detect Salmonella in chicken faeces free of pre-enrichment in a reaction time of 25 min. The Salmonella LAMP assay is a rapid, sensitive, specific and practical method for Salmonella detection and can potentially serve as new on-site diagnostics in the food and agricultural industries.

Chemerin suppresses murine allergic asthma by inhibiting CCL2 production and subsequent airway recruitment of inflammatory dendritic cells

BACKGROUND

Chemerin has been implicated to play opposing roles, either pro-inflammatory or anti-inflammatory, in various tissue inflammation processes primarily through the regulation of tissue recruitment of immune cells. However, the effect of chemerin in allergic asthma has not yet been explored. We sought to investigate the role of chemerin in the murine model of allergic asthma and explore the underlying mechanism.

METHODS

We examined the effect of intranasal (i.n.) administration of chemerin during antigen challenge in murine models of asthma. Moreover, we examined whether administration of CCL2 or bone marrow-derived dendritic cells (BMDCs) transfer reversed the effects of chemerin on ovalbumin-induced asthma. We finally examined the effect of chemerin on CCL2 expression in activated lung epithelial cells in vitro.

RESULTS

The administration of chemerin attenuated allergic airway inflammation and airway hyperreactivity during antigen challenge. Chemerin treatment caused significant decreases in BALF CD4(+) T-cell accumulation and mRNA expression of Th2-attracting chemokines, CCL17 and CCL22, which was accompanied by significantly decreased BALF CD11c(+) CD11b(+) inflammatory DC accumulation and CCL2 production. Furthermore, airway administration of exogenous CCL2 or adoptive transfer of CD11c(+) CD11b(+) BMDCs abrogated the suppressive effects of chemerin on allergic asthma. Finally, in vitro study showed that chemerin inhibited CCL2 secretion by low-dose LPS-stimulated lung epithelial cells, which led to decreased chemotaxis of BMDCs.

CONCLUSIONS

Our study demonstrates that chemerin plays a protective role in allergic asthma by suppressing airway recruitment of inflammatory CD11c(+) CD11b(+) DCs through the inhibition of CCL2 secretion by active lung epithelial cells.

Abstract P1-07-11: ERa regulates epithelial-mesenchymal transition in breast cancers through suppressing Bmi1 expression

Background: Bmi1, a polycomb-group protein, maintains stem cell self-renewal and is frequently overexpressed in cancers. Upregulation of Bmi1 by Twist1 can promote tumor-initiating capability and Epithelial-mesenchymal transition (EMT) by repressing E-cadherin expression. It has been demonstrated that Post-EMT breast cancer cells express cancer stem cell (CSC) markers including Bmi1, but display decreased ERα expression. ERα is a ligand-activated nuclear hormone receptor that regulates the transcription of E2-responsive genes in diverse target cells. It's reported that ligand-activated ERα could repress slug transcription by binding to the half-site ERE element in its promoter, and then regulate E-cadherin and EMT. Herein, we hypothesized that ERα signaling might regulate E-cadherin and EMT through Bmi1.

Methods: First, we determined Bmi1 and ERα expression at both mRNA and protein levels by quantitative RT-PCR and Western blot in various breast cancer cell lines. Further, we quantitatively analyzed mRNA and protein levels of Bmi1 as well as its down-stream genes including E-cadherin after silencing ERα in T47D cells with siRNA, or after overexpressing ERα in BT549 cells. The chromatin immunoprecipitation (ChIP) and electrophoretic mobility shift assay (EMSA) were also performed to investigate whether ERα binds directly to Bmi1 promoter region. Luciferase assay with Bmi1 reporter was performed to ERα mediated regulation. To identify whether ERα regulates EMT, transwell and matrigel invasion, flow cytometry, mammosphere assay and wound healing assay were performed to invasion, metastases and characterize stem-cell properties of EMT. Finally, we analyzed the expression of ERα, Bmi1 and E-cadherin in human breast cancer specimens with immunohistochemistry.

Results: The study showed that Bmi1 inversely correlated with ERα expression in different subtypes of breast cancer cells. We further confirmed that Bmi1 was upregulated at both mRNA and protein levels and E-cadherin was downregulated with siRNA against ERα in T47D cells, and Bmi1 was downregulated and E-cadherin was upregulated when overexpressing ERα in BT549 cells with qRT-PCR and western blot analyses. The present study also demonstrated that ERα could directly binds to the half-ERE region of the Bmi1 gene and repressing Bmi1 expression transcriptionally with CHIP/EMSA and reporter analyses. Overexpression of ERα in BT549 cell significantly decreased levels of migration of transwell and wounding healing, invasiveness, CD44high/CD24low population, and the capabilities of mammosphere formation.

Conclusions: Our results demonstrated that ERα can suppress EMT through transcriptionally down-regulating Bmi-1 and its down-stream genes in human breast cancer cells. The inverse relationship between ERα and Bmi1 expression further supports the epithelial phenotype of ERα positive tumors or mesenchymal phenotype of ERα negative tumors. Our findings provide a novel mechanistic insight into how ERα regulates EMT, and is of valuable for developing biomarkers to predict prognosis and targeted therapies in breast cancers in the future.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-07-11.

Perceived family functioning and depression in bereaved parents in China after the 2008 Sichuan earthquake

This study examined perceived family functioning and depression in bereaved parents 18 months after the 2008 Sichuan earthquake. This was a cross-sectional study with 190 bereaved parents sampled using a multistage stratified sampling method. The instruments used in the study included Family APGAR Index and Hamilton Depression Rating Scale-17. The results indicated that the prevalence of family dysfunction was 59.5%. All the respondents experienced depression with 79.5% of the respondents reporting very severe depression. Being female, being at an advanced age, being divorced or widowed, being directly exposed to the death of their children, not having another baby after the earthquake, and poorer family functioning were significant predictors for more severe depression. Strategies can be designed in post-disaster recovery programs for bereaved parents at high risk for more severe depression, particularly for those with poorer family functioning.

[Family function among the bereaved in hard-hit areas 1 year after Wenchuan earthquake]

OBJECTIVE

To investigate the family function among the bereaved in hard-hit areas 1 year after Wenchuan earthquake and to provide basic information for family reconstruction.

METHODS

A cross-sectional study was used to survey 264 bereaved who were selected according to the criteria in hard-hit areas after Wenchuan earthquake.

RESULTS

The scores of family care function of the bereaved in hard-hit areas after Wenchuan earthquake were 6.52±2.65. Fifty percent of the participants' family kept in good state. The scores of the bereaved family cohesion ranged from 28 to 83 (64.22±9.18), and the scores of family adaptability ranged from 21 to 62 (41.84±6.62). There was no significant difference in the score of family cohesion between the bereaved family and the non-bereaved family (P>0.05). But the score of the family adaptability of the bereaved family was significantly lower than that of the non-bereaved family (P<0.05). The bereaved family types were as follows: 22.0% balanced type, 53.8% middle type and 24.2% extreme type. In the 16 family types, the "intimate-rigid" (24.6%), "intimate-regular" (19.7%) and "disengaged-rigid" (19.3%) type ranked the top three.

CONCLUSION

The family care function of the bereaved in hard-hit areas after Wenchuan earthquake is damaged to different degrees. The main type of family is the middle type. The loss of relatives reduces the participant family adaptability. In the late intervention, we should help the bereaved improve and enhance family function, and promote family reconstruction of the bereaved.