Retrospective analysis of efficacy, safety, and prognostic factors in a cohort of Chinese hepatocellular carcinoma patients treated with drug-eluting bead transarterial chemoembolization

A Cross-Sectional Study on Current Perioperative Pain Management and Nurses' Pain Management Self-Efficacy in China's Interventional Department

Objective

To critically evaluate the present status of perioperative pain management among nurses in interventional departments as well as to delineate the factors influencing the self-efficacy of pain management to provide a foundation for enhancing perioperative pain management practices.

Methods

This was a descriptive cross-sectional study on 941 nurses from 24 Chinese provinces and municipalities. A questionnaire was conducted to examine the current pain management practices. Independent sample t-test and analysis of variance were used for inter-group comparison. Multiple linear regression analysis was done to analyze the influencing factors of pain management self-efficacy.

Results

About 76.5% of the nurses in the interventional departments had undergone pain management training; however, more than one-third (37.6%) had not in the past two years. Merely 4.9% of nurses expressed confidence that their knowledge in pain management was sufficient to meet the demands the clinical practice. The foremost three areas of pain management information desired by the nurses in the intervention department were pain psychology (79.6%), pharmacological pain treatment (78.1%), and non-pharmacological pain interventions (77.4%). A majority (57.6%) of the nurses failed to assess the patients' comprehension and perspectives of analgesia, elements contributing to pain exacerbation or alleviation, and the outcomes of analgesic measures. The cumulative score for the pain self-efficacy questionnaire among nurses in the intervention department was 63.95±21.83. Multiple linear regression analysis revealed that variables such as the acquisition of pain knowledge, the frequency of pain training in the past two years, the ratio of evaluation tools employed for assessment, the prevalent utilization of multi-dimensional evaluation instruments, and professional course studies in academia were determinants influencing pain management self-efficacy.

Conclusion

Perioperative pain management by interventional department nurses in China is unstandardized and lacks continuous education. Nursing administrators should create targeted training to boost pain assessment, prevention and treatment abilities.

HN1-mediated activation of lipogenesis through Akt-SREBP signaling promotes hepatocellular carcinoma cell proliferation and metastasis

Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related deaths worldwide, with more than 800,000 deaths each year, and its 5-year survival rate is less than 12%. The role of the HN1 gene in HCC has remained elusive, despite its upregulation in various cancer types. In our investigation, we identified HN1's heightened expression in HCC tissues, which, upon overexpression, fosters cell proliferation, migration, and invasion, unveiling its role as an oncogene in HCC. In addition, silencing HN1 diminished the viability and metastasis of HCC cells, whereas HN1 overexpression stimulated their growth and invasion. Gene expression profiling revealed HN1 silencing downregulated 379 genes and upregulated 130 genes, and suppressive proteins associated with the lipogenic signaling pathway networks. Notably, suppressing HN1 markedly decreased the expression levels of SREBP1 and SREBP2, whereas elevating HN1 had the converse effect. This dual modulation of HN1 affected lipid formation, hindering it upon HN1 silencing and promoting it upon HN1 overexpression. Moreover, HN1 triggers the Akt pathway, fostering tumorigenesis via SREBP1-mediated lipogenesis and silencing HN1 effectively curbed HCC tumor growth in mouse xenograft models by deactivating SREBP-1, emphasizing the potential of HN1 as a therapeutic target, impacting both external and internal factors, it holds promise as an effective therapeutic strategy for HCC.

Construction of pain prediction model for patients undergoing hepatic arterial chemoembolization

OBJECTIVE

To construct a predictive model for pain in patients undergoing hepatic arterial chemoembolization (TACE) in interventional operating room.

METHODS

Through literature review and expert interviews, a questionnaire was prepared for the assessment of pain factors in patients with hepatic arterial chemoembolization. A prospective cohort study was used to select 228 patients with hepatic arterial chemoembolization in a tertiary and first-class hospital. The data of the patients in the pain group and the non-pain group were compared, and a rapid screening prediction model was constructed by univariate analysis and logistic regression analysis, and its prediction effect was tested.

RESULTS

Tumor size, liver cancer stage, and chemoembolization with drug-loaded microspheres and pirarubicin hydrochloride (THP) mixed with lipiodol were independent predictors of pain in patients after hepatic arterial chemoembolization. Finally, the pain prediction model after TACE was obtained. The results of Hosmer-Lemeshow test showed that the model fit was good (χ² = 13.540, p = 0.095). The area under the receiver operating characteristic curve was 0.798, p < 0.001.

CONCLUSION

The rapid screening and prediction model of pain in patients undergoing hepatic arterial chemoembolization has certain efficacy, which is helpful for clinical screening of patients with high risk of pain, and can provide reference for predictive pain management decision-making.

Non-coding RNAs associated with autophagy and their regulatory role in cancer therapeutics

Cancer widely affects the world's health population and ranks second leading cause of death globally. Because of poor prognosis of various types of cancer such as sarcoma, lymphoma, adenomas etc., their high recurrence and metastasis rate and low early diagnosis rate have become concern lately. Role of autophagy in cancer progression is being studied since long. Autophagy is cell's self-degradative mechanism towards stress and has role in degradation of the cytoplasmic macromolecules which has potential to damage other cytosolic molecules. Autophagy can promote as well as inhibit tumorigenesis depending upon the associated protein combinations in cancer cells. Recent studies have shown that non-coding RNAs (ncRNAs) do not code for protein but play essential role in modulation of gene expression. At transcriptional level, different ncRNAs like lncRNAs, miRNAs and circRNAs directly or indirectly affect different stages of autophagy like autophagy-dependent and non-apoptotic cell death in cancer cells. This review focuses on the involvement of ncRNAs in autophagy and the modulation of several cancer signal transduction pathways in cancers such as lung, breast, prostate, pancreatic, thyroid, and kidney cancer.

A Comparison of Adverse Events Among Radiofrequency Ablation, Conventional Transarterial Chemoembolization (TACE) and Drug-Eluting Bead TACE in Treating Hepatocellular Carcinoma Patients

Background

There has been very limited investigation regarding the comparison of adverse events (AEs) among radiofrequency ablation (RFA), conventional transarterial chemoembolization (cTACE), and drug-eluting bead TACE (DEB-TACE) in treating HCC patients; therefore, the present study aimed to resolve this issue.

Methods

Two-hundred and forty-six HCC patients (with a total of 267 procedures [treatment times]) treated with RFA (73 patients with 79 procedures), cTACE (86 patients with 94 procedures), or DEB-TACE (87 patients with 94 procedures) were included. Demographic and clinical data were collected. The information on AEs was also retrieved and analyzed.

Results

Total AEs incidence was notably different among the RFA group, cTACE group, and DEB-TACE group and was the highest in cTACE group (86.2%), then in DEB-TACE group (76.6%), and the lowest in RFA group (63.3%). Regarding specific AEs incidence, the incidences of fever, fatigue, and nausea were distinctive among the three groups, while no distinctiveness was found in incidence of other AEs. Furthermore, multivariate logistic regression revealed that cTACE (versus RFA) was independently correlated with increased risk of total AEs, fatigue, and nausea/vomiting; however, the interventional therapies were not independently correlated with the risk of pain, fever or constipation. Other independent predictive factors for total AEs risk were male gender, bronchial asthma, and disease duration.

Conclusion

cTACE resulted in the highest AEs incidence compared with RFA and DEB-TACE in treating HCC patients.