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Yu J, Zhu H, Zhang Y, Wang D, Guo H, Liu X, Lai J, Zhang H, Xu H, Bai B. The relationship between dysphagia and frailty among Chinese hospitalized older patients: a serial mediation model through self-perceived oral health and self-reported nutritional status. BMC Geriatr 2024; 24:110. [PMID: 38287262 PMCID: PMC10826207 DOI: 10.1186/s12877-024-04684-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 01/08/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Frailty contributes to adverse outcomes in older adults and places a heavy burden on healthcare resources. Dysphagia is associated with frailty, but the mechanisms by which dysphagia affects frailty in older adults are unclear. This study aimed to investigate a serial mediating effect of self-perceived oral health and self-reported nutritional status in the relationship between dysphagia and frailty among hospitalized older patients in China. METHODS This cross-sectional study included 1200 patients aged ≥ 65 years in the Department of Geriatrics, Shaanxi Provincial People's Hospital. A structured face-to-face interview was used to survey the following questionnaires: General Information Questionnaire, Tilburg Frailty Indicators (TFI), Eating Assessment Tool-10 (EAT-10), 30mL Water Swallow Test (WST), Geriatric Oral Health Assessment Index (GOHAI), and Short-Form Mini-Nutritional Assessment (MNA-SF). A total of 980 participants with complete data were included in the analysis. Statistical analysis was performed using SPSS 26.0 and Amos 28.0 software. Spearman's correlation analysis was used for correlation analysis of study variables. The results of the multivariate linear regression analysis for frailty were used as covariates in the mediation analysis, and the structural equation model (SEM) was used to analyze the mediating effects among the study variables. RESULTS Dysphagia, self-perceived oral health, self-reported nutritional status, and frailty were significantly correlated (P<0.001). Dysphagia was found to directly affect frailty (β = 0.161, 95%CI = 0.089 to 0.235) and through three significant mediation pathways: (1) the path through self-perceived oral health (β = 0.169, 95%CI = 0.120 to 0.221), accounting for 36.98% of the total effect; (2) the path through self-reported nutritional status (β = 0.050, 95%CI = 0.023 to 0.082), accounting for 10.94% of the total effect; (3) the path through self-perceived oral health and self-reported nutritional status (β = 0.077, 95%CI = 0.058 to 0.102), accounting for 16.85% of the total effect. The total mediation effect was 64.77%. CONCLUSIONS This study indicated that dysphagia was significantly associated with frailty. Self-perceived oral health and self-reported nutritional status were serial mediators of this relationship. Improving the oral health and nutritional status of hospitalized older patients may prevent or delay the frailty caused by dysphagia.
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Affiliation(s)
- Jianjiao Yu
- School of Nursing, Xi'an Jiaotong University, 76 Yanta West Road, 710061, Xi'an, China
| | - Huolan Zhu
- Department of Geriatrics, Shaanxi Provincial People's Hospital, 256 Youyi West Road, 710068, Xi'an, China.
- Shaanxi Provincial Clinical Research Center for Geriatric Medicine, Shaanxi Provincial People's Hospital, 256 Youyi West Road, 710068, Xi'an, China.
| | - Yulian Zhang
- Director's Office, Shaanxi Provincial People's Hospital, 256 Youyi West Road, 710068, Xi'an, China.
| | - Dan Wang
- Department of Nursing, Shaanxi Provincial People's Hospital, 256 Youyi West Road, 710068, Xi'an, China
| | - Hua Guo
- Department of Nursing, Shaanxi Provincial People's Hospital, 256 Youyi West Road, 710068, Xi'an, China
| | - Xiaomei Liu
- Department of Nursing, Shaanxi Provincial People's Hospital, 256 Youyi West Road, 710068, Xi'an, China
| | - Jin Lai
- School of Nursing, Shaanxi University of Chinese Medicine, Xixian Road, 712046, Xi'an, China
| | - Huiying Zhang
- School of Nursing, Yan'an University, 580 Shengdi Road, 716000, Yan'an, China
| | - Huanhuan Xu
- School of Nursing, Yan'an University, 580 Shengdi Road, 716000, Yan'an, China
| | - Bingyue Bai
- School of Nursing, Yan'an University, 580 Shengdi Road, 716000, Yan'an, China
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Han X, Liang L, He C, Ren Q, Su J, Cao L, Zheng J. A real-world study and network pharmacology analysis of EGFR-TKIs combined with ZLJT to delay drug resistance in advanced lung adenocarcinoma. BMC Complement Med Ther 2023; 23:422. [PMID: 37990309 PMCID: PMC10664478 DOI: 10.1186/s12906-023-04213-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/12/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE This study aimed to explore the efficacy and safety of combining epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) with ZiLongJin Tablet (ZLJT) in delaying acquired resistance in advanced EGFR-mutant lung adenocarcinoma (LUAD) patients. Furthermore, we employed network pharmacology and molecular docking techniques to investigate the underlying mechanisms. METHODS A retrospective comparative study was conducted on stage IIIc/IV LUAD patients treated with EGFR-TKIs alone or in combination with ZLJT at the Second Affiliated Hospital of the Air Force Medical University between January 1, 2017, and May 1, 2023. The study evaluated the onset of TKI resistance, adverse reaction rates, safety indicators (such as aspartate aminotransferase, alanine aminotransferase, and creatinine), and inflammatory markers (neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio) to investigate the impact of EGFR-TKI combined with ZLJT on acquired resistance and prognostic indicators. Additionally, we utilized the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform, the Bioinformatics Analysis Tool for Molecular Mechanism of Traditional Chinese Medicine, PubChem, UniProt, and Swiss Target Prediction databases to identify the active ingredients and targets of ZLJT. We obtained differentially expressed genes related to EGFR-TKI sensitivity and resistance from the Gene Expression Omnibus database using the GSE34228 dataset, which included sensitive (n = 26) and resistant (n = 26) PC9 cell lines. The "limma" package in R software was employed to detect DEGs. Based on this, we constructed a protein‒protein interaction network, performed gene ontology and KEGG enrichment analyses, and conducted pathway network analysis to elucidate the correlation between the active ingredients in ZLJT and signaling pathways. Finally, molecular docking was performed using AutoDockVina, PYMOL 2.2.0, and Discovery Studio Client v19.1.0 software to simulate spatial and energy matching during the recognition process between predicted targets and their corresponding compounds. RESULTS (1) A total of 89 patients were included, with 40 patients in the EGFR-TKI combined with ZLJT group (combination group) and 49 patients in the EGFR-TKI alone group (monotherapy group). The baseline characteristics of the two groups were comparable. There was a significant difference in the onset of resistance between the combination group and the monotherapy group (P < 0.01). Compared to the monotherapy group, the combination group showed a prolongation of 3.27 months in delayed acquired resistance. There was also a statistically significant difference in the onset of resistance to first-generation TKIs between the two groups (P < 0.05). (2) In terms of safety analysis, the incidence of adverse reactions related to EGFR-TKIs was 12.5% in the combination group and 14.3% in the monotherapy group, but this difference was not statistically significant (P > 0.05). There were no statistically significant differences in serum AST, ALT, CREA, TBIL, ALB and BUN levels between the two groups after medication (P > 0.05). (3) Regarding inflammatory markers, there were no statistically significant differences in the changes in neutrophil-to-lymphocyte Ratio(NLR) and Platelet-to-lymphocyte Ratio(PLR) values before and after treatment between the two groups (P > 0.05). (4) Network pharmacology analysis identified 112 active ingredients and 290 target genes for ZLJT. From the GEO database, 2035 differentially expressed genes related to resistant LUAD were selected, and 39 target genes were obtained by taking the intersection. A "ZLJT-compound-target-disease" network was successfully constructed using Cytoscape 3.7.0. GO enrichment analysis revealed that ZLJT mainly affected biological processes such as adenylate cyclase-modulating G protein-coupled receptor. In terms of cellular components, ZLJT was associated with the cell projection membrane. The molecular function primarily focused on protein heterodimerization activity. KEGG enrichment analysis indicated that ZLJT exerted its antitumor and anti-drug resistance effects through pathways such as the PI3K-Akt pathway. Molecular docking showed that luteolin had good binding activity with FOS (-9.8 kJ/mol), as did tanshinone IIA with FOS (-9.8 kJ/mol) and quercetin with FOS (-8.7 kJ/mol). CONCLUSION ZLJT has potential antitumor progression effects. For patients with EGFR gene-mutated non-small cell LUAD, combining ZLJT with EGFR-TKI treatment can delay the occurrence of acquired resistance. The underlying mechanisms may involve altering signal transduction pathways, blocking the tumor cell cycle, inhibiting tumor activity, enhancing cellular vitality, and improving the bioavailability of combination therapy. The combination of EGFR-TKI and ZLJT represents an effective approach for the treatment of tumors using both Chinese and Western medicine.
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Affiliation(s)
- Xue Han
- Shaanxi University of Chinese Medicine, Shiji Avenue, Xixian new area, Xianyang, Shaanxi, China
- The Second Affiliated Hospital of Air Force Medical University, Xinsi Avenue, Baqiao Area, Xi'an, Shaanxi, China
| | - Lan Liang
- Shaanxi University of Chinese Medicine, Shiji Avenue, Xixian new area, Xianyang, Shaanxi, China
| | - Chenming He
- Shaanxi University of Chinese Medicine, Shiji Avenue, Xixian new area, Xianyang, Shaanxi, China
| | - Qinyou Ren
- The Second Affiliated Hospital of Air Force Medical University, Xinsi Avenue, Baqiao Area, Xi'an, Shaanxi, China
| | - Jialin Su
- The Second Affiliated Hospital of Air Force Medical University, Xinsi Avenue, Baqiao Area, Xi'an, Shaanxi, China
| | - Liang Cao
- The Second Affiliated Hospital of Air Force Medical University, Xinsi Avenue, Baqiao Area, Xi'an, Shaanxi, China.
| | - Jin Zheng
- The Second Affiliated Hospital of Air Force Medical University, Xinsi Avenue, Baqiao Area, Xi'an, Shaanxi, China.
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Luo M, Liu F, Liang Y, Strotz LC, Wang J, Hu Y, Song B, Holmer LE, Zhang Z. First Report of Small Skeletal Fossils from the Upper Guojiaba Formation (Series 2, Cambrian), Southern Shaanxi, South China. Biology (Basel) 2023; 12:902. [PMID: 37508335 PMCID: PMC10376166 DOI: 10.3390/biology12070902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023]
Abstract
A small skeletal fossil assemblage is described for the first time from the bioclastic limestone interbeds of the siltstone-dominated Guojiaba Formation, southern Shaanxi, China. The carbonate-hosted fossils include brachiopods (Eohadrotreta zhujiahensis, Eohadrotreta zhenbaensis, Spinobolus sp., Kuangshanotreta malungensis, Kyrshabaktella sp., Lingulellotreta yuanshanensis, Eoobolus incipiens, and Eoobolus sp.), sphenothallids (Sphenothallus sp.), archaeocyaths (Robustocyathus sp. and Yukonocyathus sp.), bradoriids (Kunmingella douvillei), chancelloriids sclerites (Onychia sp., Allonnia sp., Diminia sp., Archiasterella pentactina, and Chancelloria cf. eros), echinoderm plates, fragments of trilobites (Eoredlichia sp.), and hyolithelminths. The discovery of archaeocyaths in the Guojiaba Formation significantly extends their stratigraphic range in South China from the early Tsanglangpuian at least to the late Chiungchussuan. Thus, the Guojiaba Formation now represents the lowest known stratigraphic horizon where archaeocyath fossils have been found in the southern Shaanxi area. The overall assemblage is most comparable, in terms of composition, to Small skeletal fossil (SSF) assemblages from the early Cambrian Chengjiang fauna recovered from the Yu'anshan Formation in eastern Yunnan Province. The existing position that the Guojiaba Formation is correlated with Stage 3 in Cambrian Series 2 is strongly upheld based on the fossil assemblage recovered in this study.
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Affiliation(s)
- Mei Luo
- State Key Laboratory of Continental Dynamics, Shaanxi Key Laboratory of Early Life & Environments, Department of Geology, Northwest University, Xi'an 710069, China
| | - Fan Liu
- State Key Laboratory of Continental Dynamics, Shaanxi Key Laboratory of Early Life & Environments, Department of Geology, Northwest University, Xi'an 710069, China
| | - Yue Liang
- State Key Laboratory of Continental Dynamics, Shaanxi Key Laboratory of Early Life & Environments, Department of Geology, Northwest University, Xi'an 710069, China
| | - Luke C Strotz
- State Key Laboratory of Continental Dynamics, Shaanxi Key Laboratory of Early Life & Environments, Department of Geology, Northwest University, Xi'an 710069, China
- Biodiversity Institute and Department of Ecology & Evolutionary Biology, University of Kansas, Lawrence, KS 66045, USA
- Department of Palaeontology, University of Vienna, Althanstrasse 14, 1090 Vienna, Austria
| | - Jiayue Wang
- State Key Laboratory of Continental Dynamics, Shaanxi Key Laboratory of Early Life & Environments, Department of Geology, Northwest University, Xi'an 710069, China
| | - Yazhou Hu
- State Key Laboratory of Continental Dynamics, Shaanxi Key Laboratory of Early Life & Environments, Department of Geology, Northwest University, Xi'an 710069, China
| | - Baopeng Song
- State Key Laboratory of Continental Dynamics, Shaanxi Key Laboratory of Early Life & Environments, Department of Geology, Northwest University, Xi'an 710069, China
| | - Lars E Holmer
- State Key Laboratory of Continental Dynamics, Shaanxi Key Laboratory of Early Life & Environments, Department of Geology, Northwest University, Xi'an 710069, China
- Palaeobiology, Department of Earth Sciences, Uppsala University, SE-752 36 Uppsala, Sweden
| | - Zhifei Zhang
- State Key Laboratory of Continental Dynamics, Shaanxi Key Laboratory of Early Life & Environments, Department of Geology, Northwest University, Xi'an 710069, China
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