[Surgical treatment and prognosis analysis of hilar cholangiocarcinoma]

Objective: To investigate the surgical treatment effect and prognostic factors of hilar cholangiocarcinoma. Methods: This is an ambispective cohort study. From August 2005 to December 2022,data of 510 patients who diagnosed with hilar cholangiocarcinoma and underwent surgical resection at the Hepatobiliary Center of the First Affiliated Hospital of Nanjing Medical University were retrospectively collected. In the cohort,there were 324 males and 186 females,with an age of (M (IQR)) 63(13)years (range:25 to 85 years). The liver function at admission was Child-Pugh A (343 cases,67.3%) and Child-Pugh B (167 cases,32.7%). Three hundred and seventy-two(72.9%) patients had jaundice symptoms and the median total bilirubin was 126.3(197.6) μmol/L(range: 5.4 to 722.8 μmol/L) at admission. Two hundred and fourty-seven cases (48.4%) were treated with percutaneous transhepatic cholangial drainage or endoscopic nasobiliary drainage before operation. The median bilirubin level in the drainage group decreased from 186.4 μmol/L to 85.5 μmol/L before operation. Multivariate Logistic regression was used to identify the influencing factors for R0 resection,and Cox regression was used to construct multivariate prediction models for overall survival(OS) and disease-free survival(DFS). Results: Among 510 patients who underwent surgical resection,Bismuth-Corlett type Ⅲ-Ⅳ patients accounted for 71.8%,among which 86.1% (315/366) underwent hemi-hepatectomy,while 81.9% (118/144) underwent extrahepatic biliary duct resection alone in Bismuch-Corlett type Ⅰ-Ⅱ patients. The median OS time was 22.8 months, and the OS rates at 1-,3-,5-and 10-year were 72.2%,35.6%,24.8% and 11.0%,respectively. The median DFS time was 15.2 months,and the DFS rates was 66.0%,32.4%,20.9% and 11.0%,respectively. The R0 resection rate was 64.5% (329/510), and the OS rates of patients with R0 resection at 1-,3-,5-and 10-year were 82.5%, 48.6%, 34.4%, 15.2%,respectively. The morbidity of Clavien-Dindo grade Ⅲ-Ⅴ complications was 26.1%(133/510) and the 30-day mortality was 4.3% (22/510). Multivariate Logistic regression indicated that Bismuth-Corlett type Ⅰ-Ⅲ (P=0.009), hemi-hepatectomy and extended resection (P=0.001),T1 and T2 patients without vascular invasion (T2 vs. T1:OR=1.43 (0.61-3.35),P=0.413;T3 vs. T1:OR=2.57 (1.03-6.41), P=0.010;T4 vs. T1, OR=3.77 (1.37-10.38), P<0.01) were more likely to obtain R0 resection. Preoperative bilirubin,Child-Pugh grade,tumor size,surgical margin,T stage,N stage,nerve infiltration and Edmondson grade were independent prognostic factors for OS and DFS of hilar cholangiocarcinoma patients without distant metastasis. Conclusions: Radical surgical resection is necessary to prolong the long-term survival of hilar cholangiocarcinoma patients. Hemi-hepatectomy and extended resection,regional lymph node dissection and combined vascular resection if necessary,can improve R0 resection rate.

[Preparation of chitin/hyaluronic acid/collagen hydrogel loaded with mouse adipose-derived stem cells and its effects on wound healing of full-thickness skin defects in rats]

Objective: To prepare the chitin/hyaluronic acid/collagen hydrogel loaded with mouse adipose-derived stem cells and to explore its effects on wound healing of full-thickness skin defects in rats. Methods: The research was an experimental research. Chitin nanofibers were prepared by acid hydrolysis and alkaline extraction method, and then mixed with hyaluronic acid and collagen to prepare chitin/hyaluronic acid/collagen hydrogels (hereinafter referred to as hydrogels). Besides, the hydrogels loaded with mouse adipose-derived stem cells were prepared. Thirty male 12-week-old guinea pigs were divided into negative control group, positive control group, and hydrogel group according to the random number table, with 10 guinea pigs in each group. Ethanol, 4-aminobenzoic acid ethyl ester, or the aforementioned prepared hydrogels without cells were topically applied on both sides of back of guinea pigs respectively for induced contact and stimulated contact, and skin edema and erythema formation were observed at 24 and 48 h after stimulated contact. Adipose-derived stem cells from mice were divided into normal control group cultured routinely and hydrogel group cultured with the aforementioned prepared hydrogels without cells. After 3 d of culture, protein expressions of platelet-derived growth factor-D (PDGF-D), insulin-like growth factor-Ⅰ (IGF-Ⅰ), and transforming growth factor β1 (TGF-β1) were detected by Western blotting (n=3). Eight male 8-week-old Sprague-Dawley rats were taken and a circular full-thickness skin defect wound was created on each side of the back. The wounds were divided into blank control group without any treatment and hydrogel group with the aforementioned prepared hydrogels loaded with adipose-derived stem cells applied. Wound healing was observed at 0 (immediately), 2, 4, 8, and 10 d after injury, and the wound healing rate was calculated at 2, 4, 8, and 10 d after injury. Wound tissue samples at 10 d after injury were collected, the new tissue formation was observed by hematoxylin-eosin staining; the concentrations of interleukin-1α (IL-1α), IL-6, IL-4, and IL-10 were detected by enzyme-linked immunosorbent assay method; the expressions of CD16 and CD206 positive cells were observed by immunohistochemical staining and the percentages of positive cells were calculated. The sample numbers in animal experiment were all 8. Results: At 24 h after stimulated contact, no skin edema was observed in the three groups of guinea pigs, and only mild skin erythema was observed in 7 guinea pigs in positive control group. At 48 h after stimulated contact, skin erythema was observed in 8 guinea pigs and skin edema was observed in 4 guinea pigs in positive control group, while no obvious skin erythema or edema was observed in guinea pigs in the other two groups. After 3 d of culture, the protein expression levels of PDGF-D, IGF-I, and TGF-β1 in adipose-derived stem cells in hydrogel group were significantly higher than those in normal control group (with t values of 12.91, 11.83, and 7.92, respectively, P<0.05). From 0 to 10 d after injury, the wound areas in both groups gradually decreased, and the wounds in hydrogel group were almost completely healed at 10 d after injury. At 4, 8, and 10 d after injury, the wound healing rates in hydrogel group were (38±4)%, (54±5)%, and (69±6)%, respectively, which were significantly higher than (21±6)%, (29±7)%, and (31±7)% in blank control group (with t values of 3.82, 3.97, and 4.05, respectively, Pvalues all <0.05). At 10 d after injury, compared with those in blank control group, the epidermis in wound in hydrogel group was more intact, and there were increases in hair follicles, blood vessels, and other skin appendages. At 10 d after injury, the concentrations of IL-1α and IL-6 in wound tissue in hydrogel group were significantly lower than those in blank control group (with tvalues of 8.21 and 7.99, respectively, P<0.05), while the concentrations of IL-4 and IL-10 were significantly higher than those in blank control group (with tvalues of 6.57 and 9.03, respectively, P<0.05). The percentage of CD16 positive cells in wound tissue in hydrogel group was significantly lower than that in blank control group (t=8.02, P<0.05), while the percentage of CD206 positive cells was significantly higher than that in blank control group (t=7.21, P<0.05). Conclusions: The hydrogel loaded with mouse adipose-derived stem cells is non-allergenic, can promote the secretion of growth factors in adipose-derived stem cells, promote the polarization of macrophages to M2 phenotype in wound tissue in rats with full-thickness skin defects, and alleviate inflammatory reaction, thereby promoting wound healing.

[Molecular epidemiology and antibiotic resistance of Pseudomonas aeruginosa isolated from blood in a hospital in Shandong Province from 2014 to 2021]

Objective: To identify the antibiotic resistance, virulence genes, and sequence types of Pseudomonas aeruginosa (P. aeruginosa) strains isolated from blood. Methods: From November 2014 to December 2021, a total of 94 nonrepetitive P. aeruginosa isolates were obtained from blood samples of patients at the First Affiliated Hospital of Shandong First Medical University in Shandong Province, China. The bacteria were identified using matrix-assisted laser desorption ionization time of flight mass spectrometry. Antibiotic resistance of the P. aeruginosa isolates was detected using Vitek 2 Compact system. Polymerase chain reaction (PCR) was conducted for the 18 virulence genes, and multi locus sequence typing (MLST) was performed to identify the sequence types of the P. aeruginosa strains. The resistance rates and distributions of virulence genes between carbapenem resistant pseudomonas aeruginosa (CRPA) and carbapenem susceptible pseudomonas aeruginosa (CSPA) isolates were compared using the Chi-square test. Results: Among 94 P. aeruginosa isolates, 19 (20.2%) isolates were found to be multidrug resistant (MDR) bacteria, of which 17 were CRPA isolates and 2 were CSPA isolates. All strains contained more than 10 virulence genes. Except for exoU gene, the detection rate of other genes was above 83%. MLST analysis revealed a total of 66 different STs, including 59 existing STs and 7 novel STs. Among them, ST244 (n=11, 11.7%) and ST270 (n=7, 7.4%) were the dominant STs. Although these two types of isolates harbored the same virulence genes, the resistance rates to carbapenem were different. 54.5% (6/11) ST244 isolates were CRPA but all 7 ST270 isolates were CSPA. Conclusion: Although the resistance rates of P. aeruginosa strains isolated from blood were at a low level, some MDR and CRPA isolates were detected. As the high virulence gene detection rates and genetic diversity were found for P. aeruginosa strains isolated from blood, close attention should be paid to avoid transmission and outbreaks.

[Genetic mutation profiles for children with congenital hypothyroidism in Fujian province]

Objective: To explore the mutation characteristics of pathogenic genes in children with congenital hypothyroidism (CH) in Fujian. Methods: The clinical data of 116 unrelated CH children diagnosed in Fujian Provincial Maternal and Child Health Hospital from January 2019 to September 2020 were retrospectively analyzed, including 50 females and 66 males, with an average age of (20±10) days at diagnosis. Targeted exome sequencing technology was used to detect the mutation frequency, type and distribution characteristics of 29 genes related to thyroxine synthesis or thyroid development. Results: Three hundred and fifty-one potential functional mutations were detected in 105 of 116 CH patients, with a detection rate of 90.5% (105/116). DUOX2 (66.4%, 77/116) was the most frequent mutated gene, followed by TG (23.3%, 27/116), DUOXA1 (23.3%, 27/116), and TPO (12.1%, 14/116), which were all involved in thyroid hormone synthesis. Among the 105 children with CH, 70 cases carried double allele mutation. Except for 3 cases of thyroid dysplasia related genes (2 cases of TSHR and 1 case of GLIS3), the rest were also related to thyroid hormone synthesis. The gene with the highest carrier rate was DUOX2 (68.8%, 59/70), followed by TG (8.6%, 6/70), TPO (4.3%, 3/70), DUOXA2 (1.4%, 1/70) and DUOXA1 (1.4%, 1/70). Conclusion: The main mutated genes in CH children in Fujian are the key genes involved in thyroid hormone synthesis, such as DUOX2, TG and TPO.

Efficacy of cryoablation versus antiarrhythmic therapy for treatment of atrial fibrillation: a systematic review and meta-analysis

Funding Acknowledgements

Type of funding sources: None.

Introduction

Atrial fibrillation (AF) is a common arrhythmia that causes various complications if left untreated. Current primary care guidelines recommend administration of antiarrhythmic drugs (AAD) as the preferred treatment regimen for first diagnosed AF and considers ablation if there is failure of therapy. However, recent studies show the benefit of cryoablation on the initial treatment of AF.

Purpose

The primary objective of this study is to determine the efficacy and the safety of cryoablation therapy over AAD as treatment regimen for atrial fibrillation.

Methods

A comprehensive and relevant search of randomized controlled trials (RCT) was conducted examining the use of cryoablation as initial treatment of AF compared to AAD. Outcome measures for recurrence of atrial arrhythmias and serious adverse effects (SAEs) were extracted and analyzed using Review Manager 5.4. Fixed effects model was used initially for both outcomes; however, if there was substantial heterogeneity (I² &gt; 50%), random effects model was then used.

Results

Four studies were included in the meta-analysis with a total of 969 subjects analyzed. Initially, a fixed effect model was used to compute for the Risk Ratio (RR) which yielded RR of 0.55 [95% CI: 0.49-0.63], I²=93, p &lt; 0.0001. Since there was substantial heterogeneity among the four RCTs, a random effects model was then used. The heterogeneity may be attributed to the difference in study designs as some of the studies involved a cross-over design. Using the random effects model, the computed RR was 0.50 [95% CI: 0.33-0.85], I²=93, p = 0.01. Hence, cryoballoon therapy is found to be more beneficial in preventing recurrence of atrial arrhythmias. This result can be interpreted as statistically significant given that the p value is &lt; 0.05.

On the other hand, the fixed effects model revealed there was no significant difference between cryoballoon therapy and AAD in terms of SAE (RR 0.80 [95%CI: 0.58-1.10], I²=0, p=0.17). SAEs included in the studies included the following but not limited to death, stroke, acute coronary syndrome, syncope, pulmonary embolism, etc.

Conclusion

Cryoablation therapy is more beneficial in preventing atrial arrhythmias compared to AADs. The rate of serious adverse event is similar between cryoablation therapy and AAD.

[Efficacy and safety of neoadjuvant immunotherapy for hepatocellular carcinoma]

Objective: To study the surgical safety and efficacy of preoperative neoadjuvant therapy with immune checkpoint inhibitors combined with anti-angiogenic drugs in patients with China liver cancer staging(CNLC)-Ⅱb and Ⅲa resectable hepatocellular carcinoma. Methods: The data of 129 patients with Ⅱb and Ⅲa hepatocellular carcinoma who underwent surgery at the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2020 were analyzed. All patients were divided into two groups: the neoadjuvant therapy group(n=14,13 males and 1 female,aged (55.4±12.6)years(range:34 to 75 years)) received immune combined targeted therapy before surgery,immune checkpoint inhibitor camrelizumab was administered intravenously at a dose of 200 mg each time,every 2 weeks for 3 cycles,anti-angiogenesis drug apatinib was taken orally and continuously with a dose of 250 mg for 3 weeks and the conventional surgery group(n=115,103 males and 12 females,aged (55.8±12.0)years(range:21 to 83 years)) did not receive antitumor systemic therapy before surgery. There were 3 patients with CNLC-Ⅱb,11 with CNLC-Ⅲa in the neoadjuvant group;28 patients with CNLC-Ⅱb,87 with CNLC-Ⅲa in the conventional group. Student's t test or rank-sum test was used to compare the differences between two groups for quantitative data, Fisher's exact probability method was used to compare the differences of proportions between two groups, and Log-rank test was used to compare survival differences between two groups. Results: The 1-year recurrence rate in the neoadjuvant group was 42.9%,and the 1-year recurrence rate in the conventional group was 64.0%,with a statistically significant difference between the two groups(χ²=3.850,P=0.050);The 1-year survival rate in the neoadjuvant group was 100% and that in the conventional group was 74.2%,with a statistically significant difference between the two groups(χ²=5.170,P=0.023). According to the stratified analysis of the number of tumors,for single tumor,the 1-year recurrence rate in the neoadjuvant group was 25.0%,and that in the conventional surgery group was 71.0%,and the difference between the two groups was statistically significant(χ²=5.280, P=0.022). For multiple tumors, the 1-year recurrence rate in the neoadjuvant group was 66.7%,and the 1-year recurrence rate in the conventional surgery group was 58.9%,with no significant difference between the two groups(χ²=0.110,P=0.736). The operative time,intraoperative blood loss,and postoperative hospital stay in the neoadjuvant group were similar to those in the conventional group,and their differences were not statistically significant. Conclusions: Immune checkpoint inhibitors combined with anti-angiogenic targeted drugs as a neoadjuvant therapy for resectable hepatocellular carcinoma can reduce the 1-year recurrence rate and improve the 1-year survival rate,especially for those with solitary tumor. Limited by the sample size of the neoadjuvant group,the safety of immune combined targeted therapy before surgery cannot be observed more comprehensively,and further studies will be explored.

The Efficacy of an Ultrasound-Guided Improved Puncture Path Technique of Nerve Block/Pulsed Radiofrequency for Pudendal Neuralgia: A Retrospective Study

Objectives: To investigate the efficacy and safety of an improved ultrasound-guided pulsed radiofrequency (PRF) and nerve block (NB) for patients with pudendal neuralgia (PN). Methods: This retrospective analysis included 88 adults with PN treated in the Pain Department of Southwest Hospital from November 2011 to June 2021, with treatment including NB (n = 40) and PRF (n = 48). The primary outcome variable was pain severity, measured by a standardized visual analog scale (VAS). VAS values were collected at 1, 3, 7, and 14 days and 1 and 3 months after patients were treated with NB or PRF. Results: Compared with patients treated with NB (n = 40) and those treated with PRF (n = 48), no significant difference in pain reduction was observed in the short term (p = 0.739 and 0.981, at 1 and 3 days, respectively); however, in the medium and long term (1 to 3 months), there were statistically significant improvements in the PRF group over the NB group (p < 0.001). Moreover, it was noted that the average pain severity of primary PN and PN due to sacral perineurial cyst was significantly reduced with PRF therapy in the medium and long term when compared to other secondary PNs, including surgery, trauma, and diabetes. Discussion: The ultrasound-guided, improved, and innovative PRF/NB puncture path technique allows for gentler stimulation and faster identification of the pudendal nerve. The PRF technique may provide better treatments for primary PN and sacral perineurial cyst causing secondary PN in the medium and long term.

Platinum chromium everolimus-eluting stent versus cobalt chromium zotarolimus-eluting stent in very late stent thrombosis: a meta-analysis of randomized controlled trials

Funding Acknowledgements

Type of funding sources: None.

Introduction

Very late stent thrombosis is a rare but potentially lethal outcome for drug-eluting stents used in percutaneous coronary intervention. There is limited research currently on the occurrence of very late stent thrombosis as a complication of two most used second-generation drug-eluting stents, i.e. platinum chromium everolimus-eluting stent (PtCR-EES) and cobalt chromium zotarolimus-eluting stent (CoCr-ZES).

Purpose

The study provides comparative information on the formation of very late stent thrombosis as a long-term outcome of PtCr-EES and CoCr-ZES. Results of this study may guide interventional cardiologists in decision-making regarding the choice of stent.

Methods

Randomized controlled trials (RCTs) which compared stent thrombosis end point of PtCr-EES and CoCr-ZES were identified through Pubmed.

Results

Data from three RCTs analyzed a total of 7,911 participants, with 4,574 in the PtCr-EES and 3,324 in the CoCr-ZES. Treatment with either stent showed no significant difference in the incidence of very late stent thrombosis.

Conclusion

  Both stents showed comparable incidence of very late stent thrombosis. Additional RCTs are recommended to further establish the results for very late stent thrombosis. Longer follow-up is also suggested to discover more long-term outcomes.

Geolocation Inference of Forensic Individual Origin by Soil Metagenomic Analysis

Abstract

Objective To preliminarily discuss the feasibility of geolocation inference of forensic individual origin by soil metagenomic analysis. Methods The 33 soil samples from Heilongjiang, Qinghai and Tibet were collected, total bacterial DNA in the samples were extracted, and universal primers were used to amplify the V3 and V4 hypervariable region of bacterial 16S rDNA. The region was sequenced by high-throughput sequencing （HTS） with the MiSeq sequencer. Bioinformatics analysis such as species composition and sample comparison was performed on sequencing data. The richness index and diversity index were calculated based on operational taxonomic unit （OTU） results. Results A total of 2 720 149 sequences were generated by sequencing. Those sequences were clustered into 114 848 OTUs. The Chao1 indexes of soil microorganisms in Heilongjiang, Qinghai, and Tibet were 797.45, 745.11 and 535.98, respectively, and Shannon indexes were 6.46, 6.36 and 6.25, respectively. The number of bacterial species and the community diversity in the soil from high to low were Heilongjiang > Qinghai > Tibet. The composition of soil bacteria in three provinces at various classification levels were obtained, the dominant genuses in Heilongjiang were Chthoniobacteraceae DA101 and an unannotated genus of Thermogemmatisporaceae; the dominant genuses in Qinghai were an unannotated genus of Cytophagaceae and an unannotated genus of Nocardioidaceae; the dominant genuses in Tibet were an unannotated genus of Comamonadaceae and Verrucomicrobiaceae Luteolibacter. The results of principal co-ordinates analysis demonstrated that, according to the weighted UniFrac analysis, the three principle components represented 56.36% of the total variable, and according to the unweighted UniFrac analysis, the three principle components represented 34.81% of the total variable. The samples from the same province could be clustered together, and the species and content of soil microorganisms from different provinces were significantly different. Conclusion Based on the metagenomic analysis method, soil samples from different regions can be effectively distinguished, which has potential application value in geolocation inference of forensic individual origin in the future.

[Relationship between age at menarche and obesity in women]

Objective: To explore the relationship between age at menarche and general obesity (based on BMI) and central obesity (based on WC or WHtR) in middle-aged and elderly women in China. Methods: A total of 6 363 women from the China Health and Retirement Longitudinal Study were included. Restricted cubic splines based on binary logistic regressions were used to analyze the relationship between age at menarche and the risk of obesity. Age at menarche was divided into four groups: ≤13, 14- (control group), 16- , and ≥18 years old. Binary logistic regressions were applied to analyze the relationship between the continuous or grouped variable of age at menarche and the risk of obesity. Results: After adjusting potential confounders, the age at menarche showed a negative linear relationship with the risk of general obesity and central obesity. The risk for obesity based on BMI, WC and WHtR significantly decreased by 6% (OR=0.94, 95%CI: 0.90-0.99), 4% (OR=0.96, 95%CI: 0.92-1.00), and 6% (OR=0.94, 95%CI: 0.90-0.99) for each 1 year increase in age at menarche. Compared with participants who had menarche at age 14- years old, the risk for obesity based on BMI (OR=0.71, 95%CI: 0.55-0.91), WC (OR=0.75, 95%CI: 0.62-0.92) and WHtR (OR=0.76, 95%CI: 0.61-0.96) significantly decreased by 29%, 25%, and 24% in participants who had menarche at age ≥18 years old. Conclusions: There was a negative linear relationship between age at menarche and the risk for general obesity and central obesity in middle-aged and elderly women in China. Older age at menarche might be negatively associated with risk for obesity in middle-aged and elderly women.

p62 overexpression induces TDP-43 cytoplasmic mislocalisation, aggregation and cleavage and neuronal death

Amyotrophic lateral sclerosis (ALS) and frontotemporal lobar degeneration (FTLD) that exist on a spectrum of neurodegenerative disease. A hallmark of pathology is cytoplasmic TDP-43 aggregates within neurons, observed in 97% of ALS cases and ~ 50% of FTLD cases. This mislocalisation from the nucleus into the cytoplasm and TDP-43 cleavage are associated with pathology, however, the drivers of these changes are unknown. p62 is invariably also present within these aggregates. We show that p62 overexpression causes TDP-43 mislocalisation into cytoplasmic aggregates, and aberrant TDP-43 cleavage that was dependent on both the PB1 and ubiquitin-associated (UBA) domains of p62. We further show that p62 overexpression induces neuron death. We found that stressors (proteasome inhibition and arsenic) increased p62 expression and that this shifted the nuclear:cytoplasmic TDP-43 ratio. Overall, our study suggests that environmental factors that increase p62 may thereby contribute to TDP-43 pathology in ALS and FTLD.

Fecal microbiota transplantation for Crohn's disease: a systematic review and meta-analysis

BACKGROUND

Crohn's disease (CD) is a chronic idiopathic inflammatory intestinal disorder associated with fecal dysbiosis. Fecal microbiota transplantation (FMT) is an emerging treatment approach for CD. But its efficacy and safety remain controversial. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of FMT in CD patients.

METHODS

Electronic databases were searched for studies that reported efficacy and/or safety of FMT for CD. Clinical remission was established as the primary outcome. Secondary outcome was clinical response. Odds ratios with 95% confidence intervals (CIs) were reported.

RESULTS

In all, 12 trials were included in our study. Pooled analysis showed that 0.62 (95% CI 0.48, 0.81) of CD patients achieved clinical remission and 0.79 (95% CI 0.71, 0.89) of CD patients achieved clinical response post-FMT. Sub-analyses suggested the rate of clinical remission with fresh stool FMT was higher than with frozen stool FMT (73% vs 43%; p < 0.05). Most adverse events were minor and self-resolving and no major FMT-related adverse event has been reported so far.

CONCLUSIONS

The evidence showed that FMT is an effective and safe therapy for CD. FMT may be successful because it increases the overall diversity of enteric microbiome. Additional randomized controlled studies are needed.

Mitochondrial DNA Heteroplasmy of Hair Shaft Using HID Ion GeneStudioTM S5 Sequencing System

Objective To study the heteroplasmy of the whole mitochondrial genome genotyping result of hair shaft samples using HID Ion GeneStudio^TM S5 Sequencing System. Methods The buccal swabs and blood of 8 unrelated individuals, and hair shaft samples from different parts of the same individual were collected. Amplification of whole mitochondrial genome was performed using Precision ID mtDNA Whole Genome Panel. Analysis and detection of whole mitochondrial genome were carried out using the HID Ion GeneStudio^TM S5 Sequencing System. Results The mitochondrial DNA sequences in temporal hair shaft samples from 2 individuals showed heteroplasmy, while whole mitochondrial genome genotyping results of buccal swabs, blood, and hair samples from the other 6 unrelated individuals were consistent. A total of 119 base variations were observed from the 8 unrelated individuals. The numbers of variable sites of the individuals were 29, 40, 38, 35, 13, 36, 40 and 35, respectively. Conclusion Sequence polymorphism can be fully understood using HID Ion GeneStudio^TM S5 Sequencing system.

[Surgical treatment of primary liver cancer:a report of 10 966 cases]

Objective: To summarize the experience of surgical treatment of primary liver cancer. Methods: The clinical data of 10 966 surgically managed cases with primary liver cancer, from January 1986 to December 2019 at Hepatobiliary Center, the First Affiliated Hospital of Nanjing Medical University, were retrospectively analyzed. The life table method was used to calculate the survival rate and postoperative recurrence rate. Log-rank test was used to compare the survival process of different groups, and the Cox regression model was used for multivariate analysis. In addition, 2 884 cases of hepatocellular carcinoma(HCC) with more detailed follow-up data from 2009 to 2019 were selected for survival analysis. Among 2 549 patients treated with hepatectomy, there were 2 107 males and 442 females, with an age of (56.6±11.1) years (range: 20 to 86 years). Among 335 patients treated with liver transplantation, there were 292 males and 43 females, with an age of (51.0±9.7) years (range: 21 to 73 years). The outcomes of hepatectomy versus liver transplantation, anatomic versus non-anatomic hepatectomy were compared, respectively. Results: Of the 10 966 patients with primary liver cancer, 10 331 patients underwent hepatectomy and 635 patients underwent liver transplantation. Patients with liver resection were categorized into three groups: 1986－1995(712 cases), 1996－2008(3 988 cases), 2009‒2019(5 631 cases). The 5-year overall survival rate was 32.9% in the first group(1986－1995). The 5-year overall survival rate of resected primary liver cancer was 51.7% in the third group(2009-2019), among which the 5-year overal survival rates of hepatocellular carcinoma, intrahepatic cholangiocarcinoma and mixed liver cancer were 57.4%, 26.6% and 50.6%, respectively. Further analysis was performed on 2 549 HCC patients with primary hepatectomy. The 1-, 3-, 5-, and 10-year overall survival rates were 88.1%, 71.9%, 60.0%, and 41.0%, respectively, and the perioperative mortality rate was 1.0%. Two hundred and forty-seven HCC patients underwent primary liver transplantation, with 1-, 3-, 5-, and 10-year overall survival rates of 84.0%, 64.8%, 61.9%, and 57.6%, respectively. Eighty-eight HCC patients underwent salvage liver transplantation, with the 1-, 3-, 5-, and 10-year overall survival rates of 86.8%, 65.2%, 52.5%, and 52.5%, respectively. There was no significant difference in survival rates between the two groups with liver transplantation (P>0.05). Comparing the overall survival rates and recurrence rates of primary hepatectomy (2 549 cases) with primary liver transplantation (247 cases), the 1-, 3-, 5-, and 10-year overall survival rates in patients within Milan criteria treated with hepatectomy and transplantation were 96.3%, 87.1%, 76.9%, 54.7%, and 95.4%, 79.4%, 77.4%, 71.7%, respectively (P=0.754). The 1-, 3-, 5-year recurrence rates were 16.3%, 35.9%, 47.6% and 8.1%, 11.7%, 13.9%, respectively(P<0.01). The 1-, 3-, 5-, 10-year overall survival rates in patients with no large vessels invasion beyond the Milan criteria treated with liver resection and transplantation were 87.2%, 65.9%, 53.0%, 33.0% and 87.6%, 71.8%, 71.8%, 69.3%, respectively(P=0.003); the 1-, 3-, 5-year recurrence rate were 39.2%, 57.8%, 69.7% and 29.7%, 36.7%, 36.7%, respectively (P<0.01). The 1-, 3-, 5-, and 10-year overall survival rates in patients with large vessels invasion treated with liver resection and transplantation were 62.1%, 36.1%, 22.2%, 15.0% and 62.9%, 31.8%,19.9%, 0, respectively (P=0.387); the 1-, 3-, 5-year recurrence rates were 61.5%, 74.7%, 80.8% and 59.7%, 82.9%, 87.2%, respectively(P=0.909). Independent prognostic factors for both overall survival and recurrence-free survival rates of HCC patients treated with liver resection included gender, neoadjuvant therapy, symptoms, AST, intraoperative or postoperative blood transfusion, tumor number, tumor size, cirrhosis, macrovascular invasion, microvascular invasion, and pathological differentiation. Propensity score matching analysis of 443 pairs further showed that there was no significant difference in overall survival rate between anatomical liver resection and non-anatomical liver resection(P=0.895), but the recurrence rate of non-anatomical liver resection was higher than that of anatomical liver resection(P=0.035). Conclusions: In the past decade, the overall survival rate of HCC undergoing surgical treatment is significantly higher than before. For HCC patients with good liver function reservation, surgical resection can be performed first, and salvage liver transplantation can be performed after recurrence. The effect of salvage liver transplantation is comparable to that of primary liver transplantation. As for the choice of liver resection approaches, non-anatomical resection can reserve more liver tissue and can be selected as long as the negative margin is guaranteed.

[Antibiotic analysis and whole genome sequencing of two nocardia farcinica strains causing joint infection]

Objective: To analyze the molecular characteristics and antibiotic susceptibility of two strains of Nocardia farcinica isolated from patients with joint infection using whole genome sequencing. Methods: Two strains of Nocardia farcinica causing knee-joint infections in two elderly patients were collected in January 2020. Whole genome sequencing was used to determine the nocardia species. Drug sensitivity test was performed using the micro-broth dilution and E-test method according to CLSI M24 guideline. ABRicate was used to analyze drug resistance and virulence genes. Snippy and other bioinformatic tools were used for genomic comparison, and to construct SNP homologous tree. Results: The clinical isolates in this study were both Nocardia farcinica. Antimicrobial susceptibility test showed the isolates were resistant to ceftriaxone, cefepime, cefotaxime and trimethoprim/sulfamethoxazole (TMP/SMX). Imipenem, linezolid and amoxicillin-clavulanic acid showed good activity. Four antibiotic resistance genes including class A β-lactamase gene far-1, RNA polymerase binding protein gene RbpA, multi-drug resistance efflux pump transcription activator gene MtrA and regulatory transcription factor gene vanR-O were identified in the Nocardia farcinica genomes, which conferred resistance to beta-lactams, rifampicin, macrolides and vancomycin respectively. No acquired TMP/SMX resistance genes were identified. There are multiple missense mutations in the dihydrofolate reductase family genes. Four virulence genes of icl, mbtH, phoP, and relA that are homologous to Mycobacterium tuberculosis were found. SNP homologous tree analysis showed the two Nocardia strains were closely related, and there were only ten SNP sites, six compound substitutions and one deletion mutation between them. Conclusions: Whole genome sequencing technology is helpful to explore the molecular characteristics and resistance mechanisms of Nocardia species. Nocardia farcinica has a trend of spreading in China. Resistance to TMP/SMX is worthy of attention. The mutation of genes involved in the metabolic pathway of dihydrofolate might be one of multiple TMP/SMX resistance mechanisms.

MiRNA-365a-3p promotes the progression of osteoporosis by inhibiting osteogenic differentiation via targeting RUNX2

OBJECTIVE

The aim of this study was to explore the exact role of miRNA-365a-3p in the progression of osteoporosis, as well as its function in regulating osteogenic differentiation of human bone marrow mesenchymal stem cells (hBMSCs).

PATIENTS AND METHODS

The serum level of miRNA-365a-3p in osteoporosis patients and normal controls was determined by quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). After transfection of miRNA-365a-3p mimics, miRNA-365a-3p inhibitor or si-RUNX2 in hBMSCs, the relative expression levels of miRNA-365a-3p, osteocalcin (OCN), osteopontin (OPN) and collagen I were determined by qRT-PCR. Western blot was conducted to examine the protein expression of RUNX2 influenced by miRNA-365a-3p. Subsequently, the regulatory effects of miRNA-365a-3p and RUNX2 on osteogenic differentiation and capability of mineralization were evaluated by alkaline phosphatase (ALP) determination and alizarin red staining, respectively. Furthermore, the binding relationship between miRNA-365a-3p and RUNX2 was predicted and verified by miRanda and Dual-Luciferase reporter gene assay, respectively.

RESULTS

MiRNA-365a-3p was highly expressed in osteoporosis patients. The expression of miRNA-365a-3p in hBMSCs decreased gradually with the prolongation of osteogenic differentiation. The subsequent results showed that RUNX2 could bind to miRNA-365a-3p, which was negatively regulated by miRNA-365a-3p in hBMSCs. Down-regulation of miRNA-365a-3p significantly decreased the expression levels of OCN, OPN and collagen I. Furthermore, overexpression of miRNA-365a-3p markedly weakened the capability of mineralization of hBMSCs, whereas was further reversed by transfection of si-RUNX2.

CONCLUSIONS

MiRNA-365a-3p negatively regulates osteogenic differentiation of hBMSCs by targeting RUNX2, thus promoting the progression of osteoporosis.

Immunosensor-based rapid quantitative detection of Newcastle disease virus antibodies using innovative gold immunochromatographic assay

AIMS

A novel quantitative method for rapid Newcastle disease virus (NDV) antibody detection was developed based on an innovative gold immunochromatographic assay with a quantitative immunosensor.

METHODS AND RESULTS

NDV antibody-detecting test strips containing a two-reaction system and double-test lines (T1, T2) were prepared. The test results were judged according to the signal ratio between the test and control lines as measured by the quantitative immunosensor. The minimum detection limit of the test strips for NDV antibodies was 2² titres. In addition, the assay was highly specific because only NDV antibodies produced visible test lines on the strip. The clinical application of the strips was tested by detecting NDV antibodies in 506 serum samples collected from chickens. The results showed a coincidence of 92·49% with those of the haemagglutination inhibition assay.

CONCLUSIONS

The strips were successfully prepared and showed high specificity towards NDV, sensitivity and stability.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study describes a new method for detection of NDV antibody and provides a reference basis for rapid and quantitative monitoring of NDV antibodies. This new method overcomes the limitation of the existing colloidal gold immunochromatography, which only produces qualitative or semi-quantitative results.

[Exploration on the new situation of HIV/ADIS epidemic and the necessity of interdisciplinary concern in Tanzania]

Through the effort in nearly 40 years of Tanzania, the total number of reported cases, the prevalence of HIV/AIDS and the number of death have declined, while the number of patients receiving antiretroviral therapy has increased significantly in Tanzania. At the same time, however, there are new challenges that require more attention, such as the HIV spread to rural areas, middle and lower social classes, and female teenagers. Although the overall performance of the HIV/AIDS prevention and control response is great, there is still a need to survey the new trends of this disease at the micro-level in Tanzania. In addition, there is a necessity of interdisciplinary concern due to the prevalence of heterosexual anal sex in Tanzania.

Mesenchymal stem-cell therapy for perianal fistulas in Crohn's disease: a systematic review and meta-analysis

BACKGROUND

Mesenchymal stem-cell (MSC) therapy for perianal fistulas in Crohn's disease (CD) remains controversial. We performed this meta-analysis to evaluate the efficacy and safety of MSC therapy for the treatment of perianal fistulas in CD.

METHODS

Electronic databases were searched for studies that reported efficacy and/or safety of MSC therapy for perianal CD (pCD). We used the metaprop command of the meta package in R and RevMan to assess the efficacy and safety. Subgroup analyses were performed for exploration of heterogeneity regarding all outcomes.

RESULTS

After screening, 13 trials were included in our study. RevMan for meta-analysis showed that: (1) patients had healed perianal fistulas after MSC treatment, with an odds ratio (OR) of 2.05 (P = 0.0002; 95% confidence interval (CI) 1.41, 3.00) vs controls; (2) pelvic magnetic resonance imaging (MRI) used to evaluate the healing of fistulas showed that MSC therapy had a higher healing rate (HR) compared to control (OR = 1.95; P = 0.0007; 95% CI 1.33, 2.87). R software for meta-analysis showed that 63% (95% CI 0.53, 0.74) of patients achieved clinical healing as a result of local therapy with MSCs. Random-effects pooled rates of clinical response were 30% (95% CI 0.18, 0.48). Pelvic MRI used to evaluate fistula healing showed a HR of 56% (95% CI 0.46, 0.69). The HR with autologous MSCs was higher than with allogeneic MSCs (79% vs 52%; P < 0.05). Uniform injection of MSCs according to the size of fistulas improve the HR (80% vs 55%; P < 0.05) compared with fixed-dose MSCs. There was no significant increase in adverse events (OR = 1.14; P = 0.54; 95% CI 0.75, 1.74) in patients treated with MSCs and no major MSC-related adverse event has been reported so far.

CONCLUSIONS

Local administration of MSCs is an effective and safe method for pCD. It also represents hope for effective treatment of refractory pCD.

Anesthesia Management of Modified Ex Vivo Liver Resection and Autotransplantation

Background

Ex situ liver surgery allows liver resection and vascular reconstruction in patients who have liver tumors located in critical sites. Only a small series of studies about ex situ liver surgery is available in the literature. No anesthesia management experience has been previously published. The aim of the currents study was to summarize our experience with anesthetic management of patients during ex vivo liver surgery.

Material/Methods

The first 43 patients who received ex vivo liver surgery between January 2007 and April 2012 were included. A pulmonary artery catheter (PAC), transesophageal echocardiography (TEE), and pulse indicator continuous cardiac output (PiCCO) were used intraoperatively in the patients to monitor the hemodynamic changes. Thromboelastogram and the plasma coagulation test were used to monitor the coagulation changes.

Results

All patients received general anesthesia with rapid sequence induction. The data obtained by PAC, TEE, and PiCOO in these cases showed large changes in hemodynamics during the stages of the first or second vessel reconstruction. The CI decreased about 59%/63% and the MPAP decreased about 49%/37% during the first/second vessel reconstruction. Accurate judgment of the dosage of active drug for vascular support is the key for the stabilization of hemodynamics as quickly as possible. However, a high incidence (35.5%) of prophase fibrinolysis in a long anhepatic phase should be monitored and managed.

Conclusions

Ex vivo liver surgery is no longer experimental and is a therapeutic option for patients with liver cancer in critical sites. Good anesthesia support is an essential element of liver autotransplantation.

Design optimization of a viscoelastic dynamic vibration absorber using a modified fixed-points theory

A viscoelastic dynamic vibration absorber (VDVA) is proposed for suppressing infrasonic vibrations of heavy structures because the traditional dynamic vibration absorber equipped with a viscous damper is not effective in suppressing low frequency vibrations. The proposed VDVA has an elastic spring and a viscoelastic damper with frequency dependent modulus and damping properties. The standard fixed-points theory cannot be applied to derive the optimum design parameters of the VDVA because both its stiffness and damping are frequency dependent. A modified fixed-points theory is therefore proposed to solve this problem. H_∞ design optimization of the proposed VDVA have been derived for the minimization of resonant vibration amplitude of a single degree-of-freedom system excited by harmonic forces or due to ground motions. The stiffness and damping of the proposed VDVA can be decoupled such that both of these two properties of the absorber can be tuned independently to their optimal values by following a specified procedure. The proposed VDVA with optimized design is tested numerically using two real commercial viscoelastic damping materials. It is found that the proposed viscoelastic absorber can provide much stronger vibration reduction effect than the conventional VDVA without the elastic spring.

Utility of apparent diffusion coefficient as an imaging biomarker for assessing the proliferative potential of invasive ductal breast cancer

AIM

To determine the clinical utility of apparent diffusion coefficient (ADC) metrics for the non-invasive assessment of tumour proliferation indicated by Ki-67 labelling index (LI) in invasive ductal breast cancer.

MATERIALS AND METHODS

Eighty patients with 80 histopathologically proven invasive ductal breast cancers underwent diffusion-weighted imaging with b-values of 0 and 800 s/mm² at a 3-T system. ADC metrics including ADC_mean, ADC_median, ADC_min, ADC_max, and ΔADC (ADC_max-ADC_min) were recorded from the entire tumour volume on ADC maps, and correlated with the Ki-67 LI. Ki-67 staining of ≥14% was considered to indicate high proliferation and <14% was considered to indicate low proliferation.

RESULTS

ADC_min, ADC_max, and ΔADC showed significant correlations with the Ki-67 LI (for all tumours, r=-0.311, 0.436, and 0.551, respectively; for luminal/human epidermal growth factor receptor 2 (HER2)-negative group, r=-0.437, 0.512, and 0.639, respectively; all p<0.01), whereas ADC_mean and ADC_median showed no significant correlation (both p>0.05). Receiver operating characteristic (ROC) curve analysis for the differentiation of high- from low-proliferation groups showed that ΔADC yielded the highest area under the ROC curve for the whole tumour population (0.825; 95% confidence interval [CI]: 0.724, 0.901), as well as for the luminal/HER2-negative group (0.844; 95% CI: 0.692, 0.940).

CONCLUSION

ΔADC may serve as a promising imaging biomarker for the prediction of Ki-67 proliferation status in invasive ductal breast cancer.

Selective targeting p53WT lung cancer cells harboring homozygous p53 Arg72 by an inhibitor of CypA

TP53 plays essential roles in tumor initiation and progression, and is frequently mutated in cancer. However, pharmacological stabilization and reactivation of p53 have not been actively explored for targeted cancer therapies. Herein, we identify a novel Cyclophilin A (CypA) small molecule inhibitor (HL001) that induces non-small cell lung cancer (NSCLC) cell cycle arrest and apoptosis via restoring p53 expression. We find that HL001 stabilizes p53 through inhibiting the MDM2-mediated p53 ubiquitination. Further mechanistic studies reveal that the downregulation of G3BP1 and the induction of reactive oxygen species and DNA damage by HL001 contribute to p53 stabilization. Surprisingly, HL001 selectively suppresses tumor growth in p53 wild-type NSCLC harboring Arg72 homozygous alleles (p53-72R) through disrupting interaction between MDM2 and p53-72R in a CypA-dependent manner. Moreover, combining HL001 with cisplatin synergistically enhance tumor regression in orthotopic NSCLC mouse model. Collectively, this study demonstrates that pharmacologic inhibition of CypA offers a potential therapeutic strategy via specific activation of p53-72R in NSCLC.

Systems Pharmacology-Based Discovery of Natural Products for Precision Oncology Through Targeting Cancer Mutated Genes

Massive cancer genomics data have facilitated the rapid revolution of a novel oncology drug discovery paradigm through targeting clinically relevant driver genes or mutations for the development of precision oncology. Natural products with polypharmacological profiles have been demonstrated as promising agents for the development of novel cancer therapies. In this study, we developed an integrated systems pharmacology framework that facilitated identifying potential natural products that target mutated genes across 15 cancer types or subtypes in the realm of precision medicine. High performance was achieved for our systems pharmacology framework. In case studies, we computationally identified novel anticancer indications for several US Food and Drug Administration-approved or clinically investigational natural products (e.g., resveratrol, quercetin, genistein, and fisetin) through targeting significantly mutated genes in multiple cancer types. In summary, this study provides a powerful tool for the development of molecularly targeted cancer therapies through targeting the clinically actionable alterations by exploiting the systems pharmacology of natural products.

AgNP-coordinated glucosamine-grafted carbon nanotubes with enhanced antibacterial properties

After glucosamine is coated on MWCNTs, the bonding force between the AgNPs and MWCNT–glucosamine increases because the charge of the O atom changes.

Fabrication of morphology-preserved microporous carbon from a zeolitic-like porous coordination polymer

A new zeolitic-like microporous coordination polymer (PCP), [Zn₂(L)·2H₂O]·xguest, was firstly converted to morphology-preserved carbon rods with exclusive micropores and a large surface area for selective gas capture.

Synthesis and antibacterial effects of cobalt–cellulose magnetic nanocomposites

Green synthesis is employed to prepare cobalt/cellulose nanocomposites with antibacterial and magnetic properties. The cellulose-stabilised, cubic (α-cobalt) cobalt nanoclusters are distributed evenly over the surface of the cellulose fibres.

Comparison of short-term clinical outcomes between transanal and laparoscopic total mesorectal excision for the treatment of mid and low rectal cancer: A meta-analysis

AIM

The objective of this meta-analysis was to evaluate the feasibility, safety, and short-term clinical outcomes of transanal total mesorectal excision (TaTME) comparing with laparoscopy total mesorectal excision (LapTME) for mid and low rectal cancer.

METHODS

Relevant studies were searched from the databases of Pubmed, Embase, and the Cochrane Library. The qualities of all of the included studies were evaluated using Newcastle-Ottawa Scale (NOS). The synthesized outcomes were pooled using fixed-effects models or random-effects models, which weighted the odds ratio (OR) or mean difference (MD) with 95% confidence intervals (95% CI). A funnel plot was used to evaluate the publication bias.

RESULTS

Seven original studies including 209 TaTME patients and 257 LapTME patients with rectal cancer met the inclusion criteria in this meta-analysis. Compared with LapTME, TaTME showed a longer CRM, lower rate of positive CRM, complete TME rate, and less operative time. There were no significant differences in the outcomes of the harvested lymph nodes, distal margin distance, hospital stay, intraoperative complications, anastomotic leakage, postoperative complications, reoperation, readmission, or conversion between the TaTME group and the LapTME group.

CONCLUSIONS

Compared with LapTME, TaTME is a feasible and safe approach for patients with mid and low rectal cancer. In addition, TaTME showed a better short-term clinical outcomes, such as a longer CRM, lower risk of positive CRM, higher complete quality of TME rate, and shorter operative duration. Further prospective studies with long-term follow-up are required.

Design and synthesis of luminescent porous coordination polymers for chromaticity modulation, sensing of nitrobenzene and iodine encapsulation

A family of porous coordination polymers constructed from C_2v symmetry ligands with increased conjugation moieties was systematically designed and prepared, which is highly promising for chromaticity modulation, sensing of nitrobenzene, and I₂ encapsulation.

Artificial Gauge Field and Topological Phase in a Conventional Two-dimensional Electron Gas with Antidot Lattices

Based on the Born-Oppemheimer approximation, we divide the total electron Hamiltonian in a spin-orbit coupled system into the slow orbital motion and the fast interband transition processes. We find that the fast motion induces a gauge field on the slow orbital motion, perpendicular to the electron momentum, inducing a topological phase. From this general designing principle, we present a theory for generating artificial gauge field and topological phase in a conventional two-dimensional electron gas embedded in parabolically graded GaAs/InxGa1-xAs/GaAs quantum wells with antidot lattices. By tuning the etching depth and period of the antidot lattices, the band folding caused by the antidot potential leads to the formation of minibands and band inversions between neighboring subbands. The intersubband spin-orbit interaction opens considerably large nontrivial minigaps and leads to many pairs of helical edge states in these gaps.

Targeting histone deacetylase 6 mediates a dual anti-melanoma effect: Enhanced antitumor immunity and impaired cell proliferation

The median survival for metastatic melanoma is in the realm of 8-16 months and there are few therapies that offer significant improvement in overall survival. One of the recent advances in cancer treatment focuses on epigenetic modifiers to alter the survivability and immunogenicity of cancer cells. Our group and others have previously demonstrated that pan-HDAC inhibitors induce apoptosis, cell cycle arrest and changes in the immunogenicity of melanoma cells. Here we interrogated specific HDACs which may be responsible for this effect. We found that both genetic abrogation and pharmacologic inhibition of HDAC6 decreases in vitro proliferation and induces G1 arrest of melanoma cell lines without inducing apoptosis. Moreover, targeting this molecule led to an important upregulation in the expression of tumor associated antigens and MHC class I, suggesting a potential improvement in the immunogenicity of these cells. Of note, this anti-melanoma activity was operative regardless of mutational status of the cells. These effects translated into a pronounced delay of in vivo melanoma tumor growth which was, at least in part, dependent on intact immunity as evidenced by the restoration of tumor growth after CD4+ and CD8+ depletion. Given our findings, we provide the initial rationale for the further development of selective HDAC6 inhibitors as potential therapeutic anti-melanoma agents.

Changes in the Attitude and Practice Toward End-of-Life Care: Perspective of Chinese Physicians in Medical Department

INTRODUCTION

End-of-life care is affected by the attitude and cultural influence of doctors.

METHODS

To investigate the attitudes and practices of doctors on end-of-life care by questionnaire survey in 2004 and 2008.

RESULTS

In 2004, 31.7% of the respondents agreed that they "do not attempt resuscitation" (DNAR) form was useful and it rose to 54.4% in 2008. A higher proportion of respondents in 2008 claimed that they signed the DNAR form for documentation and accepted withholding noninvasive life-sustaining treatment compared to 2004. In 2004, 50% of the respondents regarded their training and education on handling DNAR issue as inadequate.

CONCLUSION

Documentation by DNAR form is gaining wider acceptance. Many doctors are expected to have more training and coaching on communication for handling such sensitive issues.