Measurements of All-Particle Energy Spectrum and Mean Logarithmic Mass of Cosmic Rays from 0.3 to 30 PeV with LHAASO-KM2A

We present the measurements of all-particle energy spectrum and mean logarithmic mass of cosmic rays in the energy range of 0.3-30 PeV using data collected from LHAASO-KM2A between September 2021 and December 2022, which is based on a nearly composition-independent energy reconstruction method, achieving unprecedented accuracy. Our analysis reveals the position of the knee at 3.67±0.05±0.15  PeV. Below the knee, the spectral index is found to be -2.7413±0.0004±0.0050, while above the knee, it is -3.128±0.005±0.027, with the sharpness of the transition measured with a statistical error of 2%. The mean logarithmic mass of cosmic rays is almost heavier than helium in the whole measured energy range. It decreases from 1.7 at 0.3 PeV to 1.3 at 3 PeV, representing a 24% decline following a power law with an index of -0.1200±0.0003±0.0341. This is equivalent to an increase in abundance of light components. Above the knee, the mean logarithmic mass exhibits a power law trend towards heavier components, which is reversal to the behavior observed in the all-particle energy spectrum. Additionally, the knee position and the change in power-law index are approximately the same. These findings suggest that the knee observed in the all-particle spectrum corresponds to the knee of the light component, rather than the medium-heavy components.

Association between micronutrients intake and metabolic-associated fatty liver disease: a cross-sectional study based on the National Health and Nutrition Examination Survey

Metabolic-associated fatty liver disease (MAFLD) has been proposed to replace the term non-alcoholic fatty liver disease (NAFLD) in 2020. The association between micronutrients and MAFLD has not been reported. Therefore, this study aims to explore the association between micronutrients intake and MAFLD. This was a cross-section study based on the National Health and Nutrition Examination Survey (NHANES). The dietary intake of copper, zinc, iron, and selenium was evaluated using the 24-h dietary recall interview. Logistic regression analysis was used to explore the association between micronutrients and MAFLD, and the results were shown as odds ratio (OR) with 95 % confidence intervals (CIs). A total of 5976 participants were finally included for analysis, with 3437 participants in the MAFLD group. After adjusting potential confounders, copper intake at quartile Q3 (OR = 0⋅68, 95 % CI 0⋅50, 0⋅93) and Q4 (OR = 0⋅60, 95 % CI 0⋅45, 0⋅80) was found to be associated with lower odds of MAFLD. Iron intake at Q2 (OR = 0⋅64, 95 % CI 0⋅45, 0⋅92) and Q3 (OR = 0⋅61, 95 % CI 0⋅41, 0⋅91) was associated with the lower odds of MAFLD. Our findings found that high intake of copper and adequate intake of iron were associated with MAFLD, which may provide guidance for the management of MAFLD.

Prevalence, Associated Factors and Adverse Outcomes of Demoralization in Cancer Patients: A Decade of Systematic Review

Demoralization has been extensively studied in oncology and palliative care settings, and is characterized by a loss of meaning and purpose in life, a sense of powerlessness over life events, and a sense of helplessness. The objective of this systematic review is to synthesize the prevalence, associated factors, and adverse outcomes of demoralization in cancer patients by reviewing the literature of the last decade. Seven databases (PubMed, PsycINFO, Embase, Web of Science, Medline, CINAHL and Cochrane Library databases) were systematically searched from January 2012 to June 2022. Roughly speaking, the prevalence of demoralization in cancer patients ranges from 13.50% to 49.4%. A total of 45 factors are associated with demoralization, of which psychological factors have been studied more frequently in the last decade. There are nine outcomes related to demoralization, with the strongest evidence for the correlation between demoralization and suicidal ideation. The study emphasizes the complexity of factors associated with demoralization in cancer patients. There appears to be a intersection between the constructs of demoralization and depression, anxiety, and suicidal ideation, which may explain the correlation between them.

Experience of verbal violence among Chinese nursing students in clinical practice: a qualitative study

BACKGROUND

Workplace violence is prevalent in the nursing profession, and as a relatively junior link of the professional hierarchy, nursing students are not immune to it. Among these, verbal violence may have more serious consequences for the victims than physical violence, but the literature on verbal violence among nursing students in Chinese clinical settings is limited.

AIMS

To explore the verbal violence experience among Chinese nursing students in clinical practice, and the strategies used by nursing students to cope with violence.

DESIGN

A descriptive qualitative study.

METHODS

From January 2022 to June 2022, semi-structured interviews were conducted with 21 nursing students in clinical practice by purposive snowball sampling. Nvivo12 software and inductive content analysis were used for data analysis. This paper followed the COREQ (Consolidated criteria for Reporting Qualitative Research) guidance.

RESULTS

Through data analysis, three themes were defined:(1) Multiform verbal violence; (2) Hurting and impacting and (3) Struggling or Coping. The findings indicated that nursing students were subjected to multiple forms of verbal violence in clinical practice, not only from patients and caregivers, but also from peers such as clinical tutors and doctors, which not only harmed students' personal health and well-being, but may also contribute to the nursing industry's future loss of human resources. Seeking emotional support from others and forcing themselves to grow up were the most commonly used coping strategies.

CONCLUSION

Nursing educators and nursing managers need to pay attention to verbal violence in the clinical environment, and actively develop the ability of nursing students to deal with uncivilized behavior. Establishing relevant courses and training such as communication, resilience, and violence prevention, establishing a stricter clinical mentor appointment system, and teaching assessment system may be strategies to help nursing students better perform clinical practice.

Trajectory analysis of the work and life experience of healthcare workers during the COVID-19 pandemic: a longitudinal qualitative study

BACKGROUND

The COVID-19 pandemic has posed a global health threat and has had a profoundly negative impact on the work and lives of healthcare workers. However, few people know how their experiences have evolved over time.

AIMS

To describe healthcare workers' experiences during clinical responses to COVID-19 and how they changed over time.

DESIGN

A longitudinal qualitative study.

METHODS

We undertook a series of four semi-structured qualitative interviews of 14 healthcare workers called as 1st responders to the COVID-19 pandemic. Participants were recruited through purposive snowball sampling. Interviews were undertaken between May 2020 and May 2022 and trajectory approach was used to reveal individual experiences over time. This paper follows the COREQ (Consolidated criteria for Reporting Qualitative Research) guidance.

RESULTS

Data analysis yielded the following four themes: (1) Changes in emotions; (2) Changes in organization and management of care; (3) Changes in knowledge and capabilities; and (4) Changes in outlook on life and career.

CONCLUSION

Healthcare workers have become stronger in the pandemic and have demonstrated a high degree of professional loyalty and responsibility. However, there is a need to focus on the issue of jealousy and create a harmonious and safe work environment to reduce harm to healthcare workers. Additionally, human resource management strategies must support well-being of healthcare workers and maximize the efficiency of human resource utilization to enable them to respond to current and future needs and emergencies.

Family resilience in a crisis: A qualitative study of family resilience in multimember infected families in the context of COVID-19

OBJECTIVE

This study aimed to understand the family experience and identify family resilience factors to help families adapt to and cope with COVID-19.

METHOD

A purposive sample of 21 patients (from nine families) diagnosed with COVID-19 were recruited for interviews. Participants were interviewed using a semistructured question guide to explore family experiences. Deductive content analysis was used to develop emerging themes.

RESULTS

Deductive findings included three main themes: belief systems, family organizational patterns, and communication and problem solving. These themes can be applied to the analysis and conclusions related to family resilience during a crisis such as the COVID-19 pandemic.

CONCLUSION

This study reveals the coping process of families after multiple members were diagnosed with COVID-19, from the establishment and reinforcement of belief systems to the determination of how the family copes with risks and finally their ability to withstand risks. In addition, the study supports the concept that family resilience can be demonstrated during epidemics. Considering that the COVID pandemic might persist for a significant period of time, doctors and nurses must focus not only on individuals but also on the overall recovery of the family and develop interventions aimed at improving family resilience during these challenging times. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Triple-Hormone-Receptor Agonist Retatrutide for Obesity - A Phase 2 Trial

BACKGROUND

Retatrutide (LY3437943) is an agonist of the glucose-dependent insulinotropic polypeptide, glucagon-like peptide 1, and glucagon receptors. Its dose-response relationships with respect to side effects, safety, and efficacy for the treatment of obesity are not known.

METHODS

We conducted a phase 2, double-blind, randomized, placebo-controlled trial involving adults who had a body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) of 30 or higher or who had a BMI of 27 to less than 30 plus at least one weight-related condition. Participants were randomly assigned in a 2:1:1:1:1:2:2 ratio to receive subcutaneous retatrutide (1 mg, 4 mg [initial dose, 2 mg], 4 mg [initial dose, 4 mg], 8 mg [initial dose, 2 mg], 8 mg [initial dose, 4 mg], or 12 mg [initial dose, 2 mg]) or placebo once weekly for 48 weeks. The primary end point was the percentage change in body weight from baseline to 24 weeks. Secondary end points included the percentage change in body weight from baseline to 48 weeks and a weight reduction of 5% or more, 10% or more, or 15% or more. Safety was also assessed.

RESULTS

We enrolled 338 adults, 51.8% of whom were men. The least-squares mean percentage change in body weight at 24 weeks in the retatrutide groups was -7.2% in the 1-mg group, -12.9% in the combined 4-mg group, -17.3% in the combined 8-mg group, and -17.5% in the 12-mg group, as compared with -1.6% in the placebo group. At 48 weeks, the least-squares mean percentage change in the retatrutide groups was -8.7% in the 1-mg group, -17.1% in the combined 4-mg group, -22.8% in the combined 8-mg group, and -24.2% in the 12-mg group, as compared with -2.1% in the placebo group. At 48 weeks, a weight reduction of 5% or more, 10% or more, and 15% or more had occurred in 92%, 75%, and 60%, respectively, of the participants who received 4 mg of retatrutide; 100%, 91%, and 75% of those who received 8 mg; 100%, 93%, and 83% of those who received 12 mg; and 27%, 9%, and 2% of those who received placebo. The most common adverse events in the retatrutide groups were gastrointestinal; these events were dose-related, were mostly mild to moderate in severity, and were partially mitigated with a lower starting dose (2 mg vs. 4 mg). Dose-dependent increases in heart rate peaked at 24 weeks and declined thereafter.

CONCLUSIONS

In adults with obesity, retatrutide treatment for 48 weeks resulted in substantial reductions in body weight. (Funded by Eli Lilly; ClinicalTrials.gov number, NCT04881760.).

The effect of death education course utilizing constructivist learning theory on first grade undergraduate nursing student attitudes and coping abilities towards death: A mixed study design

Inadequate clinical preparation for palliative care is often reflected in inadequate education about death. Nursing students as nurses of the future, it is necessary to make them aware of death and overcome fear of it so that they can cope with their future careers and provide qualified and warmly care service.

OBJECTIVES

To determine the effect of death education course using constructivist learning theory on first grade undergraduate nursing student attitudes and coping abilities towards death.

DESIGN

This study was designed using a mixed-methods design.

SETTING

Two campuses of a university school of nursing in China.

PARTICIPANTS

First grade Bachelor of Nursing Science students (n = 191).

METHODS

Data collection includes questionnaires and reflective writing as after class task. Quantitative data were analyzed using descriptive statistics, the Wilcoxon Signed Rank test, and the Mann-Whitney U test. As for reflective writing, content analysis was hired to analysis.

RESULTS

The intervention group's attitude towards death tended to be neutral acceptance. The intervention group's ability to deal with death (Z = -5.354, p < 0.001) and expression of thoughts about death (Z = -3.89 b, p < 0.001) greater than that of the control group. Four themes (Awareness of death before class, Knowledge, The meaning of palliative care, New cognition) were identified from reflecting writing.

CONCLUSION

Compared with the conventional teaching, death education course utilizing constructivist learning theory was found to be a more effective method for developing students' death coping skills and reducing fear of death.

Mindfulness-Based Stress Reduction for Quality of Life, Psychological Distress, and Cognitive Emotion Regulation Strategies in Patients With Breast Cancer Under Early Chemotherapy-a Randomized Controlled Trial

Mindfulness-based interventions (MBIs) have been receiving growing attention in cancer care. This study evaluated the impact of the mindfulness-based stress reduction (MBSR) on quality of life, psychological distress (anxiety and depression), and cognitive emotion regulation strategies in patients with breast cancer under early chemotherapy. A total of 101 patients with breast cancer under early chemotherapy were randomly assigned to either an 8-week MBSR group (n = 50) or a control group (n = 51). The primary outcome was quality of life, measured on Functional Assessment of Cancer Therapy-Breast Cancer. The secondary outcomes were anxiety (Self-rating Anxiety Scale), depression (Self-rating Depression Scale), and cognitive emotion regulation strategies (The Chinese version of Cognitive Emotion Regulation Questionnaire). The participants were assessed at baseline (T0) and week 8 (T1). The data were statistically analyzed by SPSS 21.0. The participants in the MBSR group experienced significantly better outcomes in their quality of life, psychological distress, and cognitive emotion regulation strategies than the control group. The MBSR intervention was demonstrated to improve the positive cognitive emotion regulation strategies and quality of life in patients with breast cancer under early chemotherapy and significantly reduce the patient's anxiety, depression, and negative cognitive emotion regulation strategies, and help the patients to adjust their mental state and promote positive psychology to improve their quality of life.

Barriers and Facilitators to the Choice of Active Surveillance for Low-Risk Papillary Thyroid Cancer in China: A Qualitative Study Examining Patient Perspectives

Background: Internationally, several clinical practice guidelines recommend active surveillance as a nonsurgical management strategy for select patients with low-risk papillary thyroid carcinoma. However, patient's decision making when choosing active surveillance as a management approach is not well understood. Thus, our aim was to examine the barriers and facilitators to selecting active surveillance among patients with low-risk papillary thyroid carcinoma in China. Methods: Thirty-nine participants diagnosed with low-risk papillary thyroid carcinoma were purposively recruited between July and November 2021 for semistructured interviews; 24 of whom rejected and 15 patients chose "active surveillance" as a management approach in our sample. Inductive content analysis illustrated emerging themes. Audit trails, member checks, and thematic discussions were used to assert rigor. Results: Barriers and facilitators were classified as patient-related, disease-related, and external factors. Patient-related factors included patient's knowledge, attitudes, and emotions. Disease-related factors included the response to having cancer, the constant state of being diseased, and perceived value of the thyroid gland. External factors included the residual effects of surgery, the active surveillance protocol, and physicians' recommendations. Conclusions: Patient's acceptability of the active surveillance as a management approach are complex with many influencing factors. The public acceptance of active surveillance as a disease management approach needs to be improved, through the presentation of active surveillance as an evidence-based and optimized dynamic management strategy. Clinicians must address their patients' psychological struggles when patients choose active surveillance and patients require more attention and supportive intervention.

Porphyrin Centered Paclitaxel Tetrameric Prodrug Nanoassemblies as Tumor-Selective Theranostics for Synergized Breast Cancer Therapy

Although having undergone decades of development, nanoparticulate drug delivery vehicles for efficient cancer therapy remain a challenge, confined by low drug loading, instability, and poor cancer tissue selectivity. A self-assembled prodrug, the combination of prodrug strategy and the self-assembly merits, represents a special chemical entity which spontaneously organizes into supramolecular composites with defined architecture, therefore also providing a strategy to develop new medications. Paclitaxel (PTX) is still among the most generally prescribed chemotherapeutics in oncology but is restricted by poor solubility. Although photodynamic therapy, with its noninvasive features and barely developed drug resistance, signifies an alternative tool to suppress life-threatening cancer, sole use hardly fulfills its potential. To this end, a reduction-activatable heterotetrameric prodrug with the photosensitizer is synthesized, then formulated into self-assembled nanoparticles (NPs) for tumor imaging and combined chemo- and photodynamic therapy. Coating the NPs with amphiphilic polymer distearylphosphatidylethanolamine-polyethylene glycol-arginine-glycine-aspartate (DSPE-PEG-RGD) offers high stability and enables cancer tissue targeting. The as-prepared NPs enlighten disease cells and reveal more potent cytotoxicity comparing to PTX and the photosensitizer alone. Furthermore, the NPs selectively accumulates into tumors and synergistically inhibits tumor proliferation with reduced side effects in mice.

Ethical challenges of death faced by nursing undergraduates in clinical practice: A qualitative study

BACKGROUND

The characteristics of nursing work determine that nursing practice is inseparable from ethical considerations and decision-making. Nursing students have difficulty in dealing with death and it is necessary to explore the ethical challenges faced by nursing undergraduates in the process of clinical practice of nursing dead or dying patients.

OBJECTIVE

To explore the ethical challenges faced by undergraduate nursing students in nursing of dead or dying patients.

DESIGN

This study was conducted with a phenomenological approach in a qualitative design.

SETTINGS, PARTICIPANTS, METHODS

The purposive sample of the study consisted of 35 nursing undergraduates in their last year of education at the bachelor level in nursing who had experience of clinical practice. They voluntarily participated in the study. Data were collected through semi-structured interviews and analyzed using the Colaizzi analysis method.

RESULTS

Through analysis of interviews, four themes were identified: (1) Distant death is coming-inadequate preparation; (2) Making decisions between the needs of different positions-difficult balance; (3) Experience a patient's death up close-irresistible resistance; (4) Providing bereavement care after a patient's death-insurmountable obstacle.

CONCLUSION

This study shows that nursing undergraduates face ethical challenges in the process of caring for dead or dying patients and the early identification of these ethical challenges is of great significance. University and hospital leaders should pay attention to the ethic and death education of nursing undergraduates so as to help nursing students prepare for clinical practice.

“I’m walking on eggshells”: challenges faced by mothers with breast cancer in interacting with adolescent daughters

Background

With breast cancer becoming the most diagnosed cancer in the world, the number of breast cancer-afflicted mothers with adolescent daughters is also rising. Further, adolescent daughters’ mothers serve as role models for in identity formation processes, especially concerning gender and sexuality. Nevertheless, breast cancer threats mother’s health, including such a key symbol of her womanhood—the breast—which may adversely affect the development of an adolescent daughter’s own sense of personal identity and womanhood. However, few researchers and practitioners have paid attention to mother-daughter interactions in the context of breast cancer. Therefore, this study aimed to uncover the nuances of the interactive challenges with adolescent daughters from breast cancer-afflicted mothers’ perspective.

Methods

We conducted a qualitative study following the sample saturation principle, collecting data through semi-structured interviews with 21 breast cancer patients who met the inclusion criteria. We utilized thematic analysis and partially integrated the Foucauldian discourse approach to analyze the data.

Results

Three major themes emerged from the data: (1) mothers are lost in chaos (inability to handle the shock of cancer, feelings of powerlessness about the uncertainty of their life span, and confusion about how to respond to daughter’s curiosity); (2) mothers struggle to maintain balance (torn between protecting daughters and letting them be independent, and making a tough choice between being a mother or a patient); and (3) mothers are immersed in guilt (increasing daughters’ risk of cancer, influencing daughters’ development, and imposing burdens on daughters).

Conclusions

Our research explored the interactive experience of breast cancer-afflicted mothers and adolescent daughters. The insights uncovered by this study will help mothers enhance interaction with their daughters and assist health practitioners in devising interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01872-1.

Effects of Mindfulness-Based Stress Reduction Therapy on Posttraumatic Growth and Quality of Life in Patients With Breast Cancer Under Early Chemotherapy: A Randomized Controlled Trial

Posttraumatic growth (PTG) in patients with breast cancer has been reported. Mindfulness-based stress reduction (MBSR) has been found to be effective in improving the psychological well-being during cancer care. This study aimed to evaluate the impact of MBSR on the levels of PTG, perceived social support, and quality of life. A sample of 101 participants who experienced early chemotherapy enrolled in an MBSR group (n = 50) and a routine care group (n = 51) for 8 weeks. Their postintervention data were combined with preintervention data through a bundle of questionnaires reporting levels of PTG, perceived social support, and quality of life. MBSR showed the prominent validity in raising the levels of PTG and increasing in perceived social support and quality of life from pre- to posttreatment. MBSR improved the levels of PTG, perceived social support, and quality of life in patients with breast cancer in early chemotherapy. In conclusion, MBSR may help to optimize the positive psychological processes that will be targeted to maximize the efficacy of treatment for future cancer survivors.

Managing uncertainty and responding to difficult emotions: Cancer patients' perspectives on clinician response during the COVID-19 pandemic

OBJECTIVE

Patients undergoing cancer treatment during the COVID-19 pandemic have experienced stress and uncertainty with respect to disruptions in cancer care and COVID-19 related risks. We examined whether clinicians' responsiveness to patients' uncertainty and difficult emotions were associated with better health and well-being.

METHODS

Patients were recruited from cancer support communities and a market research firm. Respondents assessed clinicians communication that addressed uncertainty and difficult emotions. Health status measures included mental and physical health, coping during the pandemic, and psychological distress.

RESULTS

317 respondents participated in the study. Patients' perceptions of their clinicians responsiveness to patient uncertainty and negative emotions were associated with better mental health, physical health, coping, and less psychological distress (all p-values <0.001). Respondents with greater self-efficacy and social support also reported better health.

CONCLUSION

Even when controlling for patients' personal and health-related characteristics, clinicians' communication addressing patients' uncertainty and difficult emotions predicted better health, better coping, and less psychological distress. Access to social support and self-efficacy also were associated with better health status.

PRACTICE IMPLICATIONS

Clinicians' communication focused on helping with uncertainty and difficult emotions is important to cancer patients, especially during the pandemic. Clinicians should also direct patients to resources for social support and patient empowerment.

Nirvana: A Qualitative Study of Posttraumatic Growth in Adolescents and Young Adults with Inflammatory Bowel Disease

(1) Background: Psychosomatic discomfort is prevalent among adolescents and young adults (AYAs) with inflammatory bowel disease (IBD). Post-traumatic growth (PTG) has been a protective factor in earlier research. However, little is known regarding PTG among AYAs with IBD. This study investigates the generation of PTG in adolescents and young adults with inflammatory bowel disease (IBD) and finds positive coping skills employed in clinical nursing practice. (2) Methods: In 2021, 32 individuals were interviewed utilizing a semi-structured interview guide. This study used qualitative content analysis. (3) Results: The interviews revealed five themes: spiritual change, internalized supportiveness, cognitive re-shaping, externalized behaviors, and future-oriented thinking. (4) Conclusions: The research revealed the presence of PTG in AYAs with IBD. To give tailored care to patients, medical professionals must monitor the state of their PTG development in a planned and focused manner.

Activated Stellate Cell Paracrine HGF Exacerbated Pancreatic Cancer Cell Ferroptosis Resistance

As a refractory tumor, pancreatic carcinoma is more vulnerable to ferroptosis, a novel regulated cell death mode. However, the exact role of pancreatic stellate cells (PSCs) in pancreatic cancer ferroptosis is still unclear. Using the coculture system, we revealed that activated PSCs promote pancreatic cancer cell ferroptosis resistance. Mechanistically, activated PSCs secreted HGF, which further activated the HGF receptor, c-MET, in pancreatic cancer cells, prevented lipid peroxidation, and ultimately triggered pancreatic cancer cell ferroptosis resistance in vitro and in vivo. TCGA and GEPIA databases also revealed a strong correlation between c-MET and antiferroptosis indicators. Our study supplied the evidence for the cross-talk between activated PSCs and pancreatic cancer cells in ferroptosis, which suggested a strategy to inhibit PSC paracrine signaling for preventing pancreatic carcinoma ferroptosis resistance.

The Entanglement between Mitochondrial DNA and Tumor Metastasis

Simple Summary

Mitochondrial dysfunction is one of the main features of cancer cells. As genetic material in mitochondria, mitochondrial DNA (mtDNA) variations and dysregulation of mitochondria-encoded genes have been shown to correlate with survival outcomes in cancer patients. Cancer metastasis is often a major cause of treatment failure, which is a multi-step cascade process. With the development of gene sequencing and in vivo modeling technology, the role of mtDNA in cancer metastasis has been continuously explored. Our review systematically provides a summary of the multiple roles of mtDNA in cancer metastasis and presents the broad prospects for mtDNA in cancer prediction and therapy.

Abstract

Mitochondrial DNA, the genetic material in mitochondria, encodes essential oxidative phosphorylation proteins and plays an important role in mitochondrial respiration and energy transfer. With the development of genome sequencing and the emergence of novel in vivo modeling techniques, the role of mtDNA in cancer biology is gaining more attention. Abnormalities of mtDNA result in not only mitochondrial dysfunction of the the cancer cells and malignant behaviors, but regulation of the tumor microenvironment, which becomes more aggressive. Here, we review the recent progress in the regulation of cancer metastasis using mtDNA and the underlying mechanisms, which may identify opportunities for finding novel cancer prediction and therapeutic targets.

[A comparative study of artificial intelligence nasal polyp classification based on whole-slide imaging and JESREC diagnostic criteria]

Objective: To explore the types and clinical characteristics of chronic rhinosinusitis with nasal polyps (CRSwNP) based on artificial intelligence and whole-slide imaging (WSI), and to explore the consistency of the diagnostic criteria of the Japanese epidemiological survey of refractory eosinophilic chronic rhinosinusitis (JESREC) in Chinese CRSwNP patients. Methods: The data of 136 patients with CRSwNP (101 males and 35 females, aging 14 to 70 years) who underwent endoscopic sinus surgery from 2018 to 2019 in the Department of Otorhinolaryngology Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-sen University were analysed retrospectively. The preoperative clinical characteristics of patients were collected, such as visual analogue scale (VAS) of nasal symptoms, peripheral blood inflammatory cell count, total immunoglobulin E (IgE), Lund-Kennedy score and Lund-Mackay score. The proportion of inflammatory cells such as eosinophils, lymphocytes, plasma cells and neutrophils were calculated on the WSI of each patient through artificial intelligence chronic rhinosinusitis evaluation platform 2.0 (AICEP 2.0), and the specific type of nasal polyps was then obtained as eosinophilic CRSwNP (eCRSwNP) or non-eosinophilic CRSwNP (non-eCRSwNP). In addition, the JESREC diagnostic criteria was used to classify the nasal polyps, and the classification results were compared with the current gold standard for nasal polyps diagnosis (pathological diagnosis based on WSI). The accuracy, sensitivity and specificity of the diagnostic criteria of JESREC were evaluated. The data were expressed in M (Q₁, Q₃) and statistically analyzed by SPSS 17.0. Results: There was no significant difference between eCRSwNP and non-eCRSwNP in age distribution, gender, time of onset, total VAS score, Lund-Kennedy score or Lund-Mackay score. However, there was a significant difference in the ratio of nasal polyp inflammatory cells (eosinophils 40.5% (22.8%, 54.7%) vs 2.5% (1.0%, 5.3%), neutrophils 0.3% (0.1%, 0.7%) vs 1.3% (0.5%, 3.6%), lymphocytes 49.9% (39.3%, 65.9%) vs 82.0% (72.8%, 87.5%), plasma cells 5.1% (3.6%, 10.5%) vs 13.0% (7.4%, 16.3%), χ² value was 9.91, 4.66, 8.28, 5.06, respectively, all P<0.05). In addition, eCRSwNP had a significantly higher level of proportion of allergic symptoms (nasal itching and sneezing), asthma, peripheral blood eosinophil and total IgE (all P<0.05). The overall accuracy, sensitivity and specificity of the JESREC diagnostic criteria was 74.3%, 81.3% and 64.3%, respectively. Conclusions: The eCRSwNP based on artificial intelligence and WSI has significant high level of allergic symptoms, asthma, peripheral blood eosinophils and total IgE, and the percentages of inflammatory cells in nasal polyps are different from that of non-eCRSwNP. The JESREC diagnostic criteria has good consistency in our research.

The impact of family function on mental health status in patient with inflammatory bowel disease: The mediating role of self-esteem

OBJECTIVE

Family function is a protective factor for mental health status in IBD patients; however, the underlying processes are unknown. This study aimed to investigate the mediating influence of self-esteem on family functioning and mental health.

METHODS

This cross-sectional study comprised a total of 133 IBD patients who were assessed for family function (APGAR) and depression symptoms. (PHQ-9), anxiety symptoms. (GAD-7) and self-esteem (RSES) via self-administered questionnaires. Mediating effects were tested using the SPSS Process program with bootstrap.

RESULTS

The total score of PHQ-9 was 7.44 ±5.54. The total score of GAD-7 was 6.15±4.78. Significant associations were identified among family function, self-esteem, depression, and anxiety symptoms. Results revealed a significant indirect effect, suggesting that the effects of family function on depression and anxiety symptoms were mediated by self-esteem; the indirect effects percentages were 41.63 and 29.25.

CONCLUSION

These results indicate that the family function of IBD patients can predict their mental health condition. As self-esteem is a mediating element, which may have been influenced by family function, mental health status is indirectly affected. Therefore, promoting the self-esteem of IBD patients is crucial for facilitating long-term mental wellness.

Dilemma: Disclosure Experience Among Young Female Breast Cancer Survivors in China

Purpose: Culture influences whether cancer patients disclose their disease diagnosis to others. Understanding Chinese young female breast cancer survivors (BCSs)' experiences and perspectives on disclosure could play a vital role in clinical nursing. This study explores the experiences of Chinese young female BCSs with disease disclosure and describes the reasons for their choices. Methods: Using the tenets of phenomenological research and a purpose sampling method, semistructured interviews were conducted with 31 BCSs from February to April 2021. Colaizzi's analysis method was performed with NVivo software to develop common themes from the data. Results: From the analysis of the interviews of the 31 participants, three main themes were identified: (1) disclosure-to whom, including core family members, close friends, roommates, and employers; (2) disclosure to achieve positive outcomes, including: to gain social support, tell others to take precautions, obtain relevant information, and get permission to work flexibly, and (3) nondisclosure to avoid negative outcomes, including fear of discrimination and stigmatization, strengthen the role of the patient, bring excessive burden, and fear of excessive compassion. Conclusions: For young women diagnosed with breast cancer in China, it is a very complicated matter whether they choose to disclose their diagnosis to others. While disclosure can bring many benefits, it is important to look at the reasons why these women are concealing their diagnosis.

Gender Bias and the Lack of Equity in Pandemic Nursing in China: A Qualitative Study

There has long been a gender bias in medicine. This qualitative study aims to identify the experience of sexism among frontline female nurses and further explore their expectations and possible strategies to get rid of gender bias. This is a descriptive phenomenological study of 23 female nurses with 11 ± 3.98 years of experience who spent 36 ± 6.50 days at the frontline during the initial COVID-19 outbreak. We employed Colaizzi’s phenomenological analysis method to understand the subjective experiences, revealing the following themes: (a) materialization of gender identity; (b) incoordinate relationships; (c) future voice of female nurses. The gender bias experienced by female frontline nurses further challenges their emotional identity and self-identity. Therefore, it is important to require extensive consciousness-raising and policy support to defend female nurses’ rights.

China's Successful Recruitment of Healthcare Professionals to the Worst-Hit City: A Lesson Learned

The outbreak of coronavirus disease in 2019 (COVID-19) in Wuhan has led Chinese health authorities to recruit healthcare providers from the least-affected areas to provide care to the infected patients in Wuhan. We took further steps to explain some plausible reasons for their experiences. We used interpretative phenomenological analysis (IPA) to understand the subjective experiences, as well as the reasons for these experiences among the healthcare providers who had traveled from the least-affected parts of China to render aid during Wuhan’s COVID-19 outbreak. Using purposive and snowball sampling, healthcare professionals were recruited from three major hospitals in Jiangsu province. Semi-structured interviews were conducted from 1 September to 14 November 2020 in face-to-face contexts. Ten nurses and four doctors provided their informed consent for the study. The primary superordinate theme from the responses highlighted how social identity and individual needs were challenged by each individual’s professional ethics. COVID-19 not only presents significant risks to the health of nurses and medical doctors; it further challenges their emotional and psychosocial wellbeing. Care should be taken in allocating support and help, with the careful deployment of professional values and beliefs, so that any human resource as precious as medical doctors and nurses can be protected.

A unified approach for evaluating the prediction of treatment effect across different types of endpoints

Phase 2 and 3 development failure is one of the key factors for high drug development cost. Robust prediction of a candidate drug's efficacy and safety profile could potentially improve the success rate of the drug development. Therefore, systematic evaluation of the prediction is important for learning and continuous improvement of the prediction. In this article, we proposed a set of unified criteria that allow to evaluate the predictions across different endpoints, indications and development stages: standardized bias (SB), standardized mean squared errors (SMSE), and credibility of prediction. We applied the SB and SMSE to the predicted treatment effects for 54 comparisons in 5 compounds in immunology and diabetes.

Ethical dilemmas faced by frontline support nurses fighting COVID-19

BACKGROUND

In 2019, an outbreak of COVID-19 broke out in Hubei, China. Medical workers from all over the country rushed to Hubei and participated in the treatment and care of COVID-19 patients. These nurses, dedicated to their professional practice, volunteered to provide compassion and expert clinical care during the pandemic. As with other acts of heroism, the ethical dilemmas associated with working on the front line must be considered for future practice.

PURPOSE

To explore the ethical dilemmas of frontline nurses of Jiangsu Province in China during deployment to Wuhan to fight the novel coronavirus pneumonia, and to provide a basis for developing strategies to help nursing staff address personal and practice concerns in order to work more effectively during this pandemic and other disasters in the future.

RESEARCH DESIGN AND METHOD

Using the phenomenological research method and the purpose sampling method, semi-structured interviews were conducted with 10 nurses, post-deployment to Wuhan, who had worked on the front line to fight the novel coronavirus.

ETHICAL CONSIDERATIONS

The research proposal was approved by the Research Ethic Committee of Yangzhou University, China.

FINDINGS

From the analysis of the interviews of the 10 participants, three main themes were identified: ethical dilemmas in clinical nursing, ethical dilemmas in interpersonal relationships, and ethical dilemmas in nursing management.

CONCLUSION

During a quick response to public health emergencies, where nurses are deployed immediately as a call to action, the issues surrounding ethical dilemmas from several perspectives must be considered. This research suggests that a team approach to proactive planning and open communication during the emergency is an efficient and productive strategy to improve the nurses' experience and sense of well-being.

Mineralization of pH-Sensitive Doxorubicin Prodrug in ZIF-8 to Enable Targeted Delivery to Solid Tumors

The zeolitic imidazolate framework (ZIF-8), composed of zinc ion and dimethylimidazole, is widely used in drug delivery because of the easy fabrication process and the good biosafety. However, ZIF-8 suffers from low affinity to nonelectric-rich drugs and does not have surface functional groups. Here, to deliver doxorubicin (DOX) with ZIF-8 to specific target sites, DOX was first modified with a pH-sensitive linker containing two carboxyl groups to form the inactive prodrug CAD and subsequently seeded inside ZIF-8 by a 5 min mineralization process. CAD has high affinity to ZIF-8 because of the carboxyl groups and can anchor to the ZIF-8 surface to enable the surface modification with folic acid for tumor targeting. Moreover, the DOX release is precisely controlled by three steps of acidic pH response, with the dissociation of the FA layer, the breakdown of the ZIF-8 structure, and the cleavage of the pH-sensitive linker in prodrug. This novel "prodrug-ZIF-8" strategy has opened a new horizon in drug delivery.

[Using the big data of internet to understand the characteristics of coronavirus disease 2019: a big data study]

Objective: To analyze the symptom characteristics of Coronavirus Disease 2019(COVID-19) and to improve its prevention by using big data. Methods: Using Baidu Index Platform (http://index.baidu.com) and the website of Chinese Center for Disease Control and Prevention as data resources, we obtained the search volume (SV) of keywords for symptoms associated with COVID-19 from January 1 to February 20 in each year from 2017 to 2020, in Hubei province and other top 10 impacted provinces in China and the epidemic data. Data of 2020 were compared with the previous three years. Data of Hubei province were compared with confirmed cases. The differences and characteristics of the SV of COVID-19-related symptoms, and the correlation between the SV of COVID-19 and new confirmed or suspected cases were analyzed and the hysteresis effects were discussed. R3.6.2 software was used to analyze the data. Results: Compared the data from January 1 to February 20, 2020, with the SV for the same period of previous three years, Hubei's SV for cough, fever, diarrhea, chest tightness, dyspnea and other symptoms were significantly increased. The total SV of lower respiratory symptoms was significantly higher than that of upper respiratory symptoms (P<0.001). The SV of COVID-19 in Hubei province was significantly correlated with new confirmed or suspected cases (r(confirmed)=0.723, r(suspected)=0.863, all P<0.001). The results of the distributed lag model suggested that the patients who retrieved relevant symptoms on the internet may begin to see a doctor in 2-3 days later and be diagnosed in 3-4 days later. Conclusions: The total SV of lower respiratory symptoms is higher than that of upper respiratory symptoms, and the SV of diarrhea also increases significantly. It warns us to pay attention to not only the symptoms of lower respiratory tract, but also the gastrointestinal symptoms, especially diarrhea in patients with COVID-19. There is a relationship between internet retrieval behavior and the number of new confirmed or suspected cases. Big data have a certain role in the early warning of infectious diseases.

Variable selection for high-dimensional partly linear additive Cox model with application to Alzheimer's disease

Variable selection has been discussed under many contexts and especially, a large literature has been established for the analysis of right-censored failure time data. In this article, we discuss an interval-censored failure time situation where there exist two sets of covariates with one being low-dimensional and having possible nonlinear effects and the other being high-dimensional. For the problem, we present a penalized estimation procedure for simultaneous variable selection and estimation, and in the method, Bernstein polynomials are used to approximate the involved nonlinear functions. Furthermore, for implementation, a coordinate-wise optimization algorithm, which can accommodate most commonly used penalty functions, is developed. A numerical study is performed for the evaluation of the proposed approach and suggests that it works well in practical situations. Finally the method is applied to an Alzheimer's disease study that motivated this investigation.

A regularized estimation approach for case-cohort periodic follow-up studies with an application to HIV vaccine trials

This paper discusses regression analysis of the failure time data arising from case-cohort periodic follow-up studies, and one feature of such data, which makes their analysis much more difficult, is that they are usually interval-censored rather than right-censored. Although some methods have been developed for general failure time data, there does not seem to exist an established procedure for the situation considered here. To address the problem, we present a semiparametric regularized procedure and develop a simple algorithm for the implementation of the proposed method. In addition, unlike some existing procedures for similar situations, the proposed procedure is shown to have the oracle property, and an extensive simulation is conducted and it suggests that the presented approach seems to work well for practical situations. The method is applied to an HIV vaccine trial that motivated this study.

Penalized estimation of semiparametric transformation models with interval-censored data and application to Alzheimer's disease

Variable selection or feature extraction is fundamental to identify important risk factors from a large number of covariates and has applications in many fields. In particular, its applications in failure time data analysis have been recognized and many methods have been proposed for right-censored data. However, developing relevant methods for variable selection becomes more challenging when one confronts interval censoring that often occurs in practice. In this article, motivated by an Alzheimer's disease study, we develop a variable selection method for interval-censored data with a general class of semiparametric transformation models. Specifically, a novel penalized expectation-maximization algorithm is developed to maximize the complex penalized likelihood function, which is shown to perform well in the finite-sample situation through a simulation study. The proposed methodology is then applied to the interval-censored data arising from the Alzheimer's disease study mentioned above.

Simultaneous Estimation and Variable Selection for Interval-Censored Data with Broken Adaptive Ridge Regression

The simultaneous estimation and variable selection for Cox model has been discussed by several authors (Fan and Li, 2002; Huang and Ma, 2010; Tibshirani, 1997) when one observes right-censored failure time data. However, there does not seem to exist an established procedure for interval-censored data, a more general and complex type of failure time data, except two parametric procedures given in Scolas et al. (2016) and Wu and Cook (2015). To address this, we propose a broken adaptive ridge (BAR) regression procedure that combines the strengths of the quadratic regularization and the adaptive weighted bridge shrinkage. In particular, the method allows for the number of covariates to be diverging with the sample size. Under some weak regularity conditions, unlike most of the existing variable selection methods, we establish both the oracle property and the grouping effect of the proposed BAR procedure. An extensive simulation study is conducted and indicates that the proposed approach works well in practical situations and deals with the collinearity problem better than the other oracle-like methods. An application is also provided.

Declining Otolaryngology Resident Training Experience in Tracheostomies: Case Log Trends from 2005 to 2015

Objective

To evaluate recent tracheostomy surgical experience among otolaryngology residents and general surgery residents.

Study Design

Retrospective database review.

Setting

Accreditation Council for Graduate Medical Education otolaryngology and general surgery programs.

Subjects and Methods

Accreditation Council for Graduate Medical Education case log data from 2005 to 2015 for resident graduates in otolaryngology and general surgery were used to obtain mean graduate tracheostomy numbers, mean graduate composite case numbers, and number of graduating residents. Market share for each specialty was estimated through the derived metric of nationwide total tracheostomy graduate experience, calculated by multiplying the number of graduating residents by the mean number of graduate tracheostomies. Linear regression analysis was used to calculate trends. Multiple linear regression analysis was used for pairwise comparison of trends.

Results

From 2005 to 2015, mean graduate tracheostomy numbers for otolaryngology residents declined 2.3% per year, while those for general surgery residents increased 1.8% per year. Accounting for changes in number of resident graduates, market share of tracheostomy decreased 1.0% per year for otolaryngology and increased 3.0% per year for general surgery. Mean graduate composite case numbers increased significantly by 1.8% and 1.0% per year for otolaryngology and general surgery residents, respectively.

Conclusion

Tracheostomy case volume in otolaryngology residency has decreased steadily in comparison with general surgery residency. However, current otolaryngology graduates have more experience in tracheostomy when compared with general surgery graduates. While otolaryngology residents have excellent exposure to tracheostomy, otolaryngology programs should be made aware of this declining trend as well as changing procedural trends, which may affect training needs.

Thallium transformation and partitioning during Pb-Zn smelting and environmental implications

Thallium (Tl) is a toxic and non-essential heavy metal. Raw Pb-Zn ores and solid smelting wastes from a large Pb-Zn smelting plant - a typical thallium (Tl) pollution source in South China, were investigated in terms of Tl distribution and fractionation. A modified IRMM (Institute for Reference Materials and Measurement, Europe) sequential extraction scheme was applied on the samples, in order to uncover the geochemical behavior and transformation of Tl during Pb-Zn smelting and to assess the potential environmental risk of Tl arising from this plant. Results showed that the Pb-Zn ore materials were relatively enriched with Tl (15.1-87.7 mg kg(-1)), while even higher accumulation existed in the electrostatic dust (3280-4050 mg kg(-1)) and acidic waste (13,300 mg kg(-1)). A comparison of Tl concentration and fraction distribution in different samples clearly demonstrated the significant role of the ore roasting in Tl transformation and mobilization, probably as a result of alteration/decomposition of related minerals followed by Tl release and subsequent deposition/co-precipitation on fine surface particles of the electrostatic dust and acidic waste. While only 10-30% of total Tl amounts was associated with the exchangeable/acid-extractable fraction of the Pb-Zn ore materials, up to 90% of total Tl was found in this fraction of the electrostatic dust and acidic waste. Taking into account the mobility and bioavailability of this fraction, these waste forms may pose significant environmental risk.

Intraoperative infusion of branched-chain amino acids in patients undergoing gastrointestinal tumor surgery

Background

The purpose of this study is to investigate the effects of intraoperative infusion of branched-chain amino acids (BCAA) in patients undergoing gastrointestinal tumor surgery.

Methods

Sixty-one patients with gastrointestinal tumors undergoing gastrointestinal surgery were enrolled and randomly assigned to receive an intraoperative infusion of 3-compound BCAA solution (N = 20), amino acids (AA) solution (N = 21), or normal saline (NS) (N = 20). Nasopharyngeal temperature, blood glucose (BG), plasma insulin, and blood free fatty acids (FFA) concentrations were measured at 30 min before and 10 min after induction (T₀,T₁), 30 min and 2 h after skin incision (T₂,T₃), and 1 h after tracheal extubation (T₄). Intensity of shivering and pain was accessed at 1 h after extubation.

Results

The temperature in the BCAA and AA group was significantly higher than that in the NS group at T₄ (P = 0.014 and 0.033). The incidence of shivering in the BCAA and AA group was significantly lower than in the NS group (P = 0.027 and 0.012). BG increased in AA group at T₃ and T₄ (P = 0.001 and 0.045). The plasma insulin concentration increased in the BCAA and AA group from T₁ to T₃. The plasma FFA concentrations in the BCAA group were lower than in the AA and NS group from T₂ to T₄.

Conclusions

Intraoperative BCAA and AA infusion alleviated postoperative hypothermia and shivering. BCAA infusion also inhibited fat mobilization, without adversely affecting blood glucose.

Trial registration

ChiCTR-TRC-14004668

Electronic supplementary material

The online version of this article (doi:10.1186/s12957-015-0751-y) contains supplementary material, which is available to authorized users.

Association of TIM4 promoter polymorphism -1419G>A with childhood asthma in a Chinese Han population

TIM4, which is expressed on dendritic cells and macrophages, plays an important role in the proliferation of T helper type 2 (Th2) cells. Asthma, as a complex genetic disease, is thought to arise from the development of a Th2-lymphocyte-predominant immune response. To evaluate the effects of the promoter polymorphisms (-1419G>A and -1609G>A) in TIM4 on asthma susceptibility, case-control and family-based association studies were conducted by polymerase chain reaction and restriction fragment length polymorphism. Our results showed that TIM4 -1419G>A polymorphism was associated with asthma susceptibility in our study population (chi(2)= 9.88, P < 0.001, OR = 1.91, 95% CI 1.37-2.64). The -1419A/A and -1419A/G genotypes were observed more common in asthmatic group (6.3%, 41.8%) than in control group (1.7%, 29.3%). No significant difference was found in genotype and allele frequencies of TIM4 -1619G>A polymorphism between asthmatic and control groups. No association between the two SNPs and total serum IgE levels, lung function was observed. In conclusion, the present findings suggest that TIM4 -1419G>A polymorphism might be the genetic factor for the risk of childhood asthma in Chinese Han population.

Fatty acid transport protein 1 is required for nonshivering thermogenesis in brown adipose tissue

Nonshivering thermogenesis in brown adipose tissue (BAT) generates heat through the uncoupling of mitochondrial beta-oxidation from ATP production. The principal energy source for this process is fatty acids that are either synthesized de novo in BAT or are imported from circulation. How uptake of fatty acids is mediated and regulated has remained unclear. Here, we show that fatty acid transport protein (FATP)1 is expressed on the plasma membrane of BAT and is upregulated in response to cold stimuli, concomitant with an increase in the rate of fatty acid uptake. In FATP1-null animals, basal fatty acid uptake is reduced and remains unchanged following cold exposure. As a consequence, FATP1 knockout (KO) animals display smaller lipid droplets in BAT and fail to defend their core body temperature at 4 degrees C, despite elevated serum free fatty acid levels. Similarly, FATP1 is expressed by the BAT-derived cell line HIB-1B upon differentiation, and both fatty acid uptake and FATP1 protein levels are rapidly elevated following isoproterenol stimulation. Stimulation of fatty uptake by isoproterenol required both protein kinase A and mitogen-activated kinase signaling and is completely dependent on FATP1 expression, as small-hairpin RNA-mediated knock down of FATP1 abrogated the effect.

FATP1 is an insulin-sensitive fatty acid transporter involved in diet-induced obesity

Fatty acid transport protein 1 (FATP1), a member of the FATP/Slc27 protein family, enhances the cellular uptake of long-chain fatty acids (LCFAs) and is expressed in several insulin-sensitive tissues. In adipocytes and skeletal muscle, FATP1 translocates from an intracellular compartment to the plasma membrane in response to insulin. Here we show that insulin-stimulated fatty acid uptake is completely abolished in FATP1-null adipocytes and greatly reduced in skeletal muscle of FATP1-knockout animals while basal LCFA uptake by both tissues was unaffected. Moreover, loss of FATP1 function altered regulation of postprandial serum LCFA, causing a redistribution of lipids from adipocyte tissue and muscle to the liver, and led to a complete protection from diet-induced obesity and insulin desensitization. This is the first in vivo evidence that insulin can regulate the uptake of LCFA by tissues via FATP1 activation and that FATPs determine the tissue distribution of dietary lipids. The strong protection against diet-induced obesity and insulin desensitization observed in FATP1-null animals suggests FATP1 as a novel antidiabetic target.

Targeted deletion of FATP5 reveals multiple functions in liver metabolism: alterations in hepatic lipid homeostasis

BACKGROUND & AIMS

Fatty acid transport protein 5 (FATP5/Slc27a5) has been shown to be a multifunctional protein that in vitro increases both uptake of fluorescently labeled long-chain fatty acid (LCFA) analogues and bile acid/coenzyme A ligase activity on overexpression. The aim of this study was to further investigate the diverse roles of FATP5 in vivo.

METHODS

We studied FATP5 expression and localization in liver of C57BL/6 mice in detail. Furthermore, we created a FATP5 knockout mouse model and characterized changes in hepatic lipid metabolism (this report) and bile metabolism (the accompanying report by Hubbard et al).

RESULTS

FATP5 is exclusively expressed by the liver and localized to the basal plasma membrane of hepatocytes, congruent with a role in LCFA uptake from the circulation. Overexpression of FATP5 in mammalian cells increased the uptake of 14C-oleate. Conversely, FATP5 deletion significantly reduced LCFA uptake by hepatocytes isolated from FATP5 knockout animals. Moreover, FATP5 deletion resulted in lower hepatic triglyceride and free fatty acid content despite increased expression of fatty acid synthetase and also caused a redistribution of lipids from liver to other LCFA-metabolizing tissues. Detailed analysis of the hepatic lipom of FATP5 knockout livers showed quantitative and qualitative alterations in line with a decreased uptake of dietary LCFAs and increased de novo synthesis.

CONCLUSIONS

Our findings support the hypothesis that efficient hepatocellular uptake of LCFAs, and thus liver lipid homeostasis in general, is largely a protein-mediated process requiring FATP5. These new insights into the physiological role of FATP5 should lead to an improved understanding of liver function and disease.

Investigation and analysis of incidence of awareness in patients undergoing cardiac surgery in Beijing, China

BACKGROUND

Awareness under general anesthesia is a serious complication which leads to psychiatric disorders. The incidence of awareness in patients undergoing cardiac surgery has been reported in as many as 1.5% - 23% in foreign countries. But so far, medical literature about awareness during cardiac surgery is still rare in China. Therefore, we investigated the incidence of awareness in patients undergoing different kinds of cardiac surgery, the phases when awareness occurred and the effect of cardiopulmonary bypass on the incidence of awareness in coronary artery bypass grafting in Beijing.

METHODS

Patients' recall of awareness during cardiac surgery was assessed. One hundred patients undergoing coronary artery bypass grafting (CABG) in Chaoyang Hospital, Beijing, one hundred patients undergoing CABG and one hundred patients undergoing valve replacement or septal defect repair in Fuwai Hospital, Beijing, were interviewed 3-6 days after surgery. Every report about patients on recall of awareness was recorded. An independent research team, blinded to patients' surgery and anesthesia, assessed every report of awareness.

RESULTS

The incidence of awareness of patients received CABG under cardiopulmonary bypass (CPB), off -pump CABG, septal repair or valve replacement under CPB was 4.7% (5 of 106 cases), 9.6% (9 of 94 cases) and 4% (4 of 100 cases), respectively. CPB did not greatly affect the incidence of awareness during the period of CABG (P > 0.05). The incidence of awareness of patients who received CABG under CPB did not increase significantly, in comparison with that of patients who received septal repair or valve replacement under CPB in Fuwai Hospital (P > 0.05). Awareness easily occurred before bypass grafting or CPB.

CONCLUSIONS

Awareness mainly occurs before bypass grafting or CPB in cardiac surgery. Most cases with awareness have auditory perceptions. CPB is not a main factor which affects the incidence of awareness of CABG. Surgical types do not affect the incidence of awareness of patients under CPB.