Carbon Ion Radiotherapy Induce Metabolic Inhibition After Functional Imaging-Guided Simultaneous Integrated Boost for Prostate Cancer

PurposeAs local recurrence remains a challenge and the advantages of the simultaneous integrated boost (SIB) technique have been validated in photon radiotherapy, we applied the SIB technique to CIRT. The aim was to investigate the metabolomic changes of the CIRT with concurrent androgen deprivation therapy (ADT) in localized prostate cancer (PCa) and the unique metabolic effect of the SIB technique.Material and MethodsThis study enrolled 24 pathologically confirmed PCa patients. All patients went through CIRT with concurrent ADT. The gross target volume (GTV) boost was defined as positive lesions on both 68Ga-PSMA PET/CT and mpMRI images. Urine samples collected before and after CIRT were analyzed by the Q-TOF UPLC-MS/MS system. R platform and MetDNA were used for peak detection and identification. Statistical analysis and metabolic pathway analysis were performed on Metaboanalyst.ResultsThe metabolite profiles were significantly altered after CIRT. The most significantly altered metabolic pathway is PSMA participated alanine, aspartate and glutamate metabolism. Metabolites in this pathway showed a trend to be better suppressed in the SIB group. A total of 11 identified metabolites were significantly discriminative between two groups and all of them were better down-regulated in the SIB group. Meanwhile, among these metabolites, three metabolites in DNA damage and repair related purine metabolism were down-regulated to a greater extent in the SIB group.ConclusionMetabolic dysfunction was one of the typical characteristics of PCa. CIRT with ADT showed a powerful inhibition of PCa metabolism, especially in PSMA participated metabolic pathway. The SIB CIRT showed even better performance on down-regulation of most metabolism than uniform-dose-distribution CIRT. Meanwhile, the SIB CIRT also showed its unique superiority to inhibit purine metabolism. PSMA PET/CT guided SIB CIRT showed its potentials to further benefit PCa patients

Preoperative CT-guided ICG injection locating SPNs

Background: Localization of small pulmonary nodules (SPNs) is challenging in minimally invasive pulmonary resection, and it is unknown whether computer tomography (CT) guided by indocyanine green (ICG) can provide accurate localization with minimal complications. Methods: We performed a retrospective study of patients who underwent thoracoscopic resection of pulmonary nodules after CT-guided preoperative localization with ICG from May 2019 to May 2020. Demographics, procedural data, postoperative complications, and pathologic information, were collected, and an analysis of the accuracy and complications after surgery was conducted. Results: In 471 patients, there was a total of 512 peripheral pulmonary nodules that were ≤2 cm in size. The average time for CT-guided percutaneous ICG injection for localization was 18 minutes, and 98.4% (504/512) of the nodules were successfully localized. The average size of the nodules was 9.1 mm, and the average depth from the pleural surface was 8.9 mm. Overall, 5.9% (28/471) of the patients had asymptomatic pneumothorax after localization, but none needed a tube thoracostomy. All the nodules were resected using video-assisted thoracoscopy technique. Conclusions: Preoperative CT-guided transthoracic ICG injection is safe and feasible for localization of small lung nodules for minimally invasive pulmonary resection. This technique should be considered for preoperative CT-guided localization of small lung nodules

Recent Advances in Tools for Early Identification of Patients with Potential Palliative Care Needs

Early recognition of patients who may gain benefits from palliative care will help medical service providers to provide such patients with targeted, patient-centered care, therebyreducing the provision of meaningless overtreatment, and improving negative emotional distress and quality of life of patients as well as the quality of life of patients' families. Many tools developed by foreign scholars for early identifying patients with potential palliative care needs, are mostly consisted of predictors of death risk and early warning signs of deterioration. In particular, some of them have been iteratively updated during the process of global application and verification, and could recognize those who could benefit from palliative care, although their applicability and accuracy levels need to be improved further. In contrast, in China, related research is scarce, and the development and application of such tools are still in the preliminary stage. In accordance with the classification of applicable diseases and people, we classified the tools for early identifyingpatients with potential palliative care needs, reviewed their main contents, characteristics and applications, thenmade a comparative analysis of the common tools in terms of basic essentials and application, with a view to providing a reference for the development and localization of such tools, and for accurateassessment and provision of potential palliative care for those who can benefit from such care

Acupoints Stimulation for Anxiety and Depression in Cancer Patients: A Quantitative Synthesis of Randomized Controlled Trials

This study aims at concluding the current evidence on the therapeutic effects of acupoints stimulation for cancer patients with anxiety and depression. Randomized controlled trials using acupoints stimulation for relieving anxiety and/or depression in cancer patients were searched, and 11 studies were finally included, of which eight trials compared acupoints stimulation with standard methods of treatment/care, and acupoints stimulation showed significantly better effects in improving depression than using standard methods of treatment/care. Four studies compared true acupoints stimulation with sham methods, and no significant differences can be found between groups for either depression or anxiety, although the pooled effects still favored true intervention. For the five studies that evaluated sleep quality, the results were conflicting, with three supporting the superiority of acupoints stimulation in improving sleep quality and two demonstrating no differences across groups. Acupoints stimulation seems to be an effective approach in relieving depression and anxiety in cancer patients, and placebo effects may partially contribute to the benefits. However, the evidence is not conclusive due to the limited number of included studies and the clinical heterogeneity identified among trials. More rigorous designed randomized, sham-controlled studies are necessary in future research

The Association and Predictive Value of Lipid Ratios to Metabolic Syndrome: a Multistage Cross-sectional Study

Background With the growing incidence of metabolic diseases, there has been increasing attention given to the prevention and control of metabolic syndrome (MS) . As important screening markers of MS, the relationship between lipid ratios and MS has become a hot research topic. Objective To analyse the association and predictive value of triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio, total cholesterol/HDL-C (TC/HDL-C) ratio, low-density lipoprotein cholesterol/ HDL-C (LDL-C/HDL-C) ratio and non-HDL-C to the risk of MS in populations included in a multistage cross-sectional study in Guizhou Province. Methods This study retrospectively selected natural populations (totally 21 727 cases) from Guizhou who attended the National Survey of Chronic Diseases and Risk Factors in Surveillance Regions 2010, China Chronic Disease and Risk Factor Surveillance 2013, and two waves of China Adult Chronic Disease and Nutrition Surveillance (2015 and 2018) . Baseline data were collected, and according to MS prevalence included in which, subjects were divided into MS group (n=4 981) and non-MS group (n=16 746) . The receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of TG/HDL-C ratio, TC/HDL-C ratio, LDL-C/HDL-C ratio and non-HDL-C for MS in males and females, respectively. The Delong test was used to compare the values of area under the ROC curve (AUC) of lipid ratios in predicting MS. Multivariate Logistic regression was used to analyze the association of lipid ratios with MS measured using odds ratio (OR) with 95% confidence interval (CI) , and to identify factors associated with MS among subjects stratified by survey time, age, sex, body mass index (BMI) , smoking and alcohol consumption. Results There were statistically significant differences in mean age, sex ratio, distribution of ethnicities, education level and marital status, prevalence of smoking and alcohol consumption, and mean BMI, TG/HDL-C ratio, TC/HDL-C ratio, LDL-C/HDL-C ratio and non-HDL-C between MS group and non-MS group (P<0.05) . TG/HDL-C ratio had a higher AUC value than TC/HDL-C ratio (Z=17.822, P<0.001) , LDL-C/HDL-C ratio (Z=23.813, P<0.001) and non-HDL-C (Z=27.608, P<0.001) . The value of AUC of TG/HDL-C ratio was higher in males than that in females (Z=4.299, P<0.001) . And the value of AUC of LDL-C/HDL-C ratio in males was lower than that in females (Z=2.061, P=0.039) . Multivariate Logistic regression analysis showed that in <60 years old, ≥60 years old, male, female, BMI<24.0 kg/m2, BMI≥24.0 kg/m2, smoking, non-smoking, drinking and non-drinking groups, TG/HDL-C ratio, TC/HDL-C ratio, LDL-C/HDL-C ratio and non-HDL-C were associated with the prevalence of MS (P<0.05) . Conclusion TG/HDL-C ratio has a good predictive value for MS. TG/HDL-C ratio, TC/HDL-C ratio, LDL-C/HDL-C ratio and non-HDL-C are associated factors of MS, which should be paid more attention clinically in females, individuals with BMI<24.0 kg/m2, non-smokers or non-drinkers

Experiences and perspectives of healthcare professionals implementing advance care planning for people suffering from life-limiting illness: a systematic review and meta-synthesis of qualitative studies

Abstract Background Life-limited patients may lose decision-making abilities during disease progression. Advance care planning can be used as a discussion method for healthcare professionals to understand patients’ future care preferences. However, due to many difficulties, the participation rate of healthcare professionals in advance care planning is not high. Aim To explore the facilitators of and barriers to healthcare professionals’ provision of advance care planning to life-limited patients to better implement it for this population. Methods We followed ENTREQ and PRISMA to guide this study. We conducted a systematic search of PubMed, Web of Science, Embase, CINAHL, PsycINFO, CNKI, and SinoMed to include qualitative data on the experiences and perspectives of healthcare professionals in different professional fields in providing advance care planning for life-limited patients. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was used to assess the quality of the included studies. Results A total of 11 studies were included. Two themes were identified: unsupported conditions and facilitative actions. Healthcare professionals regarded cultural concepts, limited time, and fragmented record services as obstacles to implementation. They had low confidence and were overly concerned about negative effects. They needed to possess multiple abilities, learn to flexibly initiate topics, and facilitate effective communication based on multidisciplinary collaboration. Conclusion Healthcare professionals need an accepting cultural environment to implement advance care planning, a sound legal system, financial support, and a coordinated and shared system to support them. Healthcare systems need to develop educational training programs to increase the knowledge and skills of healthcare professionals and to promote multidisciplinary collaboration to facilitate effective communication. Future research should compare the differences in the needs of healthcare professionals in different cultures when implementing advance care planning to develop systematic implementation guidelines in different cultures

The impact of nurse-led nonpharmacological multidisciplinary holistic nursing care on fatigue patients receiving hemodialysis: a randomized, parallel-group, controlled trial

Abstract Background Fatigue is a symptom characterized by an elevated prevalence in patients undergoing hemodialysis, which may cause extreme mental and muscular debilitation, significantly influencing social interaction, life quality and well-being. However, the significance of fatigue to patients undergoing hemodialysis has not been recognized yet, and prevention and management of fatigue in this population have not been thoroughly investigated. Additionally, previous studies mainly focused on muscular fatigue, while mental fatigue has been seldom discussed. This study aims to investigate the interaction between nurses and multidisciplinary of nonpharmacological integrated care interventions (NICIs) and assess the impact of fatigue on patients undergoing hemodialysis. Methods The integrative nonpharmacological care interventions in this study included walking, motivational interviewing (MI) and health education regarding behavioral self-management. A single-center randomized controlled trial was conducted in the dialysis center of the nephrological department in a tertiary affiliated hospital of medical university from January to June 2019. A total of 118 patients were selected and randomly divided into the intervention group (IG) and the control group (CG). Four patients dropped out during the study, and 114 patients were enrolled for the eventual analysis. The 60 patients in the IG received routine nursing combined with integrated care interventions, while the 54 patients in the CG received routine nursing only. This study lasted for six months. Results The experimental group exhibited significant reductions of overall fatigue (2.26 vs. 0.48), mental fatigue (1.41 vs. 0.54), muscular fatigue (2.13 vs. 0.75), and some biochemical indicators (e.g., serum urea) (P<0.05), compared with the CG. Conclusions Nurses and multidisciplinary teams have been demonstrated to play a key role and interplay function in chronic disease management. Hence, the nurse-led multidisciplinary NICIs significantly alleviated total fatigue (muscular fatigue and mental fatigue) and improved other parameters. Trial registration ChiCTR-IOR-16008621 (March 18, 2016

Therapeutic and adverse effects of adrenaline on patients who suffer out-of-hospital cardiac arrest: a systematic review and meta-analysis

Abstract Objective The efficacy and safety of epinephrine in patients with out-of-hospital cardiac arrest (OHCA) remains controversial. The meta-analysis was used to comprehensively appraise the influence of epinephrine in OHCA patients. Methods We searched all randomized controlled and cohort studies published by PubMed, EMBASE, and Cochrane Library from the inception to August 2022 on the prognostic impact of epinephrine on patients with OHCA. Survival to discharge was the primary outcome, while the return of spontaneous circulation (ROSC) and favorable neurological outcome were secondary outcomes. Results The meta-analysis included 18 studies involving 863,952 patients. OHCA patients with adrenaline had an observably improved chance of ROSC (RR 2.81; 95% CI 2.21–3.57; P = 0.001) in randomized controlled studies, but the difference in survival to discharge (RR 1.27; 95% CI 0.58–2.78; P = 0.55) and favorable neurological outcomes (RR 1.21; 95% CI 0.90–1.62; P = 0.21) between the two groups was not statistically significant. In cohort studies, the rate of ROSC (RR 1.62; 95% CI 1.14–2.30; P = 0.007) increased significantly with the adrenaline group, while survival to discharge (RR 0.73; 95% CI 0.55–0.98; P = 0.03) and favorable cerebral function (RR 0.42; 95% CI 0.30–0.58; P = 0.001) were lower than the non-adrenaline group. Conclusion We found that both the randomized controlled trials (RCTs) and cohort studies showed that adrenaline increased ROSC in OHCA patients. However, they were unable to agree on a long-term prognosis. The cohort studies showed that adrenaline had an adverse effect on the long-term prognosis of OHCA patients (discharge survival rate and good neurological prognosis), but adrenaline had no adverse effect in the RCTs. In addition to the differences in research methods, there are also some potential confounding factors in the included studies. Therefore, more high-quality studies are needed to fully confirm the effect of adrenaline on the long-term results of OHCA

Using expert knowledge to identify key threats and conservation strategies for wildlife: A case study with bats in China

Global biodiversity is in rapid decline, yet the key threats to wildlife in many regions remain uncertain. Bats are one of the most diverse mammalian groups, playing vital roles in the ecosystems. There are at least 140 bat species in China, with 30 % of being regionally threatened or data deficient. Here, we used expert elicitation to assess the key threats and conservation strategies of bats in China. We designed an online questionnaire concerning the conservation of Chinese bats, and then distributed the questionnaire to bat experts worldwide via email. All participants were asked to rank each threat and conservation strategy according to the urgency and significance. After excluding participants without some knowledge of Chinese bats and conservation biology, we gathered the opinions of 119 bat experts from China and abroad. The results showed that the scores of different threats and conservation strategies were predicted by their categories. Loss of habitat, killing and hunting, and roost disturbance were regarded as the three top threats faced by Chinese bats. Most experts recognized that banning hunting and improving the legislation were two priority strategies for bat conservation, although monitoring of bat diversity, scientific publicity, and education were also important. Nearly 98 % of the experts supported the suggestion that threatened bats should be under special state protection because of their ecological services, economic value, population decline, scientific value, and other features. These results provide valuable implications for guiding the protection and management of bats in China