Effectiveness of a Teach-Back Education Program on Perioperative Pain in Patients With Lung Cancer: An Intervention Study Using Behavior Change Wheel.

OBJECTIVE: To assess the effect of a teach-back educational intervention using Behavior Change Wheel (BCW) framework on perioperative pain among patients with lung cancer. METHODS: A prospective quasi-experimental study was conducted in 88 patients with lung cancer from a tertiary hospital in China. According to the order of admission, they were allocated to either control group or intervention group, with 44 patients in each group. Patients in the control group received routine nursing care, while patients in the intervention group were given a teach-back education program based on BCW framework. The visual analog scale (VAS) was adopted to evaluate patients' pain on the day of surgery (T0), 1 (T1), 2 (T2), and 3 (T3) days after surgery. We also recorded the use of patient-controlled analgesia (PCA), the length of hospital stay, and the degree of patients' satisfaction. RESULTS: Rest pain, pain when coughing, and pain during activity that patients in the intervention group experienced were significantly less severe than those in the control group on T0 and T1. The pain when coughing in the intervention group was also significantly milder on T2 and T3. In addition, the number of self-control time, use duration, and total dose of PCA were significantly lower in the intervention group. Moreover, patients' satisfaction of nursing service was significantly higher in the intervention group. CONCLUSION: A teach-back education program based on BCW framework was effective in pain management among the perioperative patients with lung cancer. This study demonstrates the application of teach-back method and the BCW in the development of patient education intervention to mitigate perioperative pain.

Effects of proximal gastrectomy with narrow gastric tube anastomosis compared with total gastrectomy with Roux-en-Y anastomosis on upper gastric cancer.

OBJECTIVE: To investigate the clinical efficacy of proximal gastrectomy with narrow gastric tube anastomosis (PG-NGT) and total gastrectomy with Roux-en-Y anastomosis (TG-RY) for upper gastric cancer. MATERIALS AND METHODS: One hundred sixty-three upper gastric cancer patients were enrolled into the PG-NGT group and TG-RY group. The propensity score matching method was used to conduct a one-to-one match between the two groups with 38 patients in each group. RESULTS: Compared with the TG-RY group, the PG-NGT group had significantly (P < 0.05) shorter operation time, shorter hospital stay, and less intraoperative blood loss. The TG-RY group had significantly (P = 0.009) more lymph nodes dissected and greater (P = 0.014) total cost than the PG-NGT group, but no significant difference existed in the surgical cost between the two groups (P = 0.214). There was no significant (P > 0.05) difference in the incidence of anastomotic stenosis (10.5% vs. 13.1%) or the reflux esophagitis rate (8.6% vs. 9.1%) in the PG-NGT group and the TG-RY group. One year after surgery, the weight and hemoglobin and albumin levels in the PG-NGT group were significantly (P < 0.05) higher than those in the TG-RY group. CONCLUSIONS: PG-NGT may be better than TG-RY in improving patient weight loss and hemoglobin and albumin levels, without increasing the rate of anastomotic stenosis and reflux symptoms.

Tacrolimus intra-patient variability measures and its associations with allograft clinical outcomes in kidney transplantation.

AIMS: Tacrolimus (Tac) is commonly prescribed in solid organ transplantation to prevent immune-mediated damage to the graft. However, its pharmacokinetics show substantial variability between and within patients. Intra-patient variability of tacrolimus (Tac-IPV) has emerged as a novel marker to predict transplant outcomes. Numerous studies report varying associations between Tac-IPV and clinical outcomes, with Tac-IPV measures showing wide discrepancies among these studies. This inconsistency could be a significant factor that influences the various outcomes reported in different studies. Our review comprehensively assesses the relationship between various Tac-IPV measures and their associations with clinical outcomes in transplant patients. METHODS: A comprehensive literature search was conducted using the PubMed and Embase databases, covering the period from 2004 to March 31, 2023. The search focused on studies that examined the relationship between Tac-IPV and clinical outcomes in kidney transplantation (KT). The inclusion criteria were specific to studies addressing Tac-IPV, including measures such as standard deviation (SD), coefficient of variation (CV), time-weighted coefficient of variability (CV), mean absolute deviation (MAD), and Tac variability score (TVS). Clinical outcomes included the development of de novo donor-specific antibodies (dnDSA), rejection episodes, graft loss, and graft failure. RESULTS: Among the 33 studies that met the inclusion criteria, a notable proportion presented conflicting findings in their assessment of various Tac-IPV measures regarding dnDSA, rejection episodes, graft loss, and graft failure. CONCLUSIONS: Most studies have identified a correlation between high Tac-IPV and poor clinical outcomes; however, this relationship is multifactorial. Influencing factors include the metabolic status of KT patients, the timing of Tac-IPV calculations, and the criteria for defining high and low Tac-IPV thresholds, including the size and selection method. CV, MAD, and TWCV are the metrics that are most frequently used to determine Tac-IPV. Additionally, most of the methods for establishing Tac-IPV thresholds typically employ receiver operating characteristic (ROC) curves and median values. It is also notable that studies examining the clinical significance of Tac-IPV often include tacrolimus levels measured six months after kidney transplantation.

Development and characterization of a novel neutralizing scFv vectored immunoprophylaxis against botulinum toxin type A.

Botulinum toxin is a protein toxin secreted by Clostridium botulinum that is strongly neurotoxic. Due to its characteristics of being super toxic, quick acting, and difficult to prevent, the currently reported antiviral studies focusing on monoclonal antibodies have limited effectiveness. Therefore, for the sake of effectively prevention and treatment of botulism and to maintain country biosecurity as well as the health of the population, in this study, we intend to establish a single chain antibody (scFv) targeting the carboxyl terminal binding functional domain of the botulinum neurotoxin heavy chain (BONT/AHc) of botulinum neurotoxin type A, and explore the value of a new passive immune method in antiviral research which based on adeno-associated virus (AAV) mediated vector immunoprophylaxis (VIP) strategy. The scFv small-molecular single-chain antibody sequenced, designed, constructed, expressed and purified by hybridoma has high neutralising activity and affinity level, which can lay a good foundation for the modification and development of antibody engineering drugs. In vivo experiments, AAV-mediated scFv engineering drug has good anti-BONT/A toxin neutralisation ability, has advantages of simple operation, stable expression and good efficacy, and may be one of the effective treatment strategies for long-term prevention and protection of BONT/A botulinum neurotoxin.

Microwave Speech Recognizer Empowered by a Programmable Metasurface.

Speech recognition becomes increasingly important in the modern society, especially for human-machine interactions, but its deployment is still severely thwarted by the struggle of machines to recognize voiced commands in challenging real-life settings: oftentimes, ambient noise drowns the acoustic sound signals, and walls, face masks or other obstacles hide the mouth motion from optical sensors. To address these formidable challenges, an experimental prototype of a microwave speech recognizer empowered by programmable metasurface is presented here that can remotely recognize human voice commands and speaker identities even in noisy environments and if the speaker's mouth is hidden behind a wall or face mask. The programmable metasurface is the pivotal hardware ingredient of the system because its large aperture and huge number of degrees of freedom allows the system to perform a complex sequence of sensing tasks, orchestrated by artificial-intelligence tools. Relying solely on microwave data, the system avoids visual privacy infringements. The developed microwave speech recognizer can enable privacy-respecting voice-commanded human-machine interactions is experimentally demonstrated in many important but to-date inaccessible application scenarios. The presented strategy will unlock new possibilities and have expectations for future smart homes, ambient-assisted health monitoring, as well as intelligent surveillance and security.

Effect of an individualized digital coaching program on swallowing function in stroke patients.

PURPOSE: Dysphagia is a common complication after a stroke. Home-based rehabilitation would be an alternative or complementary solution to dysphagia management. This study aimed to validate the effect of an individualized digital coaching program on swallowing function in stroke patients. METHODS: A total of 109 patients were enrolled and randomly assigned to either the intervention group (received a 6-week individualized digital coaching program) or the control group (standard care). The primary outcome was a functional oral intake scale (FOIS). The secondary outcomes were the swallowing quality-of-life questionnaire (SWAL-QOL) and pneumonia. RESULTS: Among 101 patients, the number of patients who recovered from dysphagia in the intervention group was significantly more than that of the control group at three weeks. Concurrently, the comparison between the control and intervention groups was non-significant at six weeks. The change in the swallowing quality-of-life questionnaire of the intervention group was significantly more significant than that of the control group. No significant difference in the incidence of pneumonia was observed. CONCLUSION: The individualized digital coaching program can improve swallowing function and swallowing quality-of-life (SWAL-QOL) in stroke patients, indicating its potential for home-based rehabilitation.

Prevalence and possible factors of cognitive frailty in the elderly with hypertension and diabetes.

Background: Cognitive frailty is the coexistence of physical frailty and mild cognitive impairment. Research shows that cognitive frailty is related to an increased risk of hospitalization, mortality, disability, and dementia. Diabetes and hypertension are common risk factors for physical frailty and cognitive impairment. However, the factors influencing cognitive frailty in the elderly with hypertension and diabetes are still unclear. This study aimed to investigate the possible factors influencing cognitive frailty in the elderly with hypertension and diabetes. Methods: A cross-sectional study was conducted. We evaluated people over 60 years with hypertension and diabetes who underwent physical examination in Wuxi Xin'an Community Health Service Center. Frail scale, Montreal Cognitive Assessment-Basic and clinical dementia rating were used to assess cognitive frailty. We collected demographic characteristics, hypertension and diabetes-related laboratory indicators of the participants. We also used various scales to assess the overall health status of the elderly. Results: Approximately 20.8% of the participants were determined to have cognitive frailty in elderly adults with hypertension and diabetes. These participants were older, had a lower monthly income, and included a higher proportion of peasants. They also had a higher level of depression (p = 0.037), higher risk of falls (p = 0.000), higher risk of malnutrition (p = 0.002), poorer ability to perform activities of daily living (ADL) (p = 0.000), and less social support (p = 0.030). Multivariate regression analysis was used to further assess the factors for cognitive frailty. After adjusting for possible confounders, age and ADL score emerged as risk factors, whereas high monthly income decreased the risk of cognitive frailty. Conclusion: Cognitive frailty is correlated with age, income, and ability to perform daily living activities in the elderly with diabetes and hypertension. Closer attention to the elderly who have low income and poor self-care ability may play an important role in the early prevention of cognitive frailty and even dementia.

[Applying a "stage of behaviors change" model on nutrition intervention in farmers].

OBJECTIVE: To study the effect of applying a "Stage of Behaviors Change (SOC)" model in nutrition intervention and health education, in order to promote health awareness and action in farmers. METHODS: People aged 18-65 recruited from two villages of Tianjin were classified into two groups, the intervention group and the control group. All subjects were categorized into 5 stages and a one year nutrition intervention was conducted. RESULTS: The rates of planning, taking an action on and keeping balanced diet increased 15%-20%, the rates of accepting, taking an action on and keeping daily physical activity increased 10%-20%, and the awareness on nutrition knowledge increased 30% after intervention in the intervention group. BMI, blood pressure, serum total cholesterol, homocysteine, folic acid, urine potassium and sodium in the intervention group was significantly different before and after intervention and between two groups. CONCLUSION: The effect of applying SOC model for nutrition intervention and health education in farmers was good, which promoted a continuous change of knowledge-attitude-practice.

Cystic metastasis of prostate cancer: A case report.

RATIONALE: Prostate cancer often metastasizes (most commonly to the pelvic lymph nodes and axial skeleton); however, metastases to the pelvic cavity as a solitary mass are unusual. While metastatic prostate cancer is unconventional in pelvic cavity, cystic pelvic lesions are even more scarce. Accurate identification of cystic metastasis can be helpful in management of prostate cancer. PATIENT CONCERNS: A 64-year-old male was admitted to our hospital due to urethral irritation symptom and dysuria. DIAGNOSIS: In addition to prostate cancer, abdominal computed tomography (CT) scanning and magnetic resonance imaging (MRI) of the prostate revealed that a cystic mass was located at right pelvic cavity. Histopathological examination diagnosed the pelvic cystic mass as metastasis from prostatic cancer. Immunohistochemistry results demonstrated Calretinin (+), D2-40 (-), Ki-67 (10%+), Vimentin (-), CK-pan (+), CK5/6 (-), WT-1 (-), PSA (+), SALL4 (-), Villin (-), CK20 (-), CK7 (-), PAX-8 (-), and TTF-1 (-). INTERVENTIONS: The cystic mass was removed. Primary cancer of the prostate was reserved as well. After discharge, the patient underwent in a two-year androgen deprivation therapy (ADT) treatment. OUTCOMES: After 13 months of discharge, no disease progression was found in the patient. LESSONS: Although cystic prostate cancer is rare, the occurrence possibility should be considered when cystic lesions are accompanied with prostate cancer.

[Systematic Evaluation and Meta-analysis on Acupuncture for Peptic Ulcer].

OBJECTIVE: To systematically evaluate the clinical efficacy of acupuncture for peptic ulcer. METHODS: Randomized controlled trials of acupuncture for peptic ulcer were searched from China National Knowledge Infrastructure (CNKI), WanFang Database, Chinese Scientific and Technological Journals (VIP), China Biomedicine (CBM), PubMed and the Cochrane Library from the establishment time of databases to September, 2016. Data extraction and quality evaluation were implemented for the literature which met the inclusive criteria. The RevMan 5.3 software was used to make Meta-analysis. RESULTS: Sixteen papers including 1 570 patients of peptic ulcer were included. The results of Meta-analysis showed that there was no statistical significance between acupuncture and western medicine in the effective rate, the healing rate of ulcer area and the HP negative rate (all P>0.05); the recurrence rate of acupuncture was significantly lower than that of western medicine[RR=0.35, 95%CI (0.14, 0.84), P<0.05]. Acupuncture plus western medicine was significantly different from simple western medicine in the effective rate, the healing rate of ulcer area and the recurrence rate[RR=1.20,95% CI (1.04, 1.38), P=0.01; RR=1.29, 95% CI (1.06, 1.58), P=0.01;RR=0.27, 95% CI (0.16, 0.45), P<0.00001]. The analysis of evidence grade (GRADE) pre-sented that the healing rate of ulcer area and the HP negative rate of acupuncture were "low grade", and others were "extremely low grade". CONCLUSIONS: Acupuncture combined with western medicine has some advantages for peptic ulcer compared with the conventional western medicine, which needs further confirmation due to the lower evidence grade. Larger samples, randomized controlled trials with high quality are highly recommended.

[Comprehensive assessment on the outcome of Tianjin Act of Tobacco Control].

OBJECTIVE: To evaluate the integrated effects of tobacco control programs through comparing the pre- and post-implementation of the Tianjin Tobacco Control Act (Act), in 4 successive years. METHODS: Case-related data on myocardial infarction was collected by Tianjin Surveillance System, New Case Registry. Both the representative sample size of indoor working places and public places for observation and PM2.5 monitored were selected through the calculation of Survey System, while the representative sample size of people involved in the survey for interview was under the Door to Door and Intercept. RESULTS: Through comparing the pre- and post-implementation programs on Act, the posting of "No Smoking Sign" had become much more visible in hospitals, schools, governmental buildings and the waiting areas of public transportation. People smoked much less in the main public places, excepting for hotels and public bath rooms (P < 0.05). Exposure to secondhand smoking (SHS) had a 26.5% (P < 0.01) decline, than the Act was implemented in workplace and public place. Despite the number of cases increased in the entire population in Tianjin (ß = -0.061, P = 0.00; ß = 0.059, P = 0.00), cases with myocardial infarction presented at the hospitals were declining annually, among the indoor workers. CONCLUSION: Act showed a positive effect in decreasing the number of smokers in public places thus protecting people from the negative effects on SHS. Message on health effect and social benefits on tobacco control should be disseminated to facilitate the comprehensive implementation of the Act.

Traumatic lumbosacral spondyloptosis treated five months after injury occurrence: a case report.

STUDY DESIGN: A case report. OBJECTIVE: To describe a case of traumatic lumbosacral spondyloptosis and present a literature review. SUMMARY OF BACKGROUND DATA: Traumatic spondyloptosis is a very rare injury caused by high-energy trauma. Eight cases of traumatic spondyloptosis of L5-S1 have been reported, including only 1 case treated 8.5 months after injury occurrence. METHODS: A 45-year-old Myanmar male experienced severe lower back pain and paresis of the lower extremities after a landslide disaster. Plain radiographs showed spondyloptosis, with the 5th lumbar vertebra located anterior to the 1st sacral vertebra. Computed tomography myelography demonstrated complete bilateral pars interarticularis fracture dislocation at L5-S1 and a complete block between L5 and S1 with apparent spondyloptosis. Neurological function of this patient improved after conservative treatment for 5 months; however, his severe lower back pain persisted. Thus, surgery for in situ posterior decompression and fusion of L3-S1 was performed. RESULTS: Lower back pain of the patient had nearly disappeared 2 weeks after surgery, and he was able to walk for more than 1 hour without assistance 2 years after surgery. CONCLUSION: We performed posterior decompression and in situ fusion of L3-S1 for the patients with traumatic lumbosacral spondyloptosis treated 5 months after injury, and the surgery produced a favorable clinical outcome.

[How to avoid hoarseness for operation of schwannoma of the cervical vagus nerve].

OBJECTIVE: To avoid hoarseness for operation of schwannoma of the cervical vagus nerve (SVN). METHODS: From Jan. 1997 to Sept. 2001, ten cases of SVN were operated. The procedures were as follows: Exposing the tumor and the vagus nerve, confirming its origin from the fascicle of recurrent laryngeal nerve (RLN) or the fascicle of non-RLN, making an small incision on the posterolateral surface of the tumor, usually posterior to the internal jugular vein, and then tearing and enlarging the small incision to enucleate the tumor. RESULTS: Two of the four cases of SVN originated from the fascicle of RLN happened temporary hoarseness and other two without hoarseness. All six cases of SVN originated from the fascicle of non-RLN, but one, happened no hoarseness. CONCLUSION: Above-mentioned technique is a good and reliable method to avoid hoarseness in the operation of SVN.