Quality improvement in the golden hour for premature infants: a scoping review.

BACKGROUND AND OBJECTIVE: Evidence-based research has shown that golden hour quality improvement (QI) measures can improve the quality of care and reduce serious complications of premature infants. Herein, we sought to review golden hour QI studies to evaluate the impact on the outcome of preterm infants. METHODS: A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, and SinoMed databases from inception to April 03, 2023. Only studies describing QI interventions in the golden hour of preterm infants were included. Outcomes were summarized and qualitative synthesis was performed. RESULTS: Ten studies were eligible for inclusion. All studies were from single centers, of which nine were conducted in the USA and one in Israel. Seven were pre-post comparative studies and three were observational studies. Most included studies were of medium quality (80%). The most common primary outcome was admission temperatures and glucose. Five studies (n = 2308) reported improvements in the admission temperature and three studies (n = 2052) reported improvements in hypoglycemia after QI. Four studies (n = 907) showed that the incidence of bronchopulmonary dysplasia (BPD) was lower in preterm infants after QI: 106/408 (26.0%) vs. 122/424(29.5%) [OR = 0.68, 95% CI 0.48-0.97, p = 0.04]. CONCLUSIONS: Our study showed that the golden hour QI bundle can improve the short-term and long-term outcomes for extremely preterm infants. There was considerable heterogeneity and deficiencies in the included studies, and the variation in impact on outcomes suggests the need to use standardized and validated measures. Future studies are needed to develop locally appropriate, high-quality, and replicable QI projects.

Glycemic variability evaluated by HbA1c rather than fasting plasma glucose is associated with adverse cardiovascular events.

Background: Although studies have shown that glycemic variability is positively associated with an increased risk of cardiovascular disease, few studies have compared hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) variability with adverse cardiovascular events in patients with type 2 diabetes mellitus (T2DM). Methods: This was a post hoc analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. Cox proportional hazards models were used to explore the relationship between HbA1c or FPG variability and the incidence of major adverse cardiovascular events (MACEs). Results: In total, 9,547 patients with T2DM were enrolled in this study. During the median 4.6 ± 1.5 years follow-up period, 907 patients developed MACEs. The risk of MACEs increased in the HbA1c variability group in each higher quartile of HbA1c variability (P < 0.01). Compared with those in the first quartile of HbA1c variability, patients in the fourth quartile had a hazard ratio of 1.37 (Model 2, 95% confidence interval: 1.13-1.67) for MACEs. Higher FPG variability was not associated with a higher risk of MACEs in patients with T2DM (P for trend=0.28). A U-shaped relationship was observed between HbA1c and FPG variability, and MACEs. Glucose control therapy modified the relationship between HbA1c and MACEs; participants with higher HbA1c variability receiving intensive glucose control were more likely to develop MACEs (P for interaction <0.01). Conclusion: In adults with T2DM, the relationship between glycemic variability evaluated using HbA1c and FPG was U-shaped, and an increase in HbA1c variability rather than FPG variability was significantly associated with MACEs. The relationship between HbA1c variability and MACEs was affected by the glucose control strategy, and a higher HbA1c variability was more strongly associated with MACEs in patients receiving an intensive glucose control strategy.

METTL3/IGF2BP3-regulated m6A modification of HYOU1 confers doxorubicin resistance in breast cancer.

Chemoresistance is a main reason for therapeutic failure and poor prognosis for breast cancer (BC) patients, especially for triple-negative BC patients. How the molecular mechanisms underlying the chemoresistance to doxorubicin (Dox) in BC is not well understood. Here, we revealed that METTL3/IGF2BP3-regulated m6A modification of HYOU1 increased Dox resistance in BC cells. CCK-8 and Annexin V-FITC/PI staining assays were employed to measure viability and cell death. Western blotting and qRT-PCR assays were applied to assay the expression of genes. Knockdown and rescue experiments were used to assay the role of METTL3, IGF2BP3 and HYOU1 in regulating BC cell responses to Dox. RIP, MeRIP and dual-luciferase activity assays were applied to examine the function of METTL3/IGF2BP3 in the m6A modification of HYOU1 mRNA. It was found that global mRNA m6A methylation levels were upregulated in Dox-resistant BC cell lines. The methyltransferase METTL3 was upregulated in Dox-resistant BC cell lines, and downregulation of METTL3 could overcome this resistance. Furthermore, HYOU1 was identified as a downstream target of METTL3-mediated m6A modification. Downregulation of HYOU1 could overcome Dox resistance, while forced expression of HYOU1 resulted in Dox resistance in BC cells. METTL3 cooperated with IGF2BP3 to modulate the m6A modification of HYOU1 mRNA and increase its stability. Collectively, our findings unveiled the key roles of the METTL3/IGF2BP3/HYOU1 axis in modulating Dox sensitivity in BC cells; thus, targeting this axis might be a potential strategy to increase Dox efficacy in the treatment of BC.

Role of in-plane shift in reconstructing the photonic spin Hall effect.

The photonic spin Hall effect (SHE) manifests itself as in-plane and transverse spin-dependent shifts of left- and right-handed circularly polarized (LCP, RCP) components and originates from the spin-orbit interaction (SOI) of light, where extrinsic orbital angular momentum (EOAM) can induce these shifts. However, previous studies mainly focus on the SOI corresponding to transverse shifts and generally consider the paraxial approximation case. In this Letter, we reconstruct a more general theory of the photonic SHE in the non-paraxial case and reveal that the induction of an in-plane shift mainly relies on the EOAM of the y direction, supplemented by the EOAM of the x and z directions under the laboratory coordinate system. In addition, the EOAM in the x and z directions completely determine the transverse shift. Moreover, the angular momentum conversion between the LCP and RCP components results in the angular momentum of the LCP (RCP) component of the incident Gaussian beam not being equal to the sum of the angular momentum of the LCP (RCP) component of the reflected and transmitted light. These findings explore the influence of in-plane shifts on the SOI of light and provide an in-depth understanding of the photonic SHE.

Enhanced photonic spin Hall effect via singularity induced by destructive interference.

In this work, we report a simple and effective method for enhancing the photonic spin Hall effect (SHE) via singularity induced by destructive interference in an ultrathin uniaxial slab. Deriving from anisotropy, the incident angles corresponding to destructive interference for p- and s-polarized waves will be deviated, leading to an enhancement peak in transverse spin shift. Interestingly, by adjusting the thickness of slab, the destructive interference and the Brewster effect can act together. At this point, the photonic SHE exhibits great singularity, and the maximum transverse spin shift can approach about three times more than that of the Brewster effect acting alone. This Letter reveals the influence of the interference effect on photonic SHE in layered media and provides a simple way to achieve enhanced photonic SHE.

From Best Evidence to Best Practice: Enteral Nutrition from Continuous Nasal Feeding in Stroke Patients.

BACKGROUND: Best evidence regarding enteral nutrition from continuous nasal feeding in stroke patients is limited. The aim of this study was to explore the best evidence of continuous nasal feeding in stroke patients and translate the evidence into clinical practice. METHODS: This study utilized the standard procedures of the Joanna Briggs Institute (JBI) evidence-based nursing centers' clinical evidence-practice application system. The baseline assessment of stroke patients in the neurology ward was conducted. A pre- and post-implementation audit approach was used in this study and adopted the Getting Research into Practice program. We analyzed the compliance of nurses with best practice and its impact on patients' gastrointestinal function and complications, aspiration, aspiration pneumonia, nurses' daily workload of nasal feeding, and the length of hospitalization before and after implementing the evidence-based strategies. RESULTS: After application of the evidence-based strategies, nurses' compliance with best practice was improved. The incidence of patients' gastrointestinal complications including vomit (χ2 = 5.195, P=0.023), palirrhea (χ2 = 4.216, P=0.039), diarrhea (χ2 = 4.514, P=0.042), constipation (χ2 = 5.535, P=0.035) and gastric retention (χ2 = 4.541, P=0.042) decreased significantly after the application of the best evidence. The working time of nurses undergoing nasal feeding decreased from 23.71 ±3.22 min to 7.73 ±1.14 min (P =0.000) and the length of patient's hospitalization decreased from 35.63 ±4.45 days to 35.00 ±3.70 days (P=0.534). The rate of aspiration, aspiration pneumonia did not show a significant difference after implementation of the evidence-based strategies. CONCLUSION: The results revealed that the evidence-based practice of continuous nasal feeding in stroke patients is an effective method to improve nursing quality and reduce gastrointestinal complications, which was worthy of clinical application.

Tunable in-plane and transverse spin angular shifts in layered dielectric structure.

The photonic spin Hall effect (SHE) manifests itself as the spin-dependent spatial and angular shifts. There are some ways for controlling the spatial shifts, however, lacks an effective method for manipulating angular shifts. In this work, we propose a simple and effective way for manipulating the spin angular shifts in photonic SHE by considering the light beam reflected at the air-layered structure interface. We theoretically derive the general expressions of the in-plane and transverse spin angular shifts in this layered structure. It is found that the in-plane and transverse spin angular shifts can be effectively regulated by adjusting the structure parameters of layered model, including amplifying or suppressing the magnitude of the angular shifts and switching their signs. Interestingly, the in-plane angular shifts can be adjusted from spin-independent to spin-dependent or vice versa when the polarization state of the incident beam varies. Importantly, as for the incident beam with vertical polarization, a near-zero reflection angle similar to Brewster angle appears. In the vicinity of this point, the large spin angular shifts can be explored.

Association of Synthetic House-Tree-Person Drawing Test and Depression in Cancer Patients.

BACKGROUND: Evidence regarding the relationship between synthetic house-tree-person (S-HTP) drawing test and depression in cancer patients is limited. The aim of this study was to explore the applicability and validity of S-HTP drawing test in cancer patients suffering from depression. METHODS: As a population based cross-sectional study, 167 patients with cancer were enrolled in a hospital in China from December 2015 to December 2017. Self-edited general information questionnaire, self-rating depression scale (SDS), and the S-HTP drawing test were completed by all participants. RESULTS: The average age of 167 selected participants was 52.92 ± 10.43 years old, and about 58.7% (98/167) of them were male. On SDS, depression rate was found in 34.1% (27/167) cancer patients. The logistic regression equation was established by using the depression drawing characteristics as the independent variables and the evaluation results from SDS as the dependent variable and 9 drawing characteristics employed in the regression equation (χ2 = 68.657, P < 0.001. Nagelkerke R2= 0.466). Correlation analysis revealed a positive correlation between S-HTP drawing test and SDS for depression state of cancer patients (p < 0.01). CONCLUSIONS: There are interrater reliability and test-retest reliability between S-HTP drawing test and SDS. The S-HTP drawing test could help in screening depression in cancer patients.

Synthetic House-Tree-Person Drawing Test: A New Method for Screening Anxiety in Cancer Patients.

The synthetic house-tree-person (S-HTP) drawing test is a projective measure primarily designed to assess specific complex personality traits. It is widely used in general psychological problems and mental illness such as psychological crisis intervention. Applicability and validity of S-HTP drawing test in cancer patients suffering from anxiety are still unclear and there are no reports on such research. The aim of this study was to explore the prevalence of anxiety in cancer patients and to investigate the applicability of S-HTP drawing test in such patients. Self-rating anxiety scale (SAS) and the S-HTP drawing test were applied to 167 cancer patients (58.7% male; 41.3% female), 52.92±10.43 years old. On SAS, anxiety rate was found in 16.17% cancer patients. Using the evaluation results from SAS as the dependent variable and the anxiety drawing characteristics as the independent variables, the logistic regression equation was established, and 9 drawing features were employed in the regression equation (χ2=56.982, P≤0.001, Nagelkerke R2=0.492). It is concluded that there is a positive correlation between S-HTP drawing test and SAS for anxiety state of cancer patients (p<0.01). S-HTP drawing test and SAS have interrater reliability and test-retest reliability. Our findings indicate that the S-HTP drawing test could help in screening anxiety in cancer patients.

Hair Loss: Evidence to Thallium Poisoning.

In clinical practice, thallium poisoning is very hard to diagnose, because it is a very uncommon disease and its clinical manifestations are extremely complicated. In the present study, we investigated a case of a 53-year-old man who was hospitalized for persistent stabbing pain in the abdomen and lower extremities for 20 days. Physical examination revealed diffuse alopecia of the scalp. The final diagnosis of thallium poisoning was confirmed based on high blood and urine thallium levels. The patient was cured by an oral administration of Prussian blue combined with hemoperfusion and continuous veno-venous hemofiltration.

Photonic spin Hall effect enabled refractive index sensor using weak measurements.

In this work, we theoretically propose an optical biosensor (consists of a BK7 glass, a metal film, and a graphene sheet) based on photonic spin Hall effect (SHE). We establish a quantitative relationship between the spin-dependent shift in photonic SHE and the refractive index of sensing medium. It is found that, by considering the surface plasmon resonance effect, the refractive index variations owing to the adsorption of biomolecules in sensing medium can effectively change the spin-dependent displacements. Remarkably, using the weak measurement method, this tiny spin-dependent shifts can be detected with a desirable accuracy so that the corresponding biomolecules concentration can be determined.

Beta3 adrenergic receptor is involved in vascular injury in deoxycorticosterone acetate-salt hypertensive mice.

Beta3 adrenergic receptor (ADRB3) mediates vessel relaxation in the endothelium while it modulates lipolysis in the adipose tissue. However, the function and regulation mechanism of ADRB3 in the perivascular adipose tissue (PVAT), especially in hypertension, is still unclear. We show that ADRB3 protein is upregulated in the PVAT of deoxycorticosterone acetate-salt (DOCA-salt) hypertensive mice, with the characteristics of PVAT browning and increased uncoupling protein 1 (UCP1) expression. Inhibition of ADRB3 with selective antagonist SR59230A caused serious vascular injury in vivo, even though UCP1 expression was downregulated. ADRB3 protein was regulated by let-7b, which was decreased in the PVAT of the DOCA-salt group. These data reveal that ADRB3 in PVAT contributes to vascular function in the progression of hypertension.

Complement-mediated macrophage polarization in perivascular adipose tissue contributes to vascular injury in deoxycorticosterone acetate-salt mice.

OBJECTIVE: We have previously shown an increased expression of complement 3 (C3) in the perivascular adipose tissue (PVAT) in the deoxycorticosterone acetate (DOCA)-salt hypertensive model. This study aims to examine the role and underlying mechanism of C3 in PVAT for understanding the pathogenesis of hypertensive vascular remodeling further. APPROACH AND RESULTS: The role of C3 in macrophage polarization was investigated using peritoneal macrophages from wild-type and C3-deficient (C3KO) mice because we found that C3 was primarily expressed in macrophages in PVAT of blood vessels from DOCA-salt mice, and results showed a decreased expression of M1 phenotypic marker in contrast to an increased level of M2 marker in the C3KO macrophages. Bone marrow transplantation studies further showed in vivo that DOCA-salt recipient mice had fewer M1 but more M2 macrophages in PVAT when the donor bone marrows were from C3KO compared with those from wild-type mice. Of note, this macrophage polarization shift was accompanied with an ameliorated vascular injury. Furthermore, we identified the complement 5a (C5a) as the major C3 activation product that was involved in macrophage polarization and DOCA-salt-induced vascular injury. Consistently, in vivo depletion of macrophages prevented the induction of C3 and C5a in PVAT, and ameliorated hypertensive vascular injury as well. CONCLUSIONS: The presence and activation of bone marrow-derived macrophages in PVAT are crucial for complement activation in hypertensive vascular inflammation, and C5a plays a critical role in DOCA-salt-induced vascular injury by stimulating macrophage polarization toward a proinflammatory M1 phenotype in PVAT.

[The interactions between the circadian clock and aging].

It is well known that almost all organisms ranging from single cell creatures to human beings exhibit circadian rhythms in physiology and behavior under the control of the internal circadian clock. The internal circadian clock is composed of a master clock which is localized in the suprachiasmatic nucleus and the peripheral clocks located in peripheral tissues such as the liver and heart. Along with aging, the circadian rhythm alters in many aspects, including the amplitude, free-running period and the expression phase. On the other hand, the circadian clock also influences the process of aging. The disorganized circadian rhythm accelerates the aging process. This article briefly reviews the recent progress in the interactions between the circadian clock and aging, and provides evidence to further understand the mechanism of aging and the impact of aging on the organisms.