Pain-Related Risk Factors Among Radiologic Stages of Knee Osteoarthritis: Data From the Osteoarthritis Initiative.

OBJECTIVE: To investigate whether risk factors related to pain vary at different stages of knee osteoarthritis (OA). METHODS: Individuals from the Osteoarthritis Initiative with available Kellgren/Lawrence (K/L) grade and numerical rating scale (NRS) data at baseline were included in this study. Pain severity was classified into 3 categories based on NRS scores: no pain, mild pain, and moderate/severe pain. Knee OA severity was stratified into 4 categories according to the K/L system. Pain risk factors were evaluated using generalized ordinal logistic regression analysis, and a heatmap was created to compare differences in standardized regression coefficients between subgroups of patients with different knee OA severities. RESULTS: A total of 4,446 subjects were included in this study: 1,574 individuals without pain (35.4%), 1,138 individuals with mild pain (25.6%), and 1,734 individuals with moderate/severe pain (39.0%). For the entire population and subjects in the premorbid-stage subgroup, knee injury history, diabetes mellitus, depression, use of nonsteroidal anti-inflammatory drugs (NSAIDs), and valgus malaligned knees were associated with more severe pain. Older age and stronger quadriceps muscles were associated with milder pain. As the disease progressed, the number of significant risk factors decreased. Only age and quadriceps muscle force remained significant in end-stage disease. CONCLUSION: Multiple factors are associated with pain in patients with knee OA. As the disease progresses, the number of significant risk factors gradually reduces. These findings suggest that strategies for managing pain related to knee OA should vary depending on radiographic grades.

Self-regulated learning ability, metacognitive ability, and general self-efficacy in a sample of nursing students: A cross-sectional and correlational study.

The healthcare sector is fast-growing and knowledge-intensive, and to meet the demands associated with it, nursing students must have high levels of self-regulated learning (SRL), metacognition, and general self-efficacy (GSE). In this cross-sectional, correlational study, data were collected from 216 nursing students through a questionnaire. The aims were: 1) to describe the levels of SRL ability, metacognitive ability and GSE among second- and third-year nursing students; 2) to explore the relationships between the SRL ability, metacognitive ability and GSE of second- and third-year nursing students; 3) and to compare SRL ability, metacognitive ability and GSE between second- and third-year nursing students. Nursing students had moderate levels of SRL ability and metacognitive ability, but lower levels of GSE. Positive relationships between SRL ability, metacognitive ability, and GSE were observed. Third-year nursing students had a higher level of SRL ability but lower levels of GSE, compared to second-year students. In terms of metacognitive ability, no significant differences were observed between the student batches. Interventions are required for the improvement of nursing students' SRL ability, metacognitive ability, and GSE.

[Surgical treatment of perforation in esophageal carcinoma].

BACKGROUND & OBJECTIVE: Perforation in esophageal carcinoma usually occurs at late stage, and is often accompanied with thoracic infections. Conventional conservative treatments, including parenteral nutritional support and stent placement under the endoscope, can neither eliminate the carcinoma nor control the infection completely. The mortality soon after perforation is fairly high. This study was to investigate the ideal operation patterns and perioperative treatment of perforation in esophageal carcinoma. METHODS: A total of 41 patients with esophageal carcinoma perforated the right lung (19 cases), the mediastinum (17 cases) and the trachea (5 cases) were treated with operations: 39 underwent open thoracic operation, and 2 only underwent palliative gastric ostomy. Of the 39 patients, 16 received operation through the right thoracic approach with 3 incisions, and 23 received staging operation; 35 received retrosternal substitution of esophagus with stomach or colon, 4 underwent substitution of the esophagus with stomach via the esophageal bed. RESULTS: The operations were success in 36 cases. The patients could eat and take care of themselves. The patients were followed up for 3-72 months after operation: 2 survived for 3 months, 31 survived for 6-12 months, 2 survived for 24 months, and 1 survived for 72 months; 2 died during operation and 3 dead in 1 month after discharge. Of the latter 3 patients, 2 had underwent palliative gastric ostomy, 1 had stoma tracheal fistula recanalization. CONCLUSIONS: The surgical treatment of perforation in esophageal carcinoma could improve the survival rate and life quality of the patients. We suggest to perform retrosternal replacement of esophagus with stomach or colon through the right thoracic approach with 3 incisions or staging operations for the patients with perforation in carcinoma.