Enhanced hepatotoxicity in zebrafish due to co-exposure of microplastics and sulfamethoxazole: Insights into ROS-mediated MAPK signaling pathway regulation.

The combined pollution of microplastics (MPs) and sulfamethoxazole (SMZ) often occurs in aquatic ecosystems, posing a serious threat to animal and human health. However, little is known about the liver damage caused by the single or co-exposure of MPs and SMZ, and its specific mechanisms are still poorly understood. In this study, we investigated the effects of co-exposure to 20 µm or 80 nm MPs and SMZ in both larval and adult zebrafish models. Firstly, we observed a significant decrease in the number of hepatocytes and the liver damage in larval zebrafish worsened following co-exposure to SMZ and MPs. Additionally, the number of macrophages and neutrophils decreased, while the expression of inflammatory cytokines and antioxidant enzyme activities increased after co-exposure in larval zebrafish. Transcriptome analysis revealed significant changes in gene expression in the co-exposed groups, particularly in processes related to oxidation-reduction, inflammatory response, and the MAPK signaling pathway in the liver of adult zebrafish. Co-exposure of SMZ and MPs also promoted hepatocyte apoptosis and inhibited proliferation levels, which was associated with the translocation of Nrf2 from the cytoplasm to the nucleus and an increase in protein levels of Nrf2 and NF-kB p65 in the adult zebrafish. Furthermore, our pharmacological experiments demonstrated that inhibiting ROS and blocking the MAPK signaling pathway partially rescued the liver injury induced by co-exposure both in larval and adult zebrafish. In conclusion, our findings suggest that co-exposure to SMZ and MPs induces hepatic dysfunction through the ROS-mediated MAPK signaling pathway in zebrafish. This information provides novel insights into the potential environmental risk of MPs and hazardous pollutants co-existence in aquatic ecosystems.

Death Anxiety and Its Influencing Factors Among Family Caregivers of Cancer Patients: A Cross-Sectional Study.

BACKGROUND: In China, caregiving for cancer patients is primarily the responsibility of family members. This role often exposes family caregivers to the contemplation of mortality. Death anxiety among family caregivers may influence the care they offer to cancer patients. OBJECTIVE: This study aims to evaluate the prevailing level of death anxiety among Chinese family caregivers of cancer patients and identify its influencing factors. DESIGN: This cross-sectional study followed the STROBE statement. METHODS: A total of 220 family caregivers of cancer patients were recruited from a prominent tertiary hospital in southern China. The survey included a general information questionnaire, the Collett-Lester Fear of Death Scale, the Social Support Rating Scale and the Simple Coping Style Questionnaire. In addition to descriptive statistics, ANOVA, mean differences, correlations and regression analyses were computed. RESULTS: The average score for death anxiety among family caregivers of cancer patients was 104.27 ± 21.02. Death anxiety was negatively correlated with a positive coping style and social support. Multiple linear regression analysis revealed that marital status, death education, patients' fear of death and coping style accounted for 41.0% of the variance in death anxiety among family caregivers. CONCLUSIONS: Family caregivers of cancer patients experienced a moderate level of death anxiety. Individuals who were unmarried or divorced, lacked death education, had negative coping styles or cared for patients with fear of death tended to have high levels of death anxiety. RELEVANCE TO CLINICAL PRACTICE: Healthcare providers should act as credible educators to reduce caregivers' death anxiety by imparting positive coping styles and accurate knowledge and values about death so caregivers can provide high-quality care to patients.

Readiness for hospital discharge and its association with post-discharge outcomes among oesophageal cancer patients after oesophagectomy: A prospective observational study.

AIM: To examine the level and influencing factors of discharge readiness among patients with oesophageal cancer following oesophagectomy and to explore its association with post-discharge outcomes (post-discharge coping difficulty and unplanned readmission). BACKGROUND: Oesophageal cancer is common and usually treated via oesophagectomy in China. The assessment of patient's discharge readiness gradually attracts attention as patients tend to be discharged more quickly. DESIGN: Prospective observational study. The STROBE statement was followed. METHODS: In total, 154 participants with oesophageal cancer after oesophagectomy were recruited in a tertiary cancer centre in Southern China from July 2019 to January 2020. The participants completed a demographic and disease-related questionnaire, the Quality of Discharge Teaching Scale and Readiness for Hospital Discharge Scale before discharge. Post-discharge outcomes were investigated on the 21st day (post-discharge coping difficulty) and 30th day (unplanned readmission) after discharge separately. Multiple linear regressions were used for statistical analysis. RESULTS: The mean scores of discharge readiness and quality of discharge teaching were (154.02 ± 31.58) and (138.20 ± 24.20) respectively. The quality of discharge teaching, self-care ability, dysphagia and primary caregiver mainly influenced patient's discharge readiness and explained 63.0% of the variance. The low discharge readiness could predict more risk of post-discharge coping difficulty (r = -0.729, p < 0.01) and unplanned readmission (t = -2.721, p < 0.01). CONCLUSIONS: Discharge readiness among patients with oesophageal cancer following oesophagectomy is influenced by various factors, especially the quality of discharge teaching. A high discharge readiness corresponds to good post-discharge outcomes. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Healthcare professionals should improve the discharge readiness by constructing high-quality discharge teaching, cultivating patients' self-care ability, mobilizing family participation and alleviating dysphagia to decrease adverse post-discharge outcomes among patients with oesophageal cancer. PATIENTS OR PUBLIC CONTRIBUTION: Patients with oesophageal cancer after oesophagectomy who met the inclusion criteria were recruited.

Prevalence of physical inactivity and its determinants among older adults living in nursing homes: A cross-sectional study based on COM-B model.

AIMS: To investigate the prevalence of physical inactivity in older adults living in nursing homes and explore the determinants of physical inactivity by using the Capability, Opportunity, Motivation-Behaviour model. DESIGN: A multisite, cross-sectional study was performed by convenience sampling and questionnaire survey. METHODS: A total of 390 nursing home residents were recruited from three nursing homes in Southern China from May 2022 to April 2023. The participants completed a self-designed general information questionnaire, Physical Activity Scale for the Elderly, Self-Efficacy for Exercise Scale, Exercise Benefits Scale, Patient Health Questionnaire-9 and the Short Physical Performance Battery test. Descriptive statistics, univariate analysis, Spearman correlation analysis, and ordinal logistic regression were applied for data analysis. RESULTS: The prevalence of physical inactivity among the nursing home residents reached 88.46%. Ordinal logistic regression results showed that exercise self-efficacy, perceived exercise benefits, physical function, availability of physical activity instruction, having depression, number of chronic diseases and living with spouse were the main influencing determinants of physical inactivity and explained 63.7% of the variance. CONCLUSIONS: Physical inactivity was considerable in nursing home residents in China and influenced by complex factors. Tailored measures should be designed and implemented based on these factors to enhance physical activity while considering the uniqueness of Chinese culture. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Healthcare professionals should enhance physical activity of residents by increasing benefits understanding, boosting self-efficacy, improving physical function, alleviating depression and integrating personalized physical activity guidance into routine care services. And more attention should be paid to the residents who had more chronic diseases or did not live with spouse. IMPACT: Physical inactivity is a significant problem in nursing home residents. Understanding physical inactivity and its determinants enables the development of tailored interventions to enhance their physical activity level. REPORTING METHOD: This study was reported conforming to the STROBE statement. PATIENTS OR PUBLIC CONTRIBUTION: Nursing home residents who met the inclusion criteria were recruited.

Effect of nonpharmacological interventions on nutrition status, complications and quality of life in head and neck cancer patients undergoing radiotherapy: A systematic review and meta-analysis.

PURPOSE: To evaluate the effect of nonpharmacological therapies on nutrition status, complications and quality of life in head and neck cancer patients and to provide a basis for clinical practice. METHODS: This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Ten databases were systematically searched for all available articles from construction to November 2023. Two researchers independently conducted literature screening, data extraction and quality evaluation. Cochrane Review Manager 5.3 was used for meta-analysis. RESULTS: Finally, 27 RCT studies including 2814 patients with head and neck cancer were included. Five categories of interventions were used: nutritional support, exercise, swallowing function training, psychological intervention and low-level laser therapy. Nonpharmacological interventions can improve body weight loss in patients with HNC at the end of treatment (MD: 1.66 kg; 95% CI: 0.80 to 2.51), and subgroup analysis showed that nutritional support, psychological intervention and low-level laser therapy were effective. Nonpharmacological interventions can also ameliorate decreases in BMI (MD: 0.71; 95% CI: 0.16 to 1.26) and reduce the incidence of malnutrition (RR: 0.76; 95% CI: 0.67 to 0.86), oral mucositis (RR: 0.54; 95% CI: 0.37 to 0.80) and gastrointestinal complications (RR: 0.61; 95% CI: 0.38 to 0.96) during radiotherapy; however, no significant differences were found in other complications and quality of life. CONCLUSION: Nonpharmacological interventions can improve the nutrition status of patients with head and neck cancer and reduce the incidence of severe oral mucositis and gastrointestinal complications during radiotherapy but have no significant impact on quality of life.

Adverse event reporting attitude and its individual and organizational predictors among nursing staff: A multisite study in Chinese nursing homes.

This study explored the status of adverse event reporting attitudes and its predictors among nursing staff in Chinese nursing homes. A cross-sectional study was conducted with 475 nursing staff, and they completed sociodemographic and facility-related questionnaire, Incident Reporting Attitude Scale, Adverse Event Reporting Awareness Scale, and Nursing Home Survey on Patient Safety Culture. Univariate analysis and multiple linear regression models were performed. The mean score for adverse event reporting attitude was 125.87 (SD=15.35). The predictors included individual variables, such as education level (ß=0.129, p = 0.001) and working years (ß=-0.102, p = 0.007), and organizational variables, such as patient safety culture (ß=0.503, p < 0.001) and adverse event reporting awareness (ß=0.261, p < 0.001). These factors explained 35.3 % of total variance. Managers in nursing homes should strengthen team-targeted education and training for nursing staff with longer working years and lower educational backgrounds. Meanwhile, a simplified and non-punitive reporting system should be established to create positive safety management climate.

Sulfoxaflor induces immunotoxicity in zebrafish (Danio rerio) by activating TLR4/NF-κB signaling pathway.

Sulfoxaflor is an insecticide that is widely used and affects the nervous system of sucking pests. However, studies on the molecular mechanism of the toxicity of sulfoxaflor to non-target species are limited. Zebrafish (Danio rerio) was used as an experimental subject in this study. Zebrafish embryos were exposed to 20, 25, and 30 mg/L sulfoxaflor solution to detect hatchability, mortality, heart rate, neutrophil count, oxidative stress, and expression of genes related to apoptosis and immune inflammation. The results showed that zebrafish embryos exposed to sulfoxaflor solution increased mortality and growth retardation, and the number of innate immune cells decreased significantly. In addition, the expression levels of apoptotic and proapoptotic genes increased significantly, and oxidative stress-related indexes changed significantly. Toll-like receptor 4 (TLR4)/nuclear factor kappa B (NF-κB) signaling pathway was further studied, and the interleukin 6 (IL-6), interleukin 1 beta (IL-1ß), cyclooxygenase-2 (COX2), tumor necrosis factor-alpha (TNF-α), TLR4, and myeloid differentiation primary response 88 (MYD88) gene expression levels were significantly up-regulated. We used small molecule inhibitor QNZ for the rescue experiment and detected the expression of relevant target proteins in the QNZ signaling pathway. QNZ reduced the expression of TLR4/NF-κB signaling pathway-related protein NF-κB p65 in the cytoplasm and nucleus and rescued the number of innate immune cells. In summary, sulfoxaflor may induce developmental toxicity and immunotoxicity in zebrafish by activating the TLR4/NF-κB signaling pathway, which provides a basis for further studies on the molecular mechanism of sulfoxaflor action in the aquatic ecosystem and the development and utilization of QNZ.

Cyhalofop-butyl exposure induces the severe hepatotoxicity and immunotoxicity in zebrafish embryos.

Cyhalofop-butyl (CyB) is a highly effective herbicide and is widely used for weed control in paddy fields. Because CyB is easily residual in the aquatic environment, its potential harm to aquatic organisms has attracted much attention and has not been fully understood. In this study, we systematically explored the hepatotoxic and immunotoxic effects of CyB exposure in zebrafish embryos. Firstly, CyB induced a decrease in the survival rate of zebrafish and led to a series of developmental abnormalities. Meanwhile, CyB can significantly reduce the size of zebrafish liver tissue and the number of hepatocytes in a dose-dependent manner. Secondly, the number of macrophages and neutrophils significantly decreased but the antioxidant enzyme activities such as CAT and MDA were greatly elevated upon CyB exposure. Thirdly, RNA-Seq analysis identified 1, 402 differentially expressed genes (DEGs) including 621 up-regulated and 781 down-regulated in zebrafish embryos after CyB exposure. KEGG and GO functional analysis revealed that the metabolic pathways of drug metabolism-cytochrome P450, biosynthesis of antibiotics, and metabolism of xenobiotics, along with oxidation-reduction process, high-density lipoprotein particle and cholesterol transport activity were significantly enriched after CyB exposure. Besides, hierarchical clustering analysis suggested that the genes involved in lipid metabolism, oxidative stress and innate immunity were largely activated in CyB-exposed zebrafish. Moreover, CyB induced zebrafish liver injury and increased hepatocyte apoptosis, which increased the protein expression levels of Bax, TLR4, NF-kB p65 and STAT3 in zebrafish. Finally, specific inhibition of TLR signaling pathway by TLR4 knock-down could significantly reduce the expression of inflammatory cytokines induced by CyB exposure. Taken together, these informations demonstrated that CyB could induce the hepatotoxicity and immunotoxicity in zebrafish embryos, and the expression levels of many genes involved in lipid metabolism and immune inflammation were obtained by RNA-Seq analysis. This study provides valuable information for future elucidating the aquatic toxicity of herbicide in aquatic ecosystems.

Effects of haloxyfop-p-methyl on the developmental toxicity, neurotoxicity, and immunotoxicity in zebrafish.

Pesticides are extensively used in agricultural production, and their residues in soil, water, and agricultural products have become a threat to aquatic ecosystem. In this study, the toxicity of haloxyfop-p-methyl, an aryloxyphenoxypropionate herbicide was studied using the model animal zebrafish. The development of zebrafish larvae was affected by haloxyfop-p-methyl including spinal deformities, decreased body length, slow heart rate, and large yolk sac area. Behavior analysis revealed that behavior activity of larvae was weakened significantly including shortened displacement distance, reduced swimming speed, increased angular speed winding degrees, in accordance with higher AChE activity. Besides, exposure to haloxyfop-p-methyl could induce oxidative stress companied by the increased intents of ROS, MDA and increased activities of CAT and SOD. In immunotoxicity, haloxyfop-p-methyl not only reduced the innate immune cells such as neutrophils and macrophages, but also affected T cells mature in thymus. Furthermore, haloxyfop-p-methyl could induce neutrophils apoptosis, accompanied with the upregulation of the expression of proapoptotic protein such as Bax and P53 and the downregulation of the expression of antiapoptotic protein Bcl-2. In addition, haloxyfop-p-methyl could induce the expression of Jak, STAT and proinflammatory cytokine genes (IFN-γ, TNF-α, and IL-8). These results indicate that haloxyfop-p-methyl induces developmental toxicity, neurotoxicity, and immunotoxicity in zebrafish, providing a perspective on the toxicological mechanism of haloxyfop-p-methyl in teleosts.

Study on the mechanism of liver toxicity induced by acenaphthene in zebrafish.

Acenaphthene is a polycyclic aromatic hydrocarbon (PAH) that is a widely distributed environmental pollutant that accumulates in organisms and leads to health risks in humans. Although acenaphthene is reported to be toxic to aquatic organisms, its effects of acenaphthene on the livers of these organisms have not been evaluated. Here, zebrafish were used as an experimental model. Zebrafish larvae were exposed to 4.5, 5.5, and 6.5 mg/L acenaphthene for 72 h while adult zebrafish were exposed to 1.5, 2, and 2.5 mg/L acenaphthene for 28 days. We investigated the mechanism by which acenaphthene causes liver toxicity in zebrafish. The results showed that acenaphthene affected the early development of zebrafish and led to mitochondrial damage by promoting the production of reactive oxygen species (ROS) resulting in oxidative stress. The expression of genes related to inflammation and apoptosis was analyzed, observing up-regulation of the pro-inflammatory factors IL-8, TNF-α, and IL-6. The pro-apoptotic genes p53, Caspase-3, and Bax and the Bax/Bcl-2 ratio were up-regulated, while the anti-apoptotic gene Bcl-2 was down-regulated. In addition, we investigated the effects of acenaphthene on liver metabolism. When exposed to acenaphthene, the glycogen content of the liver decreased, while lipid accumulation increased together with alterations in related indicators of liver metabolism. In conclusion, acenaphthene induced oxidative stress through ROS production, leading to mitochondrial damage and activation of pathways associated with inflammation and apoptosis, resulting in hepatotoxicity. This affects normal liver metabolism. Our results revealed the mechanism of hepatotoxicity in zebrafish acenaphthene, and provided new evidence for a more comprehensive understanding of the hepatotoxicity of acenaphthene.

The mediating role of self-efficacy in the association between perceived stigma and psychosocial adjustment: a cross-sectional study among nasopharyngeal cancer survivors.

OBJECTIVE: This study aims to examine the levels of and associations between perceived stigma, self-efficacy, and psychosocial adjustment (PA) among nasopharyngeal carcinoma (NPC) survivors, and to identify the mediating role of self-efficacy between stigma and PA and explore the influencing factors of PA. METHODS: A cross-sectional survey was conducted and 307 NPC survivors were recruited by convenience sampling method in Southern China from July 2019 to January 2020. Data analyses were performed with the SPSS WIN 25.0 program and PROCESS macro version 3.3. RESULTS: Stigma and self-efficacy were positively associated with PA among Chinese NPC survivors. Tumor-free survival time, late toxicities (fatigue, dizziness and headache, and hearing loss), stigma, and self-efficacy entered the final regression model and explained 55.9% of the variance of PA. The total and direct effects of stigma on PA and its subscales were significant (p < 0.05). Positive indirect effects were found for stigma on PA via self-efficacy (point estimate = 0.159, SE = 0.032, 95% CI [0.102 to 0.229]). CONCLUSIONS: Stigma and self-efficacy are significantly associated with PA, and self-efficacy is also a mediating variable between stigma and PA among NPC survivors. Medical staff could improve the PA of NPC survivors by alleviating their stigma, enhancing their self-efficacy, and relieving their late toxicities (fatigue, dizziness and headache, and hearing loss).

The mediating role of coping in the relationship between family function and resilience in adolescents and young adults who have a parent with lung cancer.

PURPOSE: Resilience plays an important role in helping individuals to adapt to adversity and improve their psychosocial outcomes. This study aims to examine the mediating role of coping in the relationship between family function and resilience in adolescents and young adults (AYAs) who have a parent with lung cancer. METHOD: A total of 135 AYAs with a lung cancer parent were recruited from a tertiary grade A cancer center in southern China, and investigated using a self-designed general information questionnaire, the Resilience Scale for Chinese Adolescents, the Simplified Coping Style Questionnaire, and the Family Adaptation, Partnership, Growth, Affection, Resolve index. RESULTS: The mean score of AYAs' resilience was (3.61 ± 0.49), and its influencing factors included AYAs' years in work, family function, and positive coping. The total effect of family function on resilience was significant (total effect = 0.38, 95% CI [0.048-0.115]), and a positive indirect effect was identified for family function on resilience via positive coping (indirect effect = 0.10, 95% CI [0.005-0.043]). CONCLUSION: Family functioning can facilitate resilience either directly or by promoting positive coping. This study suggests that individualized interventions can be made to improve resilience by promoting family function, or by enhancing positive coping in AYAs with a lung cancer parent.

Stigma, self-efficacy and late toxicities among Chinese nasopharyngeal carcinoma survivors.

OBJECTIVE: This study explores the level of stigma among Chinese nasopharyngeal carcinoma survivors, its influencing factors and relationship with self-efficacy. METHODS: In total, 281 nasopharyngeal carcinoma survivors were recruited from China, who completed the demographic, disease-related and late toxicities questionnaire, as well as the General Self-Efficacy Scale and Social Impact Scale. RESULTS: The mean scores for stigma and self-efficacy were 57.22 ± 9.58 and 28.06 ± 3.97, respectively, both showing a moderate level. The late toxicities with the highest incidence were xerostomia (91.8%), fatigue (78.3%) and hearing loss (63.0%). Stigma was significantly and negatively related to self-efficacy (r = -0.295, P < 0.001). Multivariable linear regression showed that self-efficacy, number of children, educational level, perceived support from spouse and other family members and some late toxicities (nasal obstruction and toothache) were influencing factors of stigma, accounting for 49.4% of the variance. CONCLUSION: Medical staff should be more aware of stigma among Chinese nasopharyngeal carcinoma survivors, especially those with more children and weaker educational backgrounds who are at a higher risk of stigma. They should take effective measures to alleviate stigma by improving patients' self-efficacy, relieving late toxicities and encouraging spouses and family members to provide more support for them.

Public awareness of colorectal cancer in the Chinese population: An online cross-sectional survey study.

OBJECTIVES: To investigate public awareness of colorectal cancer (three components: total knowledge, confidence and anticipated delay) in the Chinese population, to explore factors associated with total knowledge and to elucidate relationships among three components of public awareness of colorectal cancer. METHODS: We recruited 562 adult Chinese participants with no history of colorectal cancer between March and May 2020 by convenience sampling method. Data were collected online using a self-designed demographic questionnaire and a simplified Chinese version of the Bowel Cancer Awareness Measure. Univariate analysis and multivariate linear regression were applied. RESULTS: The mean score for total knowledge was 10.56 (SD: 5.89). Over half of the participants (58.2%) lacked confidence about detecting warning signs. For 42.7% of participants, the anticipated delay was not within the acceptable range (2 weeks). Totally eight demographic variables were identified as significant predictors of total knowledge, accounting for 36.2% of the variance. Total knowledge was positively correlated with confidence (r = 0.126, p < 0.01) and negatively associated with anticipated delay (F = 8.891, p < 0.01). CONCLUSION: Public awareness of colorectal cancer was low in the Chinese population. Hence, educational interventions targeted for improving knowledge, enhancing individuals' confidence in detecting symptoms and reducing barriers to seeking medical help may be urgently required.

Effects of chlorobromoisocyanuric acid on embryonic development and immunotoxicity of zebrafish.

Although chlorobromoisocyanuric acid has been widely used in agriculture, its deleterious toxicity on aquatic organisms remains rare. In this study, zebrafish were exposed to chlorobromoisocyanuric acid (0, 30, 40, and 50 mg/L) from 10 to 96 h post-fertilization (hpf). We found a significant reduction in immune cell numbers (neutrophils and macrophages) and the area of thymus at 96 hpf. The expression of immune-related genes and pro-inflammatory cytokines genes were upregulated. Besides, chlorobromoisocyanuric acid triggered neutrophils cell apoptosis. The mRNA and protein levels of pro-apoptotic p53 pathway and the Bax/Bcl-2 ratio further indicated the underlying mechanism. Furthermore, the oxidative stress was observed that the accumulation of reactive oxygen species and malondialdehyde significantly increased. Subsequently, the antioxidant agent astaxanthin significantly attenuated the level of oxidative stress and the dysregulation of inflammatory response. In summary, our results showed that chlorobromoisocyanuric acid induced developmental defects and immunotoxicity of zebrafish, partly owing to oxidative stress and cell apoptosis.

Effectiveness of silver dressings in the treatment of diabetic foot ulcers: a systematic review and meta-analysis.

OBJECTIVE: Silver dressings have been used in the treatment of diabetic foot ulcers (DFUs). However, meta-analyses examining their effectiveness is lacking. Therefore, this meta-analysis evaluates the effectiveness of silver dressings on DFU healing. METHOD: Various databases were searched for randomised controlled trials (RCTs) of silver dressing applied to DFUs. RESULTS: A total of seven studies involving 650 patients were identified for inclusion in the meta-analysis. The odds ratio (OR) for silver dressing improving wound healing rate, complete healing time, ulcer-related in-hospital time and infection resolution rate were: 4.02 (95% confidence interval [CI]: 2.25-7.17; p<0.01); 2.81 (95% CI: -3.33--2.29; p<0.01); 12.13 (95% CI:-20.64--3.62; p<0.01); and 7.36 (95% CI: 1.58-34.22; p=0.01), respectively. The OR on ulcer area reduction was 8.60 (95% CI:-8.93-26.12; p=0.34) indicating no significant effect. CONCLUSION: The results of this meta-analysis showed that silver dressings enhance DFU healing rate, shorten the time to complete healing, shorten in-hospital duration, and improve infection resolution rate, while having no significant effect on reduction of ulcer area. Large-scale, multicentre, rigorously designed RCTs are recommended for future investigation to justify the beneficial effects of silver dressings on DFU healing.

Adaptation and psychometric evaluation of the Stoma-QOL questionnaire among Chinese rectal cancer patients with colostomy.

AIM: The purpose of this study was to translate the Stoma-quality of life into Chinese and evaluate its psychometric properties in Chinese patients. BACKGROUND: Quality of life is an important issue for patients with colostomy, and its appropriate and precise measurement is beneficial to promoting better care. The Stoma-quality of life questionnaire has been widely used; however, the validity and reliability of its Chinese version has not been determined. DESIGN: A cross-sectional validation study was conducted. METHODS: We translated the Stoma-quality of life into Chinese using standardized methods. Then it was psychometrically tested on a convenience sample of 513 patients with colostomy. Construct validity was evaluated via exploratory factor analysis and confirmatory factor analysis. Reliability was measured with Cronbach's alpha and the split-half Spearman-Brown coefficient. RESULTS: The content validity, the Cronbach's α coefficient and the Spearman-Brown split-half reliability coefficient indicated adequate validity and reliability. The exploratory factor analysis yielded four common factors, and the cumulative variance contribution rate was 67.5%. Moreover, the confirmatory factor analysis showed a good model fit. CONCLUSION: This study confirmed that the Chinese version of Stoma-quality of life is an effective and reliable measurement for evaluating the quality of life of patients with colostomy.

Stigma experienced by patients with epilepsy: A systematic review and meta-synthesis of qualitative studies.

BACKGROUND: Epilepsy, one of the most common and serious chronic neurological diseases, is accompanied by a series of complex psychosocial problems. A number of qualitative studies have investigated the stigma experiences among patients with epilepsy (PWE). However, the findings are different and complementary to a certain degree. We conducted a systematic review to investigate and synthesize existing qualitative research findings to fully identify stigma experienced by PWE. The aim was to develop anti-stigma interventions and reduce any adverse sequelae. OBJECTIVE: To synthesize qualitative evidence on the stigma experiences of PWE. METHODS: This was a systematic review and qualitative evidence synthesis guided by the Joanna Briggs Methodology. Systematic literature search for primary studies was conducted in PubMed, PsychINFO, EMBASE, and Web of Science databases until December 2019. Findings from the included qualitative studies were extracted, assessed for quality, and aggregated using meta-synthesis. RESULTS: Twenty-six studies were included in the review. Four distinct synthesized findings were identified from the original researches: 'stigma experienced in daily life'; 'stigma perceived from others'; 'psychological reactions to stigma'; and 'strategies to address stigma'. CONCLUSION: The present meta-synthesis thoroughly investigated the stigma experienced by PWE. The findings suggest that appropriate multi-level interventions targeting the general public, health professionals, caregivers, and patients themselves are warranted to reduce the harmful impacts of stigma.

Sarcopenia as a predictor of mortality among the critically ill in an intensive care unit: a systematic review and meta-analysis.

BACKGROUND: The evidence of sarcopenia based on CT-scan as an important prognostic factor for critically ill patients has not seen consistent results. To determine the impact of sarcopenia on mortality in critically ill patients, we performed a systematic review and meta-analysis to quantify the association between sarcopenia and mortality. METHODS: We searched studies from the literature of PubMed, EMBASE, and Cochrane Library from database inception to June 15, 2020. All observational studies exploring the relationship between sarcopenia based on CT-scan and mortality in critically ill patients were included. The search and data analysis were independently conducted by two investigators. A meta-analysis was performed using STATA Version 14.0 software using a fixed-effects model. RESULTS: Fourteen studies with a total of 3,249 participants were included in our meta-analysis. The pooled prevalence of sarcopenia among critically ill patients was 41 % (95 % CI:33-49 %). Critically ill patients with sarcopenia in the intensive care unit have an increased risk of mortality compared to critically ill patients without sarcopenia (OR = 2.28, 95 %CI: 1.83-2.83; P < 0.001; I2 = 22.1 %). In addition, a subgroup analysis found that sarcopenia was associated with high risk of mortality when defining sarcopenia by total psoas muscle area (TPA, OR = 3.12,95 %CI:1.71-5.70), skeletal muscle index (SMI, OR = 2.16,95 %CI:1.60-2.90), skeletal muscle area (SMA, OR = 2.29, 95 %CI:1.37-3.83), and masseter muscle(OR = 2.08, 95 %CI:1.15-3.77). Furthermore, critically ill patients with sarcopenia have an increased risk of mortality regardless of mortality types such as in-hospital mortality (OR = 1.99, 95 %CI:1.45-2.73), 30-day mortality(OR = 2.08, 95 %CI:1.36-3.19), and 1-year mortality (OR = 3.23, 95 %CI:2.08 -5.00). CONCLUSIONS: Sarcopenia increases the risk of mortality in critical illness. Identifying the risk factors of sarcopenia should be routine in clinical assessments and offering corresponding interventions may help medical staff achieve good patient outcomes in ICU departments.

Toxicity of thioacetamide and protective effects of quercetin in zebrafish (Danio rerio) larvae.

Quercetin is a flavonoid compound with a variety of biological properties that is widely distributed throughout the plant kingdom. Studies have found that quercetin has anti-inflammatory, antioxidant, and liver-protective effects, while thioacetamide (TAA) can cause inflammation and liver damage in zebrafish larvae. The purpose of this study was to evaluate whether quercetin can prevent TAA-induced inflammation and liver damage in zebrafish larvae and to investigate the molecular mechanisms involved. Zebrafish Tg transgenic lines were used as the experimental animals. Behavioral, oxidative stress level, proliferative antigen chromogenic antibody, and western blot analyses were carried out on zebrafish larvae in the control group and groups treated with TAA and 12 µM quercetin. The results indicated that quercetin promoted the development of zebrafish larvae damaged by TAA, exhibited antioxidant and anti-inflammatory properties, and promoted cell proliferation. Quercetin reduced the expression of p53 protein in zebrafish larvae injured by TAA, resulting in decreased levels of Bax and increased levels of Bcl-2. The findings suggested quercetin has antiapoptotic action. Quercetin reduced the expression of DKK1 and DKK2 genes related to the Wnt signaling pathway in zebrafish larvae damaged by TAA and increased the expression of Lef1 and wnt2bb. Quercetin may regulate the development of zebrafish larvae damaged by TAA through the Wnt signaling pathway. This study provides the scientific basis for the development and utilization of quercetin and the development of new related drugs.