Vicarious trauma in nursing: A hybrid concept analysis.

BACKGROUND: Vicarious trauma can significantly affect the physical and mental health of nurses, as well as their ability to provide quality of care. However, the concept of vicarious trauma has received limited attention and remains controversial in the nursing context. OBJECTIVE: The purpose of this study was to clarify and define the concept of vicarious trauma as it pertains to the nursing context. METHODS: The Schwartz and Kim's three-stage hybrid concept analysis method was used to define the concept. In the theoretical phase, PubMed, CINAHL, OVID, Medline, Embase, Web of Science, Scopus, ProQuest, PsycINFO, CNKI database, VIP database and Wanfang database were used using keywords "nurs*"and "vicarious trauma*", resulting in a total of 25 papers. In the fieldwork phase, we conducted participatory observations in three hospitals and semi-structured in-depth interviews with 18 clinical nurses from seven cities. In the analysis phase, the results of the previous two phases were integrated to develop a comprehensive concept of vicarious trauma in nursing. RESULTS: Based on the results of the theoretical and field phases, we propose the concept of vicarious trauma in nursing as follows: vicarious trauma is a psychological trauma impacting nurses' cognitive schema which they may experience in clinical settings or on social media, resulting from deeply empathize with the physical or emotional trauma of patients, family, or colleagues, such as patients' physical injuries or death, family's grieving feelings and colleagues' received threats and attacks. Positively, vicarious trauma can transform into vicarious post-trauma growth through repositioning and connection, nourishing nurses and promoting their personal and professional development. CONCLUSION: The concept of vicarious trauma in nursing is multidimensional and holistic. This study clarifies the concept of vicarious trauma in nursing using the hybrid concept analysis, providing a framework for future research and practice on vicarious trauma in the nursing field. PATIENT OR PUBLIC CONTRIBUTION: Nurses contributed to the conduct of the study by participating in the data collection via interviews.

Factors influencing the development of nursing professionalism: a descriptive qualitative study.

BACKGROUND: The shortage of nurses threatens the entire healthcare system, and nursing professionalism can improve nurse retention and enhance the quality of care. However, nursing professionalism is dynamic, and the factors influencing its development are not fully understood. METHODS: A qualitative descriptive study was conducted. Using maximum variation and purposive sampling, 14 southern and northern China participants were recruited. Semi-structured interviews were conducted from May 2022 to August 2023 in face-to-face conversations in offices in the workplace or via voice calls. The interviews were transcribed verbatim and analyzed via thematic analysis. RESULTS: Three main themes emerged: (1) nourishment factors: promoting early sprouting; (2) growth factors: the power of self-activation and overcoming challenges; and (3) rootedness factors: stability and upward momentum. Participants described the early acquisition of nursing professionalism as derived from personality traits, family upbringing, and school professional education, promoting the growth of nursing professionalism through self-activation and overcoming challenges, and maintaining the stable and upward development of nursing professionalism through an upward atmosphere and external motivation. CONCLUSION: We revealed the dynamic factors that influence the development of nursing professionalism, including "nourishment factors", "growth factors", and "rootedness factors". Our findings provide a foundation for future development of nursing professionalism cultivation strategies. Nursing administrators can guide the development of nurses' professionalism from many angles according to the stage they are in, and the development of professionalism deserves more attention. In the future, we can no longer consider the development of nursing professionalism solely as the responsibility of individual nurses; the power of families, organizations, and society is indispensable to jointly promoting nursing professionalism among nurses.

What is nursing professionalism? a concept analysis.

BACKGROUND: Nursing professionalism plays an important role in clinical nursing. However, a clear conceptual understanding of nursing professionalism is lacking. METHOD: Walker and Avant's strategy was used to analyse the concept of nursing professionalism. We searched electronic databases, including PubMed, Scopus, and CINAHL, for studies published from 1965 to 2021. Quantitative or qualitative studies published in English that focused on nursing professionalism were included in the study. RESULTS: The three attributes of nursing professionalism are multidimensional, dynamic, and culture oriented. Based on the analysis, nursing professionalism is defined as providing individuals care based on the principles of professionalism, caring, and altruism. CONCLUSIONS: This study offers a theoretical definition and conceptual model of nursing professionalism that may be applied to develop standardized assessment tools or nursing professionalism training programs.

Effect of garlic essential oil in 97 patients hospitalized with covid-19: A multi-center experience.

To observe the synergistic effect of garlic essential oil in patients with novel coronavirus disease (COVID-19), in addition to the routine treatment, we used garlic essential oil in COVID-19 patients with mild to moderate symptoms and compared their results to those of patients who did not receive the essential oil. We conducted a quasi-experimental study with COVID-19 patients from 3 hospitals. In the experimental group, 97 patients received garlic essential oil combined with conventional treatment. In the control group, 100 patients received only the conventional treatment for COVID-19. The effectiveness and safety of the garlic essential oil were assessed. Compared to the control group, the group receiving garlic essential oil showed a shorter duration of symptoms, shorter time to negative nucleic acid testing (NAT) results and shorter time to improvement on the computed tomography (CT). In the same period, the experimental group showed an increase in the rate of the disappearance of symptoms and the improvement rates of NAT and CT. Due to its effectiveness and safety in patients with COVID-19, garlic essential oil is recommended as a preventive measure or a supportive therapy during the COVID-19 pandemic.

Prognostic Value of Pretreatment Albumin to Globulin Ratio in Lung Cancer: A Meta-Analysis.

Objective: To explore the predictive role of pretreatment albumin to globulin ratio (AGR) for prognosis in lung cancer.Methods: A comprehensive literature retrieval was performed in the PubMed, Cochrane Library, Web of Science and EMBASE databases up to May 20, 2019. The pooled hazard ratio (HR) and 95% confidence interval (CI) were applied to assess the correlation of pretreatment AGR with overall survival (OS) and disease-free survival (DFS). Sensitivity analysis was performed to assess the stability of results. Bess's funnel plot and Egger's test were conducted to detect potential publication bias.Results: Eight articles involving 3496 patients were included in our meta-analysis and all studies were from Asian countries. The results demonstrated that a low pretreatment AGR was significantly associated with poor OS (HR = 1.88, 95% CI: 1.49-2.38, P<0.001) and DFS (HR = 2.09, 95% CI: 1.56-2.81, P<0.001) and sensitivity analysis indicated the stability of above results. Publication bias test showed that there were two potentially unpublished articles, but they did not have a significant influence on the results of our meta-analysis.Conclusion: Our study manifested that pretreatment AGR was a reliable predictor for survival and it may contribute to the risk evaluation and therapy strategy formulation of lung cancer patients.

Amelioration of ischemic cardiomyopathy in patients using physiological ischemic training.

BACKGROUND: This study aimed to observe the effect and potential mechanism of physiological ischemic training (PIT) in patients with ischemic cardiomyopathy. METHODS: A total of 165 patients with ischemic cardiomyopathy were randomly selected by the convenience sampling method and were divided into the control and experimental groups. The control group received conventional drug treatment, while the experimental group received additional PIT. All patients were followed up for 6 months and renin-angiotensin-aldosterone system (RAS) activity parameters and myocardial remodeling indicators were recorded. RESULTS: After the 6­month intervention, cardiac function indicators in the two groups were significantly improved compared with before intervention (all P < 0.01), but the experimental group showed significantly more improvement compared with the control group (all P < 0.01). Similarly, RAS activity parameters and myocardial remodeling indicators of the two groups were significantly reduced after intervention compared with before intervention (all P < 0.01). However, the experimental group showed significantly lower myocardial remodeling indicators than the control group (all P < 0.01). Vascular endothelial growth factor (VEGF) and nitric oxide (NO) concentrations in peripheral blood in the experimental group were significantly increased after intervention compared with before intervention (both P < 0.01). CONCLUSIONS: PIT can be applied in patients with ischemic cardiomyopathy on the basis of the original standardized drug treatment. PIT ameliorates cardiac blood flow reserve by increasing VEGF and NO concentrations in the peripheral blood, as well as by inhibiting the RAS system and myocardial remodeling. This ultimately improves the patient's cardiac function to a greater extent.

The prognostic value of modified Glasgow prognostic score in patients with esophageal squamous cell cancer: a Meta-analysis.

Objective: To evaluate the prognostic value of modified Glasgow prognostic score (mGPS) asssessed prior to anticancer treatment in patients with esophageal squamous cell cancer (ESCC).Methods: A comprehensive search through PubMed, EMBASE, Web of Science and The Cochrane Library databases was performed to identify potential studies exploring the prognostic value of baseline mGPS in patients with ESCC. We combined the hazard ratios (HRs) with 95% confidence intervals (CIs) to assess the association of mGPS with overall survival (OS).Results: A total of 10 studies including 3415 patients were analyzed and all patients were from Japan or China. A significant correlation between elevated mGPS and poor OS (HR = 1.66, 95% CI: 1.14-2.41, P = 0.008) was observed. Subgroup analyses suggested that the country and therapy method may affect the effect of mGPS on predicting OS in ESCC and patients with mGPS 1 or two had poorer OS compared with those with mGPS 0 (HR = 2.91, 95% CI: 1.74-4.87, P<0.001; HR = 2.39, 95% CI: 1.44-3.97, P = 0.001).Conclusions: Baseline mGPS might serve as a promising indicator for the OS in Chinese and Japanese patients with ESCC. More well-designed prospective studies with large samples are needed to verify our findings.

Clinical Role of Excision Repair Cross-Complementing 1 Gene Expression in Resected Esophageal Squamous Cell Carcinoma: A Meta-Analysis.

AIMS: To explore the relationship between excision repair cross-complementing 1 (ERCC1) gene expression and clinical pathological parameters and prognosis of esophageal squamous cell carcinoma (ESCC) patients who received the surgical therapy. METHODS: To identify relevant articles, a systematic literature retrieval was conducted in several databases, including the Embase, Web of Science, Cochrane Library, PubMed, VIP, Wanfang, and CNKI. The association of ERCC1 gene expression with clinicopathological characteristics and survival was assessed by the pooled relative risk (RR) and hazard ratio (HR) with the corresponding 95% confidence interval (CI), respectively. Sensitivity analysis was conducted to assess the stability of pooled results. Begg's funnel plot and Egger's test were applied to detect potential publication bias. RESULTS: A total of nine studies involving 746 patients were included in our meta-analysis, and all patients were from Asian countries, including China, Korea, and Japan. The results indicated that ERCC1 gene expression was significantly associated with lymph node metastasis (RR = 1.30, 95% CI 1.11-1.53; P = 0.002), higher TNM stage (RR = 1.23, 95% CI 1.06-1.43; P = 0.006), worse overall survival (HR = 2.40, 95% CI 1.32-4.37; P < 0.001), and disease-free survival (HR = 1.67, 95% CI 1.15-2.41; P = 0.007). Sensitivity analysis manifested that the pooled results were stable and no significant publication bias was observed. CONCLUSIONS: ERCC1 gene expression is significantly related to tumor stage and prognosis in resected ESCC patients from Asian countries. More prospective studies with larger samples are needed to testify our findings.

Maternal and umbilical cord serum-derived exosomes enhance endothelial cell proliferation and migration.

We investigated the role of exosomes derived from maternal and umbilical cord blood in the regulation of angiogenesis. We report here that both maternal exosomes (MEs) and umbilical exosomes (UEs) significantly enhance HUVEC proliferation, migration, and tube formation. Importantly, ME-treated HUVECs (MEXs) displayed significantly increased migration, but not proliferation or tube formation, compared with UE-treated HUVECs (UEXs). We found that the expression of a subset of migration-related microRNAs (miRNAs), including miR-210-3p, miR-376c-3p, miR-151a-5p, miR-296-5p, miR-122-5p, and miR-550a-5p, among others, were significantly increased or decreased in UEs, and this altered expression was likely correlated with the differential regulation of HUVEC migration. We also found that the mRNA expression of hepatocyte growth factor (HGF) was up-regulated in MEXs and UEXs and, moreover, that inhibiting HGF partially abolished the enhanced cell migration induced by UEs. Our results suggest that both MEs and UEs greatly enhanced endothelial cell (EC) functions and differentially regulated EC migration, which was mostly attributed to the different expression profiles of exosomal miRNA. These findings highlight the importance of exosomes in the regulation of angiogenesis during pregnancy. Exosomal miRNAs, in particular, may be of great significance for the regulation of angiogenesis in maintaining normal pregnancy.-Jia, L., Zhou, X., Huang, X., Xu, X., Jia, Y., Wu, Y., Yao, J., Wu, Y., Wang, K. Maternal and umbilical cord serum-derived exosomes enhance endothelial cell proliferation and migration.

Estimated intraoperative blood loss correlates with postoperative cardiopulmonary complications and length of stay in patients undergoing video-assisted thoracoscopic lung cancer lobectomy: a retrospective cohort study.

BACKGROUND: The purpose of our study was to estimate the influence of estimated intraoperative blood loss (EIBL) on postoperative cardiopulmonary complications (PCCs) in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for non-small-cell lung cancer (NSCLC). METHODS: We conducted a single-center retrospective analysis on the clinical data of consecutive patients in our institution between April 2015 and February 2016. Demographic differences between PCC group and non-PCC group were initially assessed. Receiver operating characteristic (ROC) analysis was performed to determine the threshold value of EIBL for the prediction of PCCs. Demographic differences in the PCC rates and length of stay between two groups of patients divided by this cutoff were further evaluated. A multivariable logistic-regression model involving the clinicopathological parameters with P-value< 0.05 was finally established to identify independent risk factors for PCCs. RESULTS: A total of 429 patients with operable NSCLC were included and 80 of them developed PCCs (rate = 18.6%). The mean EIBL in PCC group was significantly higher than that in non-PCC group (133.3 ± 191.3 vs. 79.1 ± 107.1 mL; P < 0.001). The ROC analysis showed an EIBL of 100 mL as the threshold value at which the joint sensitivity (50.0%) and specificity (73.4%) was maximal. The PCC rate in patients with EIBL≥100 mL was significantly higher than that in patients with EIBL< 100 mL (30.1 vs. 13.5%; P < 0.001). Both the length of stay and chest tube duration were significantly prolonged in the patients with EIBL≥100 mL. Finally, EIBL≥100 mL was identified to be predictive of PCCs by multivariable logistic-regression analysis (odds ratio = 3.01; 95% confidence interval = 1.47-6.16; P = 0.003). CONCLUSIONS: EIBL serves as a significant categorical predictor for cardiopulmonary complications following VATS lobectomy for NSCLC. Thoracic surgeons should minimize the EIBL and strive for the 'bloodless' goal to optimize surgical outcomes.

Model-Based Fault Diagnosis of an Anti-Lock Braking System via Structural Analysis.

The anti-lock braking system (ABS) is an essential part in ensuring safe driving in vehicles. The Security of onboard safety systems is very important. In order to monitor the functions of ABS and avoid any malfunction, a model-based methodology with respect to structural analysis is employed in this paper to achieve an efficient fault detection and identification (FDI) system design. The analysis involves five essential steps of SA applied to ABS, which includes critical faults analysis, fault modelling, fault detectability analysis and fault isolability analysis, Minimal Structural Over-determined (MSO) sets selection, and MSO-based residual design. In terms of the four faults in the ABS, they are evaluated to be detectable through performing a structural representation and making the Dulmage-Mendelsohn decomposition with respect to the fault modelling, and then they are proved to be isolable based on the fault isolability matrix via SA. After that, four corresponding residuals are generated directly by a series of suggested equation combinations resulting from four MSO sets. The results generated by numerical simulations show that the proposed FDI system can detect and isolate all the injected faults, which is consistent with the theoretical analysis by SA, and also eventually validated by experimental testing on the vehicle (EcoCAR2) ABS.

Decreased maternal serum 2-methoxyestradiol levels are associated with the development of preeclampsia.

BACKGROUND: 2-methoxyestradiol (2-ME), a natural metabolite of 17ß-estradiol, is synthesized by catechol-O-methyltransferase (COMT). The aim of this study was to explore the maternal 2-ME concentration and placental COMT expression in the different trimesters of normal pregnancy and preeclamptic pregnancies, as well as the effects of 2-ME on cell proliferation and migration of HTR-8/SVneo under normoxic (20% O2) and hypoxic (2.5% O2) conditions. METHODS: 2-ME levels were examined by ELISA. COMT protein expression was analyzed by Western blot and immunohistochemistry. Cell proliferation and migration were measured by crystal violet assay and transwell system under either normoxia or hypoxia. RESULTS: Maternal 2-ME concentration was elevated with the progression of pregnancy, in contrast, 2-ME was lower in women diagnosed with mild preeclampsia (mPE; 23%) and severe preeclampsia (sPE; 32%) as compared with normotensive full term pregnancies. Meanwhile, preterm controls had lower levels of 2-ME than full term controls. Soluble cytoplasmic COMT (S-COMT), but not membrane-bound COMT (MB-COMT) levels in placentas were increased by 2.5 fold in the full term vs. the first trimester placentas. Furthermore, 2-ME suppressed cell proliferation under 20% O2 but not 2.5% O2, while 2-ME promoted cell migration under 2.5% but not 20% O2in vitro. CONCLUSION: Considering 2.5% O2 is a state more closely mimicking in vivo condition, these data suggest a decrease in 2-ME levels may inhibit trophoblast cell migration, possibly leading to PE.

Effects of combined amendments on heavy metal accumulation in rice (Oryza sativa L.) planted on contaminated paddy soil.

Stabilization of heavy metals in situ was investigated. Two combined amendments (LS, limestone+sepiolite; HZ, hydroxyhistidine+zeolite) were applied at ratios of 0.2%, 0.4%, and 0.8% (w/w) to paddy soil with multi-metal (Pb, Cd, Cu, and Zn) contamination. The effects of these two combined amendments on heavy metal bioavailability in soil, and on uptake and accumulation of heavy metals in rice plants were investigated. Application of LS and HZ significantly increased soil pH values and cation exchange capacity contents, and resulted in a reduction in exchangeable fraction of metals and in extract metal concentrations of amended soils through toxicity characteristic leaching procedure (TCLP). LS and HZ obviously inhibited uptake and accumulation of Pb, Cd, Cu, and Zn in rice plants. Compared with the control soil, concentrations of Pb, Cd, Cu, and Zn in brown rice were decreased by 10.6-31.8%, 16.7-25.5%, 11.5-22.1%, and 11.7-16.3%, respectively, as a result of 0.2% to 0.8% addition of LS, and decreased by 5.1-40.8%, 16.7-20.0%, 8.1-16.2%, and 13.3-21.7%, respectively, as a result of 0.2-0.8% addition of HZ. Significant positive linear correlations were found between heavy metal concentrations in TCLP extracts and those in rice tissues except for Pb. Extracting heavy metals with TCLP was a more suitable method for estimating heavy metal bioavailability concentrations of amended soil than exchangeable fraction of heavy metals, because the latter underestimated heavy metal bioavailability. These results demonstrate that LS and HZ could be effective in reducing heavy metal bioavailability and accumulation in rice grown on multi-metal-contaminated soils.

Elevated uric acid/albumin ratio as a predictor of poor coronary collateral circulation development in patients with non-ST segment elevation myocardial infarction.

BACKGROUND: Uric acid/albumin ratio (UAR) is a novel composite biomarker with superior predictive value for cardiovascular disease. OBJECTIVE: To investigate the relationship between UAR and coronary collateral circulation (CCC) in patients with non-ST segment elevation myocardial infarction (NSTEMI). METHODS: A total of 205 NSTEMI patients who underwent coronary arteriography with at least one major coronary stenosis, 95% were included. Patients were divided into two groups according to CCC development: poorly-developed CCC group (Rentrop 0-1) and well-developed CCC (Rentrop 2-3). Univariate analysis and logistic regression analysis were utilized to investigate the factors influencing adverse CCC formation in NSTEMI patients. The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of UAR, C-reactive protein (CRP), uric acid, and albumin for patients with poorly developed CCC, and the area under the curve (AUC) was compared. RESULTS: The UAR values of NSTEMI patients were significantly higher in the poorly developed CCC group than those in the well-developed CCC group (10.19 [8.80-11.74] vs. 7.79 [6.28-9.55], p < .001). In the multiple logistic regression tests, UAR (odds ratio [OR]: 1.365, 95% confidence interval [CI]: 1.195-1.560, p < .001), CRP (OR: 1.149, 95% CI: 1.072-1.231, p < .001), and diabetes (OR: 2.924, 95% CI: 1.444-5.920, p = .003) were independent predictors of poorly developed CCC. The ROC curve analysis showed that the optimal cut-off value of UAR was 8.78 in predicting poorly developed CCC with a sensitivity of 76.8% and specificity of 62.4%, with the AUC of 0.737 (95% Cl: 0.668-0.805, p < .001). CONCLUSION: Elevated UAR may be an independent and effective biomarker for predicting poorly-developed CCC development in NSTEMI patients.

Distributed Resilient Tracking of Multiagent Systems Under Actuator and Sensor Faults.

The distributed resilient tracking problem for multiagent systems (MASs) is investigated in the presence of actuator/sensor faults over directed topology. Both actuator fault and sensor fault are taken into account. Meanwhile, using the local information, the fault compensators are introduced. Then, based on the fuzzy-logic systems (FLSs) and modification technique of adaptive law, a novel distributed adaptive resilient control protocol is developed, which can compensate the effect of faults on the actuator and sensor. It turns out that all signals of MASs are bounded, while the tracking errors enter an adjustable bounded region around the origin. Toward the end, two simulations are provided to validate the effectiveness of the theoretical results.

A Real-Time Bionic Method Inspired by Neural Oscillators for Estimation and Extraction of Pathological Tremor.

The typical representative of pathological tremor is Parkinson's disease. One of the pathogenesis is that the synchronized neural oscillations within and between brain areas are affected. Inspired by this, this work proposes an algorithm based on neural oscillator to extract voluntary motion and estimate tremor motion in real time, which is named as RTBNO. This algorithm is composed of multiple adaptive modified Hopf oscillators linear combiner. The combiner is divided into two parts: one is used to estimate tremor motion and the other is applied to estimate voluntary motion. As it is updated iteratively in real time, this method has no phase delay. The performance of the proposed method was verified by the simulated action tremor and the actual experimental results of twenty Parkinson's disease patients. For the rest tremor signals of patients, the mean Root Mean Square Error (RMSE) values between the estimated signal and the actual signal was 0.0272±0.0077. The mean RMSE values between the estimated voluntary movement from action tremor and the actual voluntary movement were 0.0360±0.0097 (pick and put motion) and 0.0380±0.0083 (drawing motion). The execution time for the corresponding 10 seconds data was 0.0478s. The comparison results between the proposed method and the existing methods demonstrated the effectiveness of the proposed method.

Essential thrombocythemia with non-ST-segment elevation myocardial infarction as the first manifestation: A case report.

BACKGROUND: We report a case of essential thrombocythemia (ET) in a 44-year-old male who exhibited non-ST-segment-elevation myocardial infarction (NSTEMI) as the first manifestation without known cardiovascular risk factors (CVRFs). For the first time, we reported a left main trifurcation lesion in NSTEMI caused by ET, including continuous stenosis lesions from the left main to the ostial left anterior descending (LAD) artery and an obvious thrombotic lesion in the ostial and proximal left circumflex (LCX) artery. There was 60% diffuse stenosis in the left main (LM) that extended to the ostial LAD, thrombosis of the ostial LAD and proximal LCX, and 90% stenosis in the proximal LCX. During the operation, thrombus aspiration was performed, but no obvious thrombus was aspirated. Performing the kissing balloon technique (KBT) in the LCX and LM unexpectedly increased the narrowness of the LAD. Then, the single-stent crossover technique, final kissing balloon technique and proximal optimization technique (POT) were performed. On the second day after percutaneous coronary intervention (PCI), the number of platelets (PLTs) still increased significantly to as high as 696 × 109/L. The bone marrow biopsy done later, together with JAK2 (exon 14) V617F mutation, confirms the diagnosis of ET. Hydroxyurea was administered to inhibit bone marrow proliferation to control the number of PLTs. CASE SUMMARY: A 44-year-old male patient went to a local hospital for treatment for intermittent chest pain occurring over 8 h. The examination at the local hospital revealed elevated cTnI and significantly elevated platelet. Then, he was diagnosed with acute myocardial infarction and transferred to our hospital for emergency interventional treatment by ambulance. During the operation, thrombus aspiration, the single-stent crossover technique, final kissing balloon technique and POT were performed. Dual antiplatelet therapy comprising aspirin and ticagrelor was used after PCI. Evidence of mutated JAK2 V617F and bone marrow biopsy shown the onset of ET. Together with JAK2 (exon 14) V617F mutation, ET was diagnosed according to the World Health Organization (WHO) diagnostic criteria, and the patient was placed on hydroxyurea. During the one-year postoperative period, repeated examinations showed a slight increase in PLTs, but the patient no longer had chest tightness, chest pain or bleeding or developed new thromboembolisms. CONCLUSION: Routine physical examinations and screenings are conducive to the early detection of ET, and the risk for thrombosis should be assessed. Then, active antiplatelet therapy and myelosuppression therapy should be used for high-risk ET patients.

PRC2-Mediated Epigenetic Suppression of Type I IFN-STAT2 Signaling Impairs Antitumor Immunity in Luminal Breast Cancer.

The immunosuppressive tumor microenvironment in some cancer types, such as luminal breast cancer, supports tumor growth and limits therapeutic efficacy. Identifying approaches to induce an immunostimulatory environment could help improve cancer treatment. Here, we demonstrate that inhibition of cancer-intrinsic EZH2 promotes antitumor immunity in estrogen receptor α-positive (ERα+) breast cancer. EZH2 is a component of the polycomb-repressive complex 2 (PRC2) complex, which catalyzes trimethylation of histone H3 at lysine 27 (H3K27me3). A 53-gene PRC2 activity signature was closely associated with the immune responses of ERα+ breast cancer cells. The stimulatory effects of EZH2 inhibition on immune surveillance required specific activation of type I IFN signaling. Integrative analysis of PRC2-repressed genes and genome-wide H3K27me3 landscape revealed that type I IFN ligands are epigenetically silenced by H3K27me3. Notably, the transcription factor STAT2, but not STAT1, mediated the immunostimulatory functions of type I IFN signaling. Following EZH2 inhibition, STAT2 was recruited to the promoters of IFN-stimulated genes even in the absence of the cytokines, suggesting the formation of an autocrine IFN-STAT2 axis. In patients with luminal breast cancer, high levels of EZH2 and low levels of STAT2 were associated with the worst antitumor immune responses. Collectively, this work paves the way for the development of an effective therapeutic strategy that may reverse immunosuppression in cancer. SIGNIFICANCE: Inhibition of EZH2 activates a type I IFN-STAT2 signaling axis and provides a therapeutic strategy to stimulate antitumor immunity and therapy responsiveness in immunologically cold luminal breast cancer.

Fuzzy Adaptive Practical Fixed-Time Consensus for Second-Order Nonlinear Multiagent Systems Under Actuator Faults.

This article concentrates upon the problem of practical fixed-time consensus for second-order nonlinear multiagent systems (MASs) under directed communication topology. The convergence time is independent of the initial condition. Both loss of effectiveness and bias fault are taken into account. Meanwhile, fuzzy-logic systems are introduced to approximate the unknown nonlinear functions. By the adding-a-power-integrator method, a distributed fuzzy adaptive practical fixed-time fault-tolerant control scheme is proposed. Then, the leader can be tracked in a settling time, and the consensus tracking errors converge to an adjustable neighborhood of the origin. Finally, two simulations are given to further illustrate the effectiveness of the theoretical result.

Adaptive Fault-Tolerant Consensus Protocols for Multiagent Systems With Directed Graphs.

This paper investigates the problem of adaptive fault-tolerant tracking control for the multiagent systems (MASs) under the time-varying actuator faults and bounded unknown control input of the leader. On the basis of the local state information of neighboring agents, an adaptive fault-tolerant control protocol, which consists of the adaptive estimation of faults, is constructed to compensate for the loss of actuator effectiveness in the leader-follower consensus of MASs. Moreover, the modification term in the adaptive estimation can avoid high-frequency oscillations. It is shown that the tracking errors converge to a neighborhood around the origin in the presence of actuator faults, and the performance of the tracking problem is improved. Furthermore, the protocol is distributed in the sense that the coupling gains are independent. Finally, two examples are given to show the effectiveness of the proposed control protocol.