Explore the Application Value of Prospective Monitoring Model in the Nursing Management of Breast Cancer Patients During Perioperative Period.

Purpose: To explore the application value of prospective monitoring model in the nursing management of breast cancer patients during perioperative period. Methods: 300 perioperative breast cancer patients admitted to our hospital from January to August 2021 were randomly divided into the control group (n = 150) and the model group (n = 150). Both groups used routine nursing management, and the model group added nursing management based on a prospective monitoring model. The quality of surgical nursing, circumference of the upper limbs, and the scores of disability of arm-shoulder-hand (DASH), exerciseofself-care agencyscale (ESCA), social self-esteem scale (SSES), multidimensional fatigue symptom inventory-short form (MFSI-SF) and functional assessment of cancer therapy-breast cancer (FACT-B) were compared of the two groups. Results: Postoperatively, the quality of surgical nursing was better in the model group than in the control group (P < 0.05). At 3 months postoperatively, the number of cases of upper limb lymphedema was higher in both groups than before (P < 0.05), but there was no statistical difference between the two groups in the preoperative and 3 months postoperative comparisons (P > 0.05). At 3 months postoperatively, the total DASH score was higher than preoperatively in both groups, but lower in the model group than in the control group (P < 0.05). After nursing, the ESCA and SSES scores of each dimension were higher in both groups than before, and the model group was higher than the control group (P < 0.05). At 3 months postoperatively, the total MFSI-SF score was lower than preoperatively in both groups, and lower in the model group than in the control group (P < 0.05). At 3 months postoperatively, the FACT-B scores of each dimensions were higher in the model group than in the control group (P < 0.05). Conclusion: The implementation of nursing management based on a prospective monitoring model for breast cancer patients during the perioperative period has important clinical value in improving the quality of surgical nursing and improving postoperative upper limb lymphedema, upper limb function, self-care ability, social self-esteem, cancer-related fatigue symptoms, quality of life, etc.

[Anxiety and depression on gestational diabetes mellitus in early pregnancy].

OBJECTIVE: To investigate the effects of anxiety and depression on gestational diabetes mellitus(GDM) in early pregnancy. METHODS: A prospective study was conducted in 2017 to select 1426 single-child healthy pregnant women of 8-14 weeks from the Sichuan Provincial Hospital for Women and Children through a deliberate sampling method. The age was(28. 6±4. 0) years old. Basic information such as age, pre-pregnancy weight, parity, and gravidity of pregnant women was collected through questionnaire survey. The anxiety self-rating scale(SAS) and depression self-rating scale(SDS) were used to collect information of anxiety and depression in pregnant women, and their anxiety and depressive symptoms were evaluated according to the result of Chinese norm. At 24 to 28 weeks of gestation, the oral glucose tolerance test(OGTT) was conducted. GDM was diagnosed according to the Guidelines for the Diagnosis and Treatment of Pregnancy Diabetes in China(2014). Multivariate unconditional Logistic regression was adopted to analyze the effects of anxiety and depression on GDM in pregnant women. RESULTS: The incidence of GDM in early pregnancy anxiety group and depression group was 41. 8% and 33. 6%, respectively. The incidence of anxiety, depression, and anxiety combined with depression were 7. 7%, 10. 5% and 4. 8%, respectively. The incidence of anxiety and depression in the group of pregnant women younger than 30 years old(9. 0% and 11. 7%) was higher than that in the group of pregnant women older than 30 years old(5. 3% and 8. 1%). The prevalence of anxiety and depression in the group of nulliparous women(8. 8% and 11. 9%) was higher than that in the group of multiparous women(5. 4% and 6. 4%). The difference was statistically significant(P<0. 05). After adjusting the confounding factors such as age, pre-pregnancy body mass index, family history of diabetes, gravidity, parity, energy intake, conception, education, occupation, smoking and drinking, the result showed that the risk of GDM in anxious pregnant women was increased, compared with that in non-anxious pregnant women in early pregnancy(OR=1. 556, 95% CI 1. 014-2. 387). However, the association between early pregnancy depression and the occurrence of GDM was not found(P>0. 05). Compared with the non-anxiety group in the early pregnancy, the risk of GDM in the anxiety group was increased both in pregnant women under 30 years old(OR=1. 654, 95% CI 1. 004-2. 726) and nulliparous women(OR=1. 633, 95% CI 1. 013-2. 634). No correlation between anxiety and risk of GDM was observed in pregnant women over 30 years old and multiparous women(P>0. 05). CONCLUSION: Anxiety in early pregnancy increases the risk of GDM. Pregnant women under 30 years old and and nulliparous women are at high risk of anxiety.

Excessive gestational weight gain in the first trimester is associated with risk of gestational diabetes mellitus: a prospective study from Southwest China.

OBJECTIVE: To evaluate the effects of gestational weight gain (GWG) in the first trimester (GWG-F) and the rate of gestational weight gain in the second trimester (RGWG-S) on gestational diabetes mellitus (GDM), exploring the optimal GWG ranges for the avoidance of GDM in Chinese women. DESIGN: A population-based prospective study was conducted. Gestational weight was measured regularly in every antenatal visit and assessed by the Institute of Medicine (IOM) criteria (2009). GDM was assessed with the 75-g, 2-h oral glucose tolerance test at 24-28 weeks of gestation. Multivariable logistic regression was performed to assess the effects of GWG-F and RGWG-S on GDM, stratified by pre-pregnancy BMI. In each BMI category, the GWG values corresponding to the lowest prevalence of GDM were defined as the optimal GWG range. SETTING: Southwest China. PARTICIPANTS: Pregnant women (n 1910) in 2017. RESULTS: After adjusting for confounders, GWG-F above IOM recommendations increased the risk of GDM (OR; 95 % CI) among underweight (2·500; 1·106, 5·655), normal-weight (1·396; 1·023, 1·906) and overweight/obese women (3·017; 1·118, 8·138) compared with women within IOM recommendations. No significant difference was observed between RGWG-S and GDM (P > 0·05) after adjusting for GWG-F based on the previous model. The optimal GWG-F ranges for the avoidance of GDM were 0·8-1·2, 0·8-1·2 and 0·35-0·70 kg for underweight, normal-weight and overweight/obese women, respectively. CONCLUSIONS: Excessive GWG in the first trimester, rather than the second trimester, is associated with increased risk of GDM regardless of pre-pregnancy BMI. Obstetricians should provide more pre-emptive guidance in achieving adequate GWG-F.

[Energy intake as determinants of gestational weight gain in Chengdu].

OBJECTIVE: To examine the relation between energy intake and its sources and gestational weight gain( GWG). METHODS: In this prospective cohort study, 585 healthy women with singleton pregnancy were selected in 2013. The 24-hour recalls was used to collect food intake at the first, second and last trimesters, and energy intake and percentages of energy from macronutrient were calculated. Weight measuring were administered at( 12 ± 1) th, ( 28 ± 1) th weeks' gestation and last week before delivery, and the GWG rate was calculated. Multivariable linear regression was used to analyze therelationship between energy and GWG. RESULTS: The mean energy intake for the first, second and last trimesters were 1718. 6 kcal/d, 2202. 9 kcal/d and 2313. 4 kcal/d, respectively, the average percentages of energy from carbohydrate were 62. 6%, 59. 5%and 59. 1%, respectively, the average percentages of energy from fat were 21. 8% 、23. 9% and 24. 3%, respectively, the average percentages of energy from protein were15. 6% 、16. 5% and 16. 7%, respectively. Multiple linear regression analysis showed that energy intake during pregnancy was positively correlated with GWG during pregnancy( P < 0. 05). The adjusted weight gain for each trimester was 37. 3 g/week( 95% CI 22. 8 to 51. 8, P < 0. 05), 16. 8 g/week( 95% CI 4. 8 to 28. 8, P < 0. 05), and 25. 8 g/week( 95% CI 10. 6 to 41. 1, P < 0. 05) higher in the highest( Q5) versus lowest( Q1)quintile of energy intake. The adjusted weight gain in last trimester was 19. 1 g/week higher( 95% CI 3. 1 to 35. 1, P < 0. 05) in the highest( Q5) versus lowest( Q1) quintile of percentages of energy from carbohydrate. The adjusted weight gain in last trimester was16. 2 g/week lower( 95% CI-3. 1 to-0. 9, P < 0. 05) in the highest( Q5) versus lowest( Q1) quintile of percentages of energy from fat. CONCLUSION: A positive correlation is found between dietary energy intake and GWG. Percentages of energy from carbohydrate and fat in the last trimester have a significant effect on GWG.

[Effect of gestational weight gain on the neonatal birth weight among pregnancy women in Chengdu City].

OBJECTIVE: To explore the effects of total gestational weight gain( GWG)and gestational weight gain rate( GWGR) per trimester on the neonatal birth weight. METHODS: A prospective cohort study was conducted among 549 healthy pregnant women at the( 12 ± 1) th pregnant week from Chengdu City, China who delivered a singleton. Basic information about age, pre-gestational weight and so on was collected by questionnaire, while the height and weight were measured at the first time. Weight at the( 28 ± 1) th and last week before delivery was measured respectively, while the total GWG and the different trimester GWGR were calculated and assessed by Institute of Medicine( IOM) criteria( 2009). The gestational week, neonatal weight and other information were collected after delivery. Multiple non-conditional Logistic regression models were used to test the effect of the total GWG/GWGR per trimester on neonatal birth weight. RESULTS: The total GWG was( 16. 2 ± 4. 6) kg. The prevalence of abnormal total GWG was 59. 1%, the excessive GWG was 44. 3%. The prevalence of insufficient GWGR in the first trimester was 44. 3%. In the second, third, the second and third trimester, the prevalence of excessive GWGR were 63. 6%, 55. 7% and 65. 8%, respectively. After adjusting the age at delivery, pre-pregnancy body mass index, gestational week and other confounding factors, the result showed that compared with adequate GWG group, insufficient GWG group was increased risk of small for gestational age( SGA)( OR =2. 51, 95% CI 1. 08-5. 82), excessive total GWG group was increased risk of large for gestational age( LGA)( OR = 2. 54, 95% CI 1. 20-5. 36). Compared with adequate GWGR group in the second trimester, excessive GWGR group was decreased risk of SGA( OR = 0. 27, 95% CI 0. 13-0. 60). Compared with adequate GWGR group in the second and third trimester, excessive GWGR group was decreased risk of SGA( OR = 0. 28, 95%CI 0. 13-0. 59). CONCLUSION: Abnormal total GWG among pregnant women in Chengdu City is a big problem that both excessive and insufficient GWG existed. Excessive total GWG is the independent risk factor for LGA. GWGR in the second and the second and third trimester are significantly associated with SGA.

[Effect of gestational weight gain rate on pregnancy outcomes among Chengdu City pregnant women with normal pre-pregnancy body mass index].

OBJECTIVE: To explore the association between gestational weight gain rate( GWGR) and pregnancy outcomes among pregnant women with normal pre-pregnancy body mass index( BMI). METHODS: In this prospective study, 389 healthy pregnant women at the( 12 ± 1) th with normal pre-pregnancy BMI from Chengdu City who delivered a singleton were included in 2013. The basic information such as age, pre-pregnant weight was obtained by questionnaire, height and weight was measured. Then the weight was measured at the( 28 ± 1) th and last week before delivery, respectively, the different trimester GWGR was calculated and classified by IOM criteria. Gestational age, gestational diabetes mellitus( GDM) and other pregnancy outcomes were collected by questionnaire. Multiple non-conditional Logistic regression models were used to test the association between GWGR and pregnancy outcomes. RESULTS: The proportion of insufficient GWGR and excessive GWGR in first trimester was 50. 7% and 31. 8%, respectively, the proportion of excessive GWGR in the second and third trimester was68. 5% and 57. 8%, respectively. After adjusting the age, education, gravidity and family disease history and other confounding factors, multiple non-conditional logistic regression showed: compared with adequate GWGR in the third trimester, insufficient and excessive GWGR were associated with increased risk of cesarean delivery( OR = 2. 48, 95% CI 1. 18-5. 23 and OR = 1. 76, 95% CI 1. 02-3. 03, respectively). Compared with adequate GWGR in the first trimester, excessive GWGR were associated with increased risk of GDM( OR = 2. 55, 95% CI 1. 03-6. 28). CONCLUSION: The abnormal of GWGR would increase the risk of cesarean delivery and GDM.

Epigallocatechin-3-gallate attenuates acute and chronic psoriatic itch in mice: Involvement of antioxidant, anti-inflammatory effects and suppression of ERK and Akt signaling pathways.

Chronic itch is a distressing symptom of many skin diseases and negatively impacts quality of life. However, there is no medication for most forms of chronic itch, although antihistamines are often used for anti-itch treatment. Epigallocatechin-3-gallate (EGCG), a major green tea polyphenol, exhibits anti-oxidative and anti-inflammatory properties. Our previous studies highlighted a key role of oxidative stress and proinflammatory cytokines in acute and chronic itch. Here, we evaluated the effects of green tea polyphenon 60 and EGCG on acute and chronic itch in mouse models and explored its potential mechanisms. The effects of EGCG were determined by behavioral tests in mouse models of acute and chronic itch, which were induced by compound 48/80, chloroquine (CQ), and 5% imiquimod cream treatment, respectively. We found that systemic or local administration of green tea polyphenon 60 or EGCG significantly alleviated compound 48/80- and chloroquine-induced acute itch in a dose-dependent manner in mice. Incubation of EGCG significantly decreased the accumulation of intracellular reactive oxygen species (ROS) directly induced by compound 48/80 and CQ in cultured ND7-23 cells, a dorsal root ganglia derived cell line. EGCG also attenuated imiquimod-induced chronic psoriatic itch behaviors and skin epidermal hyperplasia in mice. In addition, EGCG inhibited the expression of IL-23 mRNA in skin and TRPV1 mRNA in dorsal root ganglia (DRG). Finally, EGCG remarkably inhibited compound 48/80-induced phosphorylation of extracellular signal-regulated kinase (ERK) and imiquimod-induced p-AKT in the spinal cord of mice, respectively. Collectively, these results indicated EGCG could be a promising strategy for anti-itch therapy.

[Moderate-to-vigorous Physical Activities and Gestational Weight Gains during the Second and Last Trimesters of Pregnancy].

OBJECTIVE: To determine the level of moderate-to-vigorous physical activities (MVPA) and its relationship with gestational weight gains (GWG) in the second and the last trimesters of pregnancy. METHODS: A prospective study was conducted in Chengdu on 362 healthy pregnant women at the 24-28 gestation weeks who delivered a singleton. Demographic data and pre-pregnancy body mass were collected using a questionnaire. Weight gains at the gestation weeks of 24-28 and 32-36 were measured for the first two trimesters and the last trimester of pregnancy. The Denmark self-reported physical activity scale was used for measuring the duration and intensity of physical activities. Multiple linear regression models were established to determine the relationship between MVPA and GWG. RESULTS: The last trimester had lower average daily MVPA 〔(0.76±0.93) h〕 compared with the second trimester 〔(1.61±1.61) h, t=9.056, P<0.001〕. About 74.6% of the participants met the PA recommendations for the second trimester, compared with 60.5% for the last trimester (χ2=16.387, P<0.001). The participants experienced an average GWG of (7.36±3.78) kg during the first two trimesters, and (5.80±2.57) kg during the last trimester, corresponding to a growth rate of (0.30±0.15) kg/week for the first two trimesters and (0.51±0.22) kg/week for the last trimester. Compared with the most inactive group, the participants with medium PA experienced less GWG 〔(5.34±2.91) kg vs.(6.26±2.54) kg, P<0.05〕 and a lower GWG rate 〔(0.48±0.26) kg/week vs.(0.56±0.20) kg/week, P<0.05〕 during the last trimester. Age, gestational week, ethnicity, pre-pregnant BMI, GDM, pre-pregnant smoking and employment were associated with GWG and the GWG rates during the first two trimesters and the third trimester (P<0.05). Compared with the most inactive group, low 〔-0.358(-0.691--0.026)〕 and medium 〔-0.762(-1.486- -0.037)〕 PA were associated with lower GWG during the last trimester. Moderate PA was associated with a lower GWG rate 〔-0.071(-0.133--0.008)〕 after adjustment for gestational age, energy intake, pre-pregnancy BMI and other potential confounders. CONCLUSIONS: Insufficient physical activities are a serious problem in the pregnant women of Chengdu over the last two trimesters. Appropriate MVPA in the last trimester of pregnancy may reduce GWG and GWG rates.

Antioxidants Attenuate Acute and Chronic Itch: Peripheral and Central Mechanisms of Oxidative Stress in Pruritus.

Itch (pruritus) is one of the most disabling syndromes in patients suffering from skin, liver, or kidney diseases. Our previous study highlighted a key role of oxidative stress in acute itch. Here, we evaluated the effects of antioxidants in mouse models of acute and chronic itch and explored the potential mechanisms. The effects of systemic administration of the antioxidants N-acetyl-L-cysteine (NAC) and N-tert-butyl-α-phenylnitrone (PBN) were determined by behavioral tests in mouse models of acute itch induced by compound 48/80 or chloroquine, and chronic itch by treatment with a mixture of acetone-diethyl-ether-water. We found that systemic administration of NAC or PBN significantly alleviated compound 48/80- and chloroquine-induced acute itch in a dose-dependent manner, attenuated dry skin-induced chronic itch, and suppressed oxidative stress in the affected skin. Antioxidants significantly decreased the accumulation of intracellular reactive oxygen species directly induced by compound 48/80 and chloroquine in the cultured dorsal root ganglia-derived cell line ND7-23. Finally, the antioxidants remarkably inhibited the compound 48/80-induced phosphorylation of extracellular signal-regulated kinase in the spinal cord. These results indicated that oxidative stress plays a critical role in acute and chronic itch in the periphery and spinal cord and antioxidant treatment may be a promising strategy for anti-itch therapy.

Peripheral and spinal 5-HT receptors participate in cholestatic itch and antinociception induced by bile duct ligation in rats.

Although 5-HT has been implicated in cholestatic itch and antinociception, two common phenomena in patients with cholestatic disease, the roles of 5-HT receptor subtypes are unclear. Herein, we investigated the roles of 5-HT receptors in itch and antinociception associated with cholestasis, which was induced by common bile duct ligation (BDL) in rats. 5-HT-induced enhanced scratching and antinociception to mechanical and heat stimuli were demonstrated in BDL rats. 5-HT level in the skin and spinal cord was significantly increased in BDL rats. Quantitative RT-PCR analysis showed 5-HT1B, 5-HT1D, 5-HT2A, 5-HT3A, 5-HT5B, 5-HT6, and 5-HT7 were up-regulated in peripheral nervous system and 5-HT1A, 5-HT1F, 5-HT2B, and 5-HT3A were down-regulated in the spinal cord of BDL rats. Intradermal 5-HT2, 5-HT3, and 5-HT7 receptor agonists induced scratching in BDL rats, whereas 5-HT3 agonist did not induce scratching in sham rats. 5-HT1A, 5-HT2, 5-HT3, and 5-HT7 agonists or antagonists suppressed itch in BDL rats. 5-HT1A agonist attenuated, but 5-HT1A antagonist enhanced antinociception in BDL rats. 5-HT2 and 5-HT3 agonists or antagonists attenuated antinociception in BDL rats. Our data suggested peripheral and central 5-HT system dynamically participated in itch and antinociception under cholestasis condition and targeting 5-HT receptors may be an effective treatment for cholestatic itch.

Restoring Spinal Noradrenergic Inhibitory Tone Attenuates Pain Hypersensitivity in a Rat Model of Parkinson's Disease.

In the present study, we investigated whether restoring descending noradrenergic inhibitory tone can attenuate pain in a PD rat model, which was established by stereotaxic infusion of 6-hydroxydopamine (6-OHDA) into the bilateral striatum (CPu). PD rats developed thermal and mechanical hypersensitivity at the 4th week after surgery. HPLC analysis showed that NE content, but not dopamine or 5-HT, significantly decreased in lumbar spinal cord in PD rats. Additional noradrenergic depletion by injection of N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine (DSP-4) aggravated pain hypersensitivity in PD rats. At the 5th week after injection of 6-OHDA, systemic treatment with pharmacological norepinephrine (NE) precursor droxidopa (L-DOPS) or α2 adrenoceptor agonist clonidine significantly attenuated thermal and mechanical pain hypersensitivity in PD rats. Furthermore, application of norepinephrine (NE) and 5-hydroxytryptamine (5-HT) reuptake inhibitors duloxetine, but not 5-HT selective reuptake inhibitors sertraline, significantly inhibited thermal and mechanical pain hypersensitivity in PD rats. Systemic administration of Madopar (L-DOPA) or the D2/D3 agonist pramipexole slightly inhibited the thermal, but not mechanical, hypersensitivity in PD rats. Thus, our study revealed that impairment of descending noradrenergic system may play a key role in PD-associated pain and restoring spinal noradrenergic inhibitory tone may serve as a novel strategy to manage PD-associated pain.

[Effect of Sleep in Early Pregnancy on Gestational Diabetes: a Prospective Study.]

OBJECTIVES: To investigate the influence of sleep status in early pregnant women on the occurrence of gestational diabetes mellitus (GDM). METHODS: In this prospective study,542 pregnant women in early pregnancy were selected as subjects.The sleep time,insomnia,pre-gestational body mass and basic information of the subjects were collected by the trained investigators through questionnaire.At the 24th to 28th pregnant week,the body mass of each subject was measured and oral glucose tolerance test (OGTT) was conducted.The diagnosis of GDM was followed the guidelines of diagnose and treatment of gestational diabetes mellitus in China (2014).A non-conditional logistic regression method was adopted to analyze the correlation between sleep status of early pregnant women and the occurrence of GDM. RESULTS: The numbers of subjects in sleep deficiency group,sleep sufficiency group and sleep excessive group were 16 (2.95%),268 (49.45%) and 258 (47.60%),respectively.The incidences of GDM for sleep deficiency group,sleep sufficient group,and sleep excessive group were 62.50%(10/16),25.75%(69/268) and 22.09% (57/258),respectively,the difference was statistically significant (χ2=11.280,P<0.05).Compared with either sleep sufficiency or sleep excessive group,sleep deficiency group had higher GDM occurrence rate with statistically significant (χ2=8.410,11.218,P<0.017).Insomnia subjects in early pregnancy were 137 (25.28%).The incidences of GDM in insomnia group and normal group were 32.12% and 22.72% respectively,the difference was statistically significant (χ2=4.813, P<0.05).After adjusting the confounding factors [age,education,pre-pregnant body mass index (BMI),gained body mass in early and medium pregnancy,family history of type-2 diabetes,gravidity,parity,smoke,drink,exercise and occupation],non-conditional logistic regression results show that sleep deficiency for early pregnant women was an independent risk factor for the occurrence of GDM [odds ratio (OR)=7.38,95% confidence interval (CI): 2.25-24.17].However,the association between insomnia and the occurrence of GDM was not found. CONCLUSIONS: Sleep deficiency in early pregnancy may be a risk factor for the occurrence of GDM.

[A longitudinal study of anemia status and its association with postpartum hemorrhage among pregnant women in Chengdu, China].

OBJECTIVE: To investigate the anemia status and its changing trend among pregnant women in Chengdu, China, and to explore the association between anemia and postpartum hemorrhage. METHODS: A total of 548 healthy singleton primiparas were selected and followed up from three hospitals in Chengdu until delivery. Data on maternal demographic characteristics, delivery information were collected with questionnaire, and the hemoglobin( Hb) concentration was determined using cyanide methemoglobin method in each trimesters. Mixed fitting logistic regression models were performed to test the association between anemia and postpartum hemorrhage. RESULTS: The overall prevalenceof anemia was 31. 9%. The prevalence of anemia in the 1st, 2nd and 3rd trimesters during pregnancy was 5. 5%, 22. 8% and 18. 2%, respectively. The prevalence of anemia of pregnant women in the 2nd and 3rd trimesters were significantly higher than 1st trimester( P < 0. 05). Most of them were mild anemia, and pregnant women with severe anemia had not been found. After adjustment confounding factors( age and type of delivery etc. ), pregnant women with anemia in the 3rd trimester showed a 6. 47 times higher risk of postpartum hemorrhage( 95% CI 1. 23-34. 23). CONCLUSION: The anemia status of pregnant women in the 2nd and 3rd trimesters should be paid attention and improvement. Anemia of pregnant women in 3rd trimester is negative associated with postpartum hemorrhage.