[Predictors of malignant intraductal papillary mucinous neoplasm of the pancreas].

Intraductal papillary mucinous neoplasm (IPMN) is the most common pancreatic cystic neoplasm with a tendency to malignancy,and the 5-year survival rate of patients with invasive IPMN is less than 40%. Therefore,early detection of malignant cases and surgical intervention will significantly improve patient outcomes. The clinical guidelines recommended risk factors for IPMN malignancy according to imaging characteristics,clinical manifestations and serum tumor markers,among which dilation of the main pancreatic duct≥10 mm,the presence of solid components or enhanced mural nodules,and obstructive jaundice were recognized as high-risk factors. However,clinical practice has shown that the risk factors recommended by the current guidelines are not highly accurate in predicting IPMN malignancy,and the main problem is that the guidelines are less specific and allow follow-up cases to undergo unnecessary surgical resection. In recent years,the development of new technologies and methods such as genomics,radiomics,and artificial intelligence has greatly promoted the research progress of IPMN. Endoscopic ultrasound-guided fine needle aspiration of cystic fluid combined with molecular detection such as DNA and RNA,as well as radiomics combined with machine learning modeling,have shown superiority in improving the prediction accuracy of malignant IPMN,and will become an important tool to assist the diagnosis and treatment of IPMN in the future.

Collaboration between hospital physicians and nurses: an integrated literature review.

BACKGROUND: Ineffective physician-nurse collaboration has been shown to cause work dissatisfaction among physicians and nurses and compromised the quality of patient care. AIM: The review sought to explore: (1) attitudes of physicians and nurses toward physician-nurse collaboration; (2) factors affecting physician-nurse collaboration; and (3) strategies to improve physician-nurse collaboration. METHODS: A literature search was conducted in the following databases: CINAHL, PubMed, Wiley Online Library and Scopus from year 2002 to 2012, to include papers that reported studies on physician-nurse collaboration in the hospital setting. FINDINGS: Seventeen papers were included in this review. Three of the reviewed articles were qualitative studies and the other 14 were quantitative studies. Three key themes emerged from this review: (1) attitudes towards physician-nurse collaboration, where physicians viewed physician-nurse collaboration as less important than nurses but rated the quality of collaboration higher than nurses; (2) factors affecting physician-nurse collaboration, including communication, respect and trust, unequal power, understanding professional roles, and task prioritizing; and (3) improvement strategies for physician-nurse collaboration, involving inter-professional education and interdisciplinary ward rounds. CONCLUSION: This review has highlighted important aspects of physician-nurse collaboration that could be addressed by future research studies. These include: developing a comprehensive instrument to assess collaboration in greater depth; conducting rigorous intervention studies to evaluate the effectiveness of improvement strategies for physician-nurse collaboration; and examining the role of senior physicians and nurses in facilitating collaboration among junior physicians and nurses. Other implications include inter-professional education to empower nurses in making clinical decisions and putting in place policies to resolve workplace issues.

[Preparation and characterization of a recombinant poly-epitopic vaccine EgG1Y162-2 (4) against cystic echinococcosis based on the linker GSGGSG].

OBJECTIVE: To perform prokaryotic expression and preliminary characterization of the recombinant poly-epitope vaccine EgG1Y162-2 (4) against cystic echinococcosis. METHODS: The recombinant poly-epitope vaccine EgG1Y162-2 (4) against Echinococcus granulosus based on the linker GSGGSG was subjected to structural three-dimensional (3D) modeling using immunoinformatics to analyze the structural changes and evaluate the antigenicity of the vaccine. The pET30a-EgG1Y162-2 (4) recombinant plasmid was generated using double digestion with EcoR I and Sal I, and then transformed into competent cells. Following protein induction with isopropyl-ß-D-thiogalactoside (IPTG), the prokaryotic expression proteins were characterized using Western blotting, and the antigenicity of the recombinant protein was analyzed using sera from cystic echinococcosis patients and health volunteers. RESULTS: The four EgG1Y162-2 proteins coupled by the 3D structure of the recombinant vaccine EgG1Y162-2 (4) presented independent and effective expression and good antigenicity. The highest protein expression was detected in the supernatant following induction of the recombinant plasmid pET30a-EgG1Y162-2 (4) by 0.2 mmol/L IPTG at 37 °C for 4 h, and a pure protein component was seen following elution with 60 mmol/L imidazole. Western blotting analysis of the recombinant multiepitope protein HIS-EgG1Y162-2 (4) showed a band at approximately 39 kDa, and this band was recognized by sera from cystic echinococcosis patients. CONCLUSIONS: A recombinant poly-epitope vaccine EgG1Y162-2 (4) against cystic echinococcosis has been successfully constructed, which provides a preliminary basis for researches on recombinant multi-epitope vaccine against cystic echinococcosis.

Effects of glucose in drinking water on the changes in whole blood viscosity and plasma osmolality of broiler chickens during high temperature exposure.

This study was conducted to elucidate the influence of glucose in drinking water on whole blood viscosity and plasma osmolality of broilers during high temperature exposure. Two groups of birds, which had ad libitum access to either a 4% glucose-water solution (Group G) or tap water (Group W), were exposed simultaneously to 30 C from 0300 h for 12 h each day for 3 d. During the experimental period, Group G birds had greater metabolic energy intake and body weight gain than Group W. Hematocrit and whole blood viscosity decreased significantly at 30 C compared to controls at 20 C in Group W, whereas, in Group G, no changes were found for these two variables. Plasma osmolality also decreased at 30 C compared to 20 C in Group W, whereas no change was noted in this variable in Group G. However, at 20 C, plasma osmolality was significantly higher in Group W than in Group G, but no difference was observed between the two groups at 30 C. Plasma protein concentration decreased during exposure to 30 C in both groups, but the decrease tended to be greater in Group W than in Group G. These results suggest that glucose intake may alleviate the influence of heat stress on whole blood viscosity and plasma osmolality.

Effects of environmental temperature and heat production due to food intake on abdominal temperature, shank skin temperature and respiration rate of broilers.

1. Eight broilers were used to determine the effects of environmental temperature and the increased heat production attributable to food intake on thermoregulatory physiological responses. Heat production, abdominal temperature, shank skin temperature and respiration rate were measured. 2. Heat production rose with increase in food intake and environmental temperature. Abdominal temperature, shank skin temperature and respiration rate also increased but, at 36 degrees C, there was no difference in respiration rate between the different rates of food intake after exposure for 1 h. Also, heat production decreased with exposure time when the birds were exposed to 28 degrees C and 32 degrees C, but increased at 36 degrees C ambient temperature. 3. Although the effect of the increased heat production on thermoregulatory physiological responses was not greater than that of environmental temperature, the increase in heat production enhanced the effect of ambient temperature on thermoregulatory physiological responses. However, with increasing heat production, the greatest response in shank skin temperature was at 28 degrees C, in respiration rate at 32 degrees C and in abdominal temperature at 36 degrees C. 4. These results suggest that, at high environmental temperatures, arranging feeding management to restrict the increase in heat production may alleviate the effect of environmental temperature.

Effects of early heat exposure on thermoregulatory responses and blood viscosity of broilers prior to marketing.

1. This study was to determine the effects of heat load early in life on thermoregulatory responses and whole blood viscosity of broilers during a subsequent exposure to high environmental temperature later in life. 2. The birds, which had been subjected to exposure to 38 degrees C for 24 h at 5-d-old, served as prior exposure group (group A). Both group A and control group B were exposed to 33 degrees C for 3 h when near marketable weight. 3. On exposure to 33 degrees C, although there were no significant differences in the increases in heat production (HP) between the two groups, abdominal temperature (Ta), temperature of external ear tract (Tee), shank skin temperature (Tss), standing-lying frequency and lying time were lower in group A than in group B. Heart rate (HR) and comb surface temperature (Tcs) did not differ but increased in both groups during exposure to 33 degrees C. Respiration rate (RR) was greater in group A. 4. Blood viscosity decreased markedly in both groups after exposure to 33 degrees C; the decrease was greater in group A. 5. These results suggest that early exposure may promote broilers' ability to cope with the subsequent heat load by altering thermoregulatory physiological responses and behavioural patterns, resulting in an alleviation of heat stress.

Effects of food and water withdrawal and high temperature exposure on diurnal variation in blood viscosity of broiler chickens.

1. Three experiments were conducted to investigate the diurnal variation of blood viscosity in broilers. In experiment 1 food and water were supplied freely at 20 degrees C (20-FW). In experiment 2 food and water were withdrawn at 20 degrees C (20-NFW), while in experiment 3 food and water were withdrawn at 30 degrees C (30-NFW). 2. Blood sampling time points were 09.00 h, 15.00 h, 21.00 h, 03.00 h and 09.00 h the next day in each experiment. 3. In all experiments, whole blood viscosity (WBV), red blood cell count (RBC) and haematocrit (HCT) were greater during the dark (21.00 h and 03.00 h) than during the light period. During the dark period, there were no differences in WBV, RBC and HCT between 20-FW and 20-NFW, or between 20-NFW and 30-NFW. At 09.00 h, WBV and HCT were higher in 20-FW than in 20-NFW. At 15.00 h and 09.00 h (day 2), WBV and HCT were greater in 20-NFW than in 30-NFW. 4. There were no light-dark differences in plasma viscosity (PV), plasma protein concentration (PPC) or mean corpuscular volume (MCV) in any experiment. However, 20-NFW birds had a lower PPC and higher MCV compared with 20-FW, and a higher PPC and lower MCV compared with 30-NFW, while no difference was found in PV. 5. WBV increased linearly with RBC and HCT. PV increased with PPC, while MCV decreased. 6. These results indicate that there is diurnal variation in whole blood viscosity, which is greater during the dark than during the light period. During the light period it is strongly influenced by high environmental temperature and food and water withdrawal.