Exercise prehabilitation for patients with end-stage liver disease: a best practice implementation project.

OBJECTIVES: This study aimed to promote exercise prehabilitation in patients with end-stage liver disease during their waiting period for liver transplantation. INTRODUCTION: End-stage liver disease indirectly contributes to the development of sarcopenia and affects survival after liver transplantation because of low physiological reserves and insufficient aerobic capacity while awaiting transplantation. Exercise prehabilitation could reduce postoperative complications and promote postoperative recovery. METHODS: Following the JBI Practical Application of Clinical Evidence System, this study used six audit criteria derived from the JBI Evidence Summary. A baseline audit of six patients and nine nurses was conducted, analyzed barriers, established a prehabilitation process and improved interventions, followed by the implementation of exercise prehabilitation and follow-up audit. RESULTS: In the baseline audit, the results of the six criteria [(1) multimodal prehabilitation that includes exercise and other interventions where appropriate is offered to patients scheduled for abdominal surgery; (2) prior to the commencement of an exercise program an assessment of exercise contraindications, health status, treatments, physical activity level, functional capacity and quality of life is completed; (3) exercise programs are designed by appropriately qualified personnel; (4) exercise is delivered and supervised by appropriately qualified personnel; (5) exercise prescription is tailored to each individual patient; and (6) patient response to exercise is monitored throughout prehabilitation] were 0-22%. After implementing the best-practice strategies, all six criteria were set to 100%. Patients were aware of and had high compliance with exercise prehabilitation, nurses' and patients' knowledge of exercise rehabilitation improved, and nurses' implementation rate was significantly higher than before implementation ( P  < 0.05). The differences in the 6 min walking distance and Borg Fatigue Score between the preimplementation and postimplementation were statistically significant (all P  < 0.05). CONCLUSIONS: This best-practice implementation project is feasible. These results indicate that exercise prehabilitation could improve the preoperative walking capacity and fatigue of patients with end-stage liver disease. Ongoing best practices will be expected to develop in the future.

Synergistic modification of bentonite by acid activation and hydroxyl iron pillaring for enhanced dye adsorption capacity.

Despite the fact of natural abundance, low cost and environmental friendliness, the far-from-sufficient adsorption capacity of natural bentonite (BT) has limited such a promising application to remove dye pollutants. In this paper, we proposed a facile modification strategy to enhance adsorption performance of bentonite utilizing synergistic acid activation and hydroxyl iron pillaring, by which the adsorbent (abbreviated as S-Fe-BT) exhibited the highest adsorption capacity (246.06 mg/g) and a high rapid adsorption rate for a typical organic dye, Rhodamine B (RhB). This could be ascribed to the increased interlayer spacing, the increased specific surface area, and the optimized OH/Fe ratio after the synthetic modification of the pristine BT. The adsorption behavior of RhB onto S-Fe-BT was well described by the pseudo-second-order kinetic model, indicating a chemical-adsorption-controlled process. Furthermore, its adsorption isotherm matched well with the Langmuir model due to a monolayer adsorption process. This paper opens a promising direction to remove the dye pollution using low cost bentonite adsorbents treated by such a convenient modification strategy.

Successful treatment with pazopanib plus PD-1 inhibitor and RAK cells for advanced primary hepatic angiosarcoma: a case report.

BACKGROUND: Primary hepatic angiosarcoma (PHA) is a rare and aggressive solid tumor, with high rates of local recurrence and distant metastasis, and poor prognosis. There are no established treatment guidelines for PHA. CASE PRESENTATION: A 78-year-old asymptomatic man with PHA that was successfully treated with pazopanib plus PD-1 inhibitor and RetroNectin-activated killer cells (RAK cells). After one month of treatment, there was a clear reduction in the size and number of the liver metastases; and after nearly 15 months, most of the lesions were stable, no new lesions had developed, and the side effect of treatment was minor. CONCLUSION: Pazopanib, PD-1 inhibitor and RAK cells could serve as a potential option for the treatment of advanced PHA.

Effect of serum albumin on the prognosis of elderly patients with stage 3-4 chronic kidney disease.

OBJECTIVE: To investigate the influence of serum albumin on the prognosis of elderly patients with stage 3-4 chronic kidney disease (CKD). METHODS: From July 2013 to November 2015, elderly CKD patients (≥60 years), with eGFR ≥15 mL/min/1.73 m2 and <60 mL/min/1.73 m2, with CKD stage 3-4 in the geriatric nephrology clinic were enrolled. General information and underlying diseases were recorded. Laboratory indices were evaluated. Composite endpoint events (CEE) including renal endpoint events, cardiocerebral vascular endpoint events, and death were elucidated. Based on the ROC curves, the patients were divided into lower and higher serum albumin groups (<42.5 and ≥42.5 g/L). RESULTS: The occurrence of CEEs was significantly higher in lower serum albumin group than those in the higher group. Also, the patients in the higher group were significantly younger with lower urinary protein, blood urea, brain natriuretic peptide, and cystatin C than those in the lower serum albumin group. Contrastingly, hemoglobin, total serum protein, serum calcium, and superoxide dismutase were remarkably higher. The composite endpoints of multifactor logistic regression analysis indicated that as the serum albumin is increased by every 1 g/L, the probability of CEEs would reduce 14.8%, and the risk occurrence rate of the lower serum albumin group was 4.739 fold than the higher group. CONCLUSION: The results suggest that patients with higher serum albumin had a better prognosis than those with lower serum albumin. The low level was an independent risk factor influencing the prognosis of elderly patients in stage 3-4 CKD.

Facile synthesis of porous worm-like Pd nanotubes with high electrocatalytic activity and stability towards ethylene glycol oxidation.

A facile method was developed for large-scale preparation of porous worm-like Pd nanotubes based on the reduction of PdO nanotubes, which were obtained by calcining the complex precipitate of [Pd(dimethylglyoxime)2]n. The Pd catalyst showed excellent electrocatalytic activity and stability towards ethylene glycol oxidation.

[Anatomical study of auditory brainstem implantation through retrosigmoid approach].

OBJECTIVE: To provide anatomic data for auditory brainstem implantation (ABI) through the retrosigmoid approach. METHODS: Simulated operations were performed on 30 web adult head specimens and the structure around the foramen of luschka was observed. Both microscope and endoscope were employed. RESULTS: (1)The bony window, the most adjacent but not overlapping with sigmoid sinus, was a circle with a radius of 20 mm. Its center was located behind midpoint of the line from parietal notch to mastoid apex with a distance of (26.42 +/- 1.29) mm. The distance between bony window and transverse sinus, mastoid apex, foramen of luschka, jugular foramen, posterior edge of internal auditory meatus and root entry zone of the IX cranial nerve were (22.45 +/- 1.41) mm, (35.51 +/- 1.65) mm, (43.86 +/- 2.20) mm, (16.56 +/- 1.64) mm, (15.01 +/- 0.63) mm and (46.27 +/- 1.70) mm respectively; (2) The foramen of luschka can be spotted by using microscope or endoscope, especially 30 degrees angled endoscope. By this way, we could obtain a more distinct visual field without over-retraction of cerebellum and achieve the goal of minimally invasive surgery. The distance between the foramen of luschka and internal acoustic porus was (15.01 +/- 0.53) mm; (3) The foramen of luschka lies in the triangle formed by flocculus and root entry zone of glossopharyngeal nerve and rostral margin of biventer lobule. Choroids plexus acts as a direct landmark. the length of lateral recess was (17.53 +/- 1.03) mm. The distance between acoustic tubercle and the foramen of luschka and the root of cochlea never was (16.52 +/- 1.67) mm and (13.77 +/- 1.66) mm respectively. CONCLUSION: Adjustment of the angle of skull bone window and clarification of cerebellopontine angle are the keys to positioning the foramen of luschka. The usage of 30 degrees angled endoscope can identify the angle are the keys to positioning the foramen of luschka. The usage of 30 degrees angled endoscope can identify the foramen of luschka more accurately and expose the operation area more clearly.

Increased human telomerase reverse transcriptase (hTERT) mRNA expression but not telomerase activity is related to survival in curatively resected non-small cell lung cancer.

BACKGROUND: The purpose of this study was to evaluate the significance of human telomerase reverse transcriptase (hTERT) mRNA expression and telomerase activity as prognostic markers in non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: In a series of 69 curatively resected NSCLC specimens, telomerase activity was analyzed with the telomeric repeat amplification protocol (TRAP) assay and expression of hTERT mRNA by quantitative real-time reverse transcriptase-polymerase chain reaction (RT-PCR). Partitioning of gene expression levels and protein activities to construct prognostic groups was attempted. RESULTS: Human hTERT mRNA transcripts were detected in 62 (89.9%) cases of NSCLC. Seven (10.1%) tumors were completely negative for hTERT expression. Dichotomized hTERT levels (<0.42 versus > or =0.42) were associated with prognosis and Kaplan-Meier survival curves demonstrated a significant difference (log rank: p<0.01) with 5-year survival rates of 44.3% (+/-7.1%) for low as compared to 80% (+/-8.9%) for high hTERT mRNA expression. Low hTERT expression was also significantly associated with squamous cell histology (p<0.03). Telomerase activity was not associated with survival, stage, pT and pN categories, histological type or grading. Comparison of hTERT mRNA expression and telomerase activity was possible in 66 patients and showed a significant difference (p<0.0001) by Wilcoxon rank test. CONCLUSION: This is the first study which demonstrates that high hTERT mRNA expression is associated with improved 5-year survival rates. Expression patterns are distinct among histopathological subtypes of NSCLC and telomerase activity (TRAP) is significantly higher than hTERT mRNA expression.

COX-2 mRNA expression is significantly increased in acid-exposed compared to nonexposed squamous epithelium in gastroesophageal reflux disease.

BACKGROUND: Little is known about the role of cyclooxygenase (COX)-2 in gastroesophageal reflux disease (GERD) and the development of Barrett's metaplasia. The objectives of this study were to further analyze COX-2 mRNA expression in patients with GERD compared to Barrett's esophagus (BE) and Barrett's cancer (BC). METHODS: Tissue samples from 110 patients with GERD (n = 43), BE (n = 20), and BC (n = 47) were obtained in routine upper GI endoscopy. Expression levels of COX-2 were measured by quantitative real-time reverse trancriptase polymerase chain reaction (RT-PCR). Also, 24-h pH monitoring was performed in all patients of the GERD study group and the DeMeester composite score was used to match COX-2 mRNA expression with the severity of acid exposure in the lower esophagus. RESULTS: COX-2 mRNA is progressively upregulated within the metaplasia-dysplasia-adenocarcinoma (MDA) sequence (p = 0.001). COX-2 levels of the squamous epithelium in the distal esophagus from patients with GERD and a pathologic mean DeMeester score (>14.72) were significantly higher than in patients with normal DeMeester scores (p = 0.01). CONCLUSION: In summary our findings suggest that alterations in COX-2 mRNA expression occur independently of endoscopic or histologic signs of GERD in the acid-exposed squamous epithelium of the distal esophagus. However, this early COX-2 increase in GERD is further upregulated within the MDA sequence for yet unknown reasons.

Down-regulation of Gadd45 expression is associated with tumor differentiation in non-small cell lung cancer.

BACKGROUND: Evidence suggests that the growth arrest and DNA damage-inducible gene 45 (Gadd45) is an effective indicator of poor prognosis or malignant potential in solid tumors. The purpose of this study was to determine the gene expression patterns and clinical relevance of Gadd45 in tumor specimens of non-small cell lung cancer (NSCLC) patients. PATIENTS AND METHODS: Using a quantitative real-time RT-PCR method, the mRNA expression of Gadd45 was analyzed in tumor and paired normal-appearing tissues of 66 patients with NSCLC. The gene expression data for each patient were matched to the clinicopathological parameters. RESULTS: Gadd45 mRNA expression was detectable in all (100%) specimens analyzed. The overall median mRNA expression level of Gadd45 was approximately 10-fold lower in tumor tissues than in matching normal lung tissues (p < 0.001). High intratumoral Gadd45 expression was significantly associated with a poorer histological grading (p = 0.041). CONCLUSION: The significant decrease in Gadd45 expression in tumors compared with normal tissue and its association with histological grading suggest a role for Gadd45 in the differentiation pathway of NSCLC.

Significant overexpression of SPARC/osteonectin mRNA in pancreatic cancer compared to cancer of the papilla of Vater.

Cancer of the papilla of Vater (CPV) has a significantly better outcome compared to pancreatic cancer (PC) after curative resection. Increasing evidence suggests that prognostic differences are influenced by a different tumor biology. Secreted protein acidic and rich in cystein (SPARC)/osteonectin is a multifunctional matricellular protein involved in cell-matrix interactions and might be involved in tumor pathogenesis and progression. We examined quantitative SPARC mRNA expression in CPV and PC to evaluate if varying expression might contribute to the different biologic behaviour of these entities. Quantitative real-time reverse transcription-PCR was performed to analyze expression of SPARC mRNA in a series of 31 PC and 8 CPV specimens and corresponding uninvolved pancreatic tissues. Relative mRNA levels (ratio tumor/normal) were calculated as (SPARC/beta-actin in tumor)/(SPARC/beta-actin in paired normal tissue). SPARC expression levels were associated with clinical and histopathological parameters. SPARC mRNA expression was detected in all tumor and normal tissues of the pancreas and papilla of Vater. In pancreatic cancer, 15/31 (48.4%) patients showed overexpression of SPARC (ratio tumor/normal >1) whereas in CPV only 1/8 (12.5%) exhibited SPARC overexpression and this difference was statistically significant (p<0.05, Mann-Whitney test). No associations were detected with T- and N-categories, grading or prognosis. In conclusion, SPARC mRNA overexpression is significantly more frequent in CP than CPV and adds further evidence that CP and CPV are biologically different tumor entities.

High cyclooxygenase-2 expression following neoadjuvant radiochemotherapy is associated with minor histopathologic response and poor prognosis in esophageal cancer.

PURPOSE: High expression of cyclooxygenase-2 (COX-2) was shown to inhibit chemotherapy- and radiotherapy-induced apoptosis. We analyzed the association of COX-2 mRNA and protein expression with histomorphologic response to neoadjuvant radiochemotherapy in esophageal cancer. EXPERIMENTAL DESIGN: Fifty-two patients with resectable esophageal cancers (cT2-4, Nx, and M0) received neoadjuvant radiochemotherapy (cisplatin, 5-5-fluorouracil, 36 Gy) followed by transthoracic en bloc esophagectomy. Histomorphologic regression was defined as major response when resected specimens contained less than 10% of residual vital tumor cells. RNA was isolated from endoscopic biopsies (paired tumor and normal tissue) before neoadjuvant treatment and quantitative real-time reverse transcriptase-PCR (Taqman) assays were done to determine COX-2 mRNA expression levels standardized for beta-actin. COX-2 protein expression in pretreatment biopsies and post-therapeutic resection specimens was analyzed by immunostaining of tumor cells. RESULTS: Median COX-2 mRNA expression levels were significantly (P < 0.0001) different between paired tumor (median, 2.2) and normal tissues (median, 0.159). Comparison of pre-therapeutic and posttherapeutic specimens showed a significant difference (P < 0.006) in COX-2 protein expression. Twelve of 52 tumors showed down-regulation and 3 of 52 showed up-regulation of COX-2 protein expression during neoadjuvant radiochemotherapy. High COX-2 protein expression in post-therapeutic resection specimens was significantly associated with minor histopathologic response (P < 0.04) and poor prognosis (5-year survival probabilities: 26.3 +/- 8.2% for minor and 58.6% +/- 12.9% for major histopathologic response; P < 0.01). CONCLUSION: High COX-2 protein expression following neoadjuvant radiochemotherapy in resection specimens is significantly associated with minor histopathologic response to neoadjuvant therapy and very poor prognosis.

Overexpression of survivin mRNA is associated with a favorable prognosis following neoadjuvant radiochemotherapy in esophageal cancer.

Survivin is a member of the inhibitor of apoptosis (IAP) gene family known to be involved in resistance to chemo- and radiation therapy. We examined the potential of quantitative survivin mRNA expression to predict histopathologic tumor response and prognosis following neoadjuvant radiochemotherapy (cis-platinum, 5-FU, 36 Gy) in patients with locally-advanced esophageal cancer (cT2-4, Nx, M0). Tumor (T) and normal tissue (N) samples from 51 patients were collected by endoscopic biopsy prior to treatment. Survivin mRNA expression was analyzed by quantitative real-time RT-PCR assays. Histomorphologic regression was defined as a major response when resected specimens contained <10% of residual vital tumor cells or if a pathologically complete response was achieved. Some 7/51 patients had progressive disease and 44/51 proceeded to surgical resection. Of 44 resected tumors, 17 (31.4%) showed a major and 27 (61.4%) showed a minor histopathologic response; the survival rates were significantly different (p<0.01). Median absolute survivin expression was 5.1 in the tumor and 2.4 in corresponding normal tissue samples (Wilcoxon, p<0.001). Median relative (T/N ratio) survivin mRNA expression was 1.7. Survivin mRNA expression levels did not show a significant association with histomorphologic regression. Relative survivin mRNA expression of a T/N ratio >1 indicated a favorable prognosis (log-rank, p<0.003). Expression levels of survivin mRNA in pretherapeutic biopsies did not predict the extent of histomorphologic tumor regression following preoperative radiochemotherapy for esophageal cancer. However, overexpression of survivin mRNA in pretreatment biopsies (T/N ratio >1) was associated with superior survival probabilities.