Multiple myeloma patients undergoing chemotherapy: Which symptom clusters impact quality of life?

AIMS AND OBJECTIVES: To identify symptom clusters and examine their association with health-related quality of life. BACKGROUND: Multiple myeloma patients undergoing chemotherapy suffer from disease symptoms and adverse effects during the course of the disease. However, single symptom management has little effect, and symptom management for these patients remains challenging. Symptom clusters open a new perspective and provide important clues for symptom management. DESIGN: A cross-sectional study. METHOD: Participants were invited to complete the Chinese version of the Memorial Symptom Assessment Scale and Quality of Life Questionnaire-core 30. Appropriate indicators were used for descriptive statistics. Principal component analysis was used to identify symptom clusters. Associations between symptom clusters and quality of life were examined with Pearson correlation coefficients, Pearson correlation matrix and multiple linear regression. This study was reported following the STROBE checklist. RESULTS: A total of 177 participants were recruited from seven hospitals in this study. We identified self-image disorder, psychological, gastrointestinal, neurological, somatic and pain symptom clusters in multiple myeloma patients with chemotherapy. Approximately 97.65% of patients suffer from multiple symptom clusters. The pain, psychological and gastrointestinal symptom clusters have negatively influence on health-related quality of life. The strongest association was found with the pain symptom cluster. CONCLUSION: Most of multiple myeloma patients suffer from multiple symptom clusters. When improving the multiple myeloma patients' health-related quality of life, the clinical staff should prioritise relieving the pain symptom cluster. RELEVANCE TO CLINICAL PRACTICE: When multiple myeloma patients undergoing chemotherapy suffer from multiple symptom clusters, nurses should prioritise relieving the pain symptom cluster to improve their health-related quality of life. When drawing up and providing interventions, nurses should focus on the correlation among symptoms rather than single symptom. By relieving one symptom in a given cluster, other symptoms within the same symptom cluster may also be relieved.

The core symptom in multiple myeloma patients undergoing chemotherapy: a network analysis.

BACKGROUND: During chemotherapy for multiple myeloma, symptoms include those related to the disease, as well as adverse effects of the treatment. Few studies have explored the relationships between these symptoms. Network analysis could identify the core symptom in the symptom network. OBJECTIVE: The aim of this study was to explore the core symptom in multiple myeloma patients undergoing chemotherapy. METHODS: This was a cross-sectional study in which sequential sampling was used to recruit 177 participants from Hunan, China. Demographic and clinical characteristics were surveyed using a self-developed instrument. The symptoms of chemotherapy-treated multiple myeloma, including pain, fatigue, worry, nausea, and vomiting, were measured using a questionnaire with good reliability and validity. The mean ± SD, frequency, and percentages were used as descriptive statistics. Network analysis was used to estimate the correlation between symptoms. RESULTS: The results showed that 70% of multiple myeloma patients using chemotherapy exhibited pain. In the network analysis, worrying was the dominant symptom, and the strongest relationship was between nausea and vomiting in chemotherapy-treated multiple myeloma patients' symptoms. CONCLUSION: Worrying is the core symptom of multiple myeloma patients. Interventions could be most effective if there is a symptom management focus on worrying when providing care to chemotherapy-treated multiple myeloma patients. Nausea combined with vomiting could be better managed, which would decrease the cost of health care. Understanding the relationship between the symptoms of multiple myeloma patients undergoing chemotherapy is beneficial for precise symptom management. IMPLICATIONS FOR PRACTICE: Nurses and health care teams should be a priority to intervene in the worrying for chemotherapy-treated multiple myeloma patients to maximize the effectiveness of an intervention. Except, nausea and vomiting should be managed together in a clinical setting.

The Impact of COVID-19 Pandemic on Ischemic Stroke Patients in a Comprehensive Hospital.

Purpose: This study aimed to investigate the impact of characteristic ischemic stroke and outcomes during the first COVID-19 pandemic lockdown. Patients and Methods: A retrospective, observational cohort study of a comprehensive tertiary stroke center was conducted. Patients with ischemic stroke were divided into pre-COVID-19 lockdown (11/1/2019 to 1/30/2020) and COVID-19 lockdown (1/31/2020 to 4/30/2020) period groups. Patient data on stroke admission, thrombolysis, endovascular treatment, and 3-month routine follow-up were recorded. Data analysis was performed using SPSS according to values following a Gaussian distribution. Results: The pre-COVID-19 lockdown period group comprised 230 patients compared to 215 patients in the COVID-19 lockdown period group. Atrial fibrillation was more predominant in the COVID-19 lockdown period group (11.68% vs 5.65%, p=0.02) alongside patients who were currently smoking (38.8% vs 28.7%, p=0.02) and drinking alcohol (30.37% vs 20.00%, p=0.012) compared with that of the pre-COVID-19 lockdown period group. For patients receiving thrombolysis, the median door-to-CT time was longer in the COVID-19 lockdown period group (17.0 min (13.0, 24.0) vs 12.0 min (8.0, 17.3), p=0.012), median door to needle time was 48.0 minutes (35.5, 73.0) vs 43.5 minutes (38.0, 53.3), p=0.50, compared with that of the pre-COVID-19 lockdown period group. There were no differences for patients receiving mechanical thrombectomy. The median length of hospitalization (IQR) was no different. Discharge mRS scores (IQR) were higher in the COVID-19 lockdown period group (1.0 (1.0, 3.0) vs 1.0 (1.0, 2.0), p=0.022). Compared with the pre-COVID-19 lockdown period, hospitalization cost (Chinese Yuan) in the COVID-19 period group was higher (13,445.7 (11,009.7, 20,030.5) vs 10,799.2 (8692.4, 16,381.7), p=0.000). There was no difference observed in 3-month mRS scores. Conclusion: Patients presenting with ischemic stroke during the COVID-19 pandemic lockdown period had longer median door-to-CT time and higher hospitalization costs. There were no significant differences in 3-month outcomes. Multidisciplinary collaboration and continuous workflow optimization may maintain stroke care during the COVID-19 pandemic lockdown.

Study on Multifunctional Composite Nanomaterials for Controlled Drug Release in Biomedicine.

Nanoscience is a highly comprehensive, interdisciplinary discipline based on many advanced science and technology, and has developed very rapidly in the past few decades. Nanoscience and technology has been widely used in many fields such as biomedicine, materials science, chemistry, physics, and electronic information engineering. Nanomaterials are widely used due to their many excellent properties such as quantum size effects, small size effects, surface effects, and tunneling effects, and have become hot research areas. It is very suitable as a carrier for antitumor drug molecules, which is conducive to improving drug efficacy and reducing drugs side effects. After selective functionalization, it is highly possible to achieve the loading and release of multiple drug molecules. Based on the magnetic mesoporous Fe3O4-MSNs composite nanoparticles, we have modified a series of organosilane coupling agents on its surface. The most commonly used antitumor drug (adriamycin) in clinical was selected as a model to evaluate the loading and release behavior of modified composite nanoparticles Fe3O4-MSNs on this drug. The results indicate that Fe3O4 is selectively modified after appropriate modification of the silane coupling agent. MSNs carrier can effectively regulate the adsorption and release rate of hydrophilic DOX and hydrophobic PTX, and shows a good drug control ability.

Efficacy and safety of Xiaochaihu decoction for subacute thyroiditis: A protocol of systematic review and meta-analysis.

BACKGROUND: Subacute thyroiditis (SAT) is a transient and self-limiting inflammatory thyroid disease. There is no clear evidence for specific etiology, but it is generally thought to occur after viral infection. Characteristics of SAT include severe pain of the anterior neck, enlarged firm thyroid, disordered thyroid function, elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), typical ultrasound findings (hypoechoic areas) and low thyroid uptake of radioactive iodine or technetium-99 m because of the destructive etiology of the hyperthyroidism. Evidences showed Xiaochaihu decoction (XCHD) has a significant effect on improving the symptoms of SAT patients. The purpose of this study is to assess the safety and effectiveness of XCHD for patients with SAT. METHODS AND ANALYSIS: The literature that has been identified via searching 6 Chinese electronic databases and eight English electronic databases from inception to September 21, 2020 will be included in the study. Research selection, data extraction as well as research quality assessment will be completed by 2 experienced researchers independently. The primary outcome is remission rate. Data analysis will be conducted by the RevMan 5 software, and GRADE will help to assess the level of evidence. The heterogeneity of data will be investigated by a heterogeneity x test, as well as the Higgins I test. A subgroup analyses and sensitivity analysis will be conducted to explore the sources of heterogeneity. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSION: This study will draw a conclusion about whether XCHD is safe and effective in treating SAT on the basis of evidence-based medicine. This conclusion will provide areliable scientific evidence for the alternative treatment for the management of SAT. OSF REGISTRATION NUMBER:: https://osf.io/8hbue.

MicroRNA-206 regulates the secretion of inflammatory cytokines and MMP9 expression by targeting TIMP3 in Mycobacterium tuberculosis-infected THP-1 human macrophages.

Tuberculosis (TB) is a serious disease that is characterized by Mycobacterium tuberculosis (M.tb)-triggered immune system impairment and lung tissue damage shows limited treatment options. MicroRNAs (miRNAs) are regulators of gene expression that play critical roles in many human diseases, and can be up- or downregulated by M.tb infection in macrophage. Recently, tissue inhibitor of matrix metalloproteinase (TIMP) 3 has been found to play roles in regulating macrophage inflammation. Here, we found that TIMP3 expression was regulated by miR-206 in M.tb-infected THP-1 human macrophages. In THP-1 cells infected with M.tb, the miR-206 level was significantly upregulated and the expression of TIMP3 was markedly decreased when the secretion of inflammatory cytokines was increased. Inhibition of miR-206 markedly suppressed inflammatory cytokine secretion and upregulated the expression of TIMP3. In contrast, the upregulation of miR-206 promoted the matrix metalloproteinase (MMP) 9 levels and inhibited TIMP3 levels. Using a dual-luciferase reporter assay, a direct interaction between miR-206 and the 3'-untranslated region (UTR) of TIMP3 was confirmed. SiTIMP3, the small interfering RNA (siRNA) specific for TIMP3, significantly attenuated the suppressive effects of miR-206-inhibitor on inflammatory cytokine secretion and MMP9 expression. Our data suggest that miR-206 may function as an inflammatory regulator and drive the expression of MMP9 in M.tb-infected THP-1 cells by targeting TIMP3, indicating that miR-206 is a potential therapeutic target for patients with TB.

Tenuigenin Prevents IL-1ß-induced Inflammation in Human Osteoarthritis Chondrocytes by Suppressing PI3K/AKT/NF-κB Signaling Pathway.

Tenuigenin (TEN), the main active component of Polygala tenuifolia, has been reported to have anti-inflammatory effects. However, the effects of TEN on IL-1ß-stimulated osteoarthritis chondrocytes have not been reported. The purpose of this study was to investigate the anti-inflammatory effects and mechanism of TEN on IL-1ß-stimulated human osteoarthritis chondrocytes. Human osteoarthritis chondrocytes were pretreated with or without TEN for 1 h and then stimulated with IL-1ß. The production of NO and PGE2 were detected by the Griess reagent and ELISA. The expression of NF-κB and MAPKs (p38, JNK, ERK) were measured by Western blot analysis. The production of MMP-1, MMP3, and MMP13 were measured by ELISA. The results showed that treatment of TEN significantly inhibited IL-1ß-induced NO and PGE2 production. TEN also suppressed IL-1ß-induced MMP-1, MMP3, and MMP13 expression. Furthermore, TEN was found to inhibit IL-1ß-induced NF-κB activation, PI3K, and AKT phosphorylation. In conclusion, these results suggest that TEN inhibits IL-1ß-induced inflammation in human osteoarthritis chondrocytes by inhibiting PI3K/AKT/NF-κB signaling pathway.