ABSTRACT
Since end-stage renal disease leads to a variety of problems such as disability,reduced quality of life,and mental and psychological disorders,it has become a serious public health problem around the globe.Renal palliative care integrates palliative care philosophy in the care for patients with end-stage renal disease.As a planned,comprehensive,patient-centered care,renal palliative care focuses on the patient's symptoms and needs,aiming to reduce the suffering throughout the course of the disease,including but not limited to end-of-life care.This study reports the palliative care practice for a patient on maintenance dialysis in the Blood Purification Center of Peking Union Medical College Hospital and reviews the present situation of palliative care in end-stage renal disease.
Subject(s)
Kidney Failure, Chronic , Terminal Care , Humans , Palliative Care/psychology , Quality of Life , Kidney Failure, Chronic/therapy , Terminal Care/psychology , Renal Dialysis/psychologyABSTRACT
BACKGROUND: CHCHD2 was identified a novel cell migration-promoting gene, which could promote cell migration and altered cell adhesion when ectopically overexpressed in NIH3T3 fibroblasts, and it was identified as a protein necessary for OxPhos function as well. However, the clinic relevance of CHCHD2 expression in NSCLC remains unclear. Here we assumed that CHCHD2 expression would accompanies the expression of HIF-1α to response hypoxia in the occurrence of NSCLC. METHODS: In order to verify this hypothesis, correlations among the expression levels of CHCHD2 and HIF-1α were detected and analyzed in 209 pair cases of NSCLC. The expression and location of these molecules were assessed using Immunohistochemistry, immunohistofluorescence, qRT-PCR and western blotting. The differences and correlations of the expression of these two molecules with clinical pathological characteristics in NSCLC were statistically analyzed using Wilcoxon (W) text, Mann-Whitney U, Kruskal-Wallis H and cross-table tests. Kaplan-Meier survival analysis and Cox proportional hazards models were used to estimate the effect of the expression of CHCHD2 and HIF-1α on the patients' survival. RESULTS: Data showed that CHCHD2 and HIF-1α expression were higher in NSCLC than in normal tissues (all P = 0.000). CHCHD2 expression was significantly related with smoking, tumor size, differentiation degree, TNM Stage, lymph metastasis (all P<0.05). The HIF-1α expression was significantly associated with smoking, tumor category, differentiation degree, TNM Stage, Lymph metastasis (all P<0.05). There was a marked correlation of CHCHD2 and HIF-1α expression with histological type, differentiation and lymph metastasis of NSCLC (all P<0.05, rs>0.3). Immunohistofluorescence showed that there were co-localization phenomenon in cytoplasm and nucleus between CHCHD2 and HIF-1α expression. NSCLC patients with higher CHCHD2 and HIF-1α expression had a significantly worse prognosis than those with lower CHCHD2 and HIF-1α expression (all P = 0.0001; log-rank test). The multivariate analysis indicated that CHCHD2 expression was an independent prognostic factor in NSCLC (hazard ratio [HR], 0.492, P = 0.001). CONCLUSION: Our results indicate that over-expression of CHCHD2 would promote the expression of HIF-1α to adapt the hypoxia microenviroment in NSCLC and CHCHD2 could serves as a prognostic biomarker in NSCLC.
Subject(s)
Carcinoma, Non-Small-Cell Lung/metabolism , DNA-Binding Proteins/metabolism , Hypoxia-Inducible Factor 1, alpha Subunit/metabolism , Lung Neoplasms/metabolism , Transcription Factors/metabolism , Adult , Aged , Aged, 80 and over , Animals , Biomarkers, Tumor/metabolism , Carcinoma, Non-Small-Cell Lung/mortality , Carcinoma, Non-Small-Cell Lung/pathology , Female , Humans , Immunohistochemistry , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Lymphatic Metastasis , Male , Mice , Middle Aged , Neoplasm Staging , Prognosis , Survival AnalysisABSTRACT
BACKGROUND: Patients with chronic kidney disease (CKD) require specialized management. However, the current situation of CKD management is unclear during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to investigate the influence of the COVID-19 on kidney patients' follow-ups. METHODS: In April 2020, we included patients who underwent kidney biopsy from January 2017 to December 2019 in a referral center of China, and then initiated a survey via telephone on different aspects of follow-up during the COVID-19 pandemic. We collected and analyzed demographic data, diagnoses, follow-up conditions, and telemedicine experience. RESULTS: We reached 1190 CKD patients with confirmed kidney biopsies, and included 1164 patients for analysis after excluding those on dialysis. None of our patients have had COVID-19, although more than 50% of them were complicated with other comorbidities, and over 40% were currently using immunosuppressive treatments. Face-to-face clinic visits were interrupted in 836 (71.82%) participants. Medicine adjustments and routine laboratory examinations were delayed or made irregular in about 60% of patients. To continue their follow-ups, 255 (21.90%) patients utilized telemedicine, and about 80% of them were satisfied with the experience. The proportion of telemedicine users was significantly higher in patients with immunosuppressive treatments than those without (31.88% vs. 17.12%, p < 0.001). CONCLUSION: The risk of COVID-19 was mitigated in patients with CKD and other co-existing risk factors when proper protection was utilized. The routine medical care was disrupted during the pandemic, and telemedicine could be a reasonable alternative method.
Subject(s)
Communicable Diseases, Emerging/epidemiology , Coronavirus Infections/epidemiology , Infection Control/methods , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Renal Insufficiency, Chronic/epidemiology , Renal Insufficiency, Chronic/pathology , Adult , Biopsy, Needle , COVID-19 , China/epidemiology , Comorbidity , Coronavirus Infections/diagnosis , Databases, Factual , Female , Follow-Up Studies , Humans , Immunohistochemistry , Incidence , Male , Middle Aged , Pneumonia, Viral/diagnosis , Renal Insufficiency, Chronic/physiopathology , Retrospective Studies , Risk Assessment , Surveys and QuestionnairesABSTRACT
The cell cycle-related and expression-elevated protein in tumor (CREPT) is overexpressed in several human malignancies. However, the clinical relevance of CREPT expression and its biological role in non-small-cell lung cancer (NSCLC) remains unclear. In this study, we detected the expression of CREPT in both NSCLC tissues and cell lines by immunohistochemistry, Western blot analysis, and RT-PCR. The correlation between CREPT expression and clinicopathologic features was analyzed in 271 NSCLC patients. The prognostic value of CREPT expression was evaluated by Kaplan-Meier analysis and Cox regression analysis. CREPT was overexpressed in Calu-1 cell lines by using plasmid vector and its biological function was explored both in vitro and in vivo. We found that CREPT was significantly overexpressed in NSCLC compared with paired adjacent non-tumor tissues, and the expression level of CREPT was correlated with tumor differentiation, lymph node metastasis, and clinical stage. Kaplan-Meier analysis showed that the recurrence-free survival and overall survival of high CREPT expression groups were significantly shorter than those of the low CREPT expression group. Multivariate analysis identified that CREPT might be an independent biomarker for the prediction of NSCLC prognosis. Overexpression of CREPT increased cell proliferation and enhanced the migration and invasion ability of Calu-1 cells (a human NSCLC cell line with relative low CRPET expression) in vitro. Moreover, CREPT overexpression promoted tumor growth in a nude mice model. These results suggest that CREPT is closely relevant to the proliferation of NSCLC cells and it might be a potential prognostic marker in NSCLC patients.
Subject(s)
Carcinoma, Non-Small-Cell Lung/metabolism , Carcinoma, Non-Small-Cell Lung/pathology , Cell Cycle Proteins/metabolism , Cell Cycle/physiology , Cell Proliferation/physiology , Lung Neoplasms/metabolism , Lung Neoplasms/pathology , Neoplasm Proteins/metabolism , A549 Cells , Animals , Biomarkers, Tumor/metabolism , Cell Differentiation/physiology , Cell Line, Tumor , Disease-Free Survival , Female , Humans , Lymphatic Metastasis/pathology , Male , Mice , Mice, Inbred BALB C , Mice, Nude , Middle Aged , PrognosisABSTRACT
BACKGROUND/AIMS: While systolic blood pressure variability (SBPV) is an independent risk factor for mortality in the general population, its association with outcomes in hemodialysis patients has been less well-investigated. METHODS: In this retrospective study, we enrolled 99 eligible HD patients from 2006 to 2016. Predialysis blood pressure measurements obtained over 1-year period were used to determine each patient's BPV. The standard deviation (SD), the coefficient of variation (CV) and the variation independent of the mean (VIM) were used as metrics of BPV. RESULTS: During a median follow-up period of 68 months, 52 patients died, and cardiovascular disease (31.3%) was the primary cause of death in these patients. After adjusting for covariates, the hazard ratios (HRs) for all-cause and cardiovascular mortality were 1.80 (95% confidence interval (CI) 1.11-2.92) and 1.71 (95% CI 1.01-2.90), respectively, for a one percent increase in CV. Variability in the volume removed per session and predialysis serum albumin and calcium levels were identified as factors associated with BPV. CONCLUSION: In this study, we demonstrate that greater variability in predialysis SBP is associated with long-term mortality in hemodialysis patients. Controlling volume variation, avoiding hypoalbuminemia and reducing blood calcium levels might reduce SBP variability and thereby improve prognoses in these patients.
Subject(s)
Blood Pressure , Renal Dialysis , Calcium/blood , Cardiovascular Diseases/mortality , Prognosis , Retrospective Studies , Serum Albumin/analysisABSTRACT
AIM: Uncontrolled hypertension is an independent risk factor for cardiovascular disease and is the leading cause of mortality in haemodialysis patients. The aim of this study was to examine the effectiveness of self-management support (SMS) for blood pressure (BP) control and health behaviours. METHODS: We conducted a cluster randomized controlled trial (RCT) in which 90 adult haemodialysis patients were assigned to either an SMS or common intervention (CI) group. The SMS group received an intervention consisting of self-management education and motivational interviewing. The CI group received standard care and routine health education. The primary outcome was the BP monitored before each haemodialysis. Secondary outcomes included salt intake (measured using a balance formula), home BP monitoring (HBPM) (assessed using two self-administered questions), and medication adherence (measured using the Medication-taking Behavior Scale). Data were collected at baseline and at 1, 3 and 6 months post-intervention. RESULTS: The SMS group showed continuous reductions in systolic BP from baseline: -9.2, -8.7, and -8.4 mmHg at 1, 3 and 6 months after the intervention, respectively (P < 0.01). Compared with the CI group, the SMS group had a greater decrease in systolic BP at 1 month: -5.9 mmHg (P = 0.0388), but no significant difference was found at 3 or 6 months (P > 0.05). SMS patients showed an improvement in health behaviours relative to baseline (less salt intake, more consistent HBPM, and greater medication adherence) (P < 0.05). CONCLUSIONS: Self-management support obtained short-term success in improving salt restriction, regular performance of HBPM and medication adherence, which led to better BP control.
Subject(s)
Blood Pressure , Hypertension/therapy , Kidney Diseases/therapy , Motivational Interviewing , Patient Education as Topic , Renal Dialysis , Self Care/methods , Adult , Aged , Antihypertensive Agents/therapeutic use , Blood Pressure/drug effects , Blood Pressure Monitoring, Ambulatory , China , Diet, Sodium-Restricted , Female , Health Knowledge, Attitudes, Practice , Humans , Hypertension/diagnosis , Hypertension/physiopathology , Hypertension/psychology , Kidney Diseases/diagnosis , Kidney Diseases/physiopathology , Kidney Diseases/psychology , Male , Medication Adherence , Middle Aged , Pilot Projects , Renal Dialysis/adverse effects , Sodium Chloride, Dietary/administration & dosage , Sodium Chloride, Dietary/adverse effects , Surveys and Questionnaires , Time Factors , Treatment OutcomeABSTRACT
Nurse turnover is one of the reasons for the global nurse shortage. Although previous studies have examined the determinants of turnover intention in detail, there is limited knowledge on the effect of subjective social status on nurse turnover intention. Therefore, in this study, we examined this relationship, including job satisfaction as a mediator, among Chinese nurses. This cross-sectional study employed questionnaires to assess subjective social status, job satisfaction, and turnover intention in 581 nurses who were randomly recruited from 10 hospitals in Jinan, China. The results partially supported our model. Although subjective social status exerted no significant direct effect on turnover intention, it exerted a significant indirect effect through job satisfaction. These results provide a new insight into why nurses leave their jobs, and possible new solutions to the nurse turnover problem. Efforts should be made to improve nurses' subjective social status.
Subject(s)
Job Satisfaction , Nursing Staff, Hospital/psychology , Personnel Turnover , China , Cross-Sectional Studies , Humans , Social Environment , Surveys and QuestionnairesABSTRACT
Objective To observe the clinical characteristics,dialysis modalities,and outcomes of end stage renal disease(ESRD)patients with polycystic kidney disease(PKD)and to evaluate the feasibility of peritoneal dialysis in these population. Methods The clinical data of ESRD patient whose primary diagnosis was PKD in Peking Union Medical College Hospital were retrospectively collected from January 1993 to December 2015.PKD patients were divided into two groups according to dialysis modality,namely peritoneal dialysis group(PKD-PD)group and hemodialysis(PKD-HD)group.In addition,we randomly chose non-PKD patients from 622 peritoneal dialysis patients who were matched with PKD-PD patients in age,gender and dialysis time.The primary end point was death.The survival rate was calculated by Kaplan-Meier analysis and the risk factors for suivival were analyzed by Cox regression model. Results Totally 47 PKD patients were enrolled,including 33 patients in PKD-PD group and 14 patients in PKD-HD group,and 42 non-PKD patients as the control group.The average age of PKD patients was(53±11)years,of which 38.3% were women.When compared with PKD-HD group,no significant difference in age,gender,comorbidities,kidney size,and residual glomerular filtration rate were observed in PKD-PD patients at baseline(all P>0.05).The average time on dialysis of PKD-PD patients was(36.2±33.1)months.The weekly urea clearance index(Kt/V)and weekly creatinine clearance were similar to non-PKD-PD group at 3 months,1 year,3 years,and 5 years(all P>0.05).The peritonitis rate was 1 episode/84.5 months.The survival rates at 1 year,3 years,and 5 years of PKD-PD group were 85.7%,78.6%,and 78.6%,which were similar to non-PKD-PD group and PKD-HD group respectively(all P>0.05).Multivariate Cox regression analysis showed that neither PKD nor PD independently predicted the mortality. Conclusion PD can be an option for ESRD patients with PKD.
Subject(s)
Kidney Failure, Chronic/therapy , Peritoneal Dialysis , Polycystic Kidney Diseases/therapy , Adult , Creatinine/blood , Female , Glomerular Filtration Rate , Humans , Male , Middle Aged , Retrospective Studies , Urea/bloodABSTRACT
AIMS AND OBJECTIVES: The purpose of this study was to explore the relationship between the duration of sleep per day and cardiovascular metabolic multimorbidity (CMM) in older adults and to identify how many hours of sleep per day can lead to a lower risk of CMM in older adults. BACKGROUND: CMM are a common syndrome in the older adults. There may be an association between sleep duration and CMM in older adults, with both insomnia and sleep deprivation having an impact on the health of older adults. Therefore, it is important to explore the possibility that older adults who sleep for a few hours per day may have a lower prevalence of CMM. METHODS: The study included 9710 older adults. The sleep duration in this study was assessed by the question "How many hours of sleep do you currently get in a day? ". Older adults were defined as having CMM when they had two or more of the five categories of hypertension, diabetes, heart disease, stroke or cardiovascular disease, dyslipidemia. We used multivariate logistic regression analysis to explore the association among sleep duration and CMM. Restrictive cubic splines were used to examine the shape of the association among sleep duration and the CMM. The STROBE checklist was used for this cross-sectional study. RESULTS: The mean age was 84.78 ± 11.73 years, with 55.5 % being female. Of the total sample, 21.3 % were CMM. When all covariates were adjusted, there was dose-response relationship between sleep duration and CMM. The dose-response relationship between CMM and sleep duration showed that older adults had a lower risk of cardiovascular and metabolic multimorbidity when they slept 9 h and 10 h per day. CONCLUSION: With the increasing population of older adults, the number of older adults suffering from CMM continues to rise, and adequate sleep time can effectively prevent the occurrence of CMM. We should pay attention to the sleep problem of the older adults. RELEVANCE TO CLINICAL PRACTICE: This study provided information for healthcare providers to identify circumstances that increase cardiovascular metabolic multimorbidity and suggest the appropriate sleep duration per day to reduce the risk of disease in older adults. PATIENT OR PUBLIC CONTRIBUTION: Because of the public database data used in this study, all data were collected by survey agency personnel, so this section is not applicable to this study.
Subject(s)
Multimorbidity , Sleep Duration , Humans , Female , Aged , Aged, 80 and over , Male , Cross-Sectional Studies , Sleep/physiology , Sleep Deprivation/complications , China/epidemiologyABSTRACT
OBJECTIVES: This study aimed to analyse whether safety and security equipment decreased patient and visitor violence (PVV) towards nurses in the COVID-19 period and quantify to what extent safety and security equipment affects PVV. DESIGN: Controlled before and after study and difference-in-difference (DID) analysis. SETTING: A large hospital medical group, consisting of three public tertiary teaching hospitals, namely, Xinjiekou Branch, Huilongguan Branch and Xinlongze Branch of Beijing Jishuitan Hospital, located in the west and north parts of Beijing, China. PARTICIPANTS: A panel of nine departments recruited using two-step sampling method, administered online surveys in 2021 and 2022. A total of 632 eligible nurses participated in the survey in 2021 and 725 eligible nurses in 2022. MEASURES: We assessed impacts of the safety and security equipment on the PVV. The policy had been enacted in June 2020, and the corresponding measures were established after mid-December 2020, and therefore, we use a DID design to evaluate changes in nurses' PVV incidence. Departments are classified as either department installed or non installed, and nurses are classified based on their department. RESULTS: Within the treatment group, the incidence of physical PVV significantly decreased from 13.8% in 2020 to 2.0% in 2021. In the control group, the incidence of physical PVV increased from 0.6% in 2020 to 2.7% in 2021. The application of the safety and security equipment decreased the incidence of physical PVV by 13.93% (95% CI: -23.52% to -4.34%). In contrast, no difference was observed between the treatment and control groups for the incidence of psychological PVV (6.23%, 95% CI: -11.56% to 24.02%) and overall PVV (0.88, 95% CI: -20.90% to 22.66%). CONCLUSION: The safety and security equipment reduced the incidence of physical PVV towards nurses. For hospital managers in public hospitals, longer-term strategies roadmap for PVV prevention measures are needed to create a more supportive work environment in employees.
Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , COVID-19/prevention & control , Retrospective Studies , Pandemics/prevention & control , Violence/prevention & control , Hospitals, Public , China/epidemiology , Surveys and QuestionnairesABSTRACT
INTRODUCTION: Frailty is a clinical syndrome characterised by a reduced ability to adapt to external stressors owing to a reduced physiological reserve, which is caused by degeneration of multiple organ systems. Frailty is particularly prevalent among patients with hip fractures. Research on frailty in China started late; thus, evidence regarding the prevalence of frailty among older patients with hip fracture in China is scarce. The aim of this systematic review and meta-analysis is to systematically search for available data on the prevalence of frailty among older patients with hip fracture in China, assess the pooled prevalence of frailty and describe the association between frailty and clinical outcomes. METHOD AND ANALYSIS: We will systematically search electronic databases, including Web of Science, Embase, PubMed, the Cochrane Library, Chinese National Knowledge Infrastructure and Wanfang data Database, to identify studies on the prevalence of frailty in older patients with hip fracture. Two reviewers will independently identify eligible studies according to defined inclusion criteria and critically appraise them using the Joanna Briggs Institute's standardised critical appraisal tool. Data will be analysed using Stata V.12.0. ETHICS AND DISSEMINATION: Ethics approval is not required as this review will only include data from published sources. The results will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42022265321.
Subject(s)
Frailty , Hip Fractures , Humans , Aged , Frailty/epidemiology , Prevalence , Systematic Reviews as Topic , Meta-Analysis as Topic , Hip Fractures/epidemiology , China/epidemiology , Review Literature as TopicABSTRACT
INTRODUCTION: The advance of diagnostics and treatments has greatly improved the prognosis of non-small cell lung cancer (NSCLC) patients. However, relapse and metastasis are still common problems encountered by NSCLC patients who have achieved complete remission. Therefore, overcoming the challenge of relapse and metastasis is particularly important for improving the prognosis of NSCLC patients. Research has shown that minimal residual disease (MRD) was a potential source of tumor relapse and metastasis, and circulating tumor DNA (ctDNA) MRD has obvious advantages in predicting the relapse and metastasis of NSCLC and evaluating treatment effectiveness. Therefore, dynamic monitoring of MRD is of great significance for NSCLC patient management strategies. AREAS COVERED: We have reviewed articles related to NSCLC MRD included in PubMed and describes the biological significance and historical context of MRD research, reasons for using ctDNA to evaluate MRD, and potential value and challenges of ctDNA MRD in assessing relapse and metastasis of NSCLC, ultimately guiding clinical therapeutic strategies and management. EXPERT OPINION: The standardized scope of ctDNA MRD detection for NSCLC requires more clinical research evidence to minimize study differences, making it possible to include in the clinical staging as a reliable indicator.
Subject(s)
Carcinoma, Non-Small-Cell Lung , Circulating Tumor DNA , Lung Neoplasms , Humans , Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/genetics , Carcinoma, Non-Small-Cell Lung/therapy , Circulating Tumor DNA/genetics , Lung Neoplasms/diagnosis , Lung Neoplasms/genetics , Neoplasm, Residual/diagnosis , Neoplasm, Residual/genetics , Recurrence , Biomarkers, Tumor/geneticsABSTRACT
Introduction: The aim of this study is to understand nephrology medical staff's awareness of, basic knowledge of, practical ability of, and the barriers to palliative kidney care to patients on maintenance hemodialysis (HD) in mainland China. Methods: This cross-sectional descriptive study employed convenience sampling of medical staff (physicians and nurses) working in nephrology departments in mainland China. Independent predictors of self-assessment ability for palliative care (PC) were determined using multivariate binary logistic regression. Results: Responses were received from medical staff in 28 provinces and 657 questionnaires were analyzed. Among the participants, 53.1% (349/657) were doctors, and only 4.3% claimed to be confident in providing PC to patients on HD. The average score of self-assessing ability for PC was 2.65 ± 1.15 (range 1-5). Among the 580 participants who experienced patient withdrawal from dialysis, only 16.0% reported that their patients had well-planned withdrawal from dialysis. Male (odds ratio [OR] [95% confidence interval [CI], 0.585 [0.34-0.99], P = 0.048), nurse (OR [95% CI], 1.81 [1.01-3.27], P = 0.047), more experience in dealing with deceased cases (OR [95% CI], 1.28 [1.02-1.61], P = 0.034), less experience of medical disputes before/after withdrawal from dialysis (OR [95% CI], 0.62 [0.40-0.98], P = 0.041), and PC training experiences (OR [95% CI], 2.33 [1.86-2.91], P < 0.001) were independently correlated with significant better self-assessing ability for PC. Conclusion: This study demonstrates that the nephrology medical staff had a positive attitude but lacked relative knowledge and training in PC. Institutionalized education, training models, practice guidelines for kidney PC, and guidelines for well-planned withdrawal from dialysis according to cultural background are urgently needed in mainland China.
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The development and growth of tumors remains an important and ongoing threat to human life around the world. While advanced therapeutic strategies such as immune checkpoint therapy and CAR-T have achieved astonishing progress in the treatment of both solid and hematological malignancies, the malignant initiation and progression of cancer remains a controversial issue, and further research is urgently required. The experimental animal model not only has great advantages in simulating the occurrence, development, and malignant transformation mechanisms of tumors, but also can be used to evaluate the therapeutic effects of a diverse array of clinical interventions, gradually becoming an indispensable method for cancer research. In this paper, we have reviewed recent research progress in relation to mouse and rat models, focusing on spontaneous, induced, transgenic, and transplantable tumor models, to help guide the future study of malignant mechanisms and tumor prevention.
Subject(s)
Hematologic Neoplasms , Neoplasms , Humans , Animals , Mice , Rats , Neoplasms/genetics , Neoplasms/therapy , Immunotherapy, Adoptive/methods , Disease Models, Animal , Animals, Genetically ModifiedABSTRACT
Background: The number of type 2 diabetes mellitus (T2DM) cases among empty-nest elderly increases with increasing aging in China. Self-care plays an important role in preventing and reducing adverse outcomes of diabetes; however, few studies focus on self-care experiences of empty-nest elderly with T2DM. Objective: To explore self-care experiences for a chronic disease among empty-nest elderly patients with T2DM in mainland China. Methods: A descriptive phenomenological design was used in this study. Semi-structured interviews were conducted for 15 empty-nesters with T2DM. Interviews were implemented in department of endocrinology at a tertiary teaching hospital located in Shandong province, east of China. Results: The participants were poorly adept with monitoring their blood glucose and lacked the ability to deal with abnormal blood glucose levels. Most participants had a good relationship with medication and physical activity. Living without children was perceived as a benefit that improved dietary management and is a disadvantage in terms of economic and emotional support and access to medical resources. Elderly empty-nesters also lacked knowledge about diabetes and paid little attention to potential complications. Conclusion: Empty-nest elderly patients with T2DM value medication compliance and lifestyle modification more than blood glucose monitoring, complication prevention, and coping with negative emotions. Friends and spouses play indispensable roles in patients' self-care motivation and maintenance. Diabetes education on self-care, access to medical resources, and social support is needed for better diabetes management.
Subject(s)
Aging , Diabetes Mellitus, Type 2/therapy , Self Care , Social Isolation , Aged , Aging/physiology , Aging/psychology , China/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/psychology , Female , Humans , Interviews as Topic , Male , Middle Aged , Qualitative Research , Residence Characteristics , Self Care/psychology , Self Care/statistics & numerical data , Social Isolation/psychology , Surveys and QuestionnairesABSTRACT
AIMS: Serine/threonine/tyrosine kinase 1 (STYK1) has been previously shown to have oncogenic properties, and emerging evidence suggests that STYK1 expression correlates with epithelial-mesenchymal transition (EMT). However, the mechanism of STYK1 involvement in oncogenesis remains unknown. The present study aimed to elucidate how STYK1 expression level relates to the metastasis, migration, invasion, and EMT in non-small cell lung cancer (NSCLC) and to determine the molecular mechanism of STYK1 effects. METHODS: Serine/threonine/tyrosine kinase 1 (STYK1) expression level and its relationship with the prognosis of NSCLC were determined using the ONCOMINE database and clinical cases. Non-small cell lung cancer cell lines with the overexpression or knockdown of STYK1 were established to determine whether STYK1 promotes cell migration, invasion, and EMT in vitro and in vivo. In addition, a constitutively active FoxO1 mutant (FoxO1AAA) was used to examine the role of FoxO1 in the STYK1-mediated upregulation of metastasis and EMT in NSCLC. RESULTS: Serine/threonine/tyrosine kinase 1 (STYK1) was upregulated in NSCLC tissues and cell lines, and its overexpression correlated with poor prognosis in patients with NSCLC after surgery. Enhanced expression of STYK1 potentiated the migration, invasion, and EMT in SW900 cells, thereby promoting metastasis, whereas knockdown of STYK1 inhibited these cellular phenomena in Calu-1 cells. Furthermore, STYK1 expression was positively related to the level of phosphorylated-FoxO1, whereas the constitutively active FoxO1 mutant protected against the positive effect of STYK1 overexpression on cell migration, invasion, and EMT. CONCLUSION: Serine/threonine/tyrosine kinase 1 (STYK1) was upregulated in NSCLC and correlated with poor clinical outcomes. In addition, STYK1 suppressed FoxO1 functions, thereby promoting metastasis and EMT in NSCLC.
ABSTRACT
Huntingtin interacting protein 1 (HIP1) is overexpressed in several human malignancies. However, the biological function of HIP1 in esophageal squamous cell carcinoma (ESCC), and its effect on the prognosis of patients remain unclear. The present study aimed to investigate HIP1 expression in ESCC via immunohistochemistry, reverse transcription-quantitative PCR and western blot analyses. The association between HIP1 expression and the clinicopathological characteristics of 173 patients with ESCC was statistically analyzed. The effect of HIP1 expression on patient prognosis was assessed via Kaplan-Meier and Cox regression analyses. Lentivirus-delivered RNA interfering technique was used to overexpress and downregulate HIP1 expression in ESCC cell lines. The results demonstrated that HIP1 expression was significantly higher in ESCC tissues compared with adjacent normal tissues, and HIP1 expression was associated with histological differentiation, tumor-node-metastasis stage and lymph node metastasis. Furthermore, the overall survival time of patients with high HIP1 expression was significantly shorter than those with low HIP1 expression. Cellular mobility demonstrated that overexpressing HIP1 increased ESCC proliferation, migration and invasion, whereas silencing HIP1 decreased ESCC proliferation, migration and invasion. Furthermore, overexpressing HIP1 induced ESCC cells to enter the S and G2 phases from the G1 phase, whereas HIP1 knockdown arrested the cell cycle in the G1 phase. Taken together, the results of the present study suggest that HIP1 is associated with proliferation and metastatic behaviors in ESCC, and thus may be used as a potential prognostic indicator for patients with ESCC.
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BACKGROUND: Some non-small-cell lung cancer (NSCLC) patients are unexpectedly diagnosed with stage IIIA-N2 disease at the time of thoracoscopy or thoracotomy. Because of the limited statistical evidence of induction chemotherapy for these patients, it is necessary to develop more profound treatment strategies. METHODS: The demographic and clinical characteristics of patients with stage IIIA-N2 NSCLC harboring epidermal growth factor receptor (EGFR) mutations after radical resection were retrospectively reviewed. The patients were divided into 3 groups based on treatment: EGFR tyrosine kinase inhibitors (EGFR-TKIs, erlotinib or gefitinib), adjuvant chemotherapy (docetaxel plus cisplatin), and combination treatment (chemotherapy plus EGFR-TKIs). The effect of adjuvant therapy on survival rate was assessed using univariate and Cox regression analyses. RESULTS: Patients receiving EGFR-TKIs alone showed significantly improved disease-free survival (DFS; p = 0.025) when compared to those receiving chemotherapy alone. Compared to chemotherapy alone, the combination of chemotherapy and EGFR-TKIs resulted did not significantly improve DFS (p < 0.001) and overall survival (OS p < 0.001). The combination of EGFR-TKIs with chemotherapy as adjuvant therapy led to improvements in both DFS (p = 0.116) and OS (p = 0.039) compared to patients receiving a EGFR-TKI monotherapy. Toxicities were mild in the 3 treatment groups. CONCLUSIONS: Our study demonstrated that adjuvant EGFR-TKI treatment significantly increased the DFS of patients with stage IIIA-N2 NSCLC when compared with cisplatin-based chemotherapy. The use of EGFR-TKIs and chemotherapy is recommended in the setting of combined-modality therapy.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Non-Small-Cell Lung/drug therapy , ErbB Receptors/genetics , Lung Neoplasms/drug therapy , Protein Kinase Inhibitors/therapeutic use , Adult , Aged , Carcinoma, Non-Small-Cell Lung/genetics , Carcinoma, Non-Small-Cell Lung/mortality , Carcinoma, Non-Small-Cell Lung/surgery , Chemotherapy, Adjuvant , Cisplatin/therapeutic use , Combined Modality Therapy , Disease-Free Survival , Docetaxel/therapeutic use , Erlotinib Hydrochloride/therapeutic use , Female , Gefitinib/therapeutic use , Humans , Lung Neoplasms/genetics , Lung Neoplasms/mortality , Lung Neoplasms/surgery , Male , Middle Aged , Mutation , Neoplasm Staging , Pneumonectomy/methods , Receptor Protein-Tyrosine Kinases/antagonists & inhibitors , Retrospective Studies , Survival Rate , Treatment OutcomeABSTRACT
BACKGROUND: Thrombotic thrombocytopenic purpura (TTP) is associated with more deleterious outcomes in patients with systemic lupus erythematosus (SLE). However, ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) levels and ADAMTS13 inhibitor were not routinely assayed in most previous studies. The objective of this study is to compare the characteristics and outcomes of immune-mediated TTP (iTTP) in patients with and without SLE. METHODS: The medical data of 28 patients with iTTP from Peking Union Medical College Hospital were analysed. ADAMTS13 activity and ADAMTS13 inhibitor were measured in all patients. RESULTS: All 28 patients had ADAMTS13 inhibitor and severe ADAMTS13 deficiency. iTTP was considered SLE-related (SLE-TTP) in 10 patients and primary (primary iTTP) in 18 patients. Renal involvement on presentation was more severe in patients with primary iTTP as determined by higher serum creatinine (162.7 ± 110.6 vs 73.3 ± 13.4 µmol/L, p < 0.01) and more prevalent acute kidney injury (72.2% vs 10.0%, p < 0.01) than in patients with SLE-TTP. More patients with SLE-TTP were treated with steroid pulse therapy (90.0% vs 16.7%, p < 0.01) and intravenous immunoglobulin (IVIG) (50.0% vs 5.6%, p = 0.01) compared to patients with primary iTTP. After adjustments for age and treatment, including steroid pulse therapy and IVIG treatment, the likelihood of clinical remission of SLE-TTP was significantly increased compared to that of primary iTTP (HR 7.6 [1.2, 50.1], p = 0.03). Mortality was also lower among patients with SLE-TTP than among patients with primary iTTP (0 vs 38.9%, p = 0.03). CONCLUSIONS: Renal involvement was less severe in patients with SLE-TTP than in patients with primary iTTP. The treatment responses and outcomes of SLE-TTP were no worse and perhaps even better than those of primary iTTP. When TTP is diagnosed in SLE patients, the ADAMTS13 level and ADAMTS13 inhibitor profile should be considered in addition to clinical features.
Subject(s)
Lupus Erythematosus, Systemic , Purpura, Thrombotic Thrombocytopenic , ADAMTS13 Protein , Creatinine , Humans , Lupus Erythematosus, Systemic/drug therapy , Retrospective StudiesABSTRACT
China has the largest number of diabetics in the world and there is ineffective glycemic control among empty nest elderly. A multidisciplinary team were made up and patient interviews were performed for the designation of APP which was intended to conduct disease guidance and condition monitoring for empty nest elderly with type 2 diabetes to improve self-management and outcomes. The draft version was accomplished.