Pre-hospital symptom clusters and symptom network analysis in decompensated cirrhotic patients: A cross-sectional study.

AIMS: To generate pre-hospital symptom networks, explore core, bridge and sentinel symptoms, identify pre-hospital symptom clusters and analyse relationship between influencing factors and symptom clusters in decompensated cirrhosis patients. DESIGN: A cross-sectional study design using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. METHODS: Demographical, physiological, psychological and sociological characteristics and the pre-hospital symptoms of 292 decompensated cirrhotic patients were collected from October 2021 to March 2023 in China. Frequencies, percentages, means, standard deviations, independent samples t-tests, one-way analysis of variance, exploratory factor analysis, multiple stepwise regression analysis and network analysis were used for data analysis. RESULTS: 'I don't look like myself' and itching were core and bridge symptoms, while bloating and lack of energy were sentinel symptoms in decompensated cirrhotic patients. Monthly family income, anxiety, depression, social support and disease duration influenced the neuropsychological symptom cluster, with worrying as the strongest predictor symptom. Influential factors for cirrhosis-specific symptom cluster included Child-Pugh class, monthly family income, disease duration, anxiety and depression, with itching being the strongest predictor symptom. Monthly family income, disease duration and depression were influential factors for gastrointestinal symptom cluster, with loss of appetite as the strongest predictor symptom. CONCLUSIONS: Neuropsychological, cirrhosis-specific and gastrointestinal symptom clusters were formed in decompensated cirrhotic patients. Through network analysis, direct connections between symptoms, symptom clusters and their influencing factors were revealed, thereby offering clinicians a foundation for effectively managing patients' pre-hospital symptoms. IMPACT: Decompensated cirrhosis patients commonly have multiple symptoms, while the management of pre-hospital symptoms is often suboptimal. This study identified neuropsychological, cirrhosis-specific, gastrointestinal symptom clusters and recognized core, bridge and sentinel symptoms in these patients. It also revealed the most prominent symptoms within each cluster. This provides insight into the hierarchy of symptoms, improving symptom management in decompensated cirrhosis. PATIENT AND PUBLIC INVOLVEMENT: There was no patient or public involvement.

Effects of BOPPPS combined with TBL in surgical nursing for nursing undergraduates: a mixed-method study.

BACKGROUND: Surgical Nursing is a core subject for nursing undergraduates that requires active and effective learning strategies to cultivate students' autonomous learning competencies and critical thinking. The effects of BOPPPS (Bridge-in, Objectives, Pretest, Participatory Learning, Post-test and Summary) model combined with team-based learning (TBL) have rarely been explored in Surgical Nursing courses. OBJECTIVE: To explore the effects of BOPPPS combined with TBL in Surgical Nursing for nursing undergraduates. METHODS: A mixed research method of quasi-experimental study design and descriptive qualitative research was used. The control group included 27 nursing undergraduates who had finished the Surgical Nursing course using traditional learning. The experimental group included 36 nursing undergraduates were enrolled in to receive the Surgical Nursing course in the teaching mode of BOPPPS combined with TBL. The quantitative data of students' Surgical Nursing final scores, autonomous learning competencies and critical thinking ability of the two groups were collected and compared by t-test. Qualitative results were obtained through semi-structured interviews and data were analyzed by thematic analysis method. RESULTS: Compared with the traditional learning mode, BOPPPS combined with TBL significantly improved nursing students' final examination scores, autonomous learning competencies and critical thinking ability (p < 0.05). Qualitative results from 14 undergraduate nursing students' interviews were summarized into five themes: (1) stimulating learning interest; (2) improving autonomous learning ability; (3) improving the sense of teamwork; (4) exercising critical thinking; and (5) suggestions for improvement. CONCLUSIONS: The combination of BOPPPS and TBL positively impacted nursing students by improving their autonomous learning competencies and critical thinking ability. The study suggests BOPPPS combined with TBL learning as an effective, alternative learning mode.

Association between BRAF expression in circulating tumor cells and the clinical feature of patients with multiple myeloma.

Multiple myeloma (MM) is the most common hematological malignancy with uncontrolled proliferation of monoclonal plasma cells. Despite treatment improvements, MM remains an incurable disease for most patients. Therefore, promising molecular markers are required for MM treatment decisions. In the present study, we explored the relationship between the BRAF expression in circulating tumor cells (CTCs) and the clinical features of patients with MM. The results showed that CTCs were associated with MM staging, and the expression of BRAF was associated with different CTCs. Moreover, the BRAF gene was correlated with patients' white blood cells, blood albumin levels, and Eastern Cooperative Oncology Group (ECOG) score. BRAF expression positively correlated with total CTCs, hybrid CTCs, and mesenchymal CTCs. Taken together, CTCs tightly correlated with the clinical stages and characteristics of MM. Our findings may provide a promising prognosis biomarker for MM treatment decisions.

Lipophagy in nonliver tissues and some related diseases: Pathogenic and therapeutic implications.

Lipid autophagy (lipophagy) is defined as a selective autophagy process in which some intracellular lipid droplets are selectively degraded by autophagic lysosomes pathway. The occurrence of lipophagy was first discovered in liver tissues. Additionally, abundant evidence indicated that the occurrence of hepatic lipophagy has been implicated in many liver diseases including fatty liver diseases, nonalcoholic fatty liver diseases, liver fibrosis, and liver cirrhosis. However, recent studies suggested that hepatic lipophagy occurs not only in liver tissue but also in other nonliver tissues and cells. Furthermore, the occurrence of lipophagy plays a crucial role in nonliver tissues and some related diseases. For instance, lipophagy relieves insulin resistance in adipose tissue from obesity patient with type 2 diabetes. Additionally, lipophagy has the ability to remit neurodegenerative diseases by reducing activity-dependent neurodegeneration in nervous tissue. Lipophagy decreases muscle lipid accumulation and accordingly improves lipid storage myopathy in muscle tissue. Moreover, lipophagy alleviates the malignancy and metastasis of cancer in clear renal cell carcinoma tissue. Lipophagy is also involved in other processes, such as spermatogenesis, osteoblastogenesis, and mucosal ulceration. In conclusion, targeting lipophagy may be a critical regulator and a new therapeutic strategy for nonliver tissues and some related diseases.

Prevention of Recurrent Bladder Tumors after Nephroureterectomy for Primary Upper Urinary Tract Urothelial Carcinoma: An Individualized Selection Strategy Based on Patient Risk Stratification Is Needed.

OBJECTIVE: To evaluate the efficacies of different chemotherapy regimens in different risk sub-groups for the prevention of bladder recurrence after radical nephroureterectomy (RNU). MATERIALS AND METHODS: Between 2004 and 2012, we recruited 685 patients who underwent RNU for upper tract urothelial carcinoma at 4 Chinese institutions. We assessed whether the type of intravesical chemotherapy regimen affected the bladder recurrence rate in patients with different risk levels after RNU. RESULTS: For all patients, the bladder recurrence rate was lower with intravesical chemotherapy than without, but no significant differences were found between the 2 intravesical chemotherapy regimens (single dose or relatively long-term therapy). We used multivariate analysis to define the risk factors for bladder recurrence and stratified patients into low-, intermediate-, and high-risk sub-groups accordingly. The bladder recurrence rate in the low-risk patients was not significantly different between patients with or without intravesical chemotherapy. However, in the intermediate-risk and high-risk patients, the rate was greater in patients without intravesical chemotherapy than in patients with. Furthermore, the rate was not significantly different between the 2 intravesical chemotherapy regimens in the intermediate-risk patients, while the efficacy of the relatively long-term regimen in high-risk patients remains unclear. CONCLUSIONS: Our study showed that an individualized strategy based on patient risk stratification is needed.

Correlation Between HIF1-A Expression and Airway Remodeling in COPD.

Background: Airway remodeling is a significant pathological characteristic of chronic obstructive pulmonary disease (COPD). In recent years, hypoxia-inducible factor 1-α (HIF-1α), a member of the hypoxia-inducible factor protein family, has gained attention. However, the potential correlation between HIF-1α and COPD airway remodeling remains unclear. Objective: This study explored the expression patterns of HIF-1α in patients with COPD and its association with airway remodelling. This investigation aims to furnish novel insights for the clinical identification of prospective therapeutic targets for ameliorating COPD-related airway remodelling. Patients and Methods: A total of 88 subjects were included, consisting of 28 controls and 60 COPD patients. Various staining methods were employed to observe the pathological changes in airway tissues. Immunohistochemistry was utilized to detect the expression of HIF-1α and MMP9 (matrix metalloproteinase 9) in airway tissues. Enzyme-linked immunosorbent assay (ELISA) was used to measure the concentration in serum of HIF-1α and MMP9. Computed tomography (CT) airway parameters were measured in all participants to assess airway remodeling. The relationship between serum HIF-1α and MMP9 concentrations and airway parameters was analyzed. Results: Staining of airway structures in COPD patients revealed significant pathological changes associated with airway remodelling, including mixed cilia and subepithelial fibrosis. The expression of HIF-1α and MMP9 was significantly higher in both human airway tissue and serum compared to controls. Chest CT scans exhibited typical imaging features of airway remodeling and increased airway parameters. Conclusion: The findings suggest a correlation between increased HIF-1α expression and COPD airway remodelling. This study provides novel evidence that HIF-1α may be a potential biomarker for airway remodelling in COPD patients.

Amorphous Fe substrate enhances nitrogen and phosphorus removal in sulfur autotrophic process.

The autotrophic denitrification of coupled sulfur and natural iron ore can remove nitrogen and phosphorus from wastewater with low C/N ratios. However, the low solubility of crystalline Fe limits its bioavailability and P absorption capacity. This study investigated the effects of amorphous Fe in drinking water treatment residue (DWTR) and crystalline Fe in red mud (RM) on nitrogen and phosphorus removal during sulfur autotrophic processes. Two types of S-Fe cross-linked filler particles with three-dimensional mesh structures were obtained by combining sulfur with the DWTR/RM using the hydrogel encapsulation method. Two fixed-bed reactors, sulfur-DWTR autotrophic denitrification (SDAD) and sulfur-RM autotrophic denitrification (SRAD), were constructed and stably operated for 236 d Under a 5-8-h hydraulic retention time, the average NO3--N, TN, and phosphate removal rates of SDAD and SRAD were 99.04 %, 96.29 %, 94.03 % (SDAD) and 97.33 %, 69.97 %, 82.26 % (SRAD), respectively. It is important to note that fermentative iron-reducing bacteria, specifically Clostridium_sensu_stricto_1, were present in SDAD at an abundance of 58.17 %, but were absent from SRAD. The presence of these bacteria facilitated the reduction of Fe (III) to Fe (II), which led to the complete denitrification of the S-Fe (II) co-electron donor to produce Fe (III), completing the iron cycle in the system. This study proposes an enhancement method for sulfur autotrophic denitrification using an amorphous Fe substrate, providing a new option for the efficient treatment of low-C/N wastewater.

Anti-inflammatory role of gold nanoparticles in the prevention and treatment of Alzheimer's disease.

Alzheimer's disease (AD) is a neurodegenerative disease that causes memory and cognitive dysfunction and reduces a person's decision-making and reasoning functions. AD is the leading cause of dementia in the elderly. Patients with AD have increased expression of pro-inflammatory cytokines in the nervous system, and the sustained inflammatory response impairs neuronal function. Meanwhile, long-term use of anti-inflammatory drugs can reduce the incidence of AD to some extent. This confirms that anti-neuroinflammation may be an effective treatment for AD. Gold nanoparticles (AuNPs) are an emerging nanomaterial with promising physicochemical properties, anti-inflammatory and antioxidant. AuNPs reduce neuroinflammation by inducing macrophage polarization toward the M2 phenotype, reducing pro-inflammatory cytokine expression, blocking leukocyte adhesion, and decreasing oxidative stress. Therefore, AuNPs are gradually attracting the interest of scholars and are used for treating inflammatory diseases and drug delivery. Herein, we explored the role and mechanism of AuNPs in treating neuroinflammation in AD. The use of AuNPs for treating AD is a topic worth exploring in the future, not only to help solve a global public health problem but also to provide a reference for treating other neuroinflammatory diseases.

Microanatomy of the metabolic associated fatty liver disease (MAFLD) by single-cell transcriptomics.

BACKGROUND: Metabolic-associated fatty liver disease (MAFLD) is a major cause of liver disease worldwide and comprises non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH). Due to the high prevalence and poor prognosis of NASH, it is critical to identify and treat patients at risk. However, the aetiology and mechanisms remain largely unknown, warranting further analysis. METHODS: We first identified differential genes in NASH by single-cell analysis of the GSE129516 dataset and conducted expression profiling data analysis of the GSE184019 dataset from the Gene Expression Omnibus (GEO) database. Then single-cell trajectory reconstruction and analysis, immune gene score, cellular communication, key gene screening, functional enrichment analysis, and immune microenvironment analysis were carried out. Finally, cell experiments were performed to verify the role of key genes in NASH. RESULTS: We conducted transcriptome profiling of 30,038 single cells, including hepatocytes and non-hepatocytes from normal and steatosis adult mouse livers. Comparative analysis of hepatocytes and non-hepatocytes revealed pronounced heterogeneity as non-hepatocytes acted as major cell-communication hubs. The results showed that Hspa1b, Tfrc, Hmox1 and Map4k4 could effectively distinguish NASH tissues from normal samples. The results of scRNA-seq and qPCR indicated that the expression levels of hub genes in NASH were significantly higher than in normal cells or tissues. Further immune infiltration analysis showed significant differences in M2 macrophage distribution between healthy and metabolic-associated fatty liver samples. CONCLUSIONS: Our results suggest that Hspa1b, Tfrc, Hmox1 and Map4k4 have huge prospects as diagnostic and prognostic biomarkers for NASH and may be potential therapeutic targets for NASH.

Research Hotspots and Global Trends of Transcranial Direct Current Stimulation in Stroke: A Bibliometric Analysis.

Purpose: Transcranial direct current stimulation has been widely used in the clinical treatment of stroke. The purpose of this study was to perform a bibliometric analysis of scientific literature in this field. Methods: Articles and reviews regarding transcranial direct current stimulation in stroke from January 01, 2004 to May 31, 2022 were identified from the Science Citation Index-Expanded of the Web of Science Core Collection database. CiteSpace 6.1.R2, Bibliometrix and the Bibliometric Online Analysis Platform were used to analyze data. Results: A total of 905 papers were obtained, with the highest number of publications coming from the USA. The institutions and authors with the most publications were Harvard Medical School and Fregni F respectively. Nitsche MA had the most co-citations, followed by Fregni F. Neurosciences was the most fruitful research area and Brain Stimulation had the highest H-index. The research topics could be divided into three sections: mechanisms of treatment, comparison of efficacy with transcranial magnetic stimulation, clinical application of post-stroke dysfunction. The field of "walking", "strength" and "virtual reality therapy" are the future research hotspots of transcranial direct current stimulation. Conclusion: The overall research showed a slow growth trend, and the outstanding contribution of the USA in this field cannot be ignored. Relevant researchers are suggested to focus on international collaboration and actively conduct high-quality randomized controlled clinical trials on research hotspots and frontiers in order to identify the optimal stimulation paradigm for clinical purposes.

Sandwich teaching improved students' critical thinking, self-learning ability, and course experience in the Community Nursing Course: A quasi-experimental study.

The youngest generation of students prefers a more active learning style. Sandwich teaching may suit their learning style by alternating between active individual learning and passive collective learning. Sandwich teaching has been rarely applied to the Community Nursing Course for nursing students, and its teaching effects on this course remain unclear. This study applied Sandwich teaching to the Community Nursing Course for Chinese nursing undergraduates and investigated its effects on students' critical thinking, self-learning ability, course experience, and academic performance. This is a quasi-experimental study with 72 Chinese nursing undergraduates. Students receiving traditional teaching were enrolled in the control group (n = 36), and those who received Sandwich teaching were recruited into the experimental group (n = 36). Both groups received the 12-week, 90-min Community Nursing Course. Our main outcome variable, including students' critical thinking, self-learning ability, and course experience, was assessed by specific questionnaire. The paired t-tests were applied to compare the differences of the same group in the pre-test and the post-test, and the independent-sample t-tests were used to compare the differences between the two groups. We observed that nursing students' critical thinking ability and self-learning ability were significantly improved after receiving Sandwich teaching. Students' course experience of Sandwich teaching was significantly better than that of traditional teaching. The final exam score in the experimental group was not significantly higher than that in the control group. These results suggest that Sandwich teaching in Community Nursing Course improved Chinese nursing undergraduates' critical thinking, self-learning ability, and course experience, but failed in improving academic performance.

Influence of Different Tool Electrode Materials on Electrochemical Discharge Machining Performances.

Electrochemical discharge machining (ECDM) is an emerging method for developing micro-channels in conductive or non-conductive materials. In order to machine the materials, it uses a combination of chemical and thermal energy. The tool electrode's arrangement is crucial for channeling these energies from the tool electrode to the work material. As a consequence, tool electrode optimization and analysis are crucial for efficiently utilizing energies during ECDM and ensuring machining accuracy. The main motive of this study is to experimentally investigate the influence of different electrode materials, namely titanium alloy (TC4), stainless steel (SS304), brass, and copper-tungsten (CuW) alloys (W70Cu30, W80Cu20, W90Cu10), on electrodes' electrical properties, and to select an appropriate electrode in the ECDM process. The material removal rate (MRR), electrode wear ratio (EWR), overcut (OC), and surface defects are the measurements considered. The electrical conductivity and thermal conductivity of electrodes have been identified as analytical issues for optimal machining efficiency. Moreover, electrical conductivity has been shown to influence the MRR, whereas thermal conductivity has a greater impact on the EWR, as characterized by TC4, SS304, brass, and W80Cu20 electrodes. After that, comparison experiments with three CuW electrodes (W70Cu30, W80Cu20, and W90Cu10) are carried out, with the W70Cu30 electrode appearing to be the best in terms of the ECDM process. After reviewing the research outcomes, it was determined that the W70Cu30 electrode fits best in the ECDM process, with a 70 µg/s MRR, 8.1% EWR, and 0.05 mm OC. Therefore, the W70Cu30 electrode is discovered to have the best operational efficiency and productivity with performance measures in ECDM out of the six electrodes.