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Vesicular transport relies on multimeric trafficking complexes to capture cargo and drive vesicle budding and fusion. Faithful assembly of the trafficking complexes is essential to their functions but remains largely unexplored. Assembly of AP2 adaptor, a heterotetrameric protein complex regulating clathrin-mediated endocytosis, is assisted by the chaperone AAGAB. Here, we found that AAGAB initiates AP2 assembly by stabilizing its α and σ2 subunits, but the AAGAB:α:σ2 complex cannot recruit additional AP2 subunits. We identified CCDC32 as another chaperone regulating AP2 assembly. CCDC32 recognizes the AAGAB:α:σ2 complex, and its binding leads to the formation of an α:σ2:CCDC32 ternary complex. The α:σ2:CCDC32 complex serves as a template that sequentially recruits the µ2 and ß2 subunits of AP2 to complete AP2 assembly, accompanied by CCDC32 release. The AP2-regulating function of CCDC32 is disrupted by a disease-causing mutation. These findings demonstrate that AP2 is assembled by a handover mechanism switching from AAGAB-based initiation complexes to CCDC32-based template complexes. A similar mechanism may govern the assembly of other trafficking complexes exhibiting the same configuration as AP2.
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Complejo 2 de Proteína Adaptadora , Chaperonas Moleculares , Complejo 2 de Proteína Adaptadora/metabolismo , Complejo 2 de Proteína Adaptadora/genética , Humanos , Chaperonas Moleculares/metabolismo , Chaperonas Moleculares/genética , Unión Proteica , Endocitosis/fisiología , Transporte de ProteínasRESUMEN
Dysregulation of R-loop homeostasis is closely related to various human diseases, including cancer. However, the causality of aberrant R-loops in tumor progression remains unclear. In this study, using single-cell RNA-sequencing datasets from lung adenocarcinoma (LUAD), we constructed an R-loop scoring model to characterize the R-loop state according to the identified R-loop regulators related to EGFR mutations, tissue origins, and TNM stage. We then evaluated the relationships of the R-loop score with the tumor microenvironment (TME) and treatment response. Furthermore, the potential roles of FANCI-mediated R-loops in LUAD were explored using a series of in vitro experiments. Results showed that malignant cells with low R-loop scores displayed glycolysis and epithelial-mesenchymal transition pathway activation and immune escape promotion, thereby hampering the antitumor therapeutic effects. Cell communication analysis suggested that low R-loop scores contributed to T cell exhaustion. We subsequently validated the prognostic value of R-loop scores by using bulk transcriptome datasets across 33 tumor types. The R-loop scoring model well predicted patients' therapeutic response to targeted therapy, chemotherapy, or immunotherapy in 32 independent cohorts. Remarkably, changes in R-loop distribution mediated by FANCI deficiency blocked the activity of Ras signaling pathway, suppressing tumor-cell proliferation and dissemination. In conclusion, this study reveals the underlying molecular mechanism of metabolic reprogramming and T cell exhaustion under R-loop score patterns, and the changes in R-loops mediated by R-loop regulators resulting in tumor progression. Therefore, incorporating anticancer methods based on R-loop or R-loop regulators into the treatment schemes of precision medicine may be beneficial.
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Adenocarcinoma del Pulmón , Anemia de Fanconi , Neoplasias Pulmonares , Humanos , Estructuras R-Loop , Reprogramación Metabólica , Evasión Inmune , Adenocarcinoma del Pulmón/genética , Comunicación Celular , Análisis de la Célula Individual , Neoplasias Pulmonares/genética , Microambiente Tumoral/genéticaRESUMEN
BACKGROUND: Reirradiation in standard fractionation for locally advanced recurrent nasopharyngeal carcinoma after a previous course of high-dose radiotherapy is often associated with substantial late toxicity, negating its overall benefit. We therefore aimed to investigate the efficacy and safety of hyperfractionation compared with standard fractionation in intensity-modulated radiotherapy. METHODS: This multicentre, randomised, open-label, phase 3 trial was done in three centres in Guangzhou, China. Eligible patients were aged 18-65 years with histopathologically confirmed undifferentiated or differentiated, non-keratinising, advanced locally recurrent nasopharyngeal carcinoma. Participants were randomly assigned (1:1) to either receive hyperfractionation (65 Gy in 54 fractions, given twice daily with an interfractional time interval of at least 6 h) or standard fractionation (60 Gy in 27 fractions, given once a day). Intensity-modulated radiotherapy was used in both groups. A computer program generated the assignment sequence and randomisation was stratified by treatment centre, recurrent tumour stage (T2-T3 vs T4), and recurrent nodal stage (N0 vs N1-N2), determined at the time of randomisation. The two primary endpoints were the incidence of severe late complications defined as the incidence of grade 3 or worse late radiation-induced complications occurring 3 months after the completion of radiotherapy until the latest follow-up in the safety population, and overall survival defined as the time interval from randomisation to death due to any cause in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT02456506. FINDINGS: Between July 10, 2015, and Dec 23, 2019, 178 patients were screened for eligibility, 144 of whom were enrolled and randomly assigned to hyperfractionation or standard fractionation (n=72 in each group). 35 (24%) participants were women and 109 (76%) were men. After a median follow-up of 45·0 months (IQR 37·3-53·3), there was a significantly lower incidence of grade 3 or worse late radiation-induced toxicity in the hyperfractionation group (23 [34%] of 68 patients) versus the standard fractionation group (39 [57%] of 68 patients; between-group difference -23% [95% CI -39 to -7]; p=0·023). Patients in the hyperfractionation group had better 3-year overall survival than those in the standard fractionation group (74·6% [95% CI 64·4 to 84·8] vs 55·0% [43·4 to 66·6]; hazard ratio for death 0·54 [95% CI 0·33 to 0·88]; p=0·014). There were fewer grade 5 late complications in the hyperfractionation group (five [7%] nasal haemorrhage) than in the standard fractionation group (16 [24%], including two [3%] nasopharyngeal necrosis, 11 [16%] nasal haemorrhage, and three [4%] temporal lobe necrosis). INTERPRETATION: Hyperfractionated intensity-modulated radiotherapy could significantly decrease the rate of severe late complications and improve overall survival among patients with locally advanced recurrent nasopharyngeal carcinoma. Our findings suggest that hyperfractionated intensity-modulated radiotherapy could be used as the standard of care for these patients. FUNDING: Key-Area Research and Development of Guangdong Province, the National Natural Science Foundation of China, the Special Support Program for High-level Talents in Sun Yat-sen University Cancer Center, the Guangzhou Science and Technology Plan Project, and the National Ten Thousand Talents Program Science and Technology Innovation Leading Talents, Sun Yat-Sen University Clinical Research 5010 Program.
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Neoplasias Nasofaríngeas , Radioterapia de Intensidad Modulada , Masculino , Humanos , Femenino , Carcinoma Nasofaríngeo/radioterapia , Radioterapia de Intensidad Modulada/efectos adversos , Recurrencia Local de Neoplasia/radioterapia , Neoplasias Nasofaríngeas/radioterapia , HemorragiaRESUMEN
BACKGROUND: Adenosine monophosphate-activated protein kinase (AMPK) is associated with the development of liver hepatocellular carcinoma (LIHC). AMPKα2, an α2 subunit of AMPK, is encoded by PRKAA2, and functions as the catalytic core of AMPK. However, the role of AMPKα2 in the LIHC tumor immune environment is unclear. METHODS: RNA-seq data were obtained from the Cancer Genome Atlas and Genotype-Tissue Expression databases. Using the single-cell RNA-sequencing dataset for LIHC obtained from the China National Genebank Database, the communication between malignant cells and T cells in response to different PRKAA2 expression patterns was evaluated. In addition, the association between PRKAA2 expression and T-cell evolution during tumor progression was explored using Pseudotime analysis, and the role of PRKAA2 in metabolic reprogramming was explored using the R "scMetabolis" package. Functional experiments were performed in LIHC HepG2 cells. RESULTS: AMPK subunits were expressed in tissue-specific and substrate-specific patterns. PRKAA2 was highly expressed in LIHC tissues and was associated with poor patient prognosis. Tumors with high PRKAA2 expression displayed an immune cold phenotype. High PRKAA2 expression significantly promoted LIHC immune escape. This result is supported by the following evidence: 1) the inhibition of major histocompatibility complex class I (MHC-I) expression through the regulation of interferon-gamma activity in malignant cells; 2) the promotion of CD8+ T-cell exhaustion and the formation of CD4+ Treg cells in T cells; 3) altered interactions between malignant cells and T cells in the tumor immune environment; and 4) induction of metabolic reprogramming in malignant cells. CONCLUSIONS: Our study indicate that PRKAA2 may contribute to LIHC progression by promoting metabolic reprogramming and tumor immune escape through theoretical analysis, which offers a theoretical foundation for developing PRKAA2-based strategies for personalized LIHC treatment.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Proteínas Quinasas Activadas por AMP , Carcinoma Hepatocelular/genética , Linfocitos T CD4-Positivos , Linfocitos T CD8-positivos , Neoplasias Hepáticas/genética , Agotamiento de Células T , Linfocitos T Reguladores , Escape del TumorRESUMEN
BACKGROUND: The current pandemic and future public health emergencies highlight the importance of evaluating a telehealth care model. Previous studies have reached mixed conclusions about the effectiveness of remote monitoring on glycemic control and maternal and infant outcomes in women with gestational diabetes mellitus (GDM). OBJECTIVES: This meta-analysis aimed to evaluate the effectiveness of remote blood glucose monitoring for women with gestational diabetes mellitus and to provide evidence-based guidance on the management of women with gestational diabetes mellitus for policymakers and healthcare providers during situations such as pandemics or natural disasters. METHODS: The Cochrane Library, PubMed, Web of Science, EBSCO, Embase, Medline, CINAHL databases, and ClinicalTrials.gov were systematically searched from their inception to July 10, 2021. Randomized controlled trials (RCTs) published in English with respect to remote blood glucose monitoring in women with GDM were included in the meta-analysis. Two independent reviewers performed data extraction and assessed the quality of the studies. Risk ratios, mean differences, 95% confidence intervals, and heterogeneity were calculated. RESULTS: A total of 1265 participants were included in the 11 RCTs. There were no significant differences in glycemic control and maternal-fetal outcomes between the remote monitoring group and a standard care group, which included glycosylated hemoglobin (HbA1c), fasting blood glucose, mean 2-h postprandial blood glucose, caesarean birth, gestational weight gain, shoulder dystocia, neonatal hypoglycemia, and other outcomes. CONCLUSION: This meta-analysis reveals that it is unclear if remote glucose monitoring is preferable to standard of care glucose monitoring. To improve glycemic control and maternal-fetal outcomes during the current epidemic or other natural disasters, the implementation of double-blind RCTs in the context of simulating similar disasters remains to be studied in the future.
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Diabetes Gestacional , Telemedicina , Embarazo , Recién Nacido , Lactante , Femenino , Humanos , Diabetes Gestacional/terapia , Glucemia/análisis , Control Glucémico , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
PURPOSE: To analyze the ultrasound characteristics, clinical management, and pregnancy outcomes of heterotopic intramural pregnancies (HIMPs) after embryo transfer. METHODS: This was a retrospective observational study of women who were diagnosed with HIMPs. The ultrasound characteristics, clinical treatment, and pregnancy outcomes of patients with HIMPs were evaluated. RESULTS: Eight women with HIMPs were included. Among them, 6 patients were diagnosed by transvaginal sonography, and 2 patients were misdiagnosed with heterotopic interstitial pregnancy. The diagnostic accuracy was 75% (6/8). Five patients with HIMPs were diagnosed at the time of the initial scan (5+6-6+3 weeks). An intramural gestational sac was observed in all 6 patients, and an embryo with cardiac activity was detected in one patient on the follow-up scans. Intrauterine pregnancies (IUPs) were revealed in all 6 patients, and embryo(s) with cardiac activity were observed in 5 patients at the time of the initial diagnosis or later. The patients receiving expectant treatment all presented with bagel signs, while patients with embryos with cardiac activity all underwent surgery. Among the 6 diagnosed women, 1 patient was initially treated medically, 4 were treated expectantly, and 1 was treated surgically. Among the 6 diagnosed patients, the IUPs of 5 patients resulted in live infants. CONCLUSION: Single ET should be recommended to decrease the possibility of HIMP. An accurate diagnosis of HIMP was reached in most cases by detailed ultrasound early in the first trimester. Most IUPs of HIMPs seem to have good outcomes with timely and proper management. Expectant management might be a possible choice for nonviable intramural pregnancies.
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Fear of childbirth not only brings negative psychological experiences to expectant fathers and affect their ability to prepare for parenthood but can even affect children's emotional and cognitive development. It is essential to identify men with a more severe fear of birth and its related risk factors for the better transition of fathers' role. The objective of this study was to investigate the prevalence of fear of childbirth among Chinese expectant fathers, identify its contributing factors and explore the association among fear of childbirth, resilience and dyadic coping. A cross-sectional survey was conducted in the obstetric department of two tertiary hospitals in Wuhan, China. The socio-demographic questionnaire, the father's version of the Wijma Delivery Expectancy/Experience Questionnaire version A (W-DEQ A), the Connor-Davidson Resilience Scale-10 (CD-RISC), and the Dyadic Coping Inventory (DCI) were used to explore the correlation of fear of childbirth, resilience and dyadic coping of participants. Ultimately, a total of 1176 expectant fathers were included in this study. The prevalence of fear of childbirth was 32.1%. Gestational weeks of pregnant women, monthly income, adverse birth experience, gravidity and parity of pregnant women were considered risk factors for the expectant fathers with fear of childbirth. Furthermore, there was a weak negative correlation between fear of childbirth and resilience and dyadic coping. In conclusion, the prevalence of fear of childbirth in expectant fathers in China was high. Adequate identification of factors influencing the fear of childbirth among expectant fathers is necessary to reduce the fear of childbirth and to develop appropriate interventions in preparing fathers for their new parenting role.
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Adaptación Psicológica , Padre , Miedo , Parto , Humanos , China , Padre/psicología , Padre/estadística & datos numéricos , Estudios Transversales , Adulto , Miedo/psicología , Masculino , Parto/psicología , Femenino , Embarazo , Resiliencia Psicológica , Prevalencia , Adulto Joven , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
BACKGROUND: Birth weight has been linked with various health outcomes. The association between birth weight and cerebral aneurysm remains unknown. METHODS: The two-sample Mendelian randomization (MR) approach was used to evaluate the causal effect of birth weight on cerebral aneurysm based on genome-wide association studies (GWAS), comprising 261,932 UKB participants for birth weight and 204,060 FinnGen participants for cerebral aneurysm. The inverse variance weighted (IVW) method was used as the primary method. Alternative methods were used for comparison. Sensitivity analysis was conducted to evaluate the robustness of the results. Multivariable MR (MVMR) was further conducted to evaluate the direct effect of the birth weight on cerebral aneurysm. RESULTS: The IVW detected a causal association between higher birth weight and increased risk of cerebral aneurysm (ORâ¯=â¯0.521, 95% CIâ¯=â¯0.356 â¼ 0.763, Pâ¯=â¯7.88â¯×â¯10-4), which was supported by alternative MR models. Sensitivity analysis did not find any evidence of heterogeneity or pleiotropy. MVMR further identified a direct effect of birth weight on cerebral aneurysm, independent of obesity-related traits or smoking. CONCLUSION: This MR study found evidence of the association between birth weight and cerebral aneurysm, providing novel insight into the etiology of cerebral aneurysm, indicating the promising role of birth weight as a marker for screening populations at higher risk of cerebral aneurysm.
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Anterior gradient-2 (AGR2) is crucial to breast cancer progression. However, its role in the tumor immune microenvironment remains unclear. RNA sequencing expression profiles and associated clinical information were downloaded from The Cancer Genome Atlas and Gene Expression Omnibus databases, respectively. The AGR2 expression patterns were verified using clinical samples of breast cancer. Based on single-cell transcriptomic data, AGR2 expression patterns were identified and cell communication analysis was carried out. Furthermore, the roles of AGR2 in breast tumor progression were explored by a series of functional experiments. We found that DNA methylation was an important mechanism for regulating the expression patterns of AGR2. Patients with AGR2 low expression displayed an immune "hot" and immunosuppressive phenotype characterized by high abundance of tumor immune cell infiltration and increased enrichment scores for transforming growth factor-ß (TGF-ß) and epithelial-mesenchymal transition pathways, whereas patients with AGR2 high expression showed an opposite immunologic feature with a lack of immune cell infiltration, suggestive of an immune "cold" and desert phenotype. Moreover, single-cell analysis further revealed that AGR2 in malignant cells alters cell-cell interactions by coordinating cytokine-chemokine signaling and immune infiltration. Notably, two immunotherapy cohorts revealed that AGR2-coexpressed genes could serve as prognostic indicators of patient survival. In conclusion, AGR2 could promote breast cancer progression by affecting the tumor immune microenvironment. Patients with AGR2 low expression could be suitable for combination treatment with immune checkpoint inhibitor agents and TGF-ß blockers. Therefore, this study provides a theoretical foundation for developing a strategy for personalized immunotherapy to patients with breast cancer.
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Neoplasias , Proteínas Oncogénicas , Proteínas Oncogénicas/genética , Mucoproteínas/genética , Citocinas , Comunicación Celular , Quimiocinas , Factor de Crecimiento Transformador beta/farmacología , Microambiente TumoralRESUMEN
OBJECTIVES: What is the role of transvaginal sonography (TVS) in the early diagnosis of hectopic interstitial pregnancy (HIP) after in vitro fertilization-embryo transfer (IVF-ET)? METHODS: A retrospective observational study was conducted from January 2005 to December 2018. Routine two-dimensional and three-dimensional TVS were used to confirm clinical pregnancy. Women were diagnosed with HIP when an intrauterine gestational sac was combined with an extrauterine chorionic sac, which was at least 1 cm away from the uterine cavity and surrounded by a thin myometrial layer (<5 mm). Surgery and pathology results were the gold standard for diagnosing interstitial pregnancy. Non-surgical patients were excluded from the study. The performance of TVS and the pregnancy outcomes of intrauterine pregnancies (IUPs) were evaluated. RESULTS: A total of 97,161 women underwent IVF treatment and TVS examinations in our hospital during this study. Of these, 194 patients were diagnosed with HIP, with an incidence of 0.2% (194/97,161). Surgical and pathological findings confirmed 179 interstitial pregnancies, of which 174 were diagnosed by TVS, 4 were missed, and 1 was misdiagnosed. The sensitivity of TVS diagnosis was 97.8% and the positive predictive value was 99.4%. The mean time to diagnosis was 31 days after transplantation. One hundred and thirty-nine cases of HIP (77.7%) were diagnosed at the time of initial TVS examination. In 132 patients (73.7%), IUPs resulted in live births. CONCLUSIONS: In our practice, most HIPs following IVF-ET can be accurately diagnosed by TVS, which facilitates early management of interstitial pregnancies and enables high live birth rates for IUPs.
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Embarazo Heterotópico , Embarazo Intersticial , Embarazo , Humanos , Femenino , Embarazo Intersticial/diagnóstico por imagen , Ultrasonografía Prenatal/métodos , Transferencia de Embrión , Diagnóstico Precoz , Estudios Retrospectivos , Fertilización In Vitro , Embarazo Heterotópico/diagnóstico por imagenRESUMEN
OBJECTIVES: To investigate the effectiveness of surgery for septate uterus in infertile patients before in vitro fertilization-embryo transfer (IVF-ET). METHODS: The data of 937 infertile patients with septate uterus and achieved singleton pregnancy after IVF-ET from January 2014 to December 2015 were retrospectively analyzed. Thousand five hundred seventy-eight infertile patients with a normal uterus who achieved singleton pregnancy during the same period were selected as the control group. Patients with septate uterus were divided into two groups according to whether the septum was resected. The pregnancy and perinatal outcomes of the surgical group and the nonsurgical group were compared with the control group. The secondary infertility patients who were surgically corrected septa were also chosen as self-controls and an analysis was performed on their fertility outcomes pre- and post-surgery. RESULTS: Compared with the control group, the surgical group had increased rates of early miscarriage, preterm delivery, and low birthweight and a significantly reduced live birth rate (P < .05). The outcomes of the nonsurgical and control groups were similar. Using secondary infertility patients who were surgically corrected septa as self-controls, after surgery, the rates of miscarriage and ectopic pregnancy were significantly lower and the live birth rate was significantly higher (P ≤ .001); however, perinatal mortality was not significantly different before and after surgery. CONCLUSIONS: Patients with a septum depth greater than 10 mm or 5-10 mm associated with a history of unexplained recurrent miscarriage, IVF failure, or infertility might benefit from resection of the uterine septum with hysteroscopic metroplasty.
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Aborto Espontáneo , Infertilidad Femenina , Infertilidad , Embarazo , Recién Nacido , Femenino , Humanos , Estudios Retrospectivos , Histeroscopía , Útero/cirugía , Transferencia de Embrión , Fertilización In Vitro , Infertilidad Femenina/cirugíaRESUMEN
BACKGROUND: Breastfeeding is recognized internationally as the most scientific and effective way to feed infants and young children. According to the World Health Organization in 2022, the exclusive breastfeeding rate within 6 months is 34.1% in China, which is still far from the goal of "more than 60% exclusive breastfeeding rate of infants within 6 months" by 2030 required by China's State Council. It is necessary to promote breastfeeding and provide maternal breastfeeding guidance to increase exclusive breastfeeding. Factors influencing breastfeeding can be explained by the society ecosystems theory, distributed in macro, mezzo and micro systems. The interventions focused on breastfeeding promotion are mainly carried out in the health systems and services, home and family environment, community environment, work environment, policy environment or a combination of these facilities. But there is sparse research on integrating resources in the macro, mezzo and micro systems of maternal breastfeeding processes to promote breastfeeding behavior. A randomized controlled trial will test the effect of a breastfeeding promotion intervention model based on the society ecosystems theory versus usual prenatal and postnatal care on maternal and infant health and the exclusive breastfeeding rate at 6 months. METHODS/DESIGN: The study is a single-blind, parallel design, randomized controlled trial with an intervention group (n = 109) and a control group (n = 109) that compares the effect of a breastfeeding promotion intervention model based on the society ecosystems theory with usual prenatal and postnatal care. The intervention covers macro- (policy, culture), mezzo- (family-hospital-community) and micro- (biological, psychological and social) systems of the maternal breastfeeding process. Infant feeding patterns, neonatal morbidity and physical and mental health of antenatal and postpartum women will be collected at baseline (28 to 35 weeks of gestation), 1-, 4-, and 6-month postpartum. DISCUSSION: This is a multifaceted, multifactorial, and multi-environmental breastfeeding promotion strategy to help mothers and their families learn breastfeeding knowledge and skills. The study provides a new modality for adding breastfeeding interventions to prenatal and postnatal care for healthcare providers in the hospital and the community. TRIAL REGISTRATION: Chinese Clinical Trial Registry at www.chictr.org.cn , ChiCTR2300075795.
Maternal education and support during breastfeeding can increase maternal breastfeeding self-efficacy, promote breastfeeding behaviors, and improve maternal and infant health outcomes. The interventions focused on breastfeeding promotion are mainly carried out in the health systems and services, home and family environment, community environment, work environment, policy environment or a combination of any of these facilities. But there is sparse research on integrating in multifaceted, multifactorial, and multi-environmental resources of maternal breastfeeding processes to help pregnant women and their families learn breastfeeding knowledge and skills. The current study optimizes the existing breastfeeding promotion intervention program and construct a breastfeeding promotion intervention program to correct the public's perception of breastfeeding, increase breastfeeding self-efficacy and improve breastfeeding behavior, thus increasing the breastfeeding duration and improving maternal and infant outcomes. The program includes presenting breastfeeding-related policies and support facilities; prenatal educational sessions combined with theories and skills on breastfeeding, development of lactation, infants feeding and cares for maternal families; postnatal hands-on instruction and WeChat group peer support from hospital; home visits, group counseling and experience sharing from community and one-on-one personalized counseling throughout the intervention. The present study will be conducted to evaluate the effect of breastfeeding promotion intervention including prenatal and postnatal care on the breastfeeding duration, breastfeeding attitudes, knowledge, and self-efficacy, maternal and infant health.
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Lactancia Materna , Promoción de la Salud , Lactante , Recién Nacido , Niño , Femenino , Embarazo , Humanos , Preescolar , Lactancia Materna/psicología , Promoción de la Salud/métodos , Ecosistema , Método Simple Ciego , Madres/psicología , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
AIM: To estimate the incidence and identify risk factors of postpartum hemorrhage (PPH) after vaginal delivery. METHODS: A systematic review and meta-analysis was conducted. PubMed, Cochrane Library, CINAHL, Web of Science, EMBASE, and ClinicalTrials.gov databases were systematically searched from inception to April 30th, 2022. Cross-sectional, cohort, case-control, and secondary analysis of randomized controlled studies that reported the incidence of PPH and the related risk factors in vaginal delivery were eligible through screening of 2343 articles. The incidence, associated standard error, adjusted odds ratios, relative risks and associated 95% confidence intervals were combined in the meta-analysis. RESULTS: Thirty-six articles were included in the descriptive review. The incidence of PPH (blood loss ≥500 mL and blood loss ≥1000 mL) was 17% and 6%, respectively. Forty-one identified risk factors were divided into five categories under two criteria: history and demographics; maternal comorbidity; pregnancy-related factors; labor-related factors; delivery-related factors. CONCLUSIONS: With the increasing incidence of PPH globally, obstetric health care providers need to improve their awareness of these multi-factorial risks to optimize obstetric care and reduce maternal morbidity. This systematic review and meta-analysis have raised important questions about the nature of vaginal delivery, such as the duration of prolonged labor, details on the use of oxytocin, and the presence of genital tract trauma. There should be highlighted by obstetric personnel on these factors during a patients' labor process.
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Oxitócicos , Hemorragia Posparto , Embarazo , Femenino , Humanos , Hemorragia Posparto/epidemiología , Hemorragia Posparto/etiología , Incidencia , Estudios Transversales , Parto Obstétrico/efectos adversos , Oxitocina/efectos adversos , Factores de RiesgoRESUMEN
PURPOSE: To demonstrate morphological alteration of the sulci and gyri on the convex surface in normal fetuses using innovative three-dimensional inversion and Crystalvue and Realisticvue (3D-ICRV) rendering technology. MATERIALS AND METHODS: 3D fetal brain volumes were collected from low-risk singleton pregnancies between 15+0 and 35+6 gestational weeks. Volumes were acquired from the transthalamic axial plane by transabdominal ultrasonography and were then post-processed with Crystalvue, Realisticvue rendering software and inversion mode. Volume quality was assessed. The anatomic definition of the sulci and gyri was determined according to location and orientation. The morphology alteration and sulcus display rates were recorded in sequential order of gestational weeks. Follow-up data were collected in all cases. RESULTS: 294 of 300 fetuses (294 brain volumes) (98%) with qualified fetal brain volumes were included (n=294, median 27 gestational weeks). 6 fetuses with unsatisfactory 3D-ICRV image quality were excluded. The morphology of the sulci and gyri on the brain convex surface could be demonstrated clearly on 3D-ICRV images. The Sylvian fissure was the first structure to be recognized. From 25 to 30 weeks, other sulci and gyri became visible. An ascending trend in the display rate of the sulci was found in this period. Follow-up showed no detectable anomalies. CONCLUSION: 3D-ICRV rendering technology is different from traditional 3D ultrasound. It can provide vivid and intuitive prenatal visualization of the sulci and gyri on the brain surface. Moreover, it may offer new ideas for neurodevelopment exploration.
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Corteza Cerebral , Ultrasonografía Prenatal , Femenino , Embarazo , Humanos , Ultrasonografía Prenatal/métodos , Edad Gestacional , Ultrasonografía , Corteza Cerebral/diagnóstico por imagen , Feto/diagnóstico por imagenRESUMEN
BACKGROUND: Health professionals, including nurses, experienced heavy workloads and significant physical and mental health challenges during the coronavirus disease (COVID) 19 pandemic, which may affect career choices for those considering nursing and for nursing students. The COVID-19 pandemic is not only a period of risk, but also an occasion to redeploy the professional identity (PI) of nursing students. However, the relationship between perceived social support (PSS), self-efficacy (SE), PI and anxiety remains unclear under the background of COVID-19. This study aims to explore whether PSS has an indirect effect on PI through mediation of SE and whether the anxiety can moderate the relationship between PSS and SE in nursing students during their internship period. METHODS: An observational, national cross-sectional study was conducted following the STROBE guidelines. An online questionnaire was completed by 2,457 nursing students from 24 provinces in China during their internship during September to October 2021. Measures included Chinese translations of the Professional Identity Questionnaire for Nursing Students, the Perceived Social Support Scale, the General Self-Efficacy Scale, the 7-item Generalized Anxiety disorder scale. RESULTS: Both PSS (r = 0.46, p < 0.001) and SE (r = 0.51, p < 0.001) were positively correlated with PI. The indirect effect of PSS on PI through SE was positive (ß = 0.348, p < 0.001), with an effect of 72.7%. The results of the moderating effect analysis showed that anxiety attenuated the effect of PSS on SE. Moderation models indicated that anxiety has a weak negative moderating effect on the effect of PSS on SE (ß =-0.0308, p < 0.05). CONCLUSIONS: A better PSS and higher scores in SE were associated with PI in nursing students, and a better PSS had an indirect effect on the PI of nursing students through SE. Anxiety played a negative moderating role in the relationship between PSS and SE.
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COVID-19 , Estudiantes de Enfermería , Humanos , COVID-19/epidemiología , Pandemias , Estudiantes de Enfermería/psicología , Autoeficacia , Estudios Transversales , Ansiedad/epidemiología , Apoyo SocialRESUMEN
BACKGROUND: Perinatal depression can result in short- and long-term adverse effects for women and their children if untreated. Psychological interventions, the preferred treatment for most women with perinatal depression, can also be provided online. AIMS: This study aimed to provide a comprehensive and systematic review of Internet-based psychological interventions and to evaluate their effectiveness in the treatment of perinatal depression. DESIGN: Systematic review and meta-analysis. METHODS: A systematic literature search was conducted of six databases, including CINAHL, PubMed, Embase, Web of Science, the Cochrane Library and PsycINFO. Depression and anxiety, which were the primary and secondary results of this search, were presented as standardised mean differences (SMD) and 95% confidence intervals (CIs). This review was conducted according to the PRISMA checklist. RESULTS: Thirteen studies involving 2158 perinatal women were included. Content, method, duration and frequency of Internet-based psychological interventions were varied. Participants indicated a high rate of satisfaction with these interventions; participants' dropout rates ranged from 2.6% to 60.8%. Meta-analysis demonstrated that Internet-based psychological interventions improved perinatal depression (SMD = -0.72, CI = [-1.02, -0.42], p < .01) and anxiety symptoms (SMD = -0.52, CI = [-0.73, -0.30], p < .01), with heterogeneity of 86% and 59%, respectively. CONCLUSIONS: Internet-based psychological interventions are considered as convenient and effective alternative treatment for perinatal depression and anxiety. In the future, additional studies are needed to investigate the long-term effects of these interventions on the mental health of perinatal women and the effects on the growth and development of infants while controlling for the dropout rate. RELEVANCE TO CLINICAL PRACTICE: Internet-based psychological interventions are innovative approaches to improving perinatal depressive symptoms that can leverage mental health resources and improve accessibility while promoting multidisciplinary integration. The approach, content, frequency and duration of intervention should be considered comprehensively to achieve the objectives of the intervention while maintaining compliance of women with perinatal depression.
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Terapia Cognitivo-Conductual , Niño , Femenino , Humanos , Terapia Cognitivo-Conductual/métodos , Depresión/terapia , Depresión/diagnóstico , Intervención Psicosocial , Ansiedad/terapia , Ansiedad/diagnóstico , InternetRESUMEN
AIMS AND OBJECTIVES: To systematically evaluate the effectiveness of psychological interventions for women with breast cancer on sexual function, sexual satisfaction, sexual relationships, sexual distress and sexual quality of life. BACKGROUND: Sexual dysfunction is common in women with breast cancer and seriously affects their quality of life and marital harmony. Several studies have explored the effects of psychological interventions related to sexual function of women with breast cancer, but results were inconclusive. DESIGN: A systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. METHOD: A search of PubMed, EMBASE, PsycINFO, Web of Science, the Cochrane Library, Scopus, CINAHL, ProQuest Dissertations and Theses Global, ClinicalTrials.gov. and Open Grey was conducted from inception to 9 May 2021. Two reviewers independently screened studies, extracted data and conducted a quality appraisal of included studies using the Joanna Briggs Institute critical appraisal checklists. RESULTS: Fifteen studies involving 1307 participants were included. The current study showed that psychological interventions made statistically significant improvements in sexual function (SMD = 0.82; 95% CI = [0.43, 1.20]; p < .001), sexual satisfaction (SMD = 0.95; 95% CI = [0.19, 1.72]; p = .01), sexual relationships (SMD = 0.37; 95% CI = [0.15, 0.60]; p = .001) and sexual distress (MD = -5.05; 95% CI = [-7.88, -2.22]; p = .0005) of women with breast cancer. A subgroup analysis regarding the types of psychological interventions indicated that cognitive behavioural therapy and psychoeducational therapy were beneficial to sexual function and satisfaction, and psychosexual counselling could also improve sexual function. CONCLUSION: Psychological interventions, especially psychoeducational therapy and cognitive behavioural therapy, are effective for improving the sexual health of women with breast cancer. RELEVANCE TO CLINICAL PRACTICE: This current study provides evidence for the application of psychosexual interventions in women with breast cancer. REGISTRATION: The study has been registered on the PROSPERO on 6 June 2021, with the registration number CRD42021253493.
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Neoplasias de la Mama , Humanos , Femenino , Neoplasias de la Mama/terapia , Neoplasias de la Mama/psicología , Calidad de Vida/psicología , Intervención Psicosocial , Psicoterapia/métodos , Satisfacción PersonalRESUMEN
Four types of A-related RNA modification regulators interact with each other and even the crosstalk between the regulators could characterize the tumor immune microenvironment infiltration patterns, chemosensitivity, and cancer prognosis in patients with pan-cancer.
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Adenosina , Neoplasias , Humanos , Neoplasias/patología , Pronóstico , ARN/genética , Microambiente Tumoral/genéticaRESUMEN
IgA nephropathy (IgAN) is characterized by deposition of galactose-deficient IgA1 (Gd-IgA1) in glomerular mesangium associated with mucosal immune disorders. Since environmental pollution has been associated with the progression of chronic kidney disease in the general population, we specifically investigated the influence of exposure to fine particulate matter less than 2.5 µm in diameter (PM2.5) on IgAN progression. Patients with biopsy-proven primary IgAN were recruited from seven Chinese kidney centers. PM2.5 exposure from 1998 to 2016 was derived from satellite aerosol optical depth data and a total of 1,979 patients with IgAN, including 994 males were enrolled. The PM2.5 exposure levels for patients from different provinces varied but, in general, the PM2.5 exposure levels among patients from the north were higher than those among patients from the south. The severity of PM2.5 exposure in different regions was correlated with regional kidney failure burden. In addition, each 10 µg/m3 increase in annual average concentration of PM2.5 exposure before study entry (Hazard Ratio, 1.14; 95% confidence interval, 1.06-1.22) or time-varying PM2.5 exposure after study entry (1.10; 1.01-1.18) were associated with increased kidney failure risk after adjustment for age, gender, estimated glomerular filtration rate, urine protein, uric acid, hemoglobin, mean arterial pressure, Oxford classification, glucocorticoid and renin-angiotensin system blocker therapy. The associations were robust when the time period, risk factors of cardiovascular diseases or city size were further adjusted on the basis of the above model. Thus, our results suggest that PM2.5 is an independent risk factor for kidney failure in patients with IgAN, but these findings will require validation in more diverse populations and other geographic regions.
Asunto(s)
Contaminación del Aire , Glomerulonefritis por IGA , Insuficiencia Renal , Masculino , Humanos , Glomerulonefritis por IGA/epidemiología , Material Particulado/efectos adversos , Inmunoglobulina A , Contaminación del Aire/efectos adversosRESUMEN
BACKGROUND: Prenatal anxiety is a common concern which may have adverse effects on maternal and infant health outcomes. Studies addressing needs-based education interventions for prenatal anxiety are limited. AIM: To explore the effects of needs-based education on alleviating prenatal anxiety among advanced multiparas when compared with routine prenatal health education. METHODS: A total of 86 advanced multiparas were randomized into the intervention group (n = 43) or the control group (n = 43) in this study. The control group received routine prenatal care. The intervention group received five needs-based education programs presented by trained researchers. The Pregnancy-related Anxiety Questionnaire was used to evaluate changes in anxiety level of participants. Concurrent physiological parameters, including blood pressure, heart rate and non-stress test were also measured. RESULTS: Scores on the Pregnancy-related Anxiety Questionnaire of the intervention group were significantly lower than those of the control group (t = 4.21, P < 0.05). Systolic blood pressure (t = 3.64, P < 0.05) and heart rate (t = 2.39, P < 0.05) of the intervention group were also significantly lower than the control group whereas no differences were noted in diastolic blood pressure and non-stress test. CONCLUSION: A needs-based education program is an effective intervention strategy to allay prenatal anxiety in advanced multiparas. TRIAL REGISTRATION: The trial was retrospectively registered in the Chinese Clinical Trial Registry as number ChiCTR2100047552 .