Enhanced hepatotoxicity in zebrafish due to co-exposure of microplastics and sulfamethoxazole: Insights into ROS-mediated MAPK signaling pathway regulation.

The combined pollution of microplastics (MPs) and sulfamethoxazole (SMZ) often occurs in aquatic ecosystems, posing a serious threat to animal and human health. However, little is known about the liver damage caused by the single or co-exposure of MPs and SMZ, and its specific mechanisms are still poorly understood. In this study, we investigated the effects of co-exposure to 20 µm or 80 nm MPs and SMZ in both larval and adult zebrafish models. Firstly, we observed a significant decrease in the number of hepatocytes and the liver damage in larval zebrafish worsened following co-exposure to SMZ and MPs. Additionally, the number of macrophages and neutrophils decreased, while the expression of inflammatory cytokines and antioxidant enzyme activities increased after co-exposure in larval zebrafish. Transcriptome analysis revealed significant changes in gene expression in the co-exposed groups, particularly in processes related to oxidation-reduction, inflammatory response, and the MAPK signaling pathway in the liver of adult zebrafish. Co-exposure of SMZ and MPs also promoted hepatocyte apoptosis and inhibited proliferation levels, which was associated with the translocation of Nrf2 from the cytoplasm to the nucleus and an increase in protein levels of Nrf2 and NF-kB p65 in the adult zebrafish. Furthermore, our pharmacological experiments demonstrated that inhibiting ROS and blocking the MAPK signaling pathway partially rescued the liver injury induced by co-exposure both in larval and adult zebrafish. In conclusion, our findings suggest that co-exposure to SMZ and MPs induces hepatic dysfunction through the ROS-mediated MAPK signaling pathway in zebrafish. This information provides novel insights into the potential environmental risk of MPs and hazardous pollutants co-existence in aquatic ecosystems.

Readiness for hospital discharge and its association with post-discharge outcomes among oesophageal cancer patients after oesophagectomy: A prospective observational study.

AIM: To examine the level and influencing factors of discharge readiness among patients with oesophageal cancer following oesophagectomy and to explore its association with post-discharge outcomes (post-discharge coping difficulty and unplanned readmission). BACKGROUND: Oesophageal cancer is common and usually treated via oesophagectomy in China. The assessment of patient's discharge readiness gradually attracts attention as patients tend to be discharged more quickly. DESIGN: Prospective observational study. The STROBE statement was followed. METHODS: In total, 154 participants with oesophageal cancer after oesophagectomy were recruited in a tertiary cancer centre in Southern China from July 2019 to January 2020. The participants completed a demographic and disease-related questionnaire, the Quality of Discharge Teaching Scale and Readiness for Hospital Discharge Scale before discharge. Post-discharge outcomes were investigated on the 21st day (post-discharge coping difficulty) and 30th day (unplanned readmission) after discharge separately. Multiple linear regressions were used for statistical analysis. RESULTS: The mean scores of discharge readiness and quality of discharge teaching were (154.02 ± 31.58) and (138.20 ± 24.20) respectively. The quality of discharge teaching, self-care ability, dysphagia and primary caregiver mainly influenced patient's discharge readiness and explained 63.0% of the variance. The low discharge readiness could predict more risk of post-discharge coping difficulty (r = -0.729, p < 0.01) and unplanned readmission (t = -2.721, p < 0.01). CONCLUSIONS: Discharge readiness among patients with oesophageal cancer following oesophagectomy is influenced by various factors, especially the quality of discharge teaching. A high discharge readiness corresponds to good post-discharge outcomes. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Healthcare professionals should improve the discharge readiness by constructing high-quality discharge teaching, cultivating patients' self-care ability, mobilizing family participation and alleviating dysphagia to decrease adverse post-discharge outcomes among patients with oesophageal cancer. PATIENTS OR PUBLIC CONTRIBUTION: Patients with oesophageal cancer after oesophagectomy who met the inclusion criteria were recruited.

Prevalence of physical inactivity and its determinants among older adults living in nursing homes: A cross-sectional study based on COM-B model.

AIMS: To investigate the prevalence of physical inactivity in older adults living in nursing homes and explore the determinants of physical inactivity by using the Capability, Opportunity, Motivation-Behaviour model. DESIGN: A multisite, cross-sectional study was performed by convenience sampling and questionnaire survey. METHODS: A total of 390 nursing home residents were recruited from three nursing homes in Southern China from May 2022 to April 2023. The participants completed a self-designed general information questionnaire, Physical Activity Scale for the Elderly, Self-Efficacy for Exercise Scale, Exercise Benefits Scale, Patient Health Questionnaire-9 and the Short Physical Performance Battery test. Descriptive statistics, univariate analysis, Spearman correlation analysis, and ordinal logistic regression were applied for data analysis. RESULTS: The prevalence of physical inactivity among the nursing home residents reached 88.46%. Ordinal logistic regression results showed that exercise self-efficacy, perceived exercise benefits, physical function, availability of physical activity instruction, having depression, number of chronic diseases and living with spouse were the main influencing determinants of physical inactivity and explained 63.7% of the variance. CONCLUSIONS: Physical inactivity was considerable in nursing home residents in China and influenced by complex factors. Tailored measures should be designed and implemented based on these factors to enhance physical activity while considering the uniqueness of Chinese culture. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Healthcare professionals should enhance physical activity of residents by increasing benefits understanding, boosting self-efficacy, improving physical function, alleviating depression and integrating personalized physical activity guidance into routine care services. And more attention should be paid to the residents who had more chronic diseases or did not live with spouse. IMPACT: Physical inactivity is a significant problem in nursing home residents. Understanding physical inactivity and its determinants enables the development of tailored interventions to enhance their physical activity level. REPORTING METHOD: This study was reported conforming to the STROBE statement. PATIENTS OR PUBLIC CONTRIBUTION: Nursing home residents who met the inclusion criteria were recruited.

Effect of nonpharmacological interventions on nutrition status, complications and quality of life in head and neck cancer patients undergoing radiotherapy: A systematic review and meta-analysis.

PURPOSE: To evaluate the effect of nonpharmacological therapies on nutrition status, complications and quality of life in head and neck cancer patients and to provide a basis for clinical practice. METHODS: This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Ten databases were systematically searched for all available articles from construction to November 2023. Two researchers independently conducted literature screening, data extraction and quality evaluation. Cochrane Review Manager 5.3 was used for meta-analysis. RESULTS: Finally, 27 RCT studies including 2814 patients with head and neck cancer were included. Five categories of interventions were used: nutritional support, exercise, swallowing function training, psychological intervention and low-level laser therapy. Nonpharmacological interventions can improve body weight loss in patients with HNC at the end of treatment (MD: 1.66 kg; 95% CI: 0.80 to 2.51), and subgroup analysis showed that nutritional support, psychological intervention and low-level laser therapy were effective. Nonpharmacological interventions can also ameliorate decreases in BMI (MD: 0.71; 95% CI: 0.16 to 1.26) and reduce the incidence of malnutrition (RR: 0.76; 95% CI: 0.67 to 0.86), oral mucositis (RR: 0.54; 95% CI: 0.37 to 0.80) and gastrointestinal complications (RR: 0.61; 95% CI: 0.38 to 0.96) during radiotherapy; however, no significant differences were found in other complications and quality of life. CONCLUSION: Nonpharmacological interventions can improve the nutrition status of patients with head and neck cancer and reduce the incidence of severe oral mucositis and gastrointestinal complications during radiotherapy but have no significant impact on quality of life.

Cyhalofop-butyl exposure induces the severe hepatotoxicity and immunotoxicity in zebrafish embryos.

Cyhalofop-butyl (CyB) is a highly effective herbicide and is widely used for weed control in paddy fields. Because CyB is easily residual in the aquatic environment, its potential harm to aquatic organisms has attracted much attention and has not been fully understood. In this study, we systematically explored the hepatotoxic and immunotoxic effects of CyB exposure in zebrafish embryos. Firstly, CyB induced a decrease in the survival rate of zebrafish and led to a series of developmental abnormalities. Meanwhile, CyB can significantly reduce the size of zebrafish liver tissue and the number of hepatocytes in a dose-dependent manner. Secondly, the number of macrophages and neutrophils significantly decreased but the antioxidant enzyme activities such as CAT and MDA were greatly elevated upon CyB exposure. Thirdly, RNA-Seq analysis identified 1, 402 differentially expressed genes (DEGs) including 621 up-regulated and 781 down-regulated in zebrafish embryos after CyB exposure. KEGG and GO functional analysis revealed that the metabolic pathways of drug metabolism-cytochrome P450, biosynthesis of antibiotics, and metabolism of xenobiotics, along with oxidation-reduction process, high-density lipoprotein particle and cholesterol transport activity were significantly enriched after CyB exposure. Besides, hierarchical clustering analysis suggested that the genes involved in lipid metabolism, oxidative stress and innate immunity were largely activated in CyB-exposed zebrafish. Moreover, CyB induced zebrafish liver injury and increased hepatocyte apoptosis, which increased the protein expression levels of Bax, TLR4, NF-kB p65 and STAT3 in zebrafish. Finally, specific inhibition of TLR signaling pathway by TLR4 knock-down could significantly reduce the expression of inflammatory cytokines induced by CyB exposure. Taken together, these informations demonstrated that CyB could induce the hepatotoxicity and immunotoxicity in zebrafish embryos, and the expression levels of many genes involved in lipid metabolism and immune inflammation were obtained by RNA-Seq analysis. This study provides valuable information for future elucidating the aquatic toxicity of herbicide in aquatic ecosystems.

The mediating role of coping in the relationship between family function and resilience in adolescents and young adults who have a parent with lung cancer.

PURPOSE: Resilience plays an important role in helping individuals to adapt to adversity and improve their psychosocial outcomes. This study aims to examine the mediating role of coping in the relationship between family function and resilience in adolescents and young adults (AYAs) who have a parent with lung cancer. METHOD: A total of 135 AYAs with a lung cancer parent were recruited from a tertiary grade A cancer center in southern China, and investigated using a self-designed general information questionnaire, the Resilience Scale for Chinese Adolescents, the Simplified Coping Style Questionnaire, and the Family Adaptation, Partnership, Growth, Affection, Resolve index. RESULTS: The mean score of AYAs' resilience was (3.61 ± 0.49), and its influencing factors included AYAs' years in work, family function, and positive coping. The total effect of family function on resilience was significant (total effect = 0.38, 95% CI [0.048-0.115]), and a positive indirect effect was identified for family function on resilience via positive coping (indirect effect = 0.10, 95% CI [0.005-0.043]). CONCLUSION: Family functioning can facilitate resilience either directly or by promoting positive coping. This study suggests that individualized interventions can be made to improve resilience by promoting family function, or by enhancing positive coping in AYAs with a lung cancer parent.

Stigma, self-efficacy and late toxicities among Chinese nasopharyngeal carcinoma survivors.

OBJECTIVE: This study explores the level of stigma among Chinese nasopharyngeal carcinoma survivors, its influencing factors and relationship with self-efficacy. METHODS: In total, 281 nasopharyngeal carcinoma survivors were recruited from China, who completed the demographic, disease-related and late toxicities questionnaire, as well as the General Self-Efficacy Scale and Social Impact Scale. RESULTS: The mean scores for stigma and self-efficacy were 57.22 ± 9.58 and 28.06 ± 3.97, respectively, both showing a moderate level. The late toxicities with the highest incidence were xerostomia (91.8%), fatigue (78.3%) and hearing loss (63.0%). Stigma was significantly and negatively related to self-efficacy (r = -0.295, P < 0.001). Multivariable linear regression showed that self-efficacy, number of children, educational level, perceived support from spouse and other family members and some late toxicities (nasal obstruction and toothache) were influencing factors of stigma, accounting for 49.4% of the variance. CONCLUSION: Medical staff should be more aware of stigma among Chinese nasopharyngeal carcinoma survivors, especially those with more children and weaker educational backgrounds who are at a higher risk of stigma. They should take effective measures to alleviate stigma by improving patients' self-efficacy, relieving late toxicities and encouraging spouses and family members to provide more support for them.

Public awareness of colorectal cancer in the Chinese population: An online cross-sectional survey study.

OBJECTIVES: To investigate public awareness of colorectal cancer (three components: total knowledge, confidence and anticipated delay) in the Chinese population, to explore factors associated with total knowledge and to elucidate relationships among three components of public awareness of colorectal cancer. METHODS: We recruited 562 adult Chinese participants with no history of colorectal cancer between March and May 2020 by convenience sampling method. Data were collected online using a self-designed demographic questionnaire and a simplified Chinese version of the Bowel Cancer Awareness Measure. Univariate analysis and multivariate linear regression were applied. RESULTS: The mean score for total knowledge was 10.56 (SD: 5.89). Over half of the participants (58.2%) lacked confidence about detecting warning signs. For 42.7% of participants, the anticipated delay was not within the acceptable range (2 weeks). Totally eight demographic variables were identified as significant predictors of total knowledge, accounting for 36.2% of the variance. Total knowledge was positively correlated with confidence (r = 0.126, p < 0.01) and negatively associated with anticipated delay (F = 8.891, p < 0.01). CONCLUSION: Public awareness of colorectal cancer was low in the Chinese population. Hence, educational interventions targeted for improving knowledge, enhancing individuals' confidence in detecting symptoms and reducing barriers to seeking medical help may be urgently required.

Adaptation and psychometric evaluation of the Stoma-QOL questionnaire among Chinese rectal cancer patients with colostomy.

AIM: The purpose of this study was to translate the Stoma-quality of life into Chinese and evaluate its psychometric properties in Chinese patients. BACKGROUND: Quality of life is an important issue for patients with colostomy, and its appropriate and precise measurement is beneficial to promoting better care. The Stoma-quality of life questionnaire has been widely used; however, the validity and reliability of its Chinese version has not been determined. DESIGN: A cross-sectional validation study was conducted. METHODS: We translated the Stoma-quality of life into Chinese using standardized methods. Then it was psychometrically tested on a convenience sample of 513 patients with colostomy. Construct validity was evaluated via exploratory factor analysis and confirmatory factor analysis. Reliability was measured with Cronbach's alpha and the split-half Spearman-Brown coefficient. RESULTS: The content validity, the Cronbach's α coefficient and the Spearman-Brown split-half reliability coefficient indicated adequate validity and reliability. The exploratory factor analysis yielded four common factors, and the cumulative variance contribution rate was 67.5%. Moreover, the confirmatory factor analysis showed a good model fit. CONCLUSION: This study confirmed that the Chinese version of Stoma-quality of life is an effective and reliable measurement for evaluating the quality of life of patients with colostomy.

Sarcopenia as a predictor of mortality among the critically ill in an intensive care unit: a systematic review and meta-analysis.

BACKGROUND: The evidence of sarcopenia based on CT-scan as an important prognostic factor for critically ill patients has not seen consistent results. To determine the impact of sarcopenia on mortality in critically ill patients, we performed a systematic review and meta-analysis to quantify the association between sarcopenia and mortality. METHODS: We searched studies from the literature of PubMed, EMBASE, and Cochrane Library from database inception to June 15, 2020. All observational studies exploring the relationship between sarcopenia based on CT-scan and mortality in critically ill patients were included. The search and data analysis were independently conducted by two investigators. A meta-analysis was performed using STATA Version 14.0 software using a fixed-effects model. RESULTS: Fourteen studies with a total of 3,249 participants were included in our meta-analysis. The pooled prevalence of sarcopenia among critically ill patients was 41 % (95 % CI:33-49 %). Critically ill patients with sarcopenia in the intensive care unit have an increased risk of mortality compared to critically ill patients without sarcopenia (OR = 2.28, 95 %CI: 1.83-2.83; P < 0.001; I2 = 22.1 %). In addition, a subgroup analysis found that sarcopenia was associated with high risk of mortality when defining sarcopenia by total psoas muscle area (TPA, OR = 3.12,95 %CI:1.71-5.70), skeletal muscle index (SMI, OR = 2.16,95 %CI:1.60-2.90), skeletal muscle area (SMA, OR = 2.29, 95 %CI:1.37-3.83), and masseter muscle(OR = 2.08, 95 %CI:1.15-3.77). Furthermore, critically ill patients with sarcopenia have an increased risk of mortality regardless of mortality types such as in-hospital mortality (OR = 1.99, 95 %CI:1.45-2.73), 30-day mortality(OR = 2.08, 95 %CI:1.36-3.19), and 1-year mortality (OR = 3.23, 95 %CI:2.08 -5.00). CONCLUSIONS: Sarcopenia increases the risk of mortality in critical illness. Identifying the risk factors of sarcopenia should be routine in clinical assessments and offering corresponding interventions may help medical staff achieve good patient outcomes in ICU departments.

Stigma and its correlates in people living with lung cancer: A cross-sectional study from China.

OBJECTIVES: This study aimed to examine the level of stigma and identify the correlates of stigma among lung cancer patients in China. METHODS: In total, 283 lung cancer patients were recruited from a tertiary cancer center in China by the convenience sampling method and completed a demographic, disease-related information and situational characteristics questionnaire and self-reported measures assessing stigma, state self-esteem, and coping self-efficacy. RESULTS: The mean stigma score was moderate (2.38 ± 0.45). Stigma was significantly and negatively associated with state self-esteem (r = -0.607, P < .001) and coping self-efficacy (r = -0.424, P < .001). Multivariable linear regression showed that age, cancer stage, negative changes (ie, in financial burden, body image, and family relationship), cancer disclosure, perceived blame, state self-esteem, and coping self-efficacy accounted for 49.9% of the variance in stigma. CONCLUSIONS: Stigma is a widespread psychosocial phenomenon among patients with lung cancer in China. Health care policy-makers and professionals should pay more attention to this issue and take effective measures to address stigma among lung cancer patients by improving their state self-esteem and coping self-efficacy, encouraging cancer disclosure and providing support for adjusting to negative changes after diagnosis.

Lower body mass indices and near-target early energy nutrition therapy may increase intensive care unit-associated infections: A retrospective study in Guangzhou, China.

BACKGROUND AND OBJECTIVES: The optimal energy intake for early nutrition therapy in critically ill patients is unknown, especially in Chinese patients with a lower BMI. This study investigated the relationship between energy intake and clinical outcomes in this patient population. METHODS AND STUDY DESIGN: A retrospective study was carried out at a tertiary hospital. Critically ill patients were recruited and divided into 3 tertiles according to the ratio of actual/target energy intake during the first week of hospitalization in the intensive care unit (ICU) (tertile I, <33.4%; tertile II, 33.4%-66.7%; and tertile III, >66.7%). 60-day mortality and other clinical outcomes were compared. To adjust for potentially confounding factors, multivariate and sensitivity analyses were performed exclusively in patients who stayed in the ICU for ≥7 days. RESULTS: A total of 325 patients with a mean BMI of 22.5±4.7 kg/m2 were recruited. 60-day mortality was similar between the 3 tertiles. In the unadjusted analysis, tertile III had a longer length of stay in the ICU and at the hospital, longer duration of mechanical ventilation, and higher rate of ICU-associated infections, but only the latter showed a significant difference between the 3 tertiles in the multivariate and sensitivity analyses. Logistic regression analysis showed that energy groups was an independent risk factor for ICU-associated infections. CONCLUSIONS: Energy intake in early nutrition therapy influences risk of ICU-associated infections in Chinese critically ill patients with lower BMI. Furthermore, patients with near-target energy intake have more frequent ICU-associated infections.

The hepatoprotective effects of Salvia plebeia R. Br. extract in zebrafish (Danio rerio).

Salvia plebeia R. Br. is a traditional Chinese medicinal herb that has been widely used for the treatment of many inflammatory diseases such as hepatitis. However, the underlying molecular mechanism about the hepatoprotective effects of S. plebeia remains largely unknown. Here, we investigated the antioxidant activities and anti-inflammatory effects of ethanol extracts of S. plebeia (SPEE) in the zebrafish model. Firstly, we determined the chemical compositions of SPEE and identified three major constituents by using GC-MS analysis. After that, SPEE exhibited significantly antioxidant properties in the LPS-induced zebrafish embryos, and the enzyme activities of ROS, CAT and SOD were obviously inhibited in a dose-dependent manner. Secondly, SPEE greatly reduced fat vacuoles (HE staining), lipid accumulation (Oil O staining) and hepatocyte fibrosis (Gemori staining) in the thioacetamide (TAA)-induced hepatocyte injury of adult zebrafish. Meanwhile, the NO contents and lipid metabolism-related genes were substantially down-regulated after SPEE exposure. Thirdly, we used RNA-Seq analysis to identify the differentially expressed genes (DEGs) after SPEE exposure in adult zebrafish liver. The results showed that 1289 DEGs including 558 up-regulated and 731 down-regulated were identified between the TAA + SPEE and TAA groups. KEGG pathway and GO functional analysis revealed that steroid biosynthesis, oxidation-reduction and innate immunity were significantly enriched. Mechanistically, SPEE can considerably reduce the cell apoptosis of hepatocytes and promote the translocation of Nrf2 protein from the nucleus to the cytoplasm in TAA-induced zebrafish. Moreover, SPEE can modulate various inflammatory cytokines and immune genes both in the control and H2O2-stimulated conditions. The pro-inflammatory cytokines such as IL-1ß and TNF-α was markedly up-regulated but the anti-inflammatory cytokines such as TGF-ß was greatly down-regulated after SPEE treatment. In addition, some key genes in the TLR signaling were also activated in the H2O2-stimulated conditions. In summary, our results suggested that SPEE had an important role in the antioxidant and anti-inflammatory effects in zebrafish in the near future. Some of the components identified in this study may be served as potential sources of new hepatoprotective compounds for the treatment of inflammatory diseases.

Psychosocial behaviour reactions, psychosocial needs, anxiety and depression among patients with rectal cancer before and after colostomy surgery: A longitudinal study.

AIMS AND OBJECTIVES: To compare the differences in psychosocial behaviour reactions, psychosocial needs, anxiety and depression before and after colostomy surgery and to explore the predictors of psychosocial behaviour reactions. BACKGROUND: Colorectal cancer is increasing worldwide. Abdominoperineal resection accompanied by permanent colostomy can cause complicated psychosocial reactions and needs. However, colostomy patients' trajectories of psychosocial adjustment at different time points must be discussed. DESIGN: A longitudinal study. METHODS: Using a convenience sampling method, 67 patients planning to undergo colostomy surgery were recruited from a tertiary cancer centre in southern China from January 2013-January 2014. Data collection consisted of two phases, conducted 1-2 days before surgery and 1-2 days prior to discharge. The Ostomy Psychosocial Behaviour Reaction Questionnaire, the Ostomy Psychosocial Needs Questionnaire, the Hospital Anxiety and Depression Scale and a self-designed demographic questionnaire were used to collect data. STROBE guidelines were followed. RESULTS: The participants had a moderate level of psychosocial behaviour reactions, a deep and wide range of psychosocial needs and a high incidence of anxiety and depression before and after surgery. Anxiety before surgery was significantly higher than that after surgery. Psychosocial needs and anxiety were significant predictors of psychosocial behaviour reactions. CONCLUSIONS: Patients' anxiety was alleviated after surgery. The combination of ascertaining and meeting various psychosocial needs and managing negative emotions was helpful in alleviating patients' stress responses before and after surgery. RELEVANCE TO CLINICAL PRACTICE: An increased focus on the relationships among psychosocial behaviour reactions, psychosocial needs, anxiety and depression at different time points in colostomy patients is necessary for future research and practice.

Stigma and its influencing factors among Chinese patients with stoma.

BACKGROUND: Although stomas are necessary for disease treatment, they unavoidably affect patients' lives from physical, psychological, social, spiritual, and familial perspectives and contribute to feelings of embarrassment and shame. This study explored the current status and factors influencing stigma among Chinese patients with stoma. METHODS: A total of 209 patients with stoma at the stoma clinic of a tertiary cancer centre in Guangzhou, China, were recruited and investigated by using the Social Impact Scale, the Coping Self-Efficacy Scale, the State Self-Esteem Scale, and a demographic questionnaire. Multivariate linear regression was used to identify the factors influencing stigma. RESULTS: The mean Social Impact Scale score was 69.65 ± 13.18, which represents a moderate effect; specifically, 44% of the patients experienced high levels of stigma. Stoma patients with the following characteristics had high levels of stigma: young, low coping self-efficacy, low stoma acceptance by one's spouse or other family members, poor perceived body image, stool leakage, and no experience of participating in activities with other stoma patients. CONCLUSIONS: Medical staff members should pay more attention to stigma in stoma patients. Coping self-efficacy, family members' acceptance of the stoma, and participation in activities with other stoma patients are influencing factors that protect these patients against stigma, whereas body image loss and stool leakage place them at higher risk for stigma. Interventions aimed at improving protective factors and decreasing risk factors should be considered to reduce the level of stigma in patients with stoma.

Distress, illness perception and coping style among thyroid cancer patients after thyroidectomy: A cross-sectional study.

PURPOSE: Thyroid cancer generally has a good prognosis, and thyroidectomy is the main treatment given to thyroid cancer patients. Almost every cancer patient experiences varying degrees of distress, which can reduce their quality of life. This study aims to explore the level of distress and its relationship with illness perception and coping style among Chinese thyroid cancer patients after thyroidectomy and to identify the influencing factors on distress. METHODS: A cross-sectional study with convenience sampling method was conducted. Totally 184 thyroid cancer patients after thyroidectomy were recruited in a tertiary hospital in Southern China with the response rate being 94.4% . The participants were investigated by a self-designed demographic and disease-related questionnaire, the Distress Management, the Brief Illness Perception Questionnaire, and the Medical Coping Modes Questionnaire. Descriptive statistics, univariate analysis, and multivariate linear regression were applied for data analysis. RESULTS: In total, 99 (53.8%) thyroid cancer patients after thyroidectomy scored 4 or higher on the DT. Illness perception, emotional problem, body image loss by surgical scars, and acceptance-resignation were the influencing factors of distress and could explain 67.6% of the variance of distress among thyroid cancer patients after thyroidectomy. CONCLUSIONS: Healthcare professionals should not ignore the distress among thyroid cancer patients after thyroidectomy and should take effective measures to alleviate the distress of thyroid cancer patients after thyroidectomy by enhancing their accurate and positive illness perceptions, decreasing their emotional problems, alleviating their body image loss by surgical scars, and avoiding acceptance-resignation coping style.

Optimal time to initiate early oral feeding in postoperative patients with upper gastrointestinal malignancy: A network meta-analysis.

BACKGROUND: With the development of enhanced recovery after surgery, early oral feeding is likely to become the preferred mode of nutrition after surgery for upper gastrointestinal tract malignancies. However, the optimal time to initiate early oral feeding remains unknown. OBJECTIVE: We aimed to compare the effects of different introduction times of early oral feeding in patients with upper gastrointestinal malignancies in terms of safety, tolerance, and effectiveness and to identify the optimal time for early oral feeding after surgery. METHODS: A random-effects meta-analysis was performed to identify evidence from relevant randomized controlled trials. Ten electronic databases were searched for randomized controlled trials from their earliest records to May 2023. Data were analyzed using the Stata 16.0 software. RESULTS: A total of 22 randomized controlled trials including 2510 patients and seven time points for oral feeding after surgery were considered. Regarding safety, oral feeding initiated on postoperative day 3 may be the safest (high-quality evidence) compared with other times. Regarding tolerance, oral feeding initiated on postoperative day 5 may be the most well-tolerated (moderate-quality evidence) compared with other times. Regarding effectiveness, oral feeding initiated on postoperative day 3 may be the most effective (moderate-quality evidence) compared with other times. CONCLUSIONS: Early oral feeding is safe, tolerable, and effective in postoperative patients with upper gastrointestinal malignancies. The optimal time to initiate early oral feeding after surgery was most likely postoperative day 3. The results of this meta-analysis provide evidence-based guidelines for clinical decision-making.

Patient-Family Caregiver Concordance of Symptom Assessment for Esophageal Cancer Patients Undergoing Esophagectomy.

BACKGROUND: Esophageal cancer patients suffer from multiple and severe symptoms during the postoperative recovery period. Family caregivers play a vital role in assisting patients to cope with their symptoms. OBJECTIVE: To examine the concordance of esophageal cancer patients and their caregivers on assessing patients' symptoms after surgery and identify predictors associated with the symptom concordance. METHODS: In this cross-sectional study, 213 patient-caregiver dyads completed general information questionnaires, the Memorial Symptom Assessment Scale, the Depression Subscale of Hospital Anxiety and Depression Scale, the Mutuality Scale, and the Zarit Burden Interview (for caregivers). Data were analyzed using intraclass correlation coefficients, paired t tests, and binary logistic regression. RESULTS: At the dyad level, agreement of patients' and caregivers' reported symptoms ranged from poor to fair. At the group level, patients reported significantly higher scores than caregivers in most symptoms. Of the 213 dyads, 119 (55.9%) were identified as concordant on symptom assessment. Patients' nasogastric tube, perceived mutuality, caregivers' educational background, and dyad's communication frequency with each other could predict their concordance of symptom assessment. CONCLUSIONS: There were relatively low agreements between esophageal cancer patients and caregivers on assessing patients' symptoms, and caregivers tended to underestimate patients' symptoms. The dyad's symptom concordance was influenced by patient-, caregiver-, and dyad-related factors. IMPLICATIONS FOR PRACTICE: Having an awareness of the incongruence on assessing symptoms between esophageal cancer patients and caregivers may help healthcare professionals to comprehensively interpret patients' symptoms and develop targeted dyadic interventions to improve their concordance, contributing to optimal symptom management and health outcomes.

Subchronic co-exposure of polystyrene nanoplastics and 3-BHA significantly aggravated the reproductive toxicity of ovaries and uterus in female mice.

Both nanoplastics (NPs) and 3-tert-butyl-4-hydroxyanisole (3-BHA) are environmental contaminants that can bio-accumulate through the food chain. However, the combined effects of which on mammalian female reproductive system remain unclear. Here, the female ICR-CD1 mice were used to evaluate the damage effects of ovaries and uterus after NPs and 3-BHA co-treatment for 35 days. Firstly, co-exposure significantly reduced the body weight and organ index of ovaries and uterus in mice. Secondly, combined effects of NPs and 3-BHA exacerbated the histopathological abnormalities to the ovaries and uterus and decreased female sex hormones such as FSH and LH while increased antioxidant activities including CAT and GSH-Px. Moreover, the apoptotic genes, inflammatory cytokines and the key reproductive development genes such as FSTL1 were significantly up-regulated under co-exposure conditions. Thirdly, through transcriptional and bioinformatics analysis, immunofluorescence and western blotting assays, together with molecular docking simulation, we determined that co-exposure up-regulated the FSTL1, TGF-ß and p-Smad1/5/9 but down-regulated the expression of BMP4. Finally, the pharmacological rescue experiments further demonstrated that co-exposure of NPs and 3-BHA mainly exacerbated the female reproductive toxicity through FSTL1-mediated BMP4/TGF-ß/SMAD signaling pathway. Taken together, our studies provided the theoretical basis of new environmental pollutants on the reproductive health in female mammals.

The mediating role of self-efficacy in the relationship between social support and work withdrawal behavior: A cross-sectional study among young lung cancer survivors.

Objective: The study aimed to explore the predictors of work withdrawal behavior among young lung cancer survivors and examine the mediating role of self-efficacy in the relationship between social support and work withdrawal behavior. Methods: This cross-sectional study was conducted in a cancer center in southern China. A total of 215 young lung cancer survivors were recruited from January 2021 to July 2021 and investigated by a demographic and disease-related questionnaire, the Work Withdrawal Behavior Scale, Social Support Rating Scale, and General Self-efficacy Scale. Data analysis was performed â€‹using â€‹IBM SPSS 25.0 (IBM Corp., Armonk, NY, USA) and PROCESS macro version 3.3 for SPSS developed by Preacher and Hayes. Results: The mean score of work withdrawal behavior was 3.02 (±0.70). Existing symptoms, income, residence, the duration of postoperative rest time, social support, and self-efficacy were the predictors and explained 70.2% of the variance of work withdrawal behavior. The mediating effect of self-efficacy was identified between social support and work withdrawal behavior (indirect effect â€‹= â€‹0.36, bias-corrected 95% confidence interval [-0.542 to -0.197]). Conclusions: Work withdrawal behavior was prevalent among young lung cancer survivors. Social support and self-efficacy were significantly associated with work withdrawal behavior, and self-efficacy was identified as a mediator between social support and work withdrawal behavior among this group. Health professionals could help them return and adapt to work by relieving their symptoms, providing social support, and enhancing their self-efficacy.