A nomogram for preoperative prediction of lymphatic infiltration in colorectal cancer: A personalized approach to clinical decision making.

Lymphatic infiltration (LI) is a key factor affecting the treatment of patients with colorectal cancer (CRC). Thus, the aim of this study was to develop and validate a nomogram for individual preoperative prediction of LI in patients with CRC.We conducted a retrospective analysis of 664 patients who received their initial diagnosis of CRC at our center. Those patients were allocated to a training dataset (n = 468) and a validation dataset (n = 196). The least absolute shrinkage and selection operator regression model was used for data dimension reduction and feature selection. The nomogram was constructed from the training dataset and internally verified using the concordance index (C-index), calibration, area under the receiver operating characteristic curve and decision curve analysis (DCA).The enhancement computed tomography reported N1/N2 classification, preoperative tumor differentiation, elevated carcinoembryonic antigen, and carbohydrate antigen19-9 level were selected as variables for the prediction nomogram. Encouragingly, the nomogram showed favorable calibration with C-index 0.757 in the training cohort and 0.725 in validation cohort. The DCA signified that the nomogram was clinically useful. The Kaplan-Meier survival curve showed that patients with LI had a worse prognosis and could benefit from postoperative adjuvant chemotherapy.Use common clinicopathologic factors, a non-invasive scale for individualized preoperative forecasting of LI was established conveniently. LI prediction has great significance for risk stratification of prognosis and treatment of resectable CRC.

Identifying miRNA and gene modules of colon cancer associated with pathological stage by weighted gene co-expression network analysis.

INTRODUCTION: Colorectal cancer (CRC) is the fourth most common cause of cancer-related mortality worldwide. The tumor, node, metastasis (TNM) stage remains the standard for CRC prognostication. Identification of meaningful microRNA (miRNA) and gene modules or representative biomarkers related to the pathological stage of colon cancer helps to predict prognosis and reveal the mechanisms behind cancer progression. MATERIALS AND METHODS: We applied a systems biology approach by combining differential expression analysis and weighted gene co-expression network analysis (WGCNA) to detect the pathological stage-related miRNA and gene modules and construct a miRNA-gene network. The Cancer Genome Atlas (TCGA) colon adenocarcinoma (CAC) RNA-sequencing data and miRNA-sequencing data were subjected to WGCNA analysis, and the GSE29623, GSE35602 and GSE39396 were utilized to validate and characterize the results of WGCNA. RESULTS: Two gene modules (Gmagenta and Ggreen) and one miRNA module were associated with the pathological stage. Six hub genes (COL1A2, THBS2, BGN, COL1A1, TAGLN and DACT3) were related to prognosis and validated to be associated with the pathological stage. Five hub miRNAs were identified to be related to prognosis (hsa-miR-125b-5p, hsa-miR-145-5p, hsa-let-7c-5p, hsa-miR-218-5p and hsa-miR-125b-2-3p). A total of 18 hub genes and seven hub miRNAs were predominantly expressed in tumor stroma. Proteoglycans in cancer, focal adhesion, extracellular matrix (ECM)-receptor interaction and so on were common pathways of the three modules. Hsa-let-7c-5p was located at the core of miRNA-gene network. CONCLUSION: These findings help to advance the understanding of tumor stroma in the progression of CAC and provide prognostic biomarkers as well as therapeutic targets.

Downregulation of miR­136­5p in hepatocellular carcinoma and its clinicopathological significance.

The clinical significance of microRNA (miR)­136­5p in hepatocellular carcinoma (HCC) has not been verified. Therefore, in the current study, the authors aimed to explore miR­136­5p expression and its clinical significance in HCC, as well as to investigate its potential target genes function. The authors detected the levels of miR­136­5p in 101 pairs of HCC and para­cancer tissues via reverse transcription­quantitative polymerase chain reaction. Gene Expression Omnibus database and the Cancer Genome Atlas (TCGA) database were used to further verify the clinical significance of miR­136­5p expression in HCC. The target genes prediction analysis of miR­136­5p, natural language processing (NLP) analysis of HCC in PubMed and gene functional enrichment analysis were conducted. The miR­136­5p level was markedly downregulated in HCC tissue, compared to para­non­tumor tissue. MiR­136­5p expression decreased in HCC patients with metastasis (P=0.004), advance TNM stage (P<0.001), portal vein tumor embolus (P=0.007) and vaso­invasion (P=0.003), compared with those HCC patients with non­metastasis, early TNM stage, non­portal vein tumor embolus and non­vaso­invasion, respectively. In the TCGA database, downregulated miR­136­5p was also observed in HCC tissue compared to normal liver tissue (P<0.001). There were 178 genes obtained from the overlap between predicted targets and NLP analysis. GO and KEGG pathway analyses revealed some significant pathways related to cancers. Downregulation of miR­136­5p may be responsible for the carcinogenesis and aggressiveness of HCC. miR­136­5p may act as an anti­carcinoma miRNA, which is essential for HCC progression through the regulation of various signaling pathways. Thus, miR­136­5p interaction may provide a novel strategy for HCC treatment.

The relationship between job satisfaction, work stress, work-family conflict, and turnover intention among physicians in Guangdong, China: a cross-sectional study.

OBJECTIVE: To investigate the relationship between job satisfaction, work stress, work-family conflict and turnover intention, and explore factors associated with turnover intention, among physicians in Guangdong Province, China. METHODS: From August to October 2013, physicians completed questionnaires and scales with regard to their job satisfaction, work stress, work-family conflict, and turnover intention. Binary logistic regression and structural equation modelling (SEM) were used in data analysis. RESULTS: A total of 3963 physicians were approached, with 3563 completing the questionnaire. The mean score of the overall perception of turnover intention of physicians who worked in Guangdong was 2.71 on a scale ranging from 1 to 6. Hours worked per week, working in an urban/rural area, type of institution, and age significantly impacted on turnover intention. Turnover intention was directly and negatively related to job satisfaction, and it was directly, indirectly and positively related to work stress and work-family conflict. CONCLUSION: Job satisfaction, work stress, work-family conflict, hours worked per week, working in an urban/rural area, types of institution and age are influencing factors of turnover intention. Reducing working hours, raising salary, providing more opportunities for career development and training, supporting and encouraging physicians by senior managers could potentially contribute to the reduction in turnover intention.

Job satisfaction and associated factors among healthcare staff: a cross-sectional study in Guangdong Province, China.

OBJECTIVES: This cross-sectional study aimed to explore job satisfaction among healthcare staff in Guangdong following the health system reforms in 2009, and to investigate the association between job satisfaction and work stress, work-family conflict and doctor-patient relationship. DESIGN: Cross-sectional survey. SETTING: The Fifth National Health Service Survey was carried out in Guangdong, China. PARTICIPANTS: All participants in this study were healthcare staff including physicians, nurses and public health staff from hospitals, health service centres and health clinics. A total of 6583 questionnaires were distributed and collected. After excluding the incomplete questionnaires, 5845 questionnaires were included for the analysis. OUTCOME MEASURES: Sociodemographic information and scores for evaluating job satisfaction, work stress, work-family conflict and doctor-patient relationship were obtained using the questionnaire developed by the National Health and Family Planning Commission of the People's Republic of China. To assess the significantly associated factors on job satisfaction of the healthcare staff in Guangdong, a binary logistic regression model was used. RESULTS: Based on the 5845 valid responses of the healthcare staff who worked in Guangdong, the mean score of overall perception of job satisfaction was 3.99 on a scale of 1-6. Among the sociodemographic variables, occupation, educational background, professional status, years of service, annual income and night shift frequency significantly influenced the level of job satisfaction. Work stress, work-family conflict and doctor-patient relationship also had significant effect on job satisfaction. CONCLUSIONS: The overall job satisfaction exceeded slightly dissatisfied (score 3) and approached slightly satisfied (score 4). Measures to enhance job satisfaction include the reduction of workload, increase of welfare, maintaining moderate stress and balancing work-family conflict. Moreover, relevant laws should be issued to protect the healthcare staff from violent acts.

[Time-series analysis on the acute mortality affected by air pollution, in the city of Guangzhou, 2004-2008].

OBJECTIVE: To study the associations between daily mortality and the status of exposure to air pollution. METHODS: A time-series analysis was conducted to assess the relations between acute mortality and exposure to respiratory particulate matter (PM(10)), sulfur-dioxide (SO2) and nitrogen dioxide (NO2) in urban residents of Guangzhou (2004 - 2008), using Poisson regression. RESULTS: Through controlling the factors as temperature, relative humidity, age, gender and time, significant increases were observed in all-cause mortality of 0.94% (0.79 - 1.09) for PM(10), 1.55% (1.31 - 1.78) for NO2, and 1.09% (0.91 - 1.27) for SO2, per 10 µg/m(3), when increase of the lagging 2-day average concentrations of air pollution was seen, in Guangzhou. Stronger effects of exposure to air pollution were found on cardiovascular and respiratory mortality, as well as in elderly (≥ 65 years) and female population. CONCLUSION: Our results suggested that exposure to ambient pollution was significantly associated with the increase of excess risks, on total and cardio-respiratory mortality in the residents of Guangzhou.

Subchronic toxicity studies of Radix Astragali extract in rats and dogs.

Radix Astragali extract (RAE) is obtained from Astragalus membranaceus. It consists of Astragalus polysaccharide and Astragalus membranaceus saponins. In the study, we observed the subchronic toxicity of RAE in Sprague-Dawley rats and beagle dogs to evaluate the safety dosage range in clinical application. These subjects were daily administered of RAE by intra-peritoneum or vein for three consecutive months. General index were observed such as food-intake, behavior, body weight, hematological parameters, etc. Body weight, the weight of principal organ and hematology index are normal in experimental groups and control groups. The hematological biochemistry examination and histopathology examination of experimental groups are similar to control groups. In conclusion, our studies clearly demonstrated that RAE was safe without any distinct toxicity and side effects, the safety dosage range is 5.7-39.9g/kg for rats and 2.85-19.95g/kg for beagle dogs, which is equal to 70 or 35 times of that of human (0.57g/kg, say, average BW 70kg), respectively.