Health risk study of cadmium, chromium, lead and arsenic in reservoir water of Changzhou, China.

Accurately assessing the health risks of human exposure to heavy metals via water is of great importance for performing targeted health risk prevention measures. To better understand the concentration characteristics and potential harm to human health of cadmium, chromium, lead and arsenic in the main drinking water-type reservoirs of Changzhou city, we collected samples from the Haidi Reservoir, Dongjin Reservoir, Xinfushan Reservoir, Maodong Reservoir and Xiangyang Reservoir of Changzhou in the summer of 2019. The results showed that the daily average comprehensive exposure level of metals was much lower than the provisional tolerated daily intake (PTDI), i.e., Cd: 1 µg kg-1 d-1; Cr: 3 µg kg-1 d-1; Pb: 3.57 µg kg-1 d-1; and As: 2.14 µg kg-1 d-1. The comprehensive non-carcinogenic risk levels of four metals under water-drinking exposure and water-skin exposure routes ranged from 4.68E - 3 to 1.69E - 1, and the carcinogenic risk ranged from 2.09E - 5 to 7.30E - 5, which were all at acceptable risk levels. Although lead and chromium were present at acceptable health risk levels, they still represented the main pollutants of potential health risk in the local water environment from a non-carcinogenic or carcinogenic perspective, and they should be listed as the primary targets for water environmental risk management.

Effects of exercise interventions on cancer-related fatigue in breast cancer patients: an overview of systematic reviews.

OBJECTIVE: This overview of systematic reviews aims to critically appraise and consolidate evidence from current systematic reviews (SRs)/meta-analyses on the effects of exercise interventions on cancer-related fatigue (CRF) in breast cancer patients. METHODS: SRs/meta-analyses that explored the effects of exercise interventions on CRF in breast cancer patients compared with the routine methods of treatment and care were retrieved from nine databases. The methodological quality of the included SRs was appraised using A MeaSurement Tool to Assess systematic Reviews II (AMSTAR II). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to calculate the grading of outcomes in the included SRs. The exercise type, frequency, duration, and inclusion/absence of supervision were further evaluated with subgroup analyses. The Stata 16.0 software was utilized for data analysis. RESULTS: Twenty-nine reviews were included. The overall methodological quality and level of evidence of the included reviews were unsatisfactory, with only three reviews rated as high methodological quality and no review identified as high-quality evidence. Moderate certainty evidence indicated that exercise could improve fatigue in breast cancer patients (SMD = - 0.40 [95%CI - 0.58, - 0.22]; P = 0.0001). Subgroup analysis based on the types of exercise showed that yoga (SMD = - 0.30 [95%CI - 0.56, - 0.05]; I2 = 28.7%) and aerobic exercise (SMD = - 0.29 [95%CI - 0.56, - 0.02]; I2 = 16%) had a significantly better effect on CRF in breast cancer patients; exercising for over 6 months (SMD = - 0.88 [95%CI - 1.59, - 0.17]; I2 = 42.7%; P = 0.0001), three times per week (SMD = - 0.77 [95%CI - 1.04, - 0.05]; I2 = 0%; P = 0.0001), and for 30 to 60 min per session (SMD = - 0.81 [95%CI - 1.15, - 0.47]; I2 = 42.3%; P = 0.0001) can contribute to a moderate improvement of CRF. Supervised exercise (SMD = - 0.48 [95%CI - 0.77, - 0.18]; I2 = 87%; P = 0.001) was shown to relieve CRF. CONCLUSION: Exercise played a favorable role in alleviating CRF in breast cancer. Yoga was recommended as a promising exercise modality for CRF management in the majority of the included studies. Exercising for at least three times per week with 30 to 60 min per session could be recommended as a suitable dosage for achieving improvement in CRF. Supervised exercise was found to be more effective in alleviating CRF than unsupervised exercise. More rigorously designed clinical studies are needed to specify the exact exercise type, duration, frequency, and intensity to have an optimal effect on CRF in breast cancer patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: CRD42020219866.

Clinical practice guidelines for the nutritional risk screening and assessment of cancer patients: a systematic quality appraisal using the AGREE II instrument.

PURPOSE: To evaluate the quality of published clinical practice guidelines (CPGs) regarding the nutritional risk screening and assessment of cancer patients and to identify high-quality CPGs for clinical healthcare professionals. METHODS: Guidelines for the nutritional risk screening and assessment of cancer patients were comprehensively searched in eight electronic databases, including The Lancet, PubMed, Cochrane Library, Excerpta Medica dataBASE (EMBASE), Web of Science, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBMdisc), and Wan Fang Data, through August 2020. Six relevant guideline databases, including the National Comprehensive Cancer Network (NCCN), the National Guideline Clearinghouse (NGC), the Guideline International Network (GIN), the New Zealand Guidelines Group (NZGG), the China Guideline Clearinghouse (CGC), and Medlive, and relevant nutrition society websites, were also searched through August 2020. The methodological quality of the included CPGs was appraised independently by three assessors using the Appraisal of Guidelines for Research and Evaluation, 2nd edition (AGREE II) tool. RESULTS: Seven CPGs were located, and the domain with the highest percentage was "clarity of presentation" (85.44%), while the domain with the lowest percentage was "applicability" (40.26%). From the AGREE II results, two guidelines were rated as "strongly recommended," three were assessed as "recommended with modifications," and two were deemed as "not recommended." CONCLUSION: Considering that the two "strongly recommended" guidelines were developed within the American and European contexts, translation, validation, and cultural adaptation are recommended prior to implementing these guidelines in other countries or healthcare contexts to improve their effectiveness and sensitivity for local cancer patients. TRIAL REGISTRATION: PROSPERO registration of the study protocol: CRD42020177390 (July 5, 2020).

Moxibustion for post-stroke urinary incontinence in adults: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND AND PURPOSE: Urinary incontinence (UI) is a frequently identified complication among stroke survivors. Moxibustion is commonly used to treat post-stroke UI in Asian countries. This study aimed to synthesize the evidence of using moxibustion for post-stroke UI management. METHODS: Twelve databases were searched to identify randomized controlled trials (RCTs) using moxibustion to improve post-stroke UI management. Four Chinese journals were also manually screened for potentially eligible articles. RESULTS: Ten studies with a total of 719 participants and one completed trial without published results were included. Compared with "routine methods of treatment and/or care," the meta-analyses revealed that moxibustion had superior effects in improving UI symptoms and alleviating the severity of UI. CONCLUSION: This systematic review identified preliminary research evidence that moxibustion may be effective in managing the symptoms of post-stroke UI. More rigorously designed, large-scale RCTs are warranted to provide more robust evidence in this area.

Warm-needle moxibustion for spasticity after stroke: A systematic review of randomized controlled trials.

BACKGROUND: Spasticity is a common post-stroke complication, and it results in substantial deterioration in the quality of life of patients. Although potential positive effects of warm-needle moxibustion on spasticity after stroke have been observed, evidence on its definitive effect remains uncertain. OBJECTIVES: This study aimed to summarize clinical evidence pertaining to therapeutic effects and safety of warm-needle moxibustion for treating spasticity after stroke. DESIGN: Randomized controlled trials were reviewed systematically on the basis of the Cochrane Handbook for Systematic Reviews of Interventions. The report follows the PRISMA statement. METHODS: Ten electronic databases (PubMed, CENTRAL, EMBASE, AMED, CINAHL, Web of Science, CBM, CNKI, WanFang, and VIP) were explored, and articles were retrieved manually from two Chinese journals (The Journal of Traditional Chinese Medicine and Zhong Guo Zhen Jiu) through retrospective search. Randomized controlled trials with warm-needle moxibustion as treatment intervention for patients with limb spasm after stroke were included in this review. The risk of bias assessment tool was utilized in accordance with Cochrane Handbook 5.1.0. All included studies reported spasm effect as primary outcome. Effect size was estimated using relative risk, standardized mean difference, or mean difference with a corresponding 95% confidence interval. Review Manager 5.3 was utilized for meta-analysis. RESULTS: Twelve randomized controlled trials with certain methodological flaws and risk of bias were included, and they involved a total of 878 participants. Warm-needle moxibustion was found to be superior to electroacupuncture or acupuncture in reducing spasm and in promoting motor function and daily living activities. Pooled results for spasm effect and motor function were significant when warm-needle moxibustion was compared with electroacupuncture or acupuncture. A comparison of daily living activities indicated significant differences between warm-needle moxibustion and electroacupuncture. However, no difference was observed between warm-needle moxibustion and acupuncture. CONCLUSIONS: Warm-needle moxibustion may be a promising intervention to reduce limb spasm as well as improve motor function and daily living activities for stroke patients with spasticity. However, evidence was not conclusive. Rigorously designed randomized controlled trials with sample sizes larger than that in the included trials should be conducted for verification.

Statistical Report of Central Nervous System Tumors Histologically Diagnosed in the Sichuan Province of China from 2008 to 2013: A West China Glioma Center Report.

BACKGROUND: Sichuan is a province in the west of China with a population of 81.4 million. This is the first statistical report of central nervous system (CNS) tumors surgically treated and histologically diagnosed in a large Chinese population. METHODS: All the patient data were obtained from 86 medical facilities, which covered the Sichuan province population. Data from patients who underwent surgery between 2008 and 2013 and corresponding histology samples were re-reviewed in the major pathology centers. All the CNS tumors were categorized according to International Classification of Diseases (ICD)-10 and ICD-O-3 classifications and reviewed manually. The tumor distribution was analyzed and stratified by gender, age, race, and tumor sites. Tumors in some ethnic minorities, such as the Tibetan people, also were analyzed. RESULTS: The final analytic dataset included 35,496 records. The top four histologic tumors were meningioma (28.51 %), pituitary adenoma (15.00 %), nerve sheath (13.77 %), and glioblastoma (11.82 %). There was a dramatically high incidence of malignant tumor in males. The median age at diagnosis ranged from 13 years (pineal region tumors) to 56 years (metastatic brain tumors). Most of the tumors in the insular lobe or cerebellum were low grade, whereas those in the thalamus or basal ganglia were likely to be high grade. The incidence of malignant tumors or high-grade gliomas in the Tibetans was significantly lower than in the Chinese Han population. CONCLUSION: This report is a preliminary statistical analysis of brain and spinal tumors in a large Chinese population and may serve as a useful resource for clinicians, researchers, and patients' families.

Pilomatrix carcinoma on the left side of the parotid region: A case report and review of the literature.

Pilomatrix carcinoma (PC) is a rare neoplasm, particularly in the parotid region. Thus, it is easily misdiagnosed and an optimal treatment regimen has not yet been established. The present study reports the case of a 43-year-old female who presented with a PC of the parotid region and reviews the associated published literature. The patient underwent three surgical excisions prior to the tumor being completely removed, and was misdiagnosed four times prior to the correct diagnosis. Once the tumor was completely removed, the patient received radiation therapy (RT). At the 2-year follow-up, the patient remained free of local recurrence and metastasis. To the best of our knowledge, only 3 cases of PC on the parotid region have been reported. Although an optimal treatment regimen has not been established, surgery with wide margins is recommended, with RT and chemotherapy producing mixed results.

Relationship between intracranial pressure and aneurysmal subarachnoid hemorrhage grades.

OBJECTIVE: Intracranial pressure (ICP) is frequently elevated following aneurysmal subarachnoid hemorrhage (aSAH). In this prospective study, the factors associated with increased ICP and the relationship between ICP and the aSAH grade were evaluated. METHODS: Consecutive patients with prospective aSAH were enrolled within 24h after disease onset. Clinical scoring, including the Hunt and Hess scale, the WFNS scale and the Fisher scale, was performed upon admission. Consciousness was evaluated based on the Glasgow Coma Scale, and the subarachnoid hemorrhage volume was determined according to a CT scan. Then, an ICP monitor was placed, and ICP was recorded. The relationship between ICP and the aSAH grade was examined using Spearman correlation coefficients. Additionally, some clinical characteristics of the patients, including age, sex, location and size of the aneurysm, hydrocephalus and rebleeding, were recorded and analyzed. RESULTS: A total of 165 patients were enrolled in this study. Of these patients, 111 (67.2%) displayed elevated ICP (≥ 20 mm Hg). The patients who underwent intubation or who experienced rebleeding or hydrocephalus displayed an elevated ICP compared with those who did not (P = 0.002, P = 0.001 and P = 0.008, respectively). There was a positive linear correlation between ICP and both the Hunt and Hess grade and the WFNS grade (correlation coefficients of 0.731 and 0.761, respectively). The correlation between ICP and the Fisher grade was weak according to the correlation coefficient of only 0.093. CONCLUSION: ICP following aSAH positively correlates with the patient's consciousness, but no relationship was detected between ICP and the subarachnoid hemorrhage volume.

Gain of function of mutant TP53 in glioblastoma: prognosis and response to temozolomide.

PURPOSE: Our aim was to investigate the relationship between mutant p53 and the prognosis of malignant glioma treated with temozolomide, and the regulation of mutant TP53 induced drug resistance, by molecular experimentation and a clinical trial. METHODS: Adult patients with newly surgical diagnosed glioblastoma were randomly assigned to receive either temozolomide or semustine after radiation treatment. The statuses of TP53 and expression of TP53 and O(6)-methylguanine DNA-methyltransferase (MGMT) were determined retrospectively in tumor tissue from enrolled patients. The primary end point was overall survival. Synthetic small interfering RNA was used to knock down mutant TP53 in T98G and U138 cells, which are human glioblastoma cells with a P53 mutation, by screening of exons 4-8. Viable cell survival was measured when these cells were exposed to temozolomide or semustine. Expression of MGMT at the messenger RNA level was also determined. RESULTS: The overall survival was 34.3 % at 2 years, 22.9 % at 3 years, 11.4 % at 4 years, and 8.6 % at 5 years with temozolomide, versus 18.2, 12.1, 3.0, and 0 %, respectively, with semustine. TP53 mutation and expression of mutant TP53 and MGMT showed significant inverse correlations with overall survival. Knockdown of mutant TP53 led to a fivefold increase in chemosensitivity to temozolomide but not semustine. Mutant TP53 knockdown induced down-regulation of MGMT expression. CONCLUSIONS: Mutant TP53 is strongly associated with a poor prognosis for overall survival in patients with glioblastoma. Also, TP53 mutation may decrease the chemosensitivity of glioblastoma to temozolomide by increasing MGMT expression.

Effectiveness of home-based pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials.

PURPOSE: The pulmonary rehabilitation program has become a cornerstone in the management of patients with chronic obstructive pulmonary disease (COPD). Programs based in hospital and treatment facilities, however, are inconvenient and underutilized. A home-based program is a promising alternative, but studies of its effectiveness have yielded inconsistent results. The purpose of this study is to evaluate the impact of home-based pulmonary rehabilitation programs on health-related quality of life (HRQoL) and other health outcomes in patients with COPD. METHODS: Randomized controlled trials (RCTs) of home-based pulmonary rehabilitation programs published between February 1991 and February 2012 were retrieved from electronic databases (PubMed, Cochrane Library, Science Direct, China National Knowledge Infrastructure [CNKI], and Wanfang Database). Two reviewers independently assessed topical relevance and trial quality, extracted data for meta-analysis using the Review Manager v5.1 software, and contacted the original studies' authors for additional information. FINDINGS: Eighteen trials, comprising 733 randomized patients, were included in the meta-analysis. COPD patients experienced significant relief in dyspnea status, measured by the Borg score (Fixed effects model, WMD = -0.92, 95% CI: -1.61~-0.23, p = .009) and baseline dyspnea index (BDI) (Fixed effects model, WMD = -1.77, 95% CI: -2.65~-0.89, p < .0001) after 12 weeks of home-based intervention. Home-based intervention also improved patients' HRQoL scores, measured by the Chronic Respiratory Questionnaire (CRQ) and St. George's Respiratory Questionnaire (SGRQ) (Fixed effects model, WMD = -11.33, 95% CI: -16.37~-6.29, p < .0001, SGRQ total scores after 12 weeks of intervention); exercise capacity (measured by the 6-minute walking distance test (6MWD) (Fixed effects model, WMD = 35.88, 95% CI: 9.38~62.38, p = .008, after 12 weeks of intervention); and pulmonary functions (measured by forced expiratory volume in one-second/forced vital capacity (FEV1 /FVC) [Random effects model, WMD = -10.72, 95% CI: -15.86~-5.58, p < .0001, after 12 weeks of intervention), as compared with the nonintervention control group; however, no statistically significant changes were seen in maximal workload, hospital admission, cost of care, or mortality between the two groups. CONCLUSIONS AND CLINICAL RELEVANCE: Home-based pulmonary rehabilitation programs represent effective therapeutic intervention approaches for relieving COPD-associated respiratory symptoms and improving HRQoL and exercise capacity. Rigorously designed, large-scale RCTs are still needed to identify an optimal standard home-based pulmonary rehabilitation program.

Mutant TP53 enhances the resistance of glioblastoma cells to temozolomide by up-regulating O(6)-methylguanine DNA-methyltransferase.

The "gain of function" of mutant TP53 is an important determinant in human tumor development and progression. This study aimed to investigate the possible mechanism of mutant TP53 inducing temozolomide resistance in glioblastoma cells. Three established human glioma cell lines, T98G, U87, and U138, were chemoresistant cells. The mRNA of cells was sequenced to confirm the status of TP53. Synthetic small interfering RNA (siRNA) was used to knock down TP53 in cells. TP53 mRNA was detected "silenced" by reverse transcriptase-polymerase chain reaction (RT-PCR) in five consecutive days. Viable cell survival was measured when these cells were exposed to temozolomide or semustine in step-up concentrations. The expression of O(6)-methylguanine DNA-methyltransferase (MGMT) at mRNA level was also determined. T98G, U87, and U138 cells were resistant to temozolomide. T98G and U138 cells expressed mutant-type TP53 with positive MGMT, while U87 cell expressed wild-type TP53 with negative MGMT. TP53-siRNA knocked down TP53 effectively (P = 0.021) in five consecutive days. Knockdown of mutant TP53 in T98G and U138 cells led to a fivefold increase in chemosensitivity to temozolomide, but not semustine. Knockdown of wild TP53 in U87 cell did not affect the chemoresistance. In addition, mutant TP53 knockdown induced a dramatic decrease of MGMT expression (P = 0.0000034). TP53 mutation decreases the chemosensitivity of malignant gliomas to temozolomide. This "gain of function" in drug resistance may be obtained by increasing MGMT expression.

A meta-analysis on the impact of disease-specific education programs on health outcomes for patients with chronic obstructive pulmonary disease.

Disease-specific education programs have become an important factor in the treatment and care of chronic conditions, such as heart failure and diabetes mellitus. However, the effectiveness of these educational methods on chronic obstructive pulmonary disease (COPD) remains unclear. The objective of this meta-analysis was to evaluate whether disease-specific education programs were beneficial to health-related quality of life (HRQoL) variables and other long-term health outcomes in patients with COPD. Using electronic databases (PubMed, Cochrane Library, Science Direct, Chinese Biomedical Data System, China National Knowledge Infrastructure, and Wanfang Database) and individual searches (published and unpublished Chinese studies), we identified 12 randomized controlled trials (RCTs; English and/or Chinese) from 1991 to 2011. A meta-analysis on these studies revealed a positive relationship between disease-specific education programs and HRQoL scores (as measured by the St. George's Respiratory Questionnaire). Moreover, educational programs were associated with increased knowledge about COPD, improved disease management skills, inhaler adherence, and decreased COPD-related emergency department visits and hospital admissions, as well as long-term effects on improving COPD patients' health outcomes. Although significant effects were not detected across all HRQoL variables and health measures, our findings suggest that education programs have the potential to be a valuable intervention for COPD patients. Our results provide a foundation for future research in this area, which we recommend as including more rigorously designed, large, randomized studies.

CT cisternography in intracranial symptomatic arachnoid cysts: classification and treatment.

OBJECTIVES: The symptom and neuroimaging as indications for treating arachnoid cysts (ACs) are not adequate. Understanding the communication between cyst and subarachnoid space is helpful for decision-making. We took a dynamic study of ACs using CT cisternography (CTC) and proposed a classification of arachnoid cysts. MATERIALS AND METHODS: Total 52 symptomatic patients with ACs were enrolled in this prospective study. CTC images were ordered, in all enrolled patients, at the 1, 3, 6, 12, 24 and 48 h after the intrathecal Omnipaque administration. Enhancement in cysts was measured quantitatively and was compared with neighboring subarachnoid spaces. All enrolled patients were allocated randomly in 2 groups. The CTC result was considered before treatment in one group (CTC group), while another group was surgically treated without considering CTC results (surgical group). RESULTS: ACs in our study were classified into 3 types: complete (cyst filling time at 1 h), incomplete (filling time began at 3 h) and noncommunicating cysts (no or slight filling after 24 h). Twenty-two patients in CTC group with incomplete communicating, or noncommunicating cysts underwent surgeries. And other 6 patients with complete communicating cysts were closely observed. In CTC group, the symptom of all surgical patients was relieved, and 5 out of 6 observational patients showed clinical improvement or no deterioration during the follow-up. In surgical group, only 18 out of 24 patients showed clinical improvement after surgeries, and there were 6 patients showing no difference before and after surgeries in symptom and in imaging. CONCLUSIONS: This classification based on dynamic CT cisternography is useful for the decision of surgical indication. Some symptomatic patients with complete communicating ACs may not need surgical intervention.

Iatrogenic false aneurysm caused by surgery of a traumatic intracranial false aneurysm.

A superficial temporal artery (STA) false aneurysm caused by surgery of a traumatic intracranial false aneurysm is reported. A 28-year-old man underwent craniotomy for aneurysm clipping 20 days after traumatic head injury. At surgery the aneurysm was a false aneurysm due to its avulsion from the parent artery without a real neck. A "clip wrapping" technique was used to repair the deficit on the parent artery. On postoperative Day 25, repeat digital subtraction angiogram (DSA) revealed a new right STA aneurysm, which was not apparent in the preoperative DSA. We feel that this aneurysm might have probably resulted from the iatrogenic injury to the STA during the initial surgery as the location of aneurysm was at the initial craniotomy site. The pathophysiology, etiology, surgical treatment and preventive measures of false aneurysms have been discussed.

Surgical management of traumatic intracranial pseudoaneurysms: a report of 12 cases.

AIMS: To investigate the characteristics and surgical treatment of traumatic intracranial pseudoaneurysms. MATERIALS AND METHODS: Twelve patients with traumatic intracranial pseudoaneurysms were operated on in our hospital between 2000 and 2006. Their clinical characteristics, radiological features and surgical techniques were analyzed retrospectively. Four traumatic cavernous segment pseudoaneurysms underwent trapping of the internal carotid artery and others underwent "neck reinforcement and clipping" or "crevasse clipping". RESULTS: Nine patients were excellent or good and two patients were poor when they discharged. One patient died of postoperative cerebral infarction. Nine patients underwent follow-up (three months to seven years) and rebleeding was not seen in them. CONCLUSIONS: The surgical treatment of traumatic intracranial pseudoaneurysms is risky and difficult and individualized surgical option is necessary. Understanding the compensation of intracranial blood circulation, preoperative "Matas test" if it is necessary, perioperative hemodynamics testing and the application of revascularization techniques, will help reduce surgical risk and achieve a good surgical outcome.

[Optimization of SRAP & ISSR technology and its application in the identification of seeds of Brassica oleracea L].

In this study, the molecular marker technology of SRAP and ISSR were applied in rapid identification of seeds from eight species of Brassica oleracea L. Firstly, using the genomic DNA of cabbage as template, SRAP and ISSR reaction systems were optimized through testing every factor, respectively, that affects PCR amplification. Then, using the optimized reaction systems, 30 SRAP primer pairs and 15 ISSR primers were applied to amplify genomic DNA of cabbage, savoy, purple cabbage, borecole, cauliflower, broccoli, Brussels sprouts, and kohlrabi The results showed that high polymorphisms were exhibited among the eight species of Brassica oleracea L. by SRAP primer pairs of M3-E5 and M4-E5, as well as ISSR primers of 844 and 888, especially primer 844 which can identify all eight materials efficiently.