Rehabilitation strategies for trismus post oral cancer treatment: Progress in the study of mouth opening exercises.

Oral cancer is a significant public health issue worldwide. Although its treatment methods effectively control tumor growth, they can lead to complications, including Trismus, severely affecting patients' quality of life. The practice standards for mouth opening exercises, a rehabilitative method to prevent and treat Trismus, are not yet clear. Therefore, this article aims to review the research progress of mouth opening exercises in the rehabilitation of Trismus post oral cancer treatment, providing a scientific and effective rehabilitation plan for oral cancer patients to improve their quality of life.

Social isolation in adults with cancer: An evolutionary concept analysis.

Background: In extant literature, the concept of social isolation has been explored primarily in the context of older adults. However, people with cancer may also experience social isolation, and there is a need for increased clarity regarding this phenomenon in this population. Objective: To conceptualize social isolation in adult cancer care. Methods: PubMed, Web of Science, PsycINFO, CINAHL, China National Knowledge Infrastructure, Wanfang Data, and the Chinese Biomedical Literature Database were systematically searched using the key terms "cancer," "social isolation," "social alienation," and "social exclusion" for studies (from the earliest date available to June 2022). The main disciplines involved were psychology, nursing, medicine, and public health. Rodgers' evolutionary concept analysis was employed to clarify the antecedents, attributes, and consequences of social isolation in adults with cancer. Results: A total of 60 eligible articles were reviewed entirely and the main findings were categorized into antecedents, attributes, and consequences. The antecedents of social isolation were classified into six categories: cancer-related physiological changes, cognitive beliefs, psychological wellbeing, unsatisfactory social supports or relationships, restrictions associated with receiving treatments, and social-level barriers. Attributes were characterized according to behavior or social avoidance and negative affective experiences, while consequences were attributed to low therapeutic compliance, poor health conditions and mental health problems, and low quality of life. White's heuristic model is a potential theoretical context applicable to social isolation in adults with cancer. Conclusion: This concept analysis provides a basis for developing multidimensional assessment tools and measures to alleviate social isolation in adults with cancer, a complex and varied phenomenon. However, while this review contributes to the current knowledge on social isolation in people with cancer, studies should further investigate the relationships among attributes associated with social isolation.

The Effect of Symptom Clusters and Sleep Disorder on Quality of Life among Patients with Chronic Obstructive Pulmonary Disease.

Background: Symptoms (cough, dyspnea, fatigue, depression, and sleep disorder) in chronic obstructive pulmonary disease (COPD) are related to poor quality of life (QOL). Better understanding of the symptom clusters (SCs) and sleep disorder in COPD patients could help to accelerate the development of symptom-management interventions. Objective: We aim to explore the effect of sleep disorder and symptom clusters on the QOL in patients with COPD. Methods: 223 patients with stable COPD from November 2019 to November 2020 at the Affiliated People's Hospital of Ningbo University in China were included in this cross-sectional survey. A demographic and clinical characteristics questionnaire, the Revised Memorial Symptom Assessment Scale (RMSAS), the Pittsburgh Sleep Quality Index (PSQI), and the St George Respiratory Questionnaire for COPD (SGRQ-C) were completed by the patients. Exploratory factor analysis was conducted to extract SCs, and logistic regression analysis was performed to analyze the risk factors affecting QOL. Results: Three clusters were extracted: respiratory functional cluster, emotional cluster, and fatigue-sleep cluster. 70.4% of the participants were poor sleepers. Subgroup analysis showed that COPD patients with poor sleep quality were significantly different in QOL, emotional cluster, and fatigue-sleep cluster compared with patients with normal sleep. In multiple regression, sleep quality and respiratory functional cluster were associated with QOL. Conclusion: In patients with stable COPD, three symptom clusters were explored. Symptom clusters correlate with clinical features and negatively affect QOL. Appropriate interventions are expected to inform future approaches to symptom management. Future studies are needed to test interventions that may be effective at improving the QOL of COPD patients.

Sleep quality and disease activity in patients with inflammatory bowel disease: a systematic review and meta-analysis.

Short sleep or insufficient sleep are significant health concerns among patients with inflammatory bowel disease (IBD). Although an association between sleep quality and disease activity has been reported, findings have been inconsistent. The aim of this systematic review and meta-analysis was to assess the association between sleep quality and disease activity in IBD patients by reviewing findings from cross-sectional and prospective cohort studies. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search was conducted in five electronic databases from inception to May 2020. Studies that examined the relationship between sleep quality and disease activity in IBD patients were screened for eligibility. Six studies were included for the analysis. Sleep quality was measured using subjective questionnaires in six studies and objective methods in three studies. Disease activity was diagnosed following standard guidelines. A significant association between subjective sleep quality and disease activity was observed (pooled OR = 3.52, 95%CI:1.82,6.83, P < 0.001). A significant association between sleep efficiency and disease activity was observed as well (pooled OR = 4.55, 95%CI:1.92,10.75, P = 0.001). Findings from this study indicate that both subjective and objective poor sleep quality were associated with an increased risk for disease activity. Larger studies with an experimental design are warranted to confirm the effects of sleep quality on intestinal pathological changes in IBD patients.

Serum indoxyl sulfate is associated with mortality in hospital-acquired acute kidney injury: a prospective cohort study.

BACKGROUND: Protein-bound uremic toxins are associated with poor outcomes in patients with chronic kidney disease. The aim of this study is to investigate the relationship between indoxyl sulfate (IS), a protein-bound solute, and 90-day mortality in patients with acute kidney injury. METHODS: Adults with hospital-acquired AKI (HA-AKI) were enrolled in this prospective cohort study between 2014 and 2015, according to the KDIGO creatinine criteria. The primary end point was all-cause death during follow-up. RESULTS: The mean serum IS level in patients with HA-AKI was 2.74 ± 0.75 µg/ml, which was higher than that in healthy subjects (1.73 ± 0.11 µg/ml, P < 0.001) and critically ill patients (2.46 ± 0.35 µg/ml, P = 0.016) but was lower than that in patients with chronic kidney disease (3.07 ± 0.31 µg/ml, P < 0.001). Furthermore, serum IS levels (2.83 ± 0.55 µg/ml) remained elevated in patients with HA-AKI on the seventh day after AKI diagnosis. Patients with HA-AKI were divided into the following two groups according to the median serum IS level: the low-IS group and the high-IS group. A total of 94 (35.9%) patient deaths occurred within 90 days, including 76 (29.0%) in the low-IS group and 112 (42.7%) in the high-IS group (P = 0.019). Kaplan-Meier analysis revealed that the two groups differed significantly with respect to 90-day survival (log-rank P = 0.007), and Cox regression analysis showed that an IS level ≥ 2.74 µg/ml was significantly associated with a 2.0-fold increased risk of death (adjusted hazard ratio [HR], 2.92; 95% confidence interval [CI], 1.76 to 4.86; P < 0.001) compared with an IS level < 2.74 µg/ml. CONCLUSIONS: Serum IS levels were significantly elevated in patients with HA-AKI compared to those in healthy subjects and critically ill patients and were associated with a worse prognosis of HA-AKI. TRIAL REGISTRATION: www.clinicaltrials.gov NCT 00953992. Registered 6 August 2009.

Calcium supplementation in CVVH using regional citrate anticoagulation.

INTRODUCTION: Calcium supplementation is one of the most important factors in maintaining the safety and efficacy of regional citrate anticoagulation (RCA) during continuous renal replacement therapy (CRRT). The aims of this study were to assess the determinants of calcium requirements in RCA-CVVH and to simplify the calcium supplementation approach. METHODS: Our study consisted of two parts. The first part was a discovery phase to determine the key factors of calcium supplementation. Twenty critically ill patients who required RCA-CVVH were enrolled in this part. Systemic citrate, total calcium, protein-bound calcium, and ionized calcium concentrations were serially measured using the traditional RCA protocol. A two-phase calcium supplementation protocol was then proposed, and algorithms were developed for calcium supplementation. The second part of the study was the validation phase. Another 97 critically ill patients were enrolled and were treated with RCA-CVVH using the new version of the calcium supplementation protocol. FINDINGS: The loss of calcium flux in the extracorporeal circuit and the increase in citrate-calcium complexes in vivo were the main determinants of the required calcium supplementation. In the CVVH mode, the rate of calcium infusion had to be reduced after systemic citrate level reached a steady state. With the aid of mathematical models, systemic calcium levels could be stably maintained in the normal range, and the frequencies of calcium monitoring were reduced. DISCUSSION: Calcium supplementation during RCA-CVVH undergoes two phases. We propose mathematical models to quantify the need for calcium supplementation, which enable individualization of the RCA prescription and simplify the management of RCA in the CVVH mode.

Predialysis fluid overload linked with quality of sleep in patients undergoing hemodialysis.

OBJECTIVE: Hemodialysis (HD) patients are exposed to dysregulated fluid balance which can lead to overhydration. Poor sleep quality and excessive daytime sleepiness are particularly common in these patients, however the relationship between fluid status and sleep quality and daytime sleepiness has not yet been studied. Therefore, the aim of this study is to evaluate the correlations between fluid status and sleep quality and daytime sleepiness in HD patients. METHOD: This cross-sectional study included 115 HD patients and 30 healthy control subjects from the HD center of Shanghai Ninth People's Hospital. Fluid compartments [total body water (TBW)], extracellular water (ECW)] and overhydration index (OH) were analyzed by multifrequency bio-impedance (BCM). Overhydration was defined as OH/ECW≥7%. HD patients were divided into an overhydration group and non overhydration group according to OH/ECW. Sleep quality was assessed by the Chinese version of the Pittsburgh Sleep Quality Index (PSQI), and excessive daytime sleepiness was evaluated by the Epworth Sleepiness Scale (ESS). RESULTS: The prevalence rate of fluid overload in HD patients was 65.2%. Poor sleep quality (PSQI≥5) and excessive daytime sleepiness (ESS≥11) were significantly higher in HD patients compared with the healthy controls [6 (3, 10) vs.2.11 ± 1.59, p = 0.000; 3 (0, 6) vs.1.68 ± 1.07, p = 0.045]. Furthermore, the PSQI scores were higher in HD patients with overhydration (7.8 ± 4.5 vs. 4.8 ± 3.2, p = 0.000). The component scores 1, 2, 3 and 5 of the PSQI showed significant differences between the overhydration and non overhydration groups. The ESS scores did not show differences between the two groups (3.9 ± 4.1 vs. 3.3 ± 3.5, p = 0.508). OH was correlated with Systolic BP and Diastolic BP, and additionally was an independent predictor of poor sleep quality. CONCLUSION: Fluid overload is significantly linked with poor quality of sleep in HD patients, however there is no association with excessive daytime sleepiness. Our study provides new insight into possible treatment strategies. Future studies should examine the effects of optimizing fluid status on quality of sleep.

Albumin-corrected total/ionized calcium ratio is not superior to total/ionized calcium ratio as an indicator of citrate accumulation.

BACKGROUND: Total/ionized calcium ratio has been used as an indirect index of increased plasma citrate concentration during citrate anticoagulation. However, they were obtained without any adjustment of total calcium for albumin. Herein, we investigated whether the albumin-corrected total/ionized calcium ratio performed better than total/ionized calcium ratio. METHODS: 20 critically ill patients were treated with continuous venovenous hemofiltration (CVVH) using citrate anticoagulation. The systemic total, ionized calcium and albumin levels were dynamically measured, and correlations between different calcium parameters and plasma citrate levels were analyzed. RESULTS: The highest correlation was found between plasma citrate level and total/ionized calcium ratio at the third hour (R = 0.88, p<0.001). The albumin-corrected total/ionized calcium ratio was not superior to total/ionized calcium ratio. CONCLUSIONS: The total/ionized calcium ratio at the third hour after the start of citrate-CVVH is an early and simple indicator to reflect increased plasma citrate level. Adjustment of systemic total calcium for serum albumin is not necessary.

Serum prealbumin and its changes over time are associated with mortality in acute kidney injury.

Serum prealbumin is a clinically relevant indicator of nutritional status and inflammation in patients with acute kidney injury (AKI). This study aimed to determine whether serum prealbumin and its longitudinal changes over a week could improve the prediction of 90-day mortality in AKI patients. This prospective cohort study included 340 adults with AKI between 2014 and 2015. There were 94 (27.6%) patient deaths within 90 days. Serum prealbumin level <10 mg/dL at the time of AKI diagnosis was associated with a 155% increased death risk ratio (adjusted hazard ratio [HR], 2.55; 95% confidence interval [CI], 1.18 to 5.49; P = 0.02). Serum prealbumin fall >4 mg/dL was also associated with 90-day mortality in adjusted Cox regression models (HR, 1.79; 95% CI, 1.06 to 3.03; P = 0.03). Compared to serum albumin, mortality-predictability of serum prealbumin (P = 0.01) and its changes (P = 0.01) were both increased. Adding prealbumin and its changes on the conventional covariates improved the prediction of progression to 90-day mortality (NRI 0.29, P = 0.04; aIDI 0.08; P = 0.03). In conclusion, serum prealbumin, and its changes were independent predictors of worse prognosis in AKI, and could be potential surrogates to better predict 90-day mortality.

[Establishment of an evidence-based protocol for tracheotomy care in adult patients].

PURPOSE: To establish a clinical practice protocol for tracheotomy care of adult patients. METHODS: Though constructive document retrieval, personnel interview and brain-storming, protocol draft was constructed. Delphi method was used in the study, and the final protocol was based on two rounds of consultation among 15 experts from 10 tertiary general hospitals. SPSS 16.0 software package was used for statistical analysis. RESULTS: The effective rates of two rounds of questionnaire were 100% and 93.3%, the authority coefficient was 0.83, and the P value of expert coordination coefficients W was less than 0.05. The final evidence-based protocol for tracheotomy care in adult patients consists of 5 sections, 16 dimensions and 61 items. CONCLUSIONS: The evidence-based tracheotomy care protocol was combined with Chinese clinical status and experts' opinion. The protocol was scientific and credible, which may play an important role in clinical practice.

Serum Protein Thiol Levels in Patients with Hospital-Acquired Acute Kidney Injury.

BACKGROUND/AIMS: This study aimed to examine antioxidants in patients with acute kidney injury (AKI) and determine whether serum protein thiol levels are associated with all-cause 90-day mortality in patients with hospital-acquired AKI. METHODS: According to the RIFLE criteria, 160 patients with hospital-acquired AKI were enrolled in our prospective cohort study. As controls, 72 critically ill patients without AKI and 72 age and sex-matched healthy subjects were also recruited. Serum protein thiol levels were analyzed in relation to all-cause mortality of patients with AKI. RESULTS: Serum protein thiol levels in AKI patients were lower than those in healthy people (p=0.010). Protein thiol levels showed a weak but significant positive correlation with serum albumin levels. The 90-day overall mortality rate was higher in AKI patients with high serum protein thiol levels than in those with low levels (p=0.032 by log rank test). In multivariate analysis (Cox regression), serum protein thiol levels (p=0.031) were independently associated with 90-day overall mortality after adjustment for age, sex, sepsis, and the Acute Physiology and Chronic Health Evaluation II score. CONCLUSIONS: Patients with hospital-acquired AKI have remarkably low serum protein thiol levels. Elevated protein thiol levels are associated with 90-day overall mortality in hospital-acquired AKI.