Prognosis value of heat-shock proteins in esophageal and esophagogastric cancer: A systematic review and meta-analysis.

BACKGROUND: Heat shock proteins (HSPs) are molecular chaperones that play an important role in cellular protection against stress events and have been reported to be overexpressed in many cancers. The prognostic significance of HSPs and their regulatory factors, such as heat shock factor 1 (HSF1) and CHIP, are poorly understood. AIM: To investigate the relationship between HSP expression and prognosis in esophageal and esophagogastric cancer. METHODS: A systematic review was conducted in accordance with PRISMA recommendations (PROSPERO: CRD42022370653), on Embase, PubMed, Cochrane, and LILACS. Cohort, case-control, and cross-sectional studies of patients with esophagus or esophagogastric cancer were included. HSP-positive patients were compared with HSP-negative, and the endpoints analyzed were lymph node metastasis, tumor depth, distant metastasis, and overall survival (OS). HSPs were stratified according to the HSP family, and the summary risk difference (RD) was calculated using a random-effect model. RESULTS: The final selection comprised 27 studies, including esophageal squamous cell carcinoma (21), esophagogastric adenocarcinoma (5), and mixed neoplasms (1). The pooled sample size was 3465 patients. HSP40 and 60 were associated with a higher 3-year OS [HSP40: RD = 0.22; 95% confidence interval (CI): 0.09-0.35; HSP60: RD = 0.33; 95%CI: 0.17-0.50], while HSF1 was associated with a poor 3-year OS (RD = -0.22; 95%CI: -0.32 to -0.12). The other HSP families were not associated with long-term survival. HSF1 was associated with a higher probability of lymph node metastasis (RD = -0.16; 95%CI: -0.29 to -0.04). HSP40 was associated with a lower probability of lymph node dissemination (RD = 0.18; 95%CI: 0.03-0.33). The expression of other HSP families was not significantly related to tumor depth and lymph node or distant metastasis. CONCLUSION: The expression levels of certain families of HSP, such as HSP40 and 60 and HSF1, are associated with long-term survival and lymph node dissemination in patients with esophageal and esophagogastric cancer.

The impact of sarcopenia on esophagectomy for cancer: a systematic review and meta-analysis.

BACKGROUND: Esophagectomy is the gold-standard treatment for locally advanced esophageal cancer but has high morbimortality rates. Sarcopenia is a common comorbidity in cancer patients. The exact burden of sarcopenia in esophagectomy outcomes remains unclear. Therefore, this systematic review and meta-analysis were performed to establish the impact of sarcopenia on postoperative outcomes of esophagectomy for cancer. METHODS: We performed a systematic review and meta-analysis comparing sarcopenic with non-sarcopenic patients before esophagectomy for cancer (Registration number: CRD42021270332). An electronic search was conducted on Embase, PubMed, Cochrane, and LILACS, alongside a manual search of the references. The inclusion criteria were cohorts, case series, and clinical trials; adult patients; studies evaluating patients with sarcopenia undergoing esophagectomy or gastroesophagectomy for cancer; and studies that analyze relevant outcomes. The exclusion criteria were letters, editorials, congress abstracts, case reports, reviews, cross-sectional studies, patients undergoing surgery for benign conditions, and animal studies. The meta-analysis was synthesized with forest plots. RESULTS: The meta-analysis included 40 studies. Sarcopenia was significantly associated with increased postoperative complications (RD: 0.08; 95% CI: 0.02 to 0.14), severe complications (RD: 0.11; 95% CI: 0.04 to 0.19), and pneumonia (RD: 0.13; 95% CI: 0.09 to 0.18). Patients with sarcopenia had a lower probability of survival at a 3-year follow-up (RD: -0.16; 95% CI: -0.23 to -0.10). CONCLUSION: Preoperative sarcopenia imposes a higher risk for overall complications and severe complications. Besides, patients with sarcopenia had a lower chance of long-term survival.

Jehovah's Witness Patients: Interventions for Successful Stem Cell Transplantation Without Blood Product Transfusions for Hematologic Malignancies.

BACKGROUND: Jehovah's Witnesses are members of a religion that prohibits them from accepting blood product transfusions. This refusal makes them a particularly compelling population in the context of hematologic malignancies and stem cell transplantation, because blood product transfusions are a mainstay of supportive treatment. OBJECTIVES: This article presents preventive and supportive measures allowing Jehovah's Witness patients the opportunity to receive a stem cell transplantation without blood product transfusions. METHODS: A literature review was done that included evidence focusing on optimizing hematopoiesis, blood loss prevention, alterations in chemotherapy regimens, and implications for nursing practice. FINDINGS: With proper preventive and supportive care measures, Jehovah's Witness patients can receive stem cell transplantations for hematologic malignancies without blood product transfusions.

Stem cell-based growth, regeneration, and remodeling of the planarian intestine.

Although some animals are capable of regenerating organs, the mechanisms by which this is achieved are poorly understood. In planarians, pluripotent somatic stem cells called neoblasts supply new cells for growth, replenish tissues in response to cellular turnover, and regenerate tissues after injury. For most tissues and organs, however, the spatiotemporal dynamics of stem cell differentiation and the fate of tissue that existed prior to injury have not been characterized systematically. Utilizing in vivo imaging and bromodeoxyuridine pulse-chase experiments, we have analyzed growth and regeneration of the planarian intestine, the organ responsible for digestion and nutrient distribution. During growth, we observe that new gut branches are added along the entire anteroposterior axis. We find that new enterocytes differentiate throughout the intestine rather than in specific growth zones, suggesting that branching morphogenesis is achieved primarily by remodeling of differentiated intestinal tissues. During regeneration, we also demonstrate a previously unappreciated degree of intestinal remodeling, in which pre-existing posterior gut tissue contributes extensively to the newly formed anterior gut, and vice versa. By contrast to growing animals, differentiation of new intestinal cells occurs at preferential locations, including within newly generated tissue (the blastema), and along pre-existing intestinal branches undergoing remodeling. Our results indicate that growth and regeneration of the planarian intestine are achieved by co-ordinated differentiation of stem cells and the remodeling of pre-existing tissues. Elucidation of the mechanisms by which these processes are integrated will be critical for understanding organogenesis in a post-embryonic context.

Identifying patients in financial need: cancer care providers' perceptions of barriers.

Some eligible patients with financial hardship may not be referred to assistance programs because cancer care providers do not know the full extent of patients' needs. This article describes barriers cancer care providers face in identifying patients who have financial concerns by using qualitative data from 21 interviews with providers from one Canadian province. Interviews were audio recorded, transcribed verbatim, and analyzed with a thematic approach. Four major themes emerged: no standardized approach existed for assessing needs, family members rather than patients may have better awareness of financial concerns, patients may not be forthcoming about financial concerns, and financial concerns may change over time. Adopting a standardized assessment protocol that routinely screens patients at multiple times during their care, educating patients about out-of-pocket costs, and educating providers to identify and assess financial need may enable more patients to access available financial resources. Although the Canadian and U.S. healthcare systems are different, concerns about out-of-pocket costs may be similar.

Women's decisions about maternal serum screening testing: a qualitative study exploring what they learn and the role prenatal care providers play.

BACKGROUND: Maternal serum screening (MSS) is a blood screening test that detects fetuses with an increased risk for open neural tube defects, Down syndrome and Trisomy 18. Although most physicians offer MSS to their patients, discussions about the test are brief, usually lasting less than 5min. RESEARCH PROBLEM: The short duration of these discussions raises questions about the quality of information women receive and whether their screening decisions were well informed. This article describes what women learn about MSS and from which sources, and the role of their physician in their decision to have MSS. PARTICIPANTS AND METHODS: We conducted qualitative interviews with nine pregnant women from Newfoundland and Labrador. Interviews were recorded, transcribed verbatim, and analyzed using thematic coding. MAIN FINDINGS: Women rely on multiple sources of information to learn about MSS, including prenatal health care workers, the Internet, and other mothers. Although physicians are influential in women's MSS decisions, they may not provide vital information about options in the event of a positive test. DISCUSSION: Unlike the scientific and medical communities which place greater value on rigorous, peer-previewed evidence based on research, women place greater value on information gleaned from more informal, accessible sources such as family, friends and the Internet. Prenatal care providers can aid women by directing them to credible sources of information and engaging in timely discussions about MSS. CONCLUSIONS: Understanding where women learn about MSS and how they make their decisions about testing sheds important light on the roles prenatal care providers should play.

Why do women choose or decline maternal serum screening?

OBJECTIVE: In Newfoundland and Labrador (NL), maternal serum screening (MSS) is offered during the second trimester of pregnancy to detect fetuses with an increased risk for a birth defect. A recent study of MSS found low uptake (22%) in the province. We surveyed postpartum women in NL to (1) determine where women learn about MSS, (2) understand women's reasons for having or refusing MSS, and (3) describe women's process of decision-making about MSS. METHODS: We surveyed postpartum women throughout NL to learn where women found out about MSS, whether or not they had MSS and why, and how they made their decision about MSS. RESULTS: Almost one fifth of mothers were unaware of MSS. Approximately one third (34.6%) of women who had heard of MSS had undergone screening in their most recent pregnancy. Common reasons for having MSS were a desire to undergo all available testing and wanting to know about the health of the baby. Common reasons for not undergoing MSS were opposition to terminating the pregnancy and feeling that the results would not be definitive. CONCLUSION: A majority of pregnant women in NL do not want MSS. Women's personal values influence their MSS decisions and account for the low utilization rates in the province.

Internet-based interventions have potential to affect short-term mediators and indicators of dietary behavior of young adults.

OBJECTIVE: Evaluate a theory-based, Internet-delivered nutrition education module. DESIGN: Randomized, treatment-control design with pre-post intervention assessments. SETTING AND PARTICIPANTS: Convenience sample of 160 young adults (aged 18-24) recruited by community educators in 4 states. Study completers (n = 96) included a mix of racial/ethnic groups and family demographics, but were predominately white females without children. INTERVENTION: A Transtheoretical Model (TTM)-based, stage-tailored Internet program, F&V (Fruit & Vegetable) Express Bites, was delivered to treatment group participants; controls received nontailored messages in a comparable format. MAIN OUTCOME MEASURES AND ANALYSIS: TTM constructs at baseline, immediately postviewing, and at 30-day follow-up were compared via chi-square, McNemar's test, and logistic regression. Qualitative use and acceptability indicators were collected postviewing (treatment only). RESULTS: Of baseline respondents, 86.5% completed the study. At follow-up, self-efficacy, decisional balance, and selected processes improved for both groups, with only marginal advantages for the theory-based version. Fruit and vegetable consumption changes were similar for both groups. Qualitative measures of knowledge, confidence, and motivation improved (not measured for controls). Favorable ratings of treatment program acceptability and personal relevance were reported. CONCLUSIONS AND IMPLICATIONS: The Internet is a favorable option for reaching young adults with nutrition messages. This study did not identify strong advantages of theory-based tailoring, especially for fruit consumption, which had weaker barriers than vegetable consumption among this target audience.

The contribution of Memorial University's medical school to rural physician supply.

INTRODUCTION: This study identifies the characteristics and predictors of Memorial University of Newfoundland (MUN) medical graduates working in rural Canada and rural Newfoundland and Labrador (NL). METHODS: We linked data from class lists, the alumni and postgraduate databases with the Southam Medical database to determine 2004 practice locations for MUN graduates from 1973 to 1998 (26 yr, inclusive). Multiple logistic regression was used to identify predictors for each outcome. RESULTS: In 2004, 167 (12.6%) MUN graduates worked in rural Canada and 81 (6.1%) MUN graduates worked in rural NL. Those who were more likely to practise in rural Canada (when compared with graduates from urban backgrounds, those who had not done any residency training at MUN or specialists, respectively) were graduates from a rural background (odds ratio [OR] 1.95, 95% confidence interval [CI] 1.38-2.76), those who had done residency training at MUN (OR 1.56, 95% CI 1.06-2.29) and family physicians (FPs)-general practitioners (GPs) (OR 6.64, 95% CI 4.31-10.23). Those who were more likely to practise in rural NL (when compared with graduates from urban backgrounds, those who had not done any residency training at MUN, specialists or non-Newfoundlanders, respectively) were graduates from a rural background (OR 2.54, 95% CI 1.57-4.11), those who had done residency training at MUN (OR 4.12, 95% CI 1.94-8.76), FP-GPs (OR 6.39, 95% CI 3.39-12.05) and Newfoundlanders (OR 7.01, 95% CI 2.16-22.71). CONCLUSION: The MUN medical school has made a substantial contribution to rural physician supply in both NL and Canada. Increasing the number of local rural students as well as providing incentives to graduates to complete postgraduate training in family medicine in the province may increase the number of locally trained rural physicians.

Increasing public and provider knowledge of lymphedema: evaluation of the lymphedema roadshow.

BACKGROUND: In this pilot study, we evaluated the Lymphedema Roadshow's capacity to increase public and provider awareness of postcancer lymphedema. METHODS: Participants completed preworkshop and postworkshop surveys to determine if the intervention changed their attitudes and knowledge of postcancer lymphedema. RESULTS: The workshop significantly increased 6 of 8 knowledge scores and 2 of 6 attitude scores among public participants and 7 of 8 knowledge scores and 5 of 6 attitude scores among health care providers. CONCLUSIONS: The Lymphedema Roadshow identified and addressed the public's and health care providers' need for greater awareness of postcancer lymphedema.

Retention of international medical graduates following postgraduate medical training in newfoundland and labrador.

We linked the Memorial University of Newfoundland (MUN) postgraduate database with Scott's Medical Database to determine 2004 work locations of physicians who started residency training at MUN by 1998 to assess whether international medical graduates (IMGs) are as likely as MUN and other Canadian medical graduates (CMGs) to work in Canada and Newfoundland and Labrador (NL). In 2004, 66.8% of the residents were in Canada (87.8% MUN graduates, 47.3% IMGs, 67.3% CMGs) and 18.8% were in NL (43.2% MUN graduates, 7.9% IMGs, 4.8% CMGs). Compared to MUN medical graduates, IMGs and CMGs were less likely to work in Canada and NL.

National and provincial retention of medical graduates of Memorial University of Newfoundland.

BACKGROUND: Memorial University of Newfoundland (MUN) established its medical school in 1967 to meet the growing demand for physicians and alleviate the reliance on other Canadian and international medical schools for physicians. However, it is unclear how many of the graduates remained to practise in Canada and in Newfoundland and Labrador (NL). We conducted this study to identify the characteristics and predictors of MUN medical graduates working in Canada and NL after residency training. METHODS: We linked data from class lists, and alumni and postgraduate databases with data from the Southam Medical Database to determine 2004 practice locations for MUN graduates from 1973 to 1998. Multiple logistic regression analysis was used to identify predictors for working in Canada and in NL. RESULTS: Of the 1322 MUN graduates in our study, 1147 (86.8%) were working in Canada and 406 (30.7%) in NL in 2004. Predictors of physicians working in Canada included female sex (odds ratio [OR] 1.44, 95% confidence interval [CI] 1.01-2.04), being from Canada (OR 3.71, 95% CI 1.15-2.21), graduating in the 1980s (OR 1.52, 95% CI 1.02-2.24) and 1990s (OR 2.01, 95% CI 1.31-3.09) and having done some or all residency training at MUN (OR 1.59, 95% CI 1.53-9.01). Predictors of physicians working in NL included having a rural background (OR 1.37, 95% CI 1.04-1.81), being from NL (OR 9.23, 95% CI 5.52-15.44) and having done some or all residency training at MUN (OR 5.28, 95% CI 3.80-7.34). INTERPRETATION: The MUN medical school has made a substantial contribution to the local physician supply, producing over half the physicians working in the province in 2004. Initiatives to increase national and provincial retention of medical graduates include attracting rural students to medical careers, increasing admission of local students and providing incentives for graduates to complete their residency training in the province.

The role of dsbA in colonization of the wheat rhizosphere by Pseudomonas fluorescens Q8r1-96.

Certain well-conserved genes in fluorescent Pseudomonas spp. are involved in pathogenic interactions between the bacteria and evolutionarily diverse hosts including plants, insects and vertebrate animals. One such gene, dsbA, encodes a periplasmic disulfide-bond-forming enzyme implicated in the biogenesis of exported proteins and cell surface structures. This study focused on the role of dsbA in Pseudomonas fluorescens Q8r1-96, a biological control strain that produces the antibiotic 2,4-diacetylphloroglucinol (2,4-DAPG) and is known for its exceptional ability to colonize the roots of wheat and pea. The deduced DsbA protein from Q8r1-96 is similar to other predicted thiol : disulfide interchange proteins and contains a conserved DsbA catalytic site, a pattern associated with the thioredoxin family active site, and a signal peptide and cleavage site. A dsbA mutant of Q8r1-96 exhibited decreased motility and fluorescence, and altered colony morphology; however, it produced more 2,4-DAPG and total phloroglucinol-related compounds and was more inhibitory in vitro to the fungal root pathogen Gaeumannomyces graminis var. tritici than was the parental strain. When introduced separately into a natural soil, Q8r1-96 and the dsbA mutant did not differ in their ability to colonize the rhizosphere of wheat in greenhouse experiments lasting 12 weeks. However, when the two strains were co-inoculated, the parental strain consistently out-competed the dsbA mutant. It was concluded that dsbA does not contribute to the exceptional rhizosphere competence of Q8r1-96, although the dsbA mutation reduces competitiveness when the mutant competes with the parental strain in the same niche in the rhizosphere. The results also suggest that exoenzymes and multimeric cell surface structures are unlikely to have a critical role in root colonization by this strain.