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Aim: This study aimed to analyse the effects of servant leadership on nurses' emotional failure and compliance with standard precautions and to explore the moderating effect of individual resilience. Design: A cross‐sectional survey. Methods: This descriptive cross‐sectional study was conducted from October 9 to November 1, 2022. The convenience sampling method was used to collect questionnaire data from 924 clinical nurses in a third‐class general hospital in Chongqing, China. Results: The emotional exhaustion and compliance with standard precautions were at the general level. Servant leadership mediated by emotional exhaustion had a significant positive predictive effect on compliance with standard precautions. Personal resilience played a negative moderating role in the relationship between servant leadership and emotional exhaustion. For nurses with low resilience, servant leadership had a greater impact on emotional exhaustion. Conclusion: The current compliance with standard precautions for clinical nurses is not high due to emotional exhaustion. The level of servant leadership can alleviate nurses' emotional exhaustion and improve compliance with standard precautions. Especially for nurses with low personal resilience, the care and support of department leaders are needed. Impact: We found that the compliance with standard precautions is not high, and the link between emotional exhaustion, servant leadership and compliance with standard precautions provides a basis for further patient care. No Patient or Public Contribution: There was no patient or public involvement. Impact Statement: Nurses are the key population for hospital infection prevention and control, and their level of compliance with standard precautions is of great significance for hospital infection prevention and control. However, in practice, nurses' compliance with standard precautions is generally low. Most of the previous studies on nurses' compliance with standard precautions were conducted from the perspective of individual nurses, based on the staff's 'knowledge, belief, and action' to study the current status of compliance with standard precautions and the factors affecting adherence, with less attention paid to the influence of psychological, environmental, and organizational factors. Therefore, the study focuses on the impact of servant leadership and emotional exhaustion on standard precautionary adherence, which is of great significance for good care management at the organizational level. It also explored how the impact of servant leadership on emotional exhaustion varies across levels of resilience, which is important for accurately identifying different types of nursing staff and targeting assistance. [ABSTRACT FROM AUTHOR]

Objective: To provide comprehensive evidence for the anti-cancer cachexia effect of Jianpi Decoction (JP) and to explore its mechanism of anti-cancer cachexia. Methods: A mouse model of colon cancer (CT26)-induced cancer cachexia (CC) was used to investigate the anti-CC effect of JP combined with medroxyprogesterone acetate (MPA). Thirty-six mice were equally divided into 6 groups: normal control, CC, MPA (100 mg•kg−1•d−1), MPA + low-dose (20 mg•kg−1•d−1) JP (L-JP), MPA + medium-dose (30 mg•kg−1•d−1) JP (M-JP), and MPA + high-dose (40 mg•kg−1•d−1) JP (H-JP) groups. After successful modeling, the mice were administered by gavage for 11 d. The body weight and tumor volume were measured and recorded every 2 d starting on the 8th day after implantation. The liver, heart, spleen, lung, kidney, tumor and gastrocnemius muscle of mice were collected and weighed. The pathological changes of the tumor was observed, and the cross-sectional area of the gastrocnemius muscle was calculated. The protein expressions of STAT3 and E3 ubiquitinase in the gastrocnemius muscle were measured by Western blot. In addition, an in vitro C2C12 myotube formation model was established to investigate the role of JP in hindering dexamethasone-induced muscle atrophy. In vitro experiments were divided into control, model, and JP serum groups. After 2-d administration, microscopic photographs were taken and myotube diameters were calculated. Western blot was performed to measure the protein expressions of STAT3 and E3 ubiquitinase. Results: JP combined with MPA restored tumor-induced weight loss (P<0.05, vs. CC) and muscle fiber size (P<0.01, vs. CC). Mechanistically, JP reduced the expression of atrophy-related proteins MuRF1 and MAFbx in tumor-induced muscle atrophy in vivo (P<0.05, vs. CC). In addition, JP reduced the expression of atrophy-related proteins MuRF1 and MAFbx and p-STAT3 phosphorylation (P<0.05 or P<0.01 vs. model group) in C2C12 myotubes treated with dexamethasone in vitro. Conclusions: Administration of JP combined with MPA restores tumor-induced cachexia conditions. In addition, the profound effect of JP combined with MPA on tumor-induced cachexia may be due to its inhibition of muscle proteolysis (E3 ubiquitinase system). [ABSTRACT FROM AUTHOR]

Background: As a primary form of work-related violence in the healthcare sector, patient mistreatment negatively impacts nurses' well-being. To date, there has yet reached a definitive conclusion on the mediating mechanism and boundary conditions behind the influence of patient mistreatment on nurses' emotional exhaustion. Methods: This study employed a convenience sampling method to recruit a sample of 1672 nurses from public hospitals in Western China. The data were collected through anonymous self-report questionnaires and analyzed using hierarchical regression and conditional processes to investigate a theoretical framework encompassing patient mistreatment, emotional exhaustion, social sharing of negative events, organizational support, and trait resilience. Results: Patient mistreatment led to emotional exhaustion among nurses (β = 0.625, p <.001), and social sharing of negative events mediated this positive relationship (effect = 0.073, SE = 0.013). The combined effects of organizational support and resilience moderated the mediating effect of the social sharing of negative events between patient mistreatment and emotional exhaustion (β=-0.051, p <.05). Specifically, nurses with a high level of resilience would benefit from organizational support to alleviate emotional exhaustion caused by patient mistreatment. Conclusions: This study validated a significant positive association between patient mistreatment and emotional exhaustion, which aligns with previous research findings. Integrating conservation of resources theory and goal progress theory, we addressed previous contradictory findings on the impact of social sharing of negative events on emotional exhaustion. Social sharing of negative events served as a mediator between patient mistreatment and emotional exhaustion. Additionally, the moderating effect of organizational support on the relationship between social sharing of negative events and emotional exhaustion depended on individual trait of resilience. [ABSTRACT FROM AUTHOR]

To systematically evaluate the effects of a fast‐track recovery programme on perioperative wound infections and postoperative complications in patients undergoing biliary tone surgery, we conducted a comprehensive search of PubMed, Web of Science, Cochrane Library, Embase, China Biomedical Literature Database, Wanfang and China National Knowledge Infrastructure databases from inception to 29 September 2023 for randomised controlled trials (RCTs) focusing on the application of a fast‐track recovery programme in patients undergoing biliary stone surgery. Two researchers independently screened and evaluated the studies based on predefined inclusion and exclusion criteria, and data were subsequently extracted from the included studies. Stata software (version 17.0) was employed for data analysis. Overall, 19 RCTs involving 2363 patients were included, with 1178 patients allocated to the fast‐track recovery programme group and 1185 to the conventional care group. The results revealed a significantly lower occurrence of wound infection (3.74% vs. 9.45%, OR = 0.36, 95% CI: 0.25–0.51, p < 0.001) and postoperative complications (11.38% vs. 27.34%, OR = 0.31, 95% CI: 0.25–0.39, p < 0.001) in the fast‐track recovery programme group compared to the conventional care group. The available evidence supports the assertion that implementing a fast‐track recovery programme in the perioperative period of patients undergoing biliary stone surgery effectively reduces the incidence of wound infections and postoperative complications while facilitating postoperative recovery. [ABSTRACT FROM AUTHOR]

Background: Fangcang shelter hospitals have played an important role in the battle against the COVID-19 epidemic in China. Patients' verbal and physical attacks on medical workforce are prone to occur in such hospitals. This study explored the impacts of patient mistreatment on healthcare workers' role behaviors (service performance and patient-oriented organizational citizenship behavior). Methods: We examined the influence of patient mistreatment on service performance and patient-oriented organizational citizenship behavior, as well as the mediating effect of emotional exhaustion and the moderating effect of displaced aggression by patients, using hierarchical linear regression and conditional process analysis. Results: Patient mistreatment was positively associated with emotional exhaustion among healthcare workers, while emotional exhaustion was negatively associated with service performance and patient-oriented organizational citizenship behavior. Mediation analysis revealed that emotional exhaustion mediated the association between patient mistreatment and both types of role behaviors. Moderated mediation analysis found that the mediation effect was weaker when the displaced aggression by patients was high. Conclusions: The findings clarified the relationship among patient mistreatment, emotional exhaustion, service performance, and patient-oriented organizational citizenship behavior. Additional assistance should be provided to healthcare workers dealing with patient mistreatment. Displaced aggression by patients attenuates the positive effects of patient mistreatment on the emotional exhaustion of healthcare workers. Our findings reveal the mechanism and boundary conditions of patient mistreatment affecting healthcare workers' service performance and patient-oriented organizational citizenship behavior. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is a systemic bone disease which can increase the risk of osteoporotic fractures. Dual-energy X-ray absorptiometry (DXA) is considered as the clinical standard for diagnosing osteoporosis by detecting the bone mineral density (BMD) in patients, but it has flaws in distinguishing between calcification and other degenerative diseases, thus leading to inaccurate BMD levels in subjects. Mindways quantitative computed tomography (Mindways QCT) is a classical QCT system. Similar to DXA, Mindways QCT can directly present the density of trabecular bone, vascular or tissue calcification; therefore, it is more accurate and sensitive than DXA and has been widely applied in clinic to evaluate osteoporosis. iCare QCT osteodensitometry was a new phantom-based QCT system, recently developed by iCare Inc. (China). It has been gradually applied in clinic by its superiority of taking 3-dimensional BMD of bone and converting BMD values to T value automatically. This study aimed at evaluating the osteoporosis detection rate of iCare QCT, compared with synchronous Mindways QCT (USA). Methods: In this study, 131 patients who underwent hip phantom-based CT scan were included. Bone mineral density (BMD) of the unified region of interests (ROI) defined at the European spine phantom (ESP, German QRM) including L1 (low), L2 (medium), and L3 (high) vertebral bodies was detected for QCT quality control and horizontal calibration. Every ESP scan were taken for 10 times, and the mean BMD values measured by iCare QCT and Mindways QCT were compared. Hip CT scan was conducted with ESP as calibration individually. T-scores gained from iCare QCT and Mindways QCT were analyzed with Pearson correlation test. The detection rates of osteoporosis were compared between iCare QCT and Mindways QCT. The unified region of interests (ROI) was delineated in the QCT software. Results: The results showed that there was no significant difference between iCare QCT and Mindways QCT in the evaluation of L1, L2, and L3 vertebrae bodies in ESP. A strong correlation between iCare QCT and Mindways QCT in the assessment of hip T-score was found. It was illustrated that iCare QCT had a higher detection rate of osteoporosis with the assessment of hip T-score than Mindways QCT did. In patients < 50 years subgroup, the detection rate of osteoporosis with iCare QCT and Mindways QCT was equal. In patients ≥ 50 years subgroup, the detection rate of osteoporosis with iCare QCT (35/92, 38.0%) was higher than that with Mindways QCT. In female subgroup, the detection rate of osteoporosis with iCare QCT was significantly higher than Mindways QCT. In male subgroup, the detection rate of osteoporosis with iCare QCT was also markedly higher than Mindways QCT. The detection rate of osteoporosis by iCare QCT was higher than Mindways QCT with hip bone assessment. Of course, the results of the present study remain to be further verified by multicenter studies in the future. [ABSTRACT FROM AUTHOR]

Background: Artemisiae Scopariae Herba (ASH) has been widely used as plant medicine in East Asia with remarkable antitumor activity. However, the underlying mechanisms have not been fully elucidated. Methods: This study aimed to construct a multi-disciplinary approach to screen topoisomerase I (topo I) inhibitors from ASH extract, and explore the antitumor mechanisms. Bioaffinity ultrafiltration-UFLC-ESI-Q/TOF-MS/MS was used to identify chemical constitution of ASH extract as well as the topo I inhibitors, and in silico docking coupled with multiple complex networks was applied to interpret the molecular mechanisms. Results: Crude ASH extract exhibited toxicogenetic and antiproliferative activities on A549 cells. A series of 34 ingredients were identified from the extract, and 6 compounds were screened as potential topo I inhibitors. Docking results showed that the formation of hydrogen bond and π-π stacking contributed most to their binding with topo I. Interrelationships among the 6 compounds, related targets and pathways were analyzed by multiple complex networks model. These networks displayed power-law degree distribution and small-world property. Statistical analysis indicated that isorhamnetin and quercetin were main active ingredients, and that chemical carcinogenesis-reactive oxygen species was the critical pathway. Electrophoretic results showed a therapeutic effect of ASH extract on the conversion of supercoiled DNA to relaxed forms, as well as potential synergistic effect of isorhamnetin and quercetin. Conclusions: The results improved current understanding of Artemisiae Scopariae Herba on the treatment of tumor. Moreover, the combination of multi-disciplinary methods provided a new strategy for the study of bioactive constituents in medicinal plants. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of emodin on high glucose (HG)-induced podocyte apoptosis and whether the potential anti-apoptotic mechanism of emodin is related to induction of adenosine-monophosphate-activated protein kinase (AMPK)/mammalian target of rapamycin (mTOR)-mediated autophagy in podocytes (MPC5 cells) in vitro. Methods: MPC5 cells were treated with different concentrations of HG (2.5, 5, 10, 20, 40, 80 and 160 mmol/L), emodin (2, 4, 8 µ mol/L), or HG (40 mmol/L) and emodin (4 µ mol/L) with or without rapamycin (Rap, 100 nmol/L) and compound C (10 µ mol/L). The viability and apoptosis of MPC5 cells were detected using cell counting kit-8 (CCK-8) assay and flow cytometry analysis, respectively. The expression levels of cleaved caspase-3, autophagy marker light chain 3 (LC3) I/II, and AMPK/mTOR signaling pathway-related proteins were determined by Western blot. The changes of morphology and RFP-LC3 fluorescence were observed under microscopy. Results: HG at 20, 40, 80 and 160 mmol/L dose-dependently induced cell apoptosis in MPC5 cells, whereas emodin (4 µ mol/L) significantly ameliorated HG-induced cell apoptosis and caspase-3 cleavage (P<0.01). Emodin (4 µ mol/L) significantly increased LC3-II protein expression levels and induced RFP-LC3-containing punctate structures in MPC5 cells (P<0.01). Furthermore, the protective effects of emodin were mimicked by rapamycin (100 nmol/L). Moreover, emodin increased the phosphorylation of AMPK and suppressed the phosphorylation of mTOR. The AMPK inhibitor compound C (10 µ mol/L) reversed emodin-induced autophagy activation. Conclusion: Emodin ameliorated HG-induced apoptosis of MPC5 cells in vitro that involved induction of autophagy through the AMPK/mTOR signaling pathway, which might provide a potential therapeutic option for diabetic nephropathy. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to develop the advance care planning (ACP) practice preference scale and validate its psychometric properties among clinical nurses. Design: An instrument development and validation study was completed in the following three phases: (a) the generation and revision of the item, (b) the preliminary exploration and evaluation of the item and (c) the psychometric evaluation of the scale. Methods: A literature review was conducted to develop the indicator system. A total of 360 clinical nurses (for item analysis) and 688 clinical nurses (for psychometric evaluation) were recruited. The exploratory factor analysis and confirmatory factor analysis were conducted to evaluate the construct validity. The reliability was explored by internal consistency and test–retest reliability. The study was conducted from October 2021 to January 2022. Results: A total of 24 items were finally retained by the item analysis from the initial 78‐item pool. In the exploratory factor analysis, the six‐factor model explained 79.933% of the total variation. After limiting to three factors, 59.305% of the total variation was explained. Above factor models supported by the confirmatory factor analysis were consistent with the theoretically structure, and the fitting indexes were all satisfactory. Also, the findings showed appropriate internal consistency and test–retest reliability. Conclusions: ACP practice preference scale presents satisfactory psychometric properties among clinical nurses and can be adopted to evaluate the propensity of clinical nurses to practice ACP. Impact: ACP practice preference scale can be adopted to understand the training needs of clinical nurses on ACP clinical practice. Patient or Public Contribution: Clinical nurses participated in the pilot testing and validation of ACP practice preference scale. [ABSTRACT FROM AUTHOR]

Background: The Bispectral Index (BIS) and the Patient State Index (PSI) are commonly used measures to assess intraoperative sedation depth. However, model differences lead to different results, which in turn interferes with clinicians' judgment on the depth of anesthesia. Remimazolam tosilate (RT) for injection is a new benzodiazepine used in sedation. In its clinical application, there are few effective indicators for sedation depth monitoring. To close this gap, this study aims to compare BIS and PSI in measuring the sensitivity and specificity of intraoperative RT and to explore the safety of RT for intraspinal anesthesia in elderly patients. Methods: This study included 40 patients undergoing elective electro-prostatectomy with intraspinal anesthesia, who were monitored by BIS and PSI simultaneously during operation. Remimazolam tosylate 0.1 mg/kg was intravenously administered after the intraspinal anesthesia when patients were in a completely painless status. Then BIS, PSI, the Modified Observer's Assessment of Alertness and Sedation (MOAA/S) scores and vital signs were observed and recorded per minute for 10 min. Pearson's correlation analysis and linear regression model were used to compare BIS and PSI sedation scores, and to test their associations with the MOAA/S score, respectively. ROC curves were drawn to compare the sensitivity and specificity of BIS and PSI. Changes of vital signs were presented as mean ± standard deviation. Perioperative liver and kidney function indicators were analyzed using a paired t-test to evaluate the safety of RT for intraspinal anesthesia in the elderly patients. Results: According to Pearson's correlation analysis, a significant (P < 0.01) correlation between BIS and PSI was found when used to monitor intraoperative sedation of RT (r = 0.796). Significant associations between BIS and MOAA/S (r = 0.568, P < 0.01), and between PSI and MOAA/S (r = 0.390, P < 0.01) were also found. The areas under the ROC curves of BIS and PSI were 0.801 ± 0.022 and 0.734 ± 0.026, respectively, suggesting that both measures may predict patients' state of consciousness and BIS was more accurate than PSI. Vital signs remained stable throughout the study. No abnormal changes of clinical significance were found based on laboratory test results of liver and kidney function. Conclusion: BIS and PSI are strongly associated for monitoring the sedation of RT intraoperatively. Both methods can accurately reflect sedation depth. According to correlation analyses with MOAA/S scale and ROC curves, BIS is more accurate than PSI during such intraoperative monitoring. In addition, RT can be safely used in elderly patients under intraspinal anesthesia for supportive sedation, with stable vital signs and sound kidney and liver safety profiles. Trial registration: http://www.chictr.org.cn (ChiCTR2100051912). [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore the effect of training on organizational commitment, the mediating effect of employability and the moderating role of person–organization fit. Design: A correctional cross‐sectional research design was adopted for this study. Methods: A questionnaire‐based survey of 859 nurses in a public hospital in Western China was conducted to identify their perceptions of training, employability, organizational commitment and person–organization fit. Hierarchical linear regression and conditional process analysis on moderated mediation were performed. Results: Training had a positive effect on organizational commitment (p <.01). Internal and external employability mediated the relationship between training and organizational commitment (p <.01). Person–organization fit enhanced the indirect effect of training on organizational commitment through external employability (p <.05). [ABSTRACT FROM AUTHOR]

Background. Persistent inflammation has been recognized as an important comorbid condition in patients with chronic kidney disease (CKD) and is associated with many complications, mortality, and progression of CKD. Previous studies have not drawn a clear conclusion about the anti-inflammatory effects of statins in CKD. This meta-analysis is aimed at assessing the anti-inflammatory effects of statins therapy in patients with CKD. Methods. A comprehensive literature search was conducted in these databases (Medline, Embase, Cochrane library, and clinical trials) to identify the randomized controlled trials that assess the anti-inflammatory effects of statins. Subgroup, sensitivity, and trim-and-fill analysis were conducted to determine the robustness of pooled results of the primary outcome. Results. 25 eligible studies with 7921 participants were included in this meta-analysis. The present study showed that statins therapy was associated with a decreased C-reactive protein (CRP) (-2.06 mg/L; 95% CI: -2.85 to -1.27, p < 0.01). Subgroup, sensitivity, and trim-and-fill analysis showed that the pooled results of CPR were stable. Conclusion. This meta-analysis demonstrates that statins supplementation has anti-inflammatory effects in patients with CKD. Statins exert an anti-inflammatory effect that is clinically important in improving complications, reducing mortality, and slowing progression in CKD. We believe that the benefits of statins to CKD are partly due to their anti-inflammatory effects. However, stains usually are prescribed in the CKD patients with dyslipidemia, whether statins can reduce inflammation in CKD patients with normal serum lipid needed to explore in the future. Therefore, we suggest that randomized clinical trials need to assess the effect of statins in CKD patients with normal serum lipid. Whether statins can be prescribed for aiming to inhibit inflammation in CKD also needed further study. Trial Registration. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO); registration number: CRD42022310334. [ABSTRACT FROM AUTHOR]

Background and aims: Difficult endotracheal intubation is one of the most challenging operations in anesthesia. How to better predict difficult airway and make corresponding preparations to reduce the occurrence of accidents is a difficult task faced by anesthesiologists every day. This study decide to evaluate the value of the Upper Lip Bite Test (ULBT) and the Modified Mallampati Test (MMT) in predicting difficult intubation under direct laryngoscopy and find out the most intuitive and simple method to predict difficult intubation under direct laryngoscopy in apparently normal patients. Patients and methods: This descriptive-analytical study was performed on 450 patients for elective surgery under general anesthesia requiring endotracheal intubation. The ULBT and MMT grading were evaluated preoperatively and Cormack and Lehane's (CL) classification was recorded on the day of surgery during intubation under direct laryngoscopy. The accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR), Youden index and area under ROC curve of ULBT and MMT respectively and in combination were calculated and compared. And the consistency between the total scores of ULBT and MMT combined in different ways and CL grading was counted. Results: Of the 450 patients, 69 (15.3%) were classified as difficult cases of direct laryngoscopy. The accuracy, sensitivity, specificity, PPV and NPV of ULBT were 81.33, 11.59, 93.96, 25.81, 85.44%; and those the corresponding values for MMT were 66.22, 62.32, 69.29, 26.88 and 91.03%. A combination of ULBT and MMT did not improve the sensitivity in the sample tested. The combined total scores of ULBT and MMT in both ways were less consistent with CL grading in predicting difficult intubation under direct laryngoscopy. Conclusion: Based on findings of current study, we conclude that ULBT and MMT for difficult intubation have only poor to moderate discriminative power when used alone. The combination of the two tests in fractional form is also not a good predictor of difficult intubation under direct laryngoscopy. Trial registration: Chinese Clinical Trial Registry, ChiCTR2100052987, Registered 07 November 2021, http://www.chictr.org.cn [ABSTRACT FROM AUTHOR]

Background: Nurses are one of the most critical members of advance care planning (ACP) discussion. The evaluation of ACP self-efficacy is of great significance for developing targeted ACP interventions among clinical nurses and update their professional roles. However, there are few instruments to evaluate their ACP self-efficacy in mainland China. The purpose of this study was to translate the ACP self-efficacy scale into Chinese and evaluate its psychometric properties among clinical nurses. Methods: A methodological study of the translation and validation of the ACP self-efficacy scale was conducted from January to March 2022. It involved three phases: (1) the translation and revision of the scale; (2) the exploration and evaluation of the item (n = 436); (3) the psychometric evaluation of the scale (n = 674). Results: After a rigorous translation and revision, the ACP self-efficacy scale with three dimensions and 16 items was finally formed. In this study, the critical ratios of the item ranged from 8.226 to 17.499, and the item-total correlation coefficients ranged from 0.437 to 0.732, and the factor loadings of the item ranged from 0.638 to 0.882. The content validity index of the scale was 0.946. Supported by the eigenvalues, the three-factor structure explained the cumulative 61.131% of the overall variance. As the results of confirmatory factor analysis, all the recommended fitting indexes were appropriate. The average variance extracted values ranged from 0.570 to 0.756, and the composite reliability values ranged from 0.858 to 0.925. The total Cronbach's α coefficient, split-half reliability coefficient and test–retest reliability coefficient of the scale were 0.896, 0.767 and 0.939, respectively. Conclusion: The Chinese version of ACP self-efficacy scale was successfully introduced into China, showing good psychometric properties among clinical nurses, and can effectively assess the ACP self-efficacy. Also, the scale can provide nursing educators with a significant strategy to develop ACP educational procedure and post-intervention measures for clinical nurses to improve nurse-led ACP practice. [ABSTRACT FROM AUTHOR]

Childhood allergy places significant burdens on children's health. Environmental chemical exposures during early childhood may adversely affect the immune system to increase the incidence of allergy. PFAS as a universal pollutant may affect health during multiple developmental periods. Our study investigated the association between PFAS and allergy in U.S. adolescents. Objective: The aim of this study was to investigate association between polyfluoroalkyl substances (PFASs) and allergy in US adolescents. Methods: This study was conducted in the National Health and Nutrition Examination Survey 2005–2006. PFAS as a universal pollutant can be obtained directly from laboratory data files. Allergy included current allergic symptoms and allergen sensitization. The aim of the study was to investigate the association between PFAS and allergy in US adolescents. Results: Multivariate regression models showed that PFAS was positively associated with current allergic symptoms (adjusted odds ratio, 1.01; 95% confidence interval [CI], 1–1.03). With PFAS as a categorical variable, compared with the lowest tertile, the adjusted odds ratios with increasing tertiles were 1.21 (95% CI, 0.74–1.96) and 1.67 (95% CI, 1.01–2.74). Conclusions: Our study shows that PFASs are associated with increased incidence of current allergic symptoms in US adolescents. More prospective studies are needed to provide evidences. [ABSTRACT FROM AUTHOR]

Background: ClC-3 chloride channels promote osteogenic differentiation. Transforming growth factor-β1 (TGF-β1) and its receptors are closely related to ClC-3 chloride channels, and canonical TGF-β1 signaling is largely mediated by Smad proteins. The current study aimed to explore the role of the Smad2/3/4 signaling pathway in the mechanism by which ClC-3 chloride channels regulate osteogenic differentiation in osteoblasts. Methods: First, real-time PCR and western blotting were used to detect the expression of Smad and mitogen-activated protein kinase (MAPK) proteins in response to ClC-3 chloride channels. Second, immunocytochemistry, coimmunoprecipitation (Co-IP) and immunofluorescence analyses were conducted to assess formation of the Smad2/3/4 complex and its translocation to the nucleus. Finally, markers of osteogenic differentiation were determined by real-time PCR, western blotting, ALP assays and Alizarin Red S staining. Results: ClC-3 chloride channels knockdown led to increased expression of Smad2/3 but no significant change in p38 or Erk1/2. Furthermore, ClC-3 chloride channels knockdown resulted in increases in the formation of the Smad2/3/4 complex and its translocation to the nucleus. In contrast, the inhibition of TGF-β1 receptors decreased the expression of Smad2, Smad3, p38, and Erk1/2 and the formation of the Smad2/3/4 complex. Finally, the expression of osteogenesis-related markers were decreased upon ClC-3 and Smad2/3/4 knockdown, but the degree to which these parameters were altered was decreased upon the knockdown of ClC-3 and Smad2/3/4 together compared to independent knockdown of ClC-3 or Smad2/3/4. Conclusions: The Smad2/3 proteins respond to changes in ClC-3 chloride channels. The Smad2/3/4 signaling pathway inhibits osteogenic differentiation regulation by ClC-3 chloride channels in MC3T3-E1 cells. [ABSTRACT FROM AUTHOR]

The lack of formal eye screening is the main reason for insufficient eye care utilization in rural China. Cataract, in particular, is increasingly prevalent with the aging population, but the treatment rate is relatively low. Village doctors are the most accessible health care resource for rural residents, receiving few empirical investigations into their role in eye care. This study aims to assess the role of village doctors in residents' uptake of eye screening (vision and cataract screening), the first step of cataract treatment. Data come from a community-based, cross-sectional survey conducted in 35 villages of a county of the Gansu Province, Northwestern China, in 2020. Among 1010 residents aged ≥ 50 and 35 village doctors, the multivariate logistic regression shows that village doctors' age, time spent on public health service, and service population were positively associated with residents' uptake of vision and cataract screening. Village doctors were capable of playing an active role in primary eye health services due to their richer knowledge about cataracts than residents (accuracy rate 86.75% vs. 63.50%, p < 0.001), but less than half of them were willing to undertake eye screening. This study highlights the positive role of village doctors in aging residents' eye screening and the potential role in improving the uptake of eye screening by offering health education. [ABSTRACT FROM AUTHOR]

Background: Type 1 diabetes (T1D) is a T lymphocyte-mediated and B lymphocyte-assisted autoimmune disease. We aimed to identify abnormally expressed genes in peripheral blood mononuclear cells (PBMCs) of T1D and explore their possible molecular regulatory network. Methods: Expression datasets were downloaded from the Gene Expression Omnibus (GEO) database. Then, the differentially expressed genes (DEGs) and differentially expressed miRNAs (DEmiRNAs) were identified, and functional enrichment and immune cell infiltration analysis were performed. The starBase, miRTarBase, TarBase, JASPAR, ENCODE, and TRRUST databases constructed the miRNA-mRNA-TF regulatory network. The ROC curves were plotted to evaluate the sensitivity and specificity of miRNAs and mRNAs. Result: A total of 216 DEGs directly or indirectly related to type I diabetes mellitus, natural killer cell-mediated cytotoxicity, Th1, and Th2 cell differentiation, and the IL-17 and TNF signaling pathways were obtained. The miRNA-mRNA-TF network indicates that miR-320a and SOX5 are the only miRNAs and TFs that both target ADM and RRAGD. The ROC curves showed that ADM (0.9375), RRAGD (0.8958), and hsa-mir-320a (0.9417) had high accuracy in T1D diagnosis. Conclusion: The constructed regulatory networks, including miR-320a/ADM/SOX5 and miR-320a/RRAGD/SOX5, may provide new insight into the mechanisms of development and progression in T1D. [ABSTRACT FROM AUTHOR]

Background. Mongolian medicine is a systematic theoretical system, which is based on the balance among Heyi, Xila, and Badagan. However, the underlying mechanisms remain unclear. This study aimed to explore the characteristics of intestinal microbiota and metabolites in different rat models of Mongolian medicine. Methods. After establishing rat models of Heyi, Xila, and Badagan, we integrated 16S rRNA gene sequencing and metabolomics. Results. Heyi, Xila, and Badagan rats had significantly altered intestinal microbial composition compared with rats in the MCK group. They showed 11, 18, and 8 significantly differential bacterial biomarkers and 22, 11, and 15 differential metabolites, respectively. The glucosinolate biosynthesis pathway was enriched only in Heyi rats; the biosynthesis of phenylpropanoids pathway and phenylpropanoid biosynthesis pathway were enriched only in Xila rats; the isoflavonoid biosynthesis pathway, the glycine, serine, and threonine metabolism pathway, and the arginine and proline metabolism pathway were enriched only in Badagan rats. Conclusions. The intestinal microbiota, metabolites, and metabolic pathways significantly differed among Heyi, Xila, and Badagan rats compared with control group rats. [ABSTRACT FROM AUTHOR]

It is aimed at investigating the changes of serum soluble programmed death-ligand 1 (sPD-L1) expression level in nonsmall cell lung cancer (NSCLC) before and after radiotherapy, the correlation of PD-L1, PD-1, and proteins of Akt (protein kinase B), mTOR, and HIF-1α, and the molecular mechanism of the PD-1/PD-L1 pathway in the development of NSCLS. A total of 126 NSCLC patients receiving radiotherapy in Liaoning Cancer Hospital from September 2018 to September 2019 were selected as the observation group, and another 58 healthy volunteers were selected as the control group. NSCLC patients were divided into group A (stage I-II, stereotactic radiotherapy) and group B (stage III, intensity-modulated radiation therapy) according to the cancer stage. The efficacy of radiotherapy was evaluated, and sPD-L1 expression was detected by ELISA. The immunohistochemical staining was adopted to detect protein expressions of Akt, mTOR, and HIF-1α in NSCLC tissues. The correlation between their expression and expression of PD-L1 and PD-1 was analyzed. The results showed that the overall response rate (ORR) of group A was 89.29%, the clinical benefit response (CBR) was 96.43%, the median survival time (MST) was 25 months, and the survival rate within three years was 72.56%. In group B, the ORR was 70.41%, the CBR was 97.96%, the MST was 18 months, and the survival rate within three years was 34.67%. Comparison of overall serum sPD-L1 expression in the control group, group A, and group B and between groups before radiotherapy was statistically significant (P < 0.01). After radiotherapy, serum sPD-L1 expression in group A and group B decreased compared with that before radiotherapy (P < 0.01). Among NSCLC patients, the positive expression rate of Akt, mTOR, and HIF-1α was 71.32%, 41.26%, and 80.65%, respectively. PD-L1 expression and Akt, mTOR, and HIF-1α expression showed a significant correlation. PD1 expression and Akt, mTOR, and HIF-1α expression also showed a significant correlation. It indicated that the expression level of sPD-L1 in NSCLC patients was higher than that in normal subjects, but the expression level of sPD-L1 was decreased after radiotherapy. PD-1/PD-L1 may play important roles in NSCLC procession through the Akt/mTOR and HIF-1α pathway. [ABSTRACT FROM AUTHOR]

Background: China issued strict nationwide guidelines to combat the COVID-19 outbreak in January 2020 and gradually loosened the restrictions on movement in early March. Little is known about how these disease control measures affected the 600 million people who live in rural China. The goal of this paper is to document the quarantine measures implemented in rural China outside the epicenter of Hubei Province and to assess the socioeconomic effect of the measures on rural communities over time. Methods: We conducted three rounds of interviews with informants from 726 villages in seven provinces, accounting for over 25% of China's overall rural population. The survey collected data on rural quarantine implementation; COVID-19 infections and deaths in the survey villages; and effects of the quarantine on employment, income, education, health care, and government policies to address any negative impacts. The empirical findings of the work established that strict quarantine measures were implemented in rural villages throughout China in February. Results: There was little spread of COVID-19 in rural communities: an infection rate of 0.001% and zero deaths reported in our sample. However, there were negative social and economic outcomes, including high rates of unemployment, falling household income, rising prices, and disrupted student learning. Health care was generally accessible, but many delayed their non-COVID-19 health care due to the quarantine measures. Only 20% of villagers received any form of local government aid, and only 11% of villages received financial subsidies. There were no reports of national government aid programs that targeted rural villagers in the sample areas. Conclusions: By examining the economic and social effects of the COVID-19 restrictions in rural communities, this study will help to guide other middle- and low-income countries in their containment and restorative processes. Without consideration for economically vulnerable populations, economic hardships and poverty will likely continue to have a negative impact on the most susceptible communities. [ABSTRACT FROM AUTHOR]

We tracked the motor skill development of young children aged 3–6 years and investigated the influence of middle-income home environment on the development of motor skill. 268 children were selected from kindergartens in Beijing. The Test of Gross Motor Development (TGMD) tool was used to test the development of locomotor and object-control skills (LS and OS), and a survey of children's behaviour and home environment was conducted. During the follow-up, the LS and OS of children aged 3–6 years continued to grow, with an annual growth rate of 20% and 30%. Five LS indicators and two OS indicators were significantly higher in the 3–4-year group than in the 4–5 and 5–6-year groups (p < 0.01). The age-sex trend model showed that girls' locomotor skill developed at a significantly higher rate than that of boys (β = 6.3004 and 4.6782, p < 0.001). Three-year-old boys performed significantly better than girls on object-control motor skill (p < 0.05). Factors affecting the rate of children's motor skill development in middle-income families included the frequency of playing with friends (β = 0.133 , p = 0.032) and the frequency of bicycling, skateboarding, dancing, running, and jumping (β = 0.041 , p = 0.042). Family income, parents' education level, and family activity area did not significantly affect the growth rate of motor skills. For middle-income families, the improvement of material environment at home like more playing spaces and toys did not speed up the motor development, while more opportunities to play with friends and engage in a variety of sports activities could promote children's motor skill development. [ABSTRACT FROM AUTHOR]

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Background: Chemotherapy-induced nausea and vomiting (CINV) is a common and distressing side effect. We conducted this clinical trial to compare the effectiveness of true acupuncture vs. sham acupuncture in controlling chemotherapy-induced nausea and vomiting (CINV) among patients with advanced cancer. Methods: A total of 134 participants were randomly allocated into true acupuncture (TA) (n = 68) and sham acupuncture (SA) (n = 66) groups. Participants in both groups received acupuncture session twice on the first day of chemotherapy, and once consecutively on the following 4 days. The primary outcome was using the Common Terminology Criteria for Adverse Events (CTCAE) to assess CINV. The secondary outcome measures were the Eastern Cooperative Oncology Group score (ECOG), Simplified Nutritional Appetite Questionnaire (SNAQ), and Hospital Anxiety and Depression scale (HADS). Results: Compared to the SA group, the TA group didn't show significant improvement in complete response rates of chemotherapy-induced nausea and vomiting (all P > 0.05). However, the TA group could modestly reduce the severity of nausea (from day-3 to day-21, P < 0.05) or vomiting (from day-4 to day-21, P < 0.05), which is notably superior to the control group. Besides, TA promoted the nutritional status of patients with a significantly higher score comparing to the SA group on day 14 (21.82 vs.20.12, P = 0.003) and day 21 (22.39 vs. 20.43, P = 0.001). No apparent differences were found in anxiety and depression assessment between these groups. Participants in both groups were well tolerant of acupuncture therapy. There was no adverse event occurs in our study. Conclusion: Acupuncture as an adjunctive approach could alleviate the severity of chemotherapy-induced nausea and vomiting compared to the sham control, even though the effect of acupuncture in preventing CINV occurring is relatively modest. [ABSTRACT FROM AUTHOR]

BACKGROUND: Childhood malnutrition is commonplace among poor rural communities in China. In 2012, China launched its first nationwide school‐feeding program (SFP) to address this problem. This study examines the prevalence of malnutrition before and after the SFP and identifies possible reasons for the trends observed. METHODS: Ordinary least squares regression and propensity score matching were used to analyze data from 2 cross‐sectional surveys of 100 rural primary schools in northwestern China. Participants were fourth‐and fifth‐grade students. Outcome measures include anemia rates, hemoglobin levels, body mass index, and height for age Z scores. RESULTS: Three years after implementation of the SFP, malnutrition rates among sample students had not fallen. The SFP had no statistically significant effect on either anemia rates or BMI, but was linked to an increase in the proportion of students with below normal height for age Z scores. Meals provided to students fell far short of national recommendations that the SPF should provide 40% of the recommended daily allowance of micronutrients. CONCLUSIONS: Despite significant budgetary outlays between 2012 and 2015, China's SFP has not reduced the prevalence of malnutrition among sample students. To make the SFP more effective, funding and human resources both need to be increased. [ABSTRACT FROM AUTHOR]

Activation of blood coagulation contributes to cancer progression. Tissue factor pathway inhibitor-1 (TFPI-1) is the main inhibitor of extrinsic coagulation pathway. The aim of this study is to assess the predicting significance of TFPI-1 for thrombotic complication and metastasis in lung cancer patients. Total of 188 non-small cell lung cancer (NSCLC) patients were included in this study. Plasma TFPI-1, D-dimer (D-D), antithrombin (AT), Fibrinogen (Fbg), and coagulating factor VIII activity (FVIII:C) were measured. In NSCLC patients, significantly decreased TFPI-1 and AT and increased D-D, Fbg, and FVIII:C levels were observed, and there was a significant correlation between TFPI-1 and other hemostatic parameters (P<0.001, resp.). NSCLC patients with deep venous thrombosis (DVT) or metastasis had significantly lower TFPI-1 levels than those without DVT or metastasis (P<0.01, resp.). Multivariate regression revealed that TFPI-1 acted as a predictor for DVT or tumor metastasis in NSCLC patients [OR: 4.15 or 3.28, P<0.05, resp.]. The area under ROC curve of TFPI-1 was 0.905 (95% CI, 0.842~0.967) or 0.828 (95% CI, 0.742~0.915) for predicting DVT or metastasis (P<0.001, resp.). The optimal point of TFPI-1 was 57.7 or 54.3 ng/mL for predicting DVT or metastasis, respectively. Combination of TFPI-1 and D-D measurements can improve the predicting power for DVT or metastasis in NSCLC patients. Our findings suggested that TFPI-1 was a valuable predictor of DVT and tumor metastasis in NSCLC patients. [ABSTRACT FROM AUTHOR]

Aldehyde dehydrogenase (ALDH) is an enzyme that plays an important role in retinoid metabolism and highly expressed in stem cells. This study isolated ALDH-expressing cells from subcutaneous adipose tissue and investigated their potential to enhance healing in a full-thickness skin wound in rats by co-implanting them with collagen-glycosaminoglycan (c-GAG) scaffolds. ALDH-positive cells were isolated by a fluorescence-activated cell sorting technique from Lewis rat's stromal-vascular-fraction (SVF) and transplanted with c-GAG scaffolds in a rat full-thickness skin wound model. At 7 days after surgery, the microscopic appearance of c-GAG scaffolds seeded with ALDH-positive was compared with those of uncultured-SVF, and cultured-SVF adipose-derived stromal cells (ASCs). The thickness of cellular ingrowth in the ASC group (630 ± 180 μm) was significantly thicker than that in the control (390 ± 120 μm) or SVF (380 ± 140 μm) groups, but non-significantly thicker than that in the ALDH-positive group (570 ± 220 μm). The thickness of regenerated collagen layer was significantly thicker in the ALDH-positive group (160 ± 110 μm) than in the ASCs (81 ± 41 μm), the control (65 ± 24 μm), or SVF (64 ± 34 μm) groups. Immunofluorescent staining with CD31 proved that transplanted ALDH-positive cells differentiated into vascular endothelial cells in c-GAG scaffolds. Combined transplantation with c-GAG scaffolds and adipose-derived ALDH-positive cells promoted dermal regeneration, giving a possibility that ALDH-positive cells would greatly shorten the waiting period before secondary autologous skin grafting was possible. [ABSTRACT FROM AUTHOR]

The TNM staging system is universally used for classification of cancer. This system is limited since it uses only three factors (tumor size, extent of spread to lymph nodes, and status of distant metastasis) to generate stage groups. To provide a more accurate description of cancer and thus better patient care, additional factors or variables should be used to classify cancer. In this paper we propose a hierarchical clustering algorithm to develop prognostic systems that classify cancer according to multiple prognostic factors. This algorithm has many potential applications in augmenting the data currently obtained in a staging system by allowing more prognostic factors to be incorporated. The algorithm clusters combinations of prognostic factors that are formed using categories of factors. The dissimilarity between two combinations is determined by the area between two corresponding survival curves. Groups from cutting the dendrogram and survival curves of the individual groups define our prognostic systems that classify patients using survival outcomes. A demonstration of the proposed algorithm is given for patients with breast cancer from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. [ABSTRACT FROM AUTHOR]

Background Treatment options have been historically limited for cisplatin-ineligible patients with advanced urothelial carcinoma (UC). Given the need for alternatives to platinum-based chemotherapy, including non-chemotherapy regimens for patients with both impaired renal function and borderline functional status, in 2010 (prior to the immune checkpoint blockade era in metastatic UC), we initiated a phase II trial to test the activity of everolimus or everolimus plus paclitaxel in the cisplatin-ineligible setting. Methods This was an open-label phase II trial conducted within the US-based Hoosier Cancer Research Network (ClinicalTrials.gov number: NCT01215136). Patients who were cisplatin-ineligible with previously untreated advanced UC were enrolled. Patients with both impaired renal function and poor performance status were enrolled into cohort 1; patients with either were enrolled into cohort 2. Patients received everolimus 10 mg daily alone (cohort 1) or with paclitaxel 80 mg/m2 on days 1, 8, and 15 of each 28-day cycle (cohort 2). The primary outcome was clinical benefit at 4 months. Secondary outcomes were adverse events, progression-free survival (PFS), and 1-year overall survival (OS). Exploratory endpoints included genomic correlates of outcomes. The trial was not designed for comparison between cohorts. Results A total of 36 patients were enrolled from 2010 to 2018 (cohort 1, N = 7; cohort 2, N = 29); the trial was terminated due to slow accrual. Clinical benefit at 4 months was attained by 0 (0%, 95% confidence interval [CI] 0-41.0%) patients in cohort 1 and 11 patients (37.9%, 95% CI 20.7-57.7%) in cohort 2. Median PFS was 2.33 (95% CI 1.81-Inf) months in cohort 1 and 5.85 (95% CI 2.99-8.61) months in cohort 2. Treatment was discontinued due to adverse events for 2 patients (29%) in cohort 1 and 11 patients (38%) in cohort 2. Molecular alterations in microtubule associated genes may be associated with treatment benefit but this requires further testing. Conclusion Everolimus plus paclitaxel demonstrates clinical activity in cisplatin-ineligible patients with metastatic UC, although the specific contribution of everolimus cannot be delineated. Patients with both impaired renal function and borderline functional status may be difficult to enroll to prospective trials. (ClinicalTrials.gov Identifier NCT01215136). [ABSTRACT FROM AUTHOR]

We investigated the treatment and prognosis of pleural effusion ( PE) in multiple myeloma ( MM) patients. From June 2005 to December 2013, 296 MM patients participated in this study. There were 23 PE patients, including 11 men and 12 women, with a median age of 56.8 years (range 37-68 years). A diagnosis of PE was based on physical examination, chest X-ray or computed tomography, and pleural fluid analysis. All patients demonstrated myeloma cells in the pleural fluid, and six patients were positive for PE M protein. PE patients received bortezomib combined with other drugs. Only one patient demonstrated a complete response; 10 patients showed partial responses, and 12 patients developed progressive disease and died. MM linked with myelomatous PE is associated with a poor prognosis. Myelomatous PE is likely a late manifestation of the natural history of MM or an expression of the aggressive behavior of the disease. [ABSTRACT FROM AUTHOR]

Two new 7,8-secolignans, neglectahenols E and F (1 and 2), together with four known 7,8-secolignans (3–6), were isolated from the fruits of Schisandra neglecta. The structures were elucidated by spectroscopic methods, including extensive 1D and 2D NMR techniques. Compounds 1–6 were tested for their anti-tobacco mosaic virus (anti-TMV) activities at the concentration of 20 μM. Compounds 1 and 6 showed high anti-TMV activities with inhibition rates of 38.2% and 32.7%, respectively. These rates are higher than that of a positive control. Compounds 2–5 also showed modest anti-TMV activities with inhibition rates in the range of 22.8–28.7%. These rates are close to that of a positive control. [ABSTRACT FROM AUTHOR]

Conclusion: This work demonstrated that juvenile nasopharyngeal angiofibromas (JNAs) express high levels of hormone receptors and vascular endothelial growth factor (VEGF) compared with normal nasal mucosa. The interaction between hormone receptors and VEGF may be involved in the initiation and growth of JNA. Objectives: JNA is a rare benign tumor that occurs almost exclusively in male adolescents. Although generally regarded as a hormone-dependent tumor, this has not been proven in previous studies. The aim of this study was to investigate the role of hormone receptors in JNA and the relationship with clinical characteristics. Methods: Standard immunohistochemical microarray analysis was performed on 70 JNA samples and 10 turbinate tissue samples. Specific antibodies for androgen receptor (AR), estrogen receptor-α (ER-α), estrogen receptor-β (ER-β), progesterone receptor (PR), and VEGF were examined, and the relationships of receptor expression with age, tumor stage, and bleeding were evaluated. Results: Results showed that JNA expressed ER-α (92.9%), ER-β (91.4%), AR (65.7%), PR (12.8%), and VEGF (95.7%) at different levels. High level of VEGF was linked to elevated ER-α and ER-β. There was no significant relationship between hormonal receptors and age at diagnosis, tumor stage or bleeding. However, overexpression of ER-α was found to be an indicator of poor prognosis ( p = 0.031). [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of adjunctive Buchang Naoxintong Capsule (步长脑心通胶囊, NXT) on dual antiplatelet therapy in patients with cytochrome P450 2C19*2 (CYP2C19*2) polymorphism undergoing percutaneous coronary intervention (PCI). Methods: Ninety patients with CYP2C19*2 polymorphism were enrolled, and their genotypes were confirmed by polymerase chain reaction (PCR). The patients were randomly assigned to receive either adjunctive NXT (triple group, 45 cases) or dual antiplatelet therapy (dual group, 45 cases) using a computer-generated randomization sequence and sealed envelopes. Platelet function was assessed at baseline and 7 days after treatment with conventional aggregometry. Subsequent major adverse cardiovascular events (MACE, including sudden cardiac arrest and acute coronary syndrome) were recorded during a 12-month follow-up. Results: Baseline platelet function measurements were similar in both groups. After 7 days, percent inhibitions of maximum platelet aggregation and late platelet aggregation were significantly greater in the triple versus dual group (42.3%±16.0% vs. 20.8%±15.2%, P<0.01, and 54.7%±18.3% vs. 21.5%±29.2%, P<0.01, respectively). During the 12-month follow-up, the rate of subsequent MACE (6/45) was significantly lower in the triple group compared with the dual group (14/45; P<0.05). Conclusion: Adjunctive NXT to maintenance dose clopidogrel (75 g) could enhance the antiplatelet effect and decrease subsequent MACE in patients with the CYP2C19*2 polymorphism undergoing PCI. [ABSTRACT FROM AUTHOR]

Background: Distant metastasis is the leading cause of death in patients with rectal cancer. This study aims to comprehensively analyze the risk factors of distant metastasis in T3 T4 rectal cancer using magnetic resonance imaging (MRI), pathological features, and serum indicators. Methods: The clinicopathological data of 146 cases of T3 T4 rectal cancer after radical resection from January 2015 to March 2023 were retrospectively analyzed. Pre- and postoperative follow-up data of all cases were collected to screen for distant metastatic lesions. Univariate and multivariate Logistic regression methods were used to analyze the relationship between MRI features, pathological results, serum test indexes, and distant metastasis. Results: Of the 146 included patients, synchronous or metachronous distance metastasis was confirmed in 43 (29.4%) cases. The patients' baseline data and univariate analysis showed that mrEMVI, maximum tumor diameter, mr T Stage, pathological N stage, number of lymph node metastasis, cancer nodules, preoperative serum CEA, (Carcinoembryonic antigen) and CA199 were associated with distant metastasis. In the multiple logistic regression model, mrEMVI, pathological N stage, number of lymph node metastasis, maximum tumor diameter, and preoperative serum CEA were identified as independent risk factors for distant metastasis: mrEMVI [odds ratio (OR) = 3.06], pathological N stage (OR = 6.52 for N1 vs N0; OR = 63.47 for N2 vs N0), preoperative serum CEA (OR = 0.27), tumor maximum diameter (OR = 1.03), number of lymph nodes metastasis (OR = 0.62). And, the receiver operating characteristic (ROC) curve was plotted and the area under the curve was calculated (area under the curve [AUC) = 0.817, 95% CI = 0.744-0.890, P <.001]. Conclusions: mrEMVI, pathological N stage, number of lymph node metastasis, maximum tumor diameter and preoperative serum CEA are the independent risk factors for distant metastasis in T3 T4 rectal cancer. A comprehensive analysis of the risk factors for distant metastasis in rectal cancer can provide a reliable basis for formulating individualized treatment strategies, follow-up plans, and evaluating prognosis. [ABSTRACT FROM AUTHOR]

Six previously undescribed clerodane diterpenes, cardorubellas A-F (1 - 6), along with seven known ones (7 - 13), were isolated from the aerial parts of Callicarpa pseudorubella. Their chemical structures were established by analysis of 1D and 2D NMR, HR-ESI-MS, X-ray diffraction, and electronic circular dichroism (ECD) data. Notably, cardorubella B (2) represented the first examples of naturally occurring succinic anhydride-containing clerodane diterpenes derivatives. The anti-proliferative activities of these compounds were assessed. Remarkably, compound 2 exhibited comparable inhibitory activity against HEL cell lines, surpassing the positive control with an IC 50 value of 14.01 ± 0.77 μM, compared to 17.02 ± 4.70 μM for 5-fluorouracil. [Display omitted] [ABSTRACT FROM AUTHOR]