Conectar
by Yun Feng, Wei Chen, Yang Lu, Haifei Zhou
PurposeThe aim of this study is to evaluate the changes of white matter microstructure in breast cancer patients before and after chemotherapy based on automated fiber quantification (AFQ),as well as determine if these dispersion indexes are significantly correlated with clinical data.
Materials and MethodsTwenty-four breast cancer patients scheduled for chemotherapy were enrolled. Diffusion tensor imaging (DTI), neuropsychological tests and self-report measures, and hematological tests were conducted before chemotherapy(time 0,T0) and within one week after chemotherapy(time 1,T1). AFQ was used to track 20 fiber tracts in the brain. The correlation between average abnormal tracts and changes in neuropsychological tests and self-report measures and blood indicators was analyzed.
ResultsCompared to T0, subjects at T1 showed decreased scores on the verbal fluency test; increased scores on the self-rating anxiety scale(SAS)and self-rating depression scale (SDS). Estrogen concentration was lower while luteinizing hormone(LH), follicle-stimulating hormone, and triglyceride levels were higher. Mean fractional anisotropy (FA) value decreased in the right cingulum cingulate(CGC)while mean radial diffusivity (RD) increased in the right CGC; mean axial diffusivity (AD) value decreased in callosum forceps major and callosum forceps minor. Changes in FA with in the right CGC were positively correlated with changes in SDS and LH, while changes in RD with in the right CGC were negatively correlated with changes in SDS and LH.
ConclusionEarly changes observed in brain white matter fiber tracts, along with persistent hormone and triglyceride metabolism disorders, could potentially serve as neurobiological markers for monitoring chemotherapy-induced cognitive impairment.
To systematically compare nurse-led versus traditional rehabilitation in improving clinical outcomes for stroke survivors.
Systematic review and meta-analysis.
Data were extracted from Cochrane, PubMed, Embase, and Web of Science (searched up to July 2024). Analyses with standardized mean differences (SMDs) and risk ratios (RRs) as the estimates were performed in Review Manager 5.4 and Stata 15.0. Randomized controlled trials investigating nurse-led stroke rehabilitation with outcomes such as mental component summary (MCS) and physical component summary (PCS) of quality of life, self-efficacy, National Institutes of Health Stroke Scale (NIHSS), stroke-specific quality of life (SS-QOL), Barthel Index (BI), Geriatric Depression Scale-15 (GDS-15), and pain were included. Sensitivity analyses and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were performed.
A total of 12 articles were included. The quality assessment indicated that most studies did not have a serious risk of bias. Nurse-led rehabilitation showed significant improvements in SS-QOL (SMD: 3.33, 95% CI: 1.26, 5.40; very low-quality evidence), depressive symptoms (GDS-15, SMD: −2.21; 95% CI: −2.80, −1.63; high-quality evidence), pain (SMD: −1.61; 95% CI: −2.14, −1.08; high-quality evidence), and BI (SMD: 0.24, 95% CI: 0.01, 0.48; low-quality evidence). However, there were no significant differences in MCS, PCS, self-efficacy, or NIHSS between the two groups. Sensitivity analysis showed that the results for SS-QOL and BI were unstable and should be interpreted with caution.
Nurse-led rehabilitation is effective in improving psychological outcomes, particularly depression (GDS-15) and pain, although this high-quality evidence is based on a single study. Functional independence (BI) and SS-QOL are also improved, but the evidence for these outcomes is of low quality and highly unstable in sensitivity analyses. No significant benefits are found for other outcomes. The evidence quality varies, and future high-quality studies are needed to confirm these findings.
Incorporating nurse-led rehabilitation into stroke guidelines and implementing standardized depression screening programs and non-pharmacological pain interventions in community rehabilitation could be beneficial for populations with depressive symptoms and chronic pain.
This study adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for transparent reporting of systematic reviews.
This study did not include patient or public involvement in its design, conduct, or reporting.
by Wei Chen, Lingling Zhang, Haiyan Qi
Pulmonary arterial hypertension (PAH) is a progressive and often fatal disorder characterized by increased pulmonary vascular resistance and subsequent right heart failure. Inflammation plays a pivotal role in the pathogenesis of PAH, and recent studies have highlighted the potential therapeutic significance of targeting inflammatory pathways. This study investigates the role of CD44, a cell surface receptor, in the inflammatory processes underlying PAH. By analyzing bulk RNA-seq data from idiopathic pulmonary hypertension (IPAH) patients and conducting single-cell RNA-seq analysis on pulmonary arterial cells, we identified CD44 as a key modulator of inflammation. Our findings suggest that elevated CD44 expression is not only in T cells but also prominently in pulmonary artery smooth muscle cells (SMCs), suggesting its involvement in vascular inflammation and remodeling. Molecular docking studies revealed a potential interaction between CD44 and progesterone, an anti-inflammatory drug and immunomodulator, and this indicates a novel avenue for therapeutic intervention. The results support the hypothesis that targeting CD44 may reduce inflammation and improve clinical outcomes in PAH patients.(i) To estimate the national incidence of unplanned removal of peripherally inserted central catheters (PICCs) in China. (ii) To explore the associated risk factors to provide evidence for the prevention.
A multi-centre prospective cohort study.
A representative sample of 3222 Chinese adult patients with successful PICC insertion was recruited for the PICC Safety Management Research (PATH) using a two-stage cluster sampling method from December 2020 to June 2022. Sixty hospitals from seven Chinese provinces representing all geographical regions were selected. Demographic information and PICC characteristics were collected using a standard online case report form. Risk factors for the unplanned removal of PICCs were assessed using a cause-specific hazard model and verified using a sub-distribution hazard model. STROBE guidelines were followed in reporting this study.
Three thousand one hundred and sixty-six patients were included in the final analysis with a mean age of 59 years and a total of 344,247 catheter days. The incidence of unplanned removal was 10.04%. Female, with thrombosis history, PICC insertion due to infusion failure, valved catheter and double-lumen catheter were risk factors, whereas longer insertion and exposure length were protective factors in the cause-specific hazard model. Higher BMI became an independent risk factor in the sub-distribution hazard model.
Unplanned removal of PICCs is a serious clinical challenge in China. Our findings call for prevention strategies targeting the identified risk factors.
Our study characterised the epidemiology of unplanned removal of PICCs among Chinese adult inpatients, highlighting the need for prevention among this population and providing a basis for the formulation of relevant prevention strategies.
Patients contributed through sharing their information required for the case report form. Healthcare professionals who provide direct care to the patient at each medical centre contributed by completing the online case report form.
FreshRSS 