Objective:To analyze the impact of maternal-infant separation on the physical and mental state of high-risk pregnancy patients and explore the clinical efficacy of targeted nursing interventions.Methods:A total of 80 ...Objective:To analyze the impact of maternal-infant separation on the physical and mental state of high-risk pregnancy patients and explore the clinical efficacy of targeted nursing interventions.Methods:A total of 80 high-risk pregnancy patients treated in our hospital from January 2023 to January 2024 were selected as the study subjects.These patients were randomly divided into an observation group and a control group(40 cases each)using a random number table.The control group received routine high-risk pregnancy nursing care,while the observation group received specialized maternal-infant separation nursing interventions in addition to routine care.The psychological and physiological states and nursing satisfaction of the two groups were compared before and after the intervention.Results:The SAS scores,SDS scores,and sleep quality scores of the observation group were significantly lower than those of the control group,with statistically significant differences(p<0.05).The incidence of postpartum hemorrhage in the observation group was significantly lower than that in the control group,and the initiation time of lactation was significantly earlier than that in the control group,with both differences being statistically significant(p<0.05).The nursing satisfaction of the observation group was significantly higher than that of the control group(80%vs.32/40),with a statistically significant difference(p<0.05).Conclusion:Maternal-infant separation exacerbates anxiety and depression in high-risk pregnancy patients,reduces sleep quality,increases the risk of postpartum hemorrhage,and delays the initiation of lactation.Specialized nursing interventions for maternal-infant separation can improve the physical and mental state of high-risk pregnancy patients,reduce the incidence of postpartum complications,and enhance nursing satisfaction,making them worthy of clinical application and promotion.展开更多
Objective The aim of this study was to analyze the correlation between the levels of 12 cytokines in the cervical microenvironment and cervical intraepithelial neoplasia in patients with high-risk human papillomavirus...Objective The aim of this study was to analyze the correlation between the levels of 12 cytokines in the cervical microenvironment and cervical intraepithelial neoplasia in patients with high-risk human papillomavirus(HR-HPV)infection.Methods Female patients(n=73)with HR-HPV infection were enrolled and divided into a high-grade squamous intraepithelial lesion(HSIL)group(n=33)and a non-HSIL(N-HSIL)group(n=40),which include low-grade squamous intraepithelial lesions and inflammation.Healthy screening subjects(n=31)with negative HR-HPV results were enrolled as a control group.We examined contemporaneous plasma and secretory cytokines from 25 study subjects to investigate the difference between systemic cytokine profiles and the local microenvironment immunity using the Wilcoxon matched-pairs signed rank test.The 12 cytokines from cervical secretions were compared between the three groups using the Mann-Whitney test,and logistic regression was used to analyze HSIL and N-HSIL.Results There were statistical differences in eight cytokines(IL-2,IL-6,TNF-α,IFN-γ,IL-1β,IL-12p70,IFN-α,and IL-8)between cervical secretion and plasma of the same patient,and seven cytokines were statistically different between the control and other two groups.We selected four independent variables(TNF-α,IFN-γ,IL-12p70,and IFN-α)commonly identified by univariate regression analysis and non-parametric tests for multivariate logistic regression analysis.Based on this model,HSIL could be predicted in patients with HR-HPV infection,with the area under the curve being 0.76.Conclusion The systemic cytokine profile cannot reflect the local microenvironment immunity,and the occurrence of HSIL is related to the cytokine levels in the cervical microenvironment.展开更多
Aim:Neuroblastoma has a variable outcome depending on age,stage,and molecular pathology.Distant metastatic disease is the central feature of high-risk disease.Recommendations for irradiating persistent metastatic depo...Aim:Neuroblastoma has a variable outcome depending on age,stage,and molecular pathology.Distant metastatic disease is the central feature of high-risk disease.Recommendations for irradiating persistent metastatic deposits with curative intent after systemic therapy vary.It is unclear to what extent this practice may improve local control or survival.This study systematically reviewed the evidence for skeletal metastatic site irradiation and made evidence-based recommendations for clinical practice.Methods:We systematically reviewed the literature on radical radiotherapy of persistent metastases after chemotherapy.The aim was to determine whether a position could be taken regarding metastatic site irradiation in combined modality treatment protocols aiming for a cure and whether recommendations could be formulated.Results:The initial search yielded 445 results.After the title and abstract review,13 full papers were retrieved.Ten papers were found suitable for data extraction.One additional paper was identified.All 11 were graded as Centre for Evidence-Based Medicine Step 4 in quality;there was no high-level evidence.There are suggestions of benefit for skeletal site irradiation in high-risk neuroblastoma;however,there is no certainty,and it was not possible to recommend a particular treatment policy.Conclusion:We recommend that consideration is given to a randomised evaluation of the benefits of radiotherapy to a limited number of residual post-induction-chemotherapy metastatic sites in good responders.This practice could be incorporated as an amendment to existing trials.展开更多
Importance:131I-metaiodobenzylguanidine(131I-mIBG)has a significant targeted antitumor effect for neuroblastoma.However,currently there is a paucity of data for the use of 131I-mIBG as a"front-line"therapeut...Importance:131I-metaiodobenzylguanidine(131I-mIBG)has a significant targeted antitumor effect for neuroblastoma.However,currently there is a paucity of data for the use of 131I-mIBG as a"front-line"therapeutic agent in those patients with newly diagnosed high-risk neuroblastoma as part of the conditioning regimen for myeloablative chemotherapy(MAC).Objective:To evaluate the feasibility of upfront consolidation treatment with 131I-mIBG plus MAC and hematopoietic stem cell transplantation(HSCT)in high-risk neuroblastoma patients.Methods:A retrospective,single-center study was conducted from 2003-2019 on newly diagnosed high-risk neuroblastoma patients without progressive disease(PD)after the completion of induction therapy.They received 131I-mIBG infusion and MAC followed by HSCT.Results:A total of 24 high-risk neuroblastoma patients were enrolled with a median age of 3.0 years at diagnosis.After receiving this sequential consolidation treatment,3 of 13 patients who were in partial response(PR)before 131I-mIBG treatment achieved either complete response(CR)(n=1)or very good partial response(VGPR)(n=2)after HSCT.With a median follow-up duration of 13.0 months after 131I-mIBG therapy,the 5-year event-free survival and overall survival rates estimated were 29%and 38%for the entire cohort,and 53%and 67%for the patients who were in CR/VGPR at the time of 131I-mIBG treatment.Interpretation:Upfront consolidation treatment with 131I-mIBG plus MAC and HSCT is feasible and tolerable in high-risk neuroblastoma patients,however the survival benefit of this 131I-mIBG regimen is only observed in the patients who were in CR/VGPR at the time of 131I-mIBG treatment.展开更多
Aim:Neuroblastoma is a pediatric cancer of the sympathetic nervous system.Using various parameters including stage of the disease,amplification status of N-Myc,DNA index and histopathology,neuroblastoma can be stratif...Aim:Neuroblastoma is a pediatric cancer of the sympathetic nervous system.Using various parameters including stage of the disease,amplification status of N-Myc,DNA index and histopathology,neuroblastoma can be stratified into low-and high-risk groups.Recent advances in treatment have significantly improved the survival rate of lowrisk neuroblastoma patients.However,the overall survival rate of high-risk neuroblastoma group,especially N-Myc amplified patients,is poor.Moreover,the survivors of both low-and high-risk neuroblastoma manifest adverse side effects to chemotherapy and thus their quality of life is impaired.Considering all these factors,there is an urgent need to develop therapeutic strategies with natural compounds to improve the survival rate and to reduce the side effects.In this study,we hypothesised that the mesenchymal nature of neuroblastoma cells is a reason,at least in part,for the aggressive and treatment resistant phenotype.Method:In order to validate our hypothesis,we used publicaly available RNA-Seq data,in vitro assays and xenograft mouse models.Results:Using a combinatorial treatment of mesenchymal-to-epithelial inducers(curcumin or silibinin)with doxorubicin significantly increased the cell death in a panel of neuroblastoma cells in vitro.Follow up analysis in vivo,confirmed the therapeutic benefit of utilising the combination of curcumin with doxorubicin.The combinatorial therapy significantly reduced the tumor burden and increased the survival of mice implanted with high-risk neuroblastoma cells.Conclusion:Taken together,this study shows the efficacy of using curcumin in combination with doxorubicin to improve the survival rate and has the potential to enhance the quality of life of neuroblastoma patients.展开更多
High-risk neuroblastoma still has poor survival outcome. Improvement of outcome is attributed to the consolidation of chemotherapy by autologous bone marrow transplant. Further improvement of the outcome by tandem aut...High-risk neuroblastoma still has poor survival outcome. Improvement of outcome is attributed to the consolidation of chemotherapy by autologous bone marrow transplant. Further improvement of the outcome by tandem autologous transplant is followed by immune therapy. We aimed with this study to correlate initial disease characteristics with the outcome of transplanted high-risk neuroblastoma. A retrospective analysis was done for 73 transplanted patients. Patients were treated in Children’s Cancer Hospital Egypt from July 2012 to July 2015. Seventy patients received Busulphan/Melphalan conditioning. The 3-year overall survival (OS) and event-free survival (EFS) was 63.3% and 51.3%, respectively. Disease stage did not impact the OS and EFS, P = 0.54 and 0.62 respectively. Status of MYCN did not reflect statistically on outcome for tumors with amplified compared to nonamplified (EFS, 49% and 63.1%, respectively). Response after induction chemotherapy pointed that patients who had objective response (complete response, very good partial response and partial response) were better compared to those with less response with EFS and OS of 53.3% and 64.2% compared to 49.3% and 63.5%, respectively, which may indicate that chemo-sensitive tumors have better outcome. By the end of the study, twenty-seven patients relapsed, out of them 25 patients died. Pretransplant risk features for neuroblastoma was nullified by autologous stem cell transplant. The modest outcome observed, highlights some limitations that need to be sorted out in countries with limited resources. The introduction of immune therapy and tandem transplant is needed to achieve a better outcome, yet it adds to more financial burden.展开更多
BACKGROUND Effective health management for high-risk stroke populations is essential.The hospital-community-home(HCH)collaborative health management(CHM)model leverages resources from hospitals,communities,and familie...BACKGROUND Effective health management for high-risk stroke populations is essential.The hospital-community-home(HCH)collaborative health management(CHM)model leverages resources from hospitals,communities,and families.By integrating patient information across these three domains,it facilitates the delivery of tailored guidance,health risk assessments,and three-in-one health education.AIM To explore the effects of the HCH-CHM model on stroke risk reduction in highrisk populations.METHODS In total,110 high-risk stroke patients screened in the community from January 2019 to January 2023 were enrolled,with 52 patients in the control group receiving routine health education and 58 in the observation group receiving HCH-CHM model interventions based on routine health education.Stroke awareness scores,health behavior levels,medication adherence,blood pressure,serum biochemical markers(systolic/diastolic blood pressure,total cholesterol,and triglyceride),and psychological measures(self-rating anxiety/depression scale)were evaluated and compared between groups.RESULTS The observation group showed statistically significant improvements in stroke awareness scores and health behavior levels compared to the control group(P<0.05),with notable enhancements in lifestyle and dietary habits(P<0.05)and reductions in postintervention systolic blood pressure,diastolic blood pressure,total cholesterol,triglyceride,self-rating anxiety scale,and self-rating depression scale scores(P<0.05).CONCLUSION The HCH-CHM model had a significant positive effect on high-risk stroke populations,effectively increasing disease awareness,improving health behavior and medication adherence,and appropriately ameliorating blood pressure,serum biochemical marker levels,and negative psychological symptoms.展开更多
BACKGROUND Inadequately controlled hypertension often leads to an increased cardiovascular death rate in type 2 diabetes mellitus(T2DM).It remains unclear whether systolic blood pressure(SBP)status of hypertension is ...BACKGROUND Inadequately controlled hypertension often leads to an increased cardiovascular death rate in type 2 diabetes mellitus(T2DM).It remains unclear whether systolic blood pressure(SBP)status of hypertension is related to coronary inflammation and plaques in T2DM.AIM To evaluate whether SBP variability(SBPV)and levels of hypertension are related to coronary inflammation and plaques in T2DM patients using coronary computed tomography angiography(CCTA).METHODS This retrospective study involved 881 T2DM patients with CCTA images,including 668 hypertension and 213 normotension patients.Hypertension patients were subgroup based on SBP status:(1)SBPV:Low(<8.96 mmHg)and high(≥8.96 mmHg)groups;and(2)SBP levels:Controlled(<140 mmHg)and uncontrolled(≥140 mmHg)groups.Pericoronary adipose tissue(PCAT)attenuation,high-risk plaques(HRPs)and obstructive stenosis(OS)were evaluated by CCTA.Propensity score matching was utilized to compare these CCTA findings for these groups.The impact of SBPV and SBP levels of hypertension on these CCTA findings in T2DM patients were evaluated by multivariate logistic regression and multivariable linear regression.RESULTS PCAT attenuation of the left anterior descending artery(LAD),any low attenuation plaque(LAP),any spotty calcification(SC),any positive remodeling(PR),and OS had significant differences between the hypertension group and the normotension group,as well as between the high SBPV or uncontrolled SBP group and the low SBPV or controlled SBP group(all P<0.05).Hypertension was independently positively correlated with LADPCAT attenuation(β=1.815,P=0.010),LAP(OR=1.612,P=0.019),SC(OR=1.665,P=0.013),PR(OR=1.549,P=0.033),and OS(OR=1.928,P=0.036)in all T2DM patients.Additionally,high SBPV and uncontrolled SBP were independently positively correlated with LAD-PCAT attenuation(high SBPV:β=1.673,P=0.048;uncontrolled SBP:β=2.370,P=0.004)and PR(high SBPV:OR=1.903,P=0.048;uncontrolled SBP:OR=2.230,P=0.013)in T2DM patients with hypertension.CONCLUSION Inadequately controlled hypertension,including high SBPV and/or uncontrolled SBP levels,may be related to increased coronary artery inflammation,HRPs,and OS in T2DM,leading to increased cardiovascular risk.Achieving both low SBPV and controlled SBP levels simultaneously,especially in individuals with T2DM and hypertension,warrants clinical attention.展开更多
Objective: Stroke is perceived as a serious illness although it is preventable, and lifestyle alterations can be made to reduce its risk. Improvement of stroke care should be achieved through awareness of public, espe...Objective: Stroke is perceived as a serious illness although it is preventable, and lifestyle alterations can be made to reduce its risk. Improvement of stroke care should be achieved through awareness of public, especially through high-risk group. Henceforth, the aim of this study was to evaluate the effect of nursing intervention on improving awareness of high-risk people about stroke prevention. Methods: A quasi-experimental design was used to carry out this study, where a purposive sample of 80 adult patients at high risk for stroke were enrolled while they were attending the out-patient clinics of Zagazig University Hospitals for follow-up treatment;they were divided into two groups: case (40 patients) and control (40 patients). An interview questionnaire was used to assess patients’ knowledge regarding warning signs, risk factors, and immediate treatment;attitude;and their practice for prevention for stroke at pretest and posttest. Results: The study revealed the poor level of knowledge, bad level of preventive behavior, and negative attitude regarding stroke prevention at pre-intervention. However, after intervention, the high-risk people had fair level of knowledge with moderate practice for stroke prevention and positive attitude, with statistically significant difference between pre-post intervention and between the case and control groups. Conclusions: The study revealed that the nursing intervention seemed to change the knowledge, practice, and attitude of subjects regarding stroke prevention. This, in turn, implies that awareness of prevention of stroke and high-risk factor control could be important to reduce the burden of stroke in Egypt. Thus, further research on a larger scale is required to improve population knowledge and behavior for stroke prevention and control.展开更多
Objective:To explore the perspectives of high-risk pregnant women regarding the home care program for high-risk pregnancies.Methods:This qualitative study was conducted in a university hospital and 5 comprehensive hea...Objective:To explore the perspectives of high-risk pregnant women regarding the home care program for high-risk pregnancies.Methods:This qualitative study was conducted in a university hospital and 5 comprehensive health centers in Ahvaz,Iran,from February 2023 to July 2023.The sampling method used was purposive sampling considering the maximum possible diversity,which continued until data saturation.11 in-depth and semistructured interviews were conducted with high-risk pregnant women.Data were simultaneously analysed using Graneheim and Lundman content analysis by MAXQDA version 20 software.Results:Data analysis extracted 3 themes,12 categories,and 26 subcategories.The themes and categories were“high-risk pregnancy and related issues(pursuing treatment and paying attention to the high-risk situation by pregnant women,psychological aspect of high-risk pregnancy on pregnant women and caregivers,emotional and physical aspects of high-risk pregnancy,the consequences of high-risk pregnancy on the people around them and empowerment of high-risk pregnant women)”,“support dimension(family and community support for high-risk pregnant women)”,and“framework of program(acculturalization,means and equipment,security,manpower and the necessary arrangements for the home care)”.Conclusions:High-risk pregnancy affects various aspects of the lives of high-risk pregnant women and their families.Creating the necessary conditions for providing care at home plays a vital role in supporting high-risk pregnant women and removing related obstacles to receiving prenatal care in person.It will be especially beneficial for high-risk pregnant women in low-income areas.展开更多
Objective:Neuroblastoma is the most common extracranial solid tumor in children and has complex genetic underpinnings.Previous genome-wide association studies(GWASs)have identified many loci associated with neuroblast...Objective:Neuroblastoma is the most common extracranial solid tumor in children and has complex genetic underpinnings.Previous genome-wide association studies(GWASs)have identified many loci associated with neuroblastoma susceptibility;however,their application in risk prediction for Chinese children has not been systematically explored.This study seeks to enhance neuroblastoma risk prediction by validating these loci and evaluating their performance in polygenic risk models.Methods:We validated 35 GWAS-identified neuroblastoma susceptibility loci in a cohort of Chinese children,consisting of 402 neuroblastoma patients and 473 healthy controls.Genotyping these polymorphisms was conducted via the TaqMan method.Univariable and multivariable logistic regression analyses revealed the genetic loci significantly associated with neuroblastoma risk.We constructed polygenic risk models by combining these loci and assessed their predictive performance via area under the curve(AUC)analysis.We also established a polygenic risk scoring(PRS)model for risk prediction by adopting the PLINK method.Results:Fourteen loci,including ten protective polymorphisms from CASC15,BARD1,LMO1,HSD17B12,and HACE1,and four risk variants from BARD1,RSRC1,CPZ and MMP20 were significantly associated with neuroblastoma risk.Compared with single-gene model,the 8-gene model(AUC=0.72)and 13-gene model(AUC=0.73)demonstrated superior predictive performance.Additionally,a PRS incorporating six significant loci achieved an AUC of 0.66,effectively stratifying individuals into distinct risk categories regarding neuroblastoma susceptibility.A higher PRS was significantly associated with advanced International Neuroblastoma Staging System(INSS)stages,suggesting its potential for clinical risk stratification.Conclusions:Our findings validate multiple loci as neuroblastoma risk factors in Chinese children and demonstrate the utility of polygenic risk models,particularly the PRS,in improving risk prediction.These results suggest that integrating multiple genetic variants into a PRS can enhance neuroblastoma risk stratification and potentially improve early diagnosis by guiding targeted screening programs for high-risk children.展开更多
The published article titled“Triptolide inhibits proliferation and migration of human neuroblastoma SH-SY5Y cells by upregulating microRNA-181a”has been retracted from Oncology Research,Vol.26,No.8,2018,PP.1235-1243.
Objective:Our previous studies have indicated potentially higher proliferative activity of tumor cells in Chinese patients with mantle-cell lymphoma(MCL)than those in Western.Given the success and tolerability of R-DA...Objective:Our previous studies have indicated potentially higher proliferative activity of tumor cells in Chinese patients with mantle-cell lymphoma(MCL)than those in Western.Given the success and tolerability of R-DA-EDOCH immunochemotherapy in treating aggressive B-cell lymphomas,we designed a prospective,phase 3 trial to explore the efficacy and safety of alternating R-DA-EDOCH/R-DHAP induction therapy for young patients with newly diagnosed MCL.The primary endpoint was the complete remission rate(CRR)at the end of induction(EOI).Methods:A total of 55 patients were enrolled.The CRR at the EOI was 89.1%[95%confidence interval(CI)78%±96%],and the overall response rate was 98.1%(95%CI 90%±100%).Most patients with bone marrow involvement quickly attained minimal residual disease(MRD)negative status,with a 95.7%rate at the EOI.Results:The 3-year progression-free survival(PFS)and overall survival rates were 66.3%and 83.2%,respectively.No patients discontinued treatment because of adverse events.Univariate analysis identified pathologic morphology and TP53 mutations as risk factors for PFS.However,high tumor proliferative activity and certain cytogenetic abnormalities showed no significant adverse prognostic significance.Conclusions:Intensive therapy based on a high cytarabine dose and continuously administered EDOCH achieved a high MRDnegative rate and provides an optional induction choice for young patients with MCL with high-risk factors.展开更多
Background:Loneliness is a common experience for pregnant women and correlates with perinatal depression and negative pregnancy outcomes.Women experiencing a high-risk pregnancy are at greater risk for loneliness beca...Background:Loneliness is a common experience for pregnant women and correlates with perinatal depression and negative pregnancy outcomes.Women experiencing a high-risk pregnancy are at greater risk for loneliness because of uncertainty with disease and the medicalization of pregnancy.International studies have identified an association between perceived stress and loneliness in pregnant women.The aim of this study is to explore factors related to loneliness among women of high-risk pregnancy,and to examine the associated relationship of loneliness and perceived stress.Methods:Using convenience sampling,109 women with high-risk pregnancies were enrolled.Data collection involved questionnaires on general demographic characteristics,the 6-item Loneliness Scale(ULS-6),and the Chinese version of the Perceived Stress Scale(CPSS-14).Data analysis was performed using SPSS 28.0 statistical software.Results:The mean loneliness score was 9.95±2.99,and the mean perceived stress score was 22.84±5.80.Women with high-risk pregnancies exhibited statistically significant differences in loneliness scores compared to the control group across among age,marital status,educational attainment,per capita monthly household income,spousal relationship,in-law relationship,and parental relationship(P<0.05).Correlation analysis revealed a positive correlation between loneliness and perceived stress(r=0.456,P<0.01).Multivariate regression analysis indicated that per capita monthly household income,marital relationship,in-law relationship,and perceived stress were the primary factors influencing loneliness among women with high-risk pregnancies(P<0.05).Conclusion:The results highlight the need for specific interventions addressing loneliness among women with high-risk pregnancies.Such interventions should focus on improving spousal and in-law relationships,reducing perceived stress,and implementing support measures,such as financial counseling or assistance programs,for those with lower per capita household income.This study establishes a foundation for the creation of integrated support systems that bring together families and healthcare providers to strengthen maternal mental health.展开更多
BACKGROUND Despite advances in treatment,the prognosis for patients with high-risk pediatric solid tumors remains dismal.Tandem autologous stem cell transplantation(ASCT)offers promise for improving outcomes in these ...BACKGROUND Despite advances in treatment,the prognosis for patients with high-risk pediatric solid tumors remains dismal.Tandem autologous stem cell transplantation(ASCT)offers promise for improving outcomes in these patients.This study aimed to examine the efficacy and prognostic factors of tandem ASCT in pediatric patients with high-risk solid tumors.AIM To determine the survival outcomes and prognostic factors in pediatric patients with high-risk solid tumors undergoing tandem ASCT.METHODS A total of 40 pediatric patients with high-risk solid tumors treated from March 2015 to August 2022 were included in this retrospective study.The diagnoses of the patients included neuroblastoma,germ cell tumors,atypical teratoid/rhabdoid tumor,medulloblastoma,and pineoblastoma.After induction chemotherapy,all patients received tandem ASCT and were allocated into two groups(group A and group B)based on high-dose chemotherapy regimens.Prognostic relevance was evaluated by examining patient characteristics,such as sex,age,lactate dehydrogenase levels,primary site,the number of metastatic sites,and bone marrow involvement.RESULTS The median follow-up duration since the first ASCT was 24 months(range:1-91 months),with 5-year overall survival(OS)and event-free survival(EFS)rates of 73%and 70%,respectively,for the entire cohort.The 3-year OS rates were 67%for group A and 87%for group B(P=0.29),with corresponding 3-year EFS rates of 67%and 79%(P=0.57).Among neuroblastoma patients,the 5-year OS and EFS were 69%and 63%(P=0.23).Univariable analysis revealed a notable association of age≥36 months and elevated lactate dehydrogenase level at diagnosis with poorer OS.Despite acute adverse effects,all patients demonstrated good tolerance to the treatment,with no occurrences of transplant-related mortality.CONCLUSION Tandem ASCT demonstrates promising survival outcomes for patients with high-risk solid tumors,particularly neuroblastoma,with manageable toxicity and no transplant-related mortality.展开更多
Pregnant women with high-risk pregnancy face a higher risk of complications due to factors such as chronic diseases,multiple pregnancies,and a history of adverse pregnancy and childbirth,requiring more systematic and ...Pregnant women with high-risk pregnancy face a higher risk of complications due to factors such as chronic diseases,multiple pregnancies,and a history of adverse pregnancy and childbirth,requiring more systematic and dynamic health management support.In view of this,“Internet+continuous nursing”can break the limitations of time and space by integrating mobile communication,remote monitoring,data sharing,and intelligent analysis technologies,realizing closed-loop care with collaboration among hospitals,communities,and families.Research shows that continuous nursing based on the“Internet+”significantly improves the professional response ability of caregivers.Medical staff can grasp the patient’s status in real time,optimize diagnosis and treatment decisions,providing a feasible path for building an efficient,precise,and humanized high-risk pregnancy management system,which has broad clinical promotion value and public health significance.展开更多
Diabetic foot(DF)has emerged as one of the most common chronic consequences of diabetes mellitus,characterized by prolonged disease duration,high treatment costs,a poor prognosis,and a high disability rate.Diabetic hi...Diabetic foot(DF)has emerged as one of the most common chronic consequences of diabetes mellitus,characterized by prolonged disease duration,high treatment costs,a poor prognosis,and a high disability rate.Diabetic high-risk foot is the early stage of diabetic foot,the“disease prevention”of“treating no disease”,which provides a critical window for clinical prevention and treatment.Traditional Chinese medicine(TCM)has emphasized the importance of preventive health care since ancient times.External therapies such as acupuncture,massage,acupoint injection,foot bath fumigation,and moxibustion have the advantages of simplicity,low cost,precise efficacy,and fewer side effects in preventing and treating diabetic high-risk foot.The multidisciplinary synergistic model formed by TCM complementary therapies and modern medical treatments,such as nutritional,peripheral nerve,and blood glucose regulation,provides new ideas for establishing standardized prevention and treatment protocols.In this paper,studies related to TCM-related complementary therapies for diabetic high-risk feet are systematically reviewed.Current advances in external application in TCM were described to better understand its effectiveness and safety in elderly patients.展开更多
Childhood neuroblastoma,a leading cause of cancer-related mortality in young children,accounts for approximately 8%-10%of pediatric cancers1.Originating from neural crest cells of the sympathetic nervous system,these ...Childhood neuroblastoma,a leading cause of cancer-related mortality in young children,accounts for approximately 8%-10%of pediatric cancers1.Originating from neural crest cells of the sympathetic nervous system,these tumors affect primarily children younger than 5 years of age and are often diagnosed in advanced stages,because of their aggressive nature and vague early symptoms2-4.展开更多
Objective:Neuroblastoma(NB)is frequently associated with high-risk pediatric cases that demonstrate limited response to cisplatin,contributing to a poor prognosis.Recent studies have explored the role of tumor cell se...Objective:Neuroblastoma(NB)is frequently associated with high-risk pediatric cases that demonstrate limited response to cisplatin,contributing to a poor prognosis.Recent studies have explored the role of tumor cell senescence in increasing sensitivity to this chemotherapy agent.This study aims to identify genes related to cell senescence in children diagnosed with NB,evaluate their influence on cisplatin sensitivity,and investigate potential strategies to enhance the efficacy of chemotherapy.Methods:Gene expression profiles and clinical data were obtained for 498 NB patients from the GEO database(GSE49710).The study focused on identifying genes that were differentially expressed between stage IV and other stages,particularly those linked to cell senescence and cisplatin resistance.To analyze the prognostic significance of these differentially expressed genes,we employed LASSO regression and multivariate Cox proportional hazards models.Transcriptomic and proteomic analyses of 15 NB specimens revealed a significant correlation between Flap endonuclease-1(FEN1)expression levels and both cellular senescence and sensitivity to cisplatin.We quantified FEN1 expression and cisplatin IC50 values in four different NB cell lines.The influence of FEN1 knockdown and overexpression on NB cell proliferation,invasion,and migration was evaluated using cloning assays,transwell assays,and scratch assays.Furthermore,we utilized Western blotting to analyze senescenceassociated proteins p21 and proliferating cell nuclear antigen(PCNA),thereby evaluating the role of FEN1 in cellular senescence.The impact of FEN1 on cisplatin sensitivity was investigated via the CCK-8 cell counting assay.Additionally,we investigated how FEN1 inhibitors might impact NB cell proliferation and enhance the therapeutic efficacy of cisplatin treatment.Results:FEN1 was found to be highly expressed in stage IV NB and showed a strong association with cisplatin sensitivity,establishing it as a critical molecular marker linked to poor patient prognosis.Notably,elevated FEN1 expression correlated with reduced sensitivity to cisplatin,as evidenced by higher IC50 values.In the SH-SY5Y cell line,FEN1 knockdown led to significant reductions in cell proliferation,invasion,and migration,along with an increase inβ-galactosidase staining—indicative of senescence.This knockdown also resulted in elevated levels of the p21 protein and decreased expression of PCNA,concurrently lowering cisplatin IC50 values.Conversely,FEN1 overexpression in the SK-N-SH cell line resulted in enhanced cell proliferation,invasion,and migration.This overexpression was associated with reducedβ-galactosidase staining,decreased levels of p21,and increased expression of PCNA,ultimately resulting in higher cisplatin IC50 values.Importantly,FEN1 inhibitors alone significantly impeded NB cell proliferation,and their combination with cisplatin further amplified this inhibitory effect compared to cisplatin treatment alone.Conclusions:Bioinformatics and sequencing analyses indicate that the senescence-related gene FEN1 is significantly associated with cisplatin sensitivity and adverse prognosis in pediatric NB.FEN1 plays a pivotal role in regulating NB cell proliferation,invasion,and migration,thereby facilitating cancer progression.Furthermore,it influences cisplatin sensitivity through its effects on cellular senescence.FEN1 inhibitors demonstrate potential both as monotherapies and in conjunction with cisplatin,suggesting that targeting FEN1 may be represent a valuable strategy for improving outcomes in high-risk NB patients.展开更多
Background:Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. While liver transplantation (LT) provides the best long-term survival, it is constrained by organ scarcity and strict criteria....Background:Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. While liver transplantation (LT) provides the best long-term survival, it is constrained by organ scarcity and strict criteria. Liver resection (LR) is often the initial treatment for patients with solitary tumors and preserved liver function. The high recurrence rates associated with LR has prompted the exploration of sequential living donor liver transplantation (seq LDLT) after LR as a strategy for HCC patients with high-risk of recurrence.Methods:We analyzed data from 27 adult patients who underwent seq LDLT after LR for HCC at Kaohsiung Chang Gung Memorial Hospital (KCGMH) between June 1994 and December 2023. Patients were selected based on high-risk histopathological features post-LR or as part of downstaging strategy. Outcomes measured included overall survival (OS) and disease-free survival (DFS).Results:Among 765 HCC patients who underwent LDLT, 204 received LR before LDLT, and 27 underwent seqL DLT. Five patients (19%) underwent living donor liver transplantation (LDLT) following LR as a downstaging strategy while the rest received seqL DLT as a preemptive strategy. The median age was 53.5 years with 85%males. Chronic hepatitis B was the predominant underlying disease (74%). The 1-, 3-, and 5-year OS and DFS rates were 100%, 96.0%, 96.0%and 100%, 96.2%, 96.2%, respectively, with two patients experiencing HCC recurrence. One patient died from HCC recurrence. High-risk histopathological features included microvascular invasion (52%), satellite nodules (15%), multiple tumors (26%), tumors> 5 cm(19%), and a total tumor diameter> 10 cm (7%).Conclusions:Seq LDLT offers a promising, tailored approach for managing HCC with adverse histopathologic features. Combining seq LDLT, downstaging strategies, and multidisciplinary treatments can achieve satisfactory OS and DFS in carefully selected patients, highlighting the need for refined criteria to identify the best candidates.展开更多
文摘Objective:To analyze the impact of maternal-infant separation on the physical and mental state of high-risk pregnancy patients and explore the clinical efficacy of targeted nursing interventions.Methods:A total of 80 high-risk pregnancy patients treated in our hospital from January 2023 to January 2024 were selected as the study subjects.These patients were randomly divided into an observation group and a control group(40 cases each)using a random number table.The control group received routine high-risk pregnancy nursing care,while the observation group received specialized maternal-infant separation nursing interventions in addition to routine care.The psychological and physiological states and nursing satisfaction of the two groups were compared before and after the intervention.Results:The SAS scores,SDS scores,and sleep quality scores of the observation group were significantly lower than those of the control group,with statistically significant differences(p<0.05).The incidence of postpartum hemorrhage in the observation group was significantly lower than that in the control group,and the initiation time of lactation was significantly earlier than that in the control group,with both differences being statistically significant(p<0.05).The nursing satisfaction of the observation group was significantly higher than that of the control group(80%vs.32/40),with a statistically significant difference(p<0.05).Conclusion:Maternal-infant separation exacerbates anxiety and depression in high-risk pregnancy patients,reduces sleep quality,increases the risk of postpartum hemorrhage,and delays the initiation of lactation.Specialized nursing interventions for maternal-infant separation can improve the physical and mental state of high-risk pregnancy patients,reduce the incidence of postpartum complications,and enhance nursing satisfaction,making them worthy of clinical application and promotion.
基金supported by the National Key Research and Development Program of China(2023YFC2308800)the Natural Science Foundation of Shanghai(25ZR1402053)the Key Discipline of Public Health of the Shanghai Municipal Health Commission(Grant No.GWVI-11.1-07).
文摘Objective The aim of this study was to analyze the correlation between the levels of 12 cytokines in the cervical microenvironment and cervical intraepithelial neoplasia in patients with high-risk human papillomavirus(HR-HPV)infection.Methods Female patients(n=73)with HR-HPV infection were enrolled and divided into a high-grade squamous intraepithelial lesion(HSIL)group(n=33)and a non-HSIL(N-HSIL)group(n=40),which include low-grade squamous intraepithelial lesions and inflammation.Healthy screening subjects(n=31)with negative HR-HPV results were enrolled as a control group.We examined contemporaneous plasma and secretory cytokines from 25 study subjects to investigate the difference between systemic cytokine profiles and the local microenvironment immunity using the Wilcoxon matched-pairs signed rank test.The 12 cytokines from cervical secretions were compared between the three groups using the Mann-Whitney test,and logistic regression was used to analyze HSIL and N-HSIL.Results There were statistical differences in eight cytokines(IL-2,IL-6,TNF-α,IFN-γ,IL-1β,IL-12p70,IFN-α,and IL-8)between cervical secretion and plasma of the same patient,and seven cytokines were statistically different between the control and other two groups.We selected four independent variables(TNF-α,IFN-γ,IL-12p70,and IFN-α)commonly identified by univariate regression analysis and non-parametric tests for multivariate logistic regression analysis.Based on this model,HSIL could be predicted in patients with HR-HPV infection,with the area under the curve being 0.76.Conclusion The systemic cytokine profile cannot reflect the local microenvironment immunity,and the occurrence of HSIL is related to the cytokine levels in the cervical microenvironment.
文摘Aim:Neuroblastoma has a variable outcome depending on age,stage,and molecular pathology.Distant metastatic disease is the central feature of high-risk disease.Recommendations for irradiating persistent metastatic deposits with curative intent after systemic therapy vary.It is unclear to what extent this practice may improve local control or survival.This study systematically reviewed the evidence for skeletal metastatic site irradiation and made evidence-based recommendations for clinical practice.Methods:We systematically reviewed the literature on radical radiotherapy of persistent metastases after chemotherapy.The aim was to determine whether a position could be taken regarding metastatic site irradiation in combined modality treatment protocols aiming for a cure and whether recommendations could be formulated.Results:The initial search yielded 445 results.After the title and abstract review,13 full papers were retrieved.Ten papers were found suitable for data extraction.One additional paper was identified.All 11 were graded as Centre for Evidence-Based Medicine Step 4 in quality;there was no high-level evidence.There are suggestions of benefit for skeletal site irradiation in high-risk neuroblastoma;however,there is no certainty,and it was not possible to recommend a particular treatment policy.Conclusion:We recommend that consideration is given to a randomised evaluation of the benefits of radiotherapy to a limited number of residual post-induction-chemotherapy metastatic sites in good responders.This practice could be incorporated as an amendment to existing trials.
文摘Importance:131I-metaiodobenzylguanidine(131I-mIBG)has a significant targeted antitumor effect for neuroblastoma.However,currently there is a paucity of data for the use of 131I-mIBG as a"front-line"therapeutic agent in those patients with newly diagnosed high-risk neuroblastoma as part of the conditioning regimen for myeloablative chemotherapy(MAC).Objective:To evaluate the feasibility of upfront consolidation treatment with 131I-mIBG plus MAC and hematopoietic stem cell transplantation(HSCT)in high-risk neuroblastoma patients.Methods:A retrospective,single-center study was conducted from 2003-2019 on newly diagnosed high-risk neuroblastoma patients without progressive disease(PD)after the completion of induction therapy.They received 131I-mIBG infusion and MAC followed by HSCT.Results:A total of 24 high-risk neuroblastoma patients were enrolled with a median age of 3.0 years at diagnosis.After receiving this sequential consolidation treatment,3 of 13 patients who were in partial response(PR)before 131I-mIBG treatment achieved either complete response(CR)(n=1)or very good partial response(VGPR)(n=2)after HSCT.With a median follow-up duration of 13.0 months after 131I-mIBG therapy,the 5-year event-free survival and overall survival rates estimated were 29%and 38%for the entire cohort,and 53%and 67%for the patients who were in CR/VGPR at the time of 131I-mIBG treatment.Interpretation:Upfront consolidation treatment with 131I-mIBG plus MAC and HSCT is feasible and tolerable in high-risk neuroblastoma patients,however the survival benefit of this 131I-mIBG regimen is only observed in the patients who were in CR/VGPR at the time of 131I-mIBG treatment.
基金Suresh Mathivanan is supported by Australian Research Council Future Fellowship(FT180100333)the project was not funded by the basic science fellowship.Angela Di Giannatale is supported by a Grant from the Italian Ministry of Health(GR-2016-02364088).
文摘Aim:Neuroblastoma is a pediatric cancer of the sympathetic nervous system.Using various parameters including stage of the disease,amplification status of N-Myc,DNA index and histopathology,neuroblastoma can be stratified into low-and high-risk groups.Recent advances in treatment have significantly improved the survival rate of lowrisk neuroblastoma patients.However,the overall survival rate of high-risk neuroblastoma group,especially N-Myc amplified patients,is poor.Moreover,the survivors of both low-and high-risk neuroblastoma manifest adverse side effects to chemotherapy and thus their quality of life is impaired.Considering all these factors,there is an urgent need to develop therapeutic strategies with natural compounds to improve the survival rate and to reduce the side effects.In this study,we hypothesised that the mesenchymal nature of neuroblastoma cells is a reason,at least in part,for the aggressive and treatment resistant phenotype.Method:In order to validate our hypothesis,we used publicaly available RNA-Seq data,in vitro assays and xenograft mouse models.Results:Using a combinatorial treatment of mesenchymal-to-epithelial inducers(curcumin or silibinin)with doxorubicin significantly increased the cell death in a panel of neuroblastoma cells in vitro.Follow up analysis in vivo,confirmed the therapeutic benefit of utilising the combination of curcumin with doxorubicin.The combinatorial therapy significantly reduced the tumor burden and increased the survival of mice implanted with high-risk neuroblastoma cells.Conclusion:Taken together,this study shows the efficacy of using curcumin in combination with doxorubicin to improve the survival rate and has the potential to enhance the quality of life of neuroblastoma patients.
文摘High-risk neuroblastoma still has poor survival outcome. Improvement of outcome is attributed to the consolidation of chemotherapy by autologous bone marrow transplant. Further improvement of the outcome by tandem autologous transplant is followed by immune therapy. We aimed with this study to correlate initial disease characteristics with the outcome of transplanted high-risk neuroblastoma. A retrospective analysis was done for 73 transplanted patients. Patients were treated in Children’s Cancer Hospital Egypt from July 2012 to July 2015. Seventy patients received Busulphan/Melphalan conditioning. The 3-year overall survival (OS) and event-free survival (EFS) was 63.3% and 51.3%, respectively. Disease stage did not impact the OS and EFS, P = 0.54 and 0.62 respectively. Status of MYCN did not reflect statistically on outcome for tumors with amplified compared to nonamplified (EFS, 49% and 63.1%, respectively). Response after induction chemotherapy pointed that patients who had objective response (complete response, very good partial response and partial response) were better compared to those with less response with EFS and OS of 53.3% and 64.2% compared to 49.3% and 63.5%, respectively, which may indicate that chemo-sensitive tumors have better outcome. By the end of the study, twenty-seven patients relapsed, out of them 25 patients died. Pretransplant risk features for neuroblastoma was nullified by autologous stem cell transplant. The modest outcome observed, highlights some limitations that need to be sorted out in countries with limited resources. The introduction of immune therapy and tandem transplant is needed to achieve a better outcome, yet it adds to more financial burden.
基金Supported by Guiding Project of Hebei Provincial Health Commission,No.20201190 and 20180220.
文摘BACKGROUND Effective health management for high-risk stroke populations is essential.The hospital-community-home(HCH)collaborative health management(CHM)model leverages resources from hospitals,communities,and families.By integrating patient information across these three domains,it facilitates the delivery of tailored guidance,health risk assessments,and three-in-one health education.AIM To explore the effects of the HCH-CHM model on stroke risk reduction in highrisk populations.METHODS In total,110 high-risk stroke patients screened in the community from January 2019 to January 2023 were enrolled,with 52 patients in the control group receiving routine health education and 58 in the observation group receiving HCH-CHM model interventions based on routine health education.Stroke awareness scores,health behavior levels,medication adherence,blood pressure,serum biochemical markers(systolic/diastolic blood pressure,total cholesterol,and triglyceride),and psychological measures(self-rating anxiety/depression scale)were evaluated and compared between groups.RESULTS The observation group showed statistically significant improvements in stroke awareness scores and health behavior levels compared to the control group(P<0.05),with notable enhancements in lifestyle and dietary habits(P<0.05)and reductions in postintervention systolic blood pressure,diastolic blood pressure,total cholesterol,triglyceride,self-rating anxiety scale,and self-rating depression scale scores(P<0.05).CONCLUSION The HCH-CHM model had a significant positive effect on high-risk stroke populations,effectively increasing disease awareness,improving health behavior and medication adherence,and appropriately ameliorating blood pressure,serum biochemical marker levels,and negative psychological symptoms.
基金Supported by Natural Science Foundation of Hubei Province,No.2023AFB848.
文摘BACKGROUND Inadequately controlled hypertension often leads to an increased cardiovascular death rate in type 2 diabetes mellitus(T2DM).It remains unclear whether systolic blood pressure(SBP)status of hypertension is related to coronary inflammation and plaques in T2DM.AIM To evaluate whether SBP variability(SBPV)and levels of hypertension are related to coronary inflammation and plaques in T2DM patients using coronary computed tomography angiography(CCTA).METHODS This retrospective study involved 881 T2DM patients with CCTA images,including 668 hypertension and 213 normotension patients.Hypertension patients were subgroup based on SBP status:(1)SBPV:Low(<8.96 mmHg)and high(≥8.96 mmHg)groups;and(2)SBP levels:Controlled(<140 mmHg)and uncontrolled(≥140 mmHg)groups.Pericoronary adipose tissue(PCAT)attenuation,high-risk plaques(HRPs)and obstructive stenosis(OS)were evaluated by CCTA.Propensity score matching was utilized to compare these CCTA findings for these groups.The impact of SBPV and SBP levels of hypertension on these CCTA findings in T2DM patients were evaluated by multivariate logistic regression and multivariable linear regression.RESULTS PCAT attenuation of the left anterior descending artery(LAD),any low attenuation plaque(LAP),any spotty calcification(SC),any positive remodeling(PR),and OS had significant differences between the hypertension group and the normotension group,as well as between the high SBPV or uncontrolled SBP group and the low SBPV or controlled SBP group(all P<0.05).Hypertension was independently positively correlated with LADPCAT attenuation(β=1.815,P=0.010),LAP(OR=1.612,P=0.019),SC(OR=1.665,P=0.013),PR(OR=1.549,P=0.033),and OS(OR=1.928,P=0.036)in all T2DM patients.Additionally,high SBPV and uncontrolled SBP were independently positively correlated with LAD-PCAT attenuation(high SBPV:β=1.673,P=0.048;uncontrolled SBP:β=2.370,P=0.004)and PR(high SBPV:OR=1.903,P=0.048;uncontrolled SBP:OR=2.230,P=0.013)in T2DM patients with hypertension.CONCLUSION Inadequately controlled hypertension,including high SBPV and/or uncontrolled SBP levels,may be related to increased coronary artery inflammation,HRPs,and OS in T2DM,leading to increased cardiovascular risk.Achieving both low SBPV and controlled SBP levels simultaneously,especially in individuals with T2DM and hypertension,warrants clinical attention.
文摘Objective: Stroke is perceived as a serious illness although it is preventable, and lifestyle alterations can be made to reduce its risk. Improvement of stroke care should be achieved through awareness of public, especially through high-risk group. Henceforth, the aim of this study was to evaluate the effect of nursing intervention on improving awareness of high-risk people about stroke prevention. Methods: A quasi-experimental design was used to carry out this study, where a purposive sample of 80 adult patients at high risk for stroke were enrolled while they were attending the out-patient clinics of Zagazig University Hospitals for follow-up treatment;they were divided into two groups: case (40 patients) and control (40 patients). An interview questionnaire was used to assess patients’ knowledge regarding warning signs, risk factors, and immediate treatment;attitude;and their practice for prevention for stroke at pretest and posttest. Results: The study revealed the poor level of knowledge, bad level of preventive behavior, and negative attitude regarding stroke prevention at pre-intervention. However, after intervention, the high-risk people had fair level of knowledge with moderate practice for stroke prevention and positive attitude, with statistically significant difference between pre-post intervention and between the case and control groups. Conclusions: The study revealed that the nursing intervention seemed to change the knowledge, practice, and attitude of subjects regarding stroke prevention. This, in turn, implies that awareness of prevention of stroke and high-risk factor control could be important to reduce the burden of stroke in Egypt. Thus, further research on a larger scale is required to improve population knowledge and behavior for stroke prevention and control.
文摘Objective:To explore the perspectives of high-risk pregnant women regarding the home care program for high-risk pregnancies.Methods:This qualitative study was conducted in a university hospital and 5 comprehensive health centers in Ahvaz,Iran,from February 2023 to July 2023.The sampling method used was purposive sampling considering the maximum possible diversity,which continued until data saturation.11 in-depth and semistructured interviews were conducted with high-risk pregnant women.Data were simultaneously analysed using Graneheim and Lundman content analysis by MAXQDA version 20 software.Results:Data analysis extracted 3 themes,12 categories,and 26 subcategories.The themes and categories were“high-risk pregnancy and related issues(pursuing treatment and paying attention to the high-risk situation by pregnant women,psychological aspect of high-risk pregnancy on pregnant women and caregivers,emotional and physical aspects of high-risk pregnancy,the consequences of high-risk pregnancy on the people around them and empowerment of high-risk pregnant women)”,“support dimension(family and community support for high-risk pregnant women)”,and“framework of program(acculturalization,means and equipment,security,manpower and the necessary arrangements for the home care)”.Conclusions:High-risk pregnancy affects various aspects of the lives of high-risk pregnant women and their families.Creating the necessary conditions for providing care at home plays a vital role in supporting high-risk pregnant women and removing related obstacles to receiving prenatal care in person.It will be especially beneficial for high-risk pregnant women in low-income areas.
基金supported by grants from the National Natural Science Foundation of China(No.82173593,32300473)Guangzhou Science and Technology Project(No.2025A04J4537,2025A04J4696)+1 种基金Guangdong Basic and Applied Basic Research Foundation(No.2023A1515220053)Postdoctoral Science Foundation of Jiangsu Province(No.2021K524C).
文摘Objective:Neuroblastoma is the most common extracranial solid tumor in children and has complex genetic underpinnings.Previous genome-wide association studies(GWASs)have identified many loci associated with neuroblastoma susceptibility;however,their application in risk prediction for Chinese children has not been systematically explored.This study seeks to enhance neuroblastoma risk prediction by validating these loci and evaluating their performance in polygenic risk models.Methods:We validated 35 GWAS-identified neuroblastoma susceptibility loci in a cohort of Chinese children,consisting of 402 neuroblastoma patients and 473 healthy controls.Genotyping these polymorphisms was conducted via the TaqMan method.Univariable and multivariable logistic regression analyses revealed the genetic loci significantly associated with neuroblastoma risk.We constructed polygenic risk models by combining these loci and assessed their predictive performance via area under the curve(AUC)analysis.We also established a polygenic risk scoring(PRS)model for risk prediction by adopting the PLINK method.Results:Fourteen loci,including ten protective polymorphisms from CASC15,BARD1,LMO1,HSD17B12,and HACE1,and four risk variants from BARD1,RSRC1,CPZ and MMP20 were significantly associated with neuroblastoma risk.Compared with single-gene model,the 8-gene model(AUC=0.72)and 13-gene model(AUC=0.73)demonstrated superior predictive performance.Additionally,a PRS incorporating six significant loci achieved an AUC of 0.66,effectively stratifying individuals into distinct risk categories regarding neuroblastoma susceptibility.A higher PRS was significantly associated with advanced International Neuroblastoma Staging System(INSS)stages,suggesting its potential for clinical risk stratification.Conclusions:Our findings validate multiple loci as neuroblastoma risk factors in Chinese children and demonstrate the utility of polygenic risk models,particularly the PRS,in improving risk prediction.These results suggest that integrating multiple genetic variants into a PRS can enhance neuroblastoma risk stratification and potentially improve early diagnosis by guiding targeted screening programs for high-risk children.
文摘The published article titled“Triptolide inhibits proliferation and migration of human neuroblastoma SH-SY5Y cells by upregulating microRNA-181a”has been retracted from Oncology Research,Vol.26,No.8,2018,PP.1235-1243.
基金supported by grants from the National Natural Science Foundation of China(Grant Nos.82200215,82170193,and 82370197)the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(Grant No.2022-I2M-1-002)。
文摘Objective:Our previous studies have indicated potentially higher proliferative activity of tumor cells in Chinese patients with mantle-cell lymphoma(MCL)than those in Western.Given the success and tolerability of R-DA-EDOCH immunochemotherapy in treating aggressive B-cell lymphomas,we designed a prospective,phase 3 trial to explore the efficacy and safety of alternating R-DA-EDOCH/R-DHAP induction therapy for young patients with newly diagnosed MCL.The primary endpoint was the complete remission rate(CRR)at the end of induction(EOI).Methods:A total of 55 patients were enrolled.The CRR at the EOI was 89.1%[95%confidence interval(CI)78%±96%],and the overall response rate was 98.1%(95%CI 90%±100%).Most patients with bone marrow involvement quickly attained minimal residual disease(MRD)negative status,with a 95.7%rate at the EOI.Results:The 3-year progression-free survival(PFS)and overall survival rates were 66.3%and 83.2%,respectively.No patients discontinued treatment because of adverse events.Univariate analysis identified pathologic morphology and TP53 mutations as risk factors for PFS.However,high tumor proliferative activity and certain cytogenetic abnormalities showed no significant adverse prognostic significance.Conclusions:Intensive therapy based on a high cytarabine dose and continuously administered EDOCH achieved a high MRDnegative rate and provides an optional induction choice for young patients with MCL with high-risk factors.
文摘Background:Loneliness is a common experience for pregnant women and correlates with perinatal depression and negative pregnancy outcomes.Women experiencing a high-risk pregnancy are at greater risk for loneliness because of uncertainty with disease and the medicalization of pregnancy.International studies have identified an association between perceived stress and loneliness in pregnant women.The aim of this study is to explore factors related to loneliness among women of high-risk pregnancy,and to examine the associated relationship of loneliness and perceived stress.Methods:Using convenience sampling,109 women with high-risk pregnancies were enrolled.Data collection involved questionnaires on general demographic characteristics,the 6-item Loneliness Scale(ULS-6),and the Chinese version of the Perceived Stress Scale(CPSS-14).Data analysis was performed using SPSS 28.0 statistical software.Results:The mean loneliness score was 9.95±2.99,and the mean perceived stress score was 22.84±5.80.Women with high-risk pregnancies exhibited statistically significant differences in loneliness scores compared to the control group across among age,marital status,educational attainment,per capita monthly household income,spousal relationship,in-law relationship,and parental relationship(P<0.05).Correlation analysis revealed a positive correlation between loneliness and perceived stress(r=0.456,P<0.01).Multivariate regression analysis indicated that per capita monthly household income,marital relationship,in-law relationship,and perceived stress were the primary factors influencing loneliness among women with high-risk pregnancies(P<0.05).Conclusion:The results highlight the need for specific interventions addressing loneliness among women with high-risk pregnancies.Such interventions should focus on improving spousal and in-law relationships,reducing perceived stress,and implementing support measures,such as financial counseling or assistance programs,for those with lower per capita household income.This study establishes a foundation for the creation of integrated support systems that bring together families and healthcare providers to strengthen maternal mental health.
基金Guangzhou Municipal Science and Technology Bureau,Municipal School and College Joint Funding Project,No.2024A03J1240.
文摘BACKGROUND Despite advances in treatment,the prognosis for patients with high-risk pediatric solid tumors remains dismal.Tandem autologous stem cell transplantation(ASCT)offers promise for improving outcomes in these patients.This study aimed to examine the efficacy and prognostic factors of tandem ASCT in pediatric patients with high-risk solid tumors.AIM To determine the survival outcomes and prognostic factors in pediatric patients with high-risk solid tumors undergoing tandem ASCT.METHODS A total of 40 pediatric patients with high-risk solid tumors treated from March 2015 to August 2022 were included in this retrospective study.The diagnoses of the patients included neuroblastoma,germ cell tumors,atypical teratoid/rhabdoid tumor,medulloblastoma,and pineoblastoma.After induction chemotherapy,all patients received tandem ASCT and were allocated into two groups(group A and group B)based on high-dose chemotherapy regimens.Prognostic relevance was evaluated by examining patient characteristics,such as sex,age,lactate dehydrogenase levels,primary site,the number of metastatic sites,and bone marrow involvement.RESULTS The median follow-up duration since the first ASCT was 24 months(range:1-91 months),with 5-year overall survival(OS)and event-free survival(EFS)rates of 73%and 70%,respectively,for the entire cohort.The 3-year OS rates were 67%for group A and 87%for group B(P=0.29),with corresponding 3-year EFS rates of 67%and 79%(P=0.57).Among neuroblastoma patients,the 5-year OS and EFS were 69%and 63%(P=0.23).Univariable analysis revealed a notable association of age≥36 months and elevated lactate dehydrogenase level at diagnosis with poorer OS.Despite acute adverse effects,all patients demonstrated good tolerance to the treatment,with no occurrences of transplant-related mortality.CONCLUSION Tandem ASCT demonstrates promising survival outcomes for patients with high-risk solid tumors,particularly neuroblastoma,with manageable toxicity and no transplant-related mortality.
文摘Pregnant women with high-risk pregnancy face a higher risk of complications due to factors such as chronic diseases,multiple pregnancies,and a history of adverse pregnancy and childbirth,requiring more systematic and dynamic health management support.In view of this,“Internet+continuous nursing”can break the limitations of time and space by integrating mobile communication,remote monitoring,data sharing,and intelligent analysis technologies,realizing closed-loop care with collaboration among hospitals,communities,and families.Research shows that continuous nursing based on the“Internet+”significantly improves the professional response ability of caregivers.Medical staff can grasp the patient’s status in real time,optimize diagnosis and treatment decisions,providing a feasible path for building an efficient,precise,and humanized high-risk pregnancy management system,which has broad clinical promotion value and public health significance.
文摘Diabetic foot(DF)has emerged as one of the most common chronic consequences of diabetes mellitus,characterized by prolonged disease duration,high treatment costs,a poor prognosis,and a high disability rate.Diabetic high-risk foot is the early stage of diabetic foot,the“disease prevention”of“treating no disease”,which provides a critical window for clinical prevention and treatment.Traditional Chinese medicine(TCM)has emphasized the importance of preventive health care since ancient times.External therapies such as acupuncture,massage,acupoint injection,foot bath fumigation,and moxibustion have the advantages of simplicity,low cost,precise efficacy,and fewer side effects in preventing and treating diabetic high-risk foot.The multidisciplinary synergistic model formed by TCM complementary therapies and modern medical treatments,such as nutritional,peripheral nerve,and blood glucose regulation,provides new ideas for establishing standardized prevention and treatment protocols.In this paper,studies related to TCM-related complementary therapies for diabetic high-risk feet are systematically reviewed.Current advances in external application in TCM were described to better understand its effectiveness and safety in elderly patients.
基金supported by grants from the National Natural Science Foundation of China(Grant No.82470544)the Fundamental Research Funds for the Central Universities(Grant No.226-2024-00153).
文摘Childhood neuroblastoma,a leading cause of cancer-related mortality in young children,accounts for approximately 8%-10%of pediatric cancers1.Originating from neural crest cells of the sympathetic nervous system,these tumors affect primarily children younger than 5 years of age and are often diagnosed in advanced stages,because of their aggressive nature and vague early symptoms2-4.
基金supported by grant from Affiliated Hospital of Nantong University(YJXYY202204)Postgraduate Research&Practice Innovation Program of Jiangsu Province(SJCX24_2063).
文摘Objective:Neuroblastoma(NB)is frequently associated with high-risk pediatric cases that demonstrate limited response to cisplatin,contributing to a poor prognosis.Recent studies have explored the role of tumor cell senescence in increasing sensitivity to this chemotherapy agent.This study aims to identify genes related to cell senescence in children diagnosed with NB,evaluate their influence on cisplatin sensitivity,and investigate potential strategies to enhance the efficacy of chemotherapy.Methods:Gene expression profiles and clinical data were obtained for 498 NB patients from the GEO database(GSE49710).The study focused on identifying genes that were differentially expressed between stage IV and other stages,particularly those linked to cell senescence and cisplatin resistance.To analyze the prognostic significance of these differentially expressed genes,we employed LASSO regression and multivariate Cox proportional hazards models.Transcriptomic and proteomic analyses of 15 NB specimens revealed a significant correlation between Flap endonuclease-1(FEN1)expression levels and both cellular senescence and sensitivity to cisplatin.We quantified FEN1 expression and cisplatin IC50 values in four different NB cell lines.The influence of FEN1 knockdown and overexpression on NB cell proliferation,invasion,and migration was evaluated using cloning assays,transwell assays,and scratch assays.Furthermore,we utilized Western blotting to analyze senescenceassociated proteins p21 and proliferating cell nuclear antigen(PCNA),thereby evaluating the role of FEN1 in cellular senescence.The impact of FEN1 on cisplatin sensitivity was investigated via the CCK-8 cell counting assay.Additionally,we investigated how FEN1 inhibitors might impact NB cell proliferation and enhance the therapeutic efficacy of cisplatin treatment.Results:FEN1 was found to be highly expressed in stage IV NB and showed a strong association with cisplatin sensitivity,establishing it as a critical molecular marker linked to poor patient prognosis.Notably,elevated FEN1 expression correlated with reduced sensitivity to cisplatin,as evidenced by higher IC50 values.In the SH-SY5Y cell line,FEN1 knockdown led to significant reductions in cell proliferation,invasion,and migration,along with an increase inβ-galactosidase staining—indicative of senescence.This knockdown also resulted in elevated levels of the p21 protein and decreased expression of PCNA,concurrently lowering cisplatin IC50 values.Conversely,FEN1 overexpression in the SK-N-SH cell line resulted in enhanced cell proliferation,invasion,and migration.This overexpression was associated with reducedβ-galactosidase staining,decreased levels of p21,and increased expression of PCNA,ultimately resulting in higher cisplatin IC50 values.Importantly,FEN1 inhibitors alone significantly impeded NB cell proliferation,and their combination with cisplatin further amplified this inhibitory effect compared to cisplatin treatment alone.Conclusions:Bioinformatics and sequencing analyses indicate that the senescence-related gene FEN1 is significantly associated with cisplatin sensitivity and adverse prognosis in pediatric NB.FEN1 plays a pivotal role in regulating NB cell proliferation,invasion,and migration,thereby facilitating cancer progression.Furthermore,it influences cisplatin sensitivity through its effects on cellular senescence.FEN1 inhibitors demonstrate potential both as monotherapies and in conjunction with cisplatin,suggesting that targeting FEN1 may be represent a valuable strategy for improving outcomes in high-risk NB patients.
文摘Background:Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. While liver transplantation (LT) provides the best long-term survival, it is constrained by organ scarcity and strict criteria. Liver resection (LR) is often the initial treatment for patients with solitary tumors and preserved liver function. The high recurrence rates associated with LR has prompted the exploration of sequential living donor liver transplantation (seq LDLT) after LR as a strategy for HCC patients with high-risk of recurrence.Methods:We analyzed data from 27 adult patients who underwent seq LDLT after LR for HCC at Kaohsiung Chang Gung Memorial Hospital (KCGMH) between June 1994 and December 2023. Patients were selected based on high-risk histopathological features post-LR or as part of downstaging strategy. Outcomes measured included overall survival (OS) and disease-free survival (DFS).Results:Among 765 HCC patients who underwent LDLT, 204 received LR before LDLT, and 27 underwent seqL DLT. Five patients (19%) underwent living donor liver transplantation (LDLT) following LR as a downstaging strategy while the rest received seqL DLT as a preemptive strategy. The median age was 53.5 years with 85%males. Chronic hepatitis B was the predominant underlying disease (74%). The 1-, 3-, and 5-year OS and DFS rates were 100%, 96.0%, 96.0%and 100%, 96.2%, 96.2%, respectively, with two patients experiencing HCC recurrence. One patient died from HCC recurrence. High-risk histopathological features included microvascular invasion (52%), satellite nodules (15%), multiple tumors (26%), tumors> 5 cm(19%), and a total tumor diameter> 10 cm (7%).Conclusions:Seq LDLT offers a promising, tailored approach for managing HCC with adverse histopathologic features. Combining seq LDLT, downstaging strategies, and multidisciplinary treatments can achieve satisfactory OS and DFS in carefully selected patients, highlighting the need for refined criteria to identify the best candidates.
