Gastric cancer is a common neoplastic disease and, more precisely, is the third leading cause of cancer death in the world, with differences amongst geographic areas. The definition of advanced gastric cancer is still...Gastric cancer is a common neoplastic disease and, more precisely, is the third leading cause of cancer death in the world, with differences amongst geographic areas. The definition of advanced gastric cancer is still debated. Different stadiating systems lead to slightly different stadiation of the disease, thus leading to variations between the single countries in the treatment and outcomes. In the present review all the possibilities of treatment for advanced gastric cancer have been analyzed. Surgery, the cornerstone of treatment for advanced gastric cancer, is analyzed first, followed by an investigation of the different forms and drugs of chemotherapy and radiotherapy. New frontiers in treatment suggest the growing consideration for intraperitoneal administration of chemotherapeutics and combination of traditional drugs with new ones. Moreover, the necessity to prevent the relapse of the disease leads to the consideration of administering intraperitoneal chemotherapy earlier in the therapeutical algorithm.展开更多
AIM To investigate the epidemiology,treatment and outcomes of acute appendicitis(AA) in a large population study.METHODS This is a retrospective cohort study derived from the administrative dataset of the Bergamo dist...AIM To investigate the epidemiology,treatment and outcomes of acute appendicitis(AA) in a large population study.METHODS This is a retrospective cohort study derived from the administrative dataset of the Bergamo district healthcare system(more than 1 million inhabitants) from 1997 to 2013.Data about treatment,surgery,length of stay were collected.Moreover for each patients were registered data about relapse of appendicitis and hospital admission due to intestinal obstruction.RESULTS From 1997 to 2013 in the Bergamo district we collected 16544 cases of AA,with a crude incidence rate of 89/100000 inhabitants per year; mean age was 24.51 ± 16.17,54.7% were male and the mean Charlson's comorbidity index was 0.32 ± 0.92.Mortality was < 0.0001%.Appendectomy was performed in 94.7% of the patients and the mean length of stay was 5.08 ± 2.88 d; the cumulative hospital stay was 5.19 ± 3.36 d and 1.2% of patients had at least one further hospitalization due intestinal occlusion.Laparoscopic appendectomy was performed in 48% of cases.Percent of 5.34 the patients were treated conservatively with a mean length of stay of 3.98 ± 3.96 d; the relapse rate was 23.1% and the cumulative hospital stay during the study period was 5.46 ± 6.05 d.CONCLUSION The treatment of acute appendicitis in Northern Italy is slowly changing,with the large diffusion of laparoscopic approach; conservative treatment of non-complicated appendicitis is still a neglected option,but rich of promising results.展开更多
Objective:Evidence-based practices(EBPs)have been taught to students by identifying the best evidence/evidence from research results.However,the experiences of Indonesian nurse preceptors in helping students implement...Objective:Evidence-based practices(EBPs)have been taught to students by identifying the best evidence/evidence from research results.However,the experiences of Indonesian nurse preceptors in helping students implement research findings have not been explored thoroughly.This study aimed to explore Indonesian nurse preceptors in guiding nursing students to use research findings.Methods:This study used interpretive phenomenology analysis that involves 9 nurse preceptors from hospitals in West Kalimantan,Indonesia.Semi-structured in-depth interviews were recorded and then transcribed verbatim.Results:Three themes were generated during the analysis:“types of student supervision,”“issues during supervision,”and“the need for research literacy and supervision.”Conclusions:Nurse preceptors need support to supervise the nursing students to use research findings.In addition to upgrading nursing skills,nurse preceptors must receive training in research and its utilization.Developing an appropriate strategy to assist students in using research findings will enhance the promotion of evidence-based nursing practices on a daily basis.展开更多
Pancreatic adenocarcinoma is a low-incident but highly mortal disease. It accounts for only 3% of estimated new cancer cases each year but is currently the fourth common cause of cancer mortality. By 2030, it is expec...Pancreatic adenocarcinoma is a low-incident but highly mortal disease. It accounts for only 3% of estimated new cancer cases each year but is currently the fourth common cause of cancer mortality. By 2030, it is expected to be the 2nd leading cause of cancer death. There is a clear need to diagnose and classify pancreatic cancer at earlier stages in order to give patients the best chance at a definitive cure through surgery. Three precursor lesions that distinctly lead to pancreatic adenocarcinoma have been identified, and we have increasing understanding the non-genetic and genetic risk factors for the disease. With increased understanding about the risk factors, the familial patters, and associated accumulation of genetic mutations involved in pancreatic cancer, we know that there are mutations that occur early in the development of pancreatic cancer and that improved genetic risk-based strategies in screening for pancreatic cancer may be possible and successful at saving or prolonging lives. The remaining challenge is that current standards for diagnosing pancreatic cancer remain too invasive and too costly for widespread screening for pancreatic cancer. Furthermore, the promises of noninvasive methods of detection such as blood, saliva, and stool remain underdeveloped or lack robust testing. However, significant progress has been made, and we are drawing closer to a strategy for the screening and early detection of pancreatic cancer.展开更多
Powered by the mitochondrial membrane potential,Ca2+ permeates the mitochondria via a Ca2+ channel termed Ca2+ uniporter and is pumped out by a Na+/Ca2+ exchanger,both of which are located on the inner mitochondrial m...Powered by the mitochondrial membrane potential,Ca2+ permeates the mitochondria via a Ca2+ channel termed Ca2+ uniporter and is pumped out by a Na+/Ca2+ exchanger,both of which are located on the inner mitochondrial membrane.Mitochondrial Ca2+ transients are critical for metabolic activity and regulating global Ca2+ responses.On the other hand,failure to control mitochondrial Ca2+ is a hallmark of ischemic and neurodegenerative diseases.Despite their importance,identifying the uniporter and exchanger remains elusive and their inhibitors are non-specific.This review will focus on the mitochondrial exchanger,initially describing how it was molecularly identified and linked to a novel member of the Na+/Ca2+ exchanger superfamily termed NCLX.Molecular control of NCLX expression provides a selective tool to determine its physiological role in a variety of cell types.In lymphocytes,NCLX is essential for refilling the endoplasmic reticulum Ca2+ stores required for antigen-dependent signaling.Communication of NCLX with the store-operated channel in astroglia controls Ca2+ influx and thereby neuro-transmitter release and cell proliferation.The refilling of the Ca2+ stores in the sarcoplasmic reticulum,which is controlled by NCLX,determines the frequency of action potential and Ca2+ transients in cardiomyocytes.NCLX is emerging as a hub for integrating glucose-dependent Na+ and Ca2+ signaling in pancreatic β cells,and the specific molecular control of NCLX expression resolved the controversy regarding its role in neurons and β cells.Future studies on an NCLX knockdown mouse model and identification of human NCLX mutations are expected to determine the role of mitochondrial Ca2+ efflux in organ activity and whether NCLX inactivation is linked to ischemic and/or neurodegenerative syndromes.Structure-function analysis and protein analysis will identify the NCLX mode of regulation and its partners in the inner membrane of the mitochondria.展开更多
Plants require a number of essential elements in different proportions for ensuring their growth and development.The elemental concentrations in leaves reflect the functions and adaptations of plants under specific en...Plants require a number of essential elements in different proportions for ensuring their growth and development.The elemental concentrations in leaves reflect the functions and adaptations of plants under specific environmental conditions.However,less is known about how the spectrum of leaf elements associated with resource acquisition,photosynthesis and growth regulates forest biomass along broad elevational gradients.We examined the influence of leaf element distribution and diversity on forest biomass by analyzing ten elements(C,N,P,K,Ca,Mg,Zn,Fe,Cu,and Mn)in tree communities situated every 100 meters along an extensive elevation gradient,ranging from the tropical forest(80 meters above sea level)to the alpine treeline(4200 meters above sea level)in the Kangchenjunga Landscape in eastern Nepal Himalayas.We calculated communityweighted averages(reflecting dominant traits governing biomass,i.e.,mass-ratio effect)and functional divergence(reflecting increased trait variety,i.e.,complementarity effect)for leaf elements in a total of 1,859 trees representing 116 species.An increasing mass-ratio effect and decreasing complementarity in leaf elements enhance forest biomass accumulation.A combination of elements together with elevation explains biomass(52.2%of the variance)better than individual elemental trait diversity(0.05%to 21%of the variance).Elevation modulates trait diversity among plant species in biomass accumulation.Complementarity promotes biomass at lower elevations,but reduces biomass at higher elevations,demonstrating an interaction between elevation and complementarity.The interaction between elevation and mass-ratio effect produces heterogeneous effects on biomass along the elevation gradient.Our research indicates that biomass accumulation can be disproportionately affected by elevation due to interactions among trait diversities across vegetation zones.While higher trait variation enhances the adaptation of species to environmental changes,it reduces biomass accumulation,especially at higher elevat展开更多
High-entropy concept introduced with a promising paradigm to obtain exotic physical properties has motivated us to explore the thermoelectric properties of Sr-substituted high-entropy rare-earth cobaltates i.e.,(LaNdP...High-entropy concept introduced with a promising paradigm to obtain exotic physical properties has motivated us to explore the thermoelectric properties of Sr-substituted high-entropy rare-earth cobaltates i.e.,(LaNdPrSmEu)_(1-x)Sr_(x)CoO_(3)(0≤x≤0.10).The structural analysis of the samples,synthesized using the standard solid-state route,confirms the orthorhombic structure with the Pbnm space group.The Seebeck coefficient and electrical resistivity decrease with rising Sr concentration as well as with an increase in temperature.The multiple A-site ions in high-entropy rare-earth cobaltates result in an improved Seebeck coefficient(α)compared to La_(0.95)Sr_(0.05)CoO_(3),associated with a decrease in the Cosingle bondOsingle bondCo bond angle,which further enhances the power factor.The random distribution of cations at the rare-earth site results in a significant lowering of phonon thermal conductivity.As a result,a maximum figure of merit(zT)of 0.23 is obtained at 350K for(LaNdPrSmEu)_(0.95)Sr_(0.05)CoO_(3),which is one of the highest values of zT reported at this temperature for oxide materials.This study shows promise to decouple thermoelectric parameters using the high-entropy concept in several materials.展开更多
An epidemic model is a simplified means of describing the transmission of infectious diseases through individuals. The modeling of infectious diseases is a tool which has been used to study the mechanisms by which dis...An epidemic model is a simplified means of describing the transmission of infectious diseases through individuals. The modeling of infectious diseases is a tool which has been used to study the mechanisms by which diseases spread, to predict the future course of an outbreak and to evaluate strategies to control an epidemic. Epidemic models are of many types. Here, SEIR model is discussed. We first discuss the basics of SEIR model. Then it is applied for vector borne diseases. Steady state conditions are derived. A threshold parameter R0 is defined and is shown that the disease will spread only if its value exceeds 1. We have applied the basic model to one specific diseases-malaria and did the sensitivity analysis too using the data for India. We found sensitivity analysis very important as it told us the most sensitive parameter to be taken care of. This makes the work more of practical use. Numerical simulation is done for vector and host which shows the population dynamics in different compartments.展开更多
AIM: To evaluate the epidemiological, clinical, laboratory and histological variables capable of predicting the progression of hepatic structural disturbances in chronic hepatitis C patients during the time interval b...AIM: To evaluate the epidemiological, clinical, laboratory and histological variables capable of predicting the progression of hepatic structural disturbances in chronic hepatitis C patients during the time interval between two liver biopsies. METHODS: Clinical charts of 112 chronic hepatitis C patients were retrospectively analyzed, whereas liver biopsies were revised. Immunohistochemical detection of interferon receptor was based on the Envision-Peroxidase System. RESULTS: In the multivariate analysis, the variables in the age at first biopsy, ALT levels, presence of lymphoid aggregates and siderosis were the determinants of the best model for predicting the severity of the disease. The direct progression rate of hepatic structural lesions was significantly higher in untreated patients, intermediate in treated non-responders and lower in treated responders to antiviral therapy (non-treated vs responders, 0.22 ± 0.50 vs -0.15 ± 0.46, P = 0.0053). Immuno-expression of interferon receptor is not a relevant factor. CONCLUSION: The best predictors of the progression of fibrosis are age at the first liver biopsy, extent of ALT elevation, inflammation at liver histology and hepatic siderosis. Antiviral treatment is effective in preventing the progression of liver structural lesions in chronic hepatitis C patients.展开更多
The human epidermal growth factor receptor 2(HER2)is overexpressed in 25%e30%of breast cancer patients.Anti-HER2 therapies have changed the aggressive course of HER2t breast cancer.In spite of the therapeutic benefits...The human epidermal growth factor receptor 2(HER2)is overexpressed in 25%e30%of breast cancer patients.Anti-HER2 therapies have changed the aggressive course of HER2t breast cancer.In spite of the therapeutic benefits,their cardiotoxicities are major concerns,especially when used concurrently with anthracyclines.Here we present an elderly patient with relapsed HER2t breast cancer.Her presentation for relapsed disease was unusual for the physical finding as well as the history of trastuzumabinduced severe cardiotoxicity while requiring additional anti-HER2 therapy.She received neoadjuvant anti-HER2 treatment for stage III breast caner.Due to severe reduction of cardiac ejection fraction(EF),she only received five doses of adjuvant transtuzumab.Unfortunately her disease relapsed one year later with chest wall lesions and a persistent low EF.We treated the patient with lapatinib combined with capecitabine which resulted rapid resolution of her chest wall lesion.More importantly,the patient had one year of disease control without deterioration in her ejection fraction.We discussed the management of recurrent HER2t breast cancer with chest wall disease and the choice of anti-HER2 therapy in patients with a history of transtuzumab-induced cardiac dysfunction.展开更多
Objective:This study aimed to identify the influence of predisposing,enabling,and reinforcing factors and the adherence to medication behavior among tuberculosis patients in Selogiri Wonogiri Public Health Center.Meth...Objective:This study aimed to identify the influence of predisposing,enabling,and reinforcing factors and the adherence to medication behavior among tuberculosis patients in Selogiri Wonogiri Public Health Center.Methods:This study employed a descriptive cross-sectional research design.A questionnaire was used to collect primary data.Secondary data were obtained from patient treatment cards(Form TB 01).This research was carried out at Selogiri Health Center from November to December 2017.The participants were patients,both new and old patients,who had completed their treatment in the last 2 months or more,recorded from January 2016 to December 2017.A total sampling technique was used in this study.Logistic regression analysis was used to analyze the influence of predisposing,enabling,and reinforcing factors and the adherence to medication among tuberculosis patients.Results:The results of logistic regression analysis indicated that there were four independent variables that have a significant relationship with treatment variables,namely education(odds ratio(OR)=0.025;95%confidence interval(CI)=0.001-0.039);knowledge(OR=3.37;95%CI=0.19-57.71);type of drug(OR=0.448;95%CI=0.012-16.07),and means of transportation(OR=25.77;95%CI=1.33-500.47).Conclusions:Education,knowledge,type of drug,and means of transportation influence medication compliance among tuberculosis patients.Therefore,supporting patients during medication program of tuberculosis is needed to improve their adherence medication during multidrug therapy.展开更多
AIM: To find the most reproducible quantitative parameter of a standard 13C-methacetin breath test (13C-MBT). METHODS: Twenty healthy volunteers (10 female, 10 male) underwent the 13C-MBT after intake of 75 mg 13C-met...AIM: To find the most reproducible quantitative parameter of a standard 13C-methacetin breath test (13C-MBT). METHODS: Twenty healthy volunteers (10 female, 10 male) underwent the 13C-MBT after intake of 75 mg 13C-methacetin p.o. on three occasions. Short-and medium-term reproducibility was assessed with paired examinations taken at an interval of 2 and 18 d (medians), respectively. RESULTS: The reproducibility of the 1-h cumulative 13C recovery (AUC0-60), characterized by a coefficient of variation of 10%, appeared to be considerably better than the reproducibility of the maximum momentary 13C recovery or the time of reaching it. Remarkably, as opposed to the short gap between consecutive examinations, the capacity of the liver to handle 13C-methacetin increased slightly but statistically significantly when a repeat dose was administered after two to three weeks.Regarding the AUC0-60, the magnitude of this fixed bias amounted to 7.5%. Neither the time gap between the repeat examinations nor the gender of the subjects affected the 13C-MBT reproducibility. CONCLUSION: 13C-MBT is most reproducibly quantified by the cumulative 13C recovery, but the exactitude thereof may be modestly affected by persistent stimulation of CYP1A2 on repeat examinations.展开更多
BACKGROUND:Though gallbladder carcinoma is asso- ciated with early lymphatic and hematogenous spread, the only common extra-abdominal site of metastasis is lung.Gallbladder carcinoma metastasizing to breast and subcut...BACKGROUND:Though gallbladder carcinoma is asso- ciated with early lymphatic and hematogenous spread, the only common extra-abdominal site of metastasis is lung.Gallbladder carcinoma metastasizing to breast and subcutaneous tissue is not known. METHOD:This report describes an interesting and unusual case of asymptomatic gallbladder carcinoma presenting with subcutaneous and breast metastasis. RESULTS:A 42-year-old woman presented with multiple subcutaneous nodules over the abdominal wall,anterior chest wall,back and in bilateral breasts.Fine needle aspiration cytology(FNAC)of these nodules revealed metastatic adenocarcinoma.The patient was investigated for a primary neoplasm.An ultrasound of the abdomen followed by a contrast-enhanced CT scan showed a growth in gallbladder,infiltrating the liver with multiple hepatic metastases.CT-guided FNAC from the growth in the gallbladder revealed adenocarcinoma.She was diagnosed as a case of metastatic adenocarcinoma of the gallbladder and palliative combination chemotherapy with gemcitabine and carboplatin was given.But she developed jaundice and deteriorated dramatically in a short span of time.No specific therapy could be started and she was given supportive treatment.She died within three weeks of diagnosis due to hepatic encephalopathy. CONCLUSIONS:This report highlights an unusual metastasis of gallbladder carcinoma to the breast and subcutaneous tissue presenting as multiple lesions,which has never been reported in the English literature.These were unknown sites of metastasis for carcinoma of the gallbladder.Moreover,bilateral multiple metastatic lesions to breast are also very rare.展开更多
New research suggests that gut microbiota helps adenoma colon cancer spread worldwide.This study seeks therapeutic microbiota changes to prevent adenoma colon cancer and discusses their drawbacks.Prebiotics feed good ...New research suggests that gut microbiota helps adenoma colon cancer spread worldwide.This study seeks therapeutic microbiota changes to prevent adenoma colon cancer and discusses their drawbacks.Prebiotics feed good bacteria and promote the formation of short-chain fatty acids,which have anti-inflammatory and anti-cancer properties.To promote healthy gut bacteria and reduce adenoma risk,fiber-rich diets and particular dietary interventions are being researched..FMT(fecal microbiota transplantation)may help restore gut flora and prevent adenoma colon cancer,according to the study.FMT transfers healthy donor feces to patients to restore microbial diversity.Different gut flora,persons,and therapies make it tricky to draw conclusions.Personalizing therapeutic approaches to each person's microbiota,host features,and genetic factors can improve treatment.Changing microorganisms may prevent adenoma colon cancer.Probiotics,prebiotics,dietary modifications,FMT,and bacteria metabolites may assist.More research is needed to determine the best ways to aid,solve difficulties,and personalize methods.We can prevent adenoma colon cancer and improve public health by learning more about gut flora and optimizing treatment methods.展开更多
The incorporation of therapeutic-capable ions into bioactive glasses(BGs),either based on silica(SBGs)or phosphate(PBGs),is currently envisaged as a proficient path for facilitating bone regeneration.Inconjunction wit...The incorporation of therapeutic-capable ions into bioactive glasses(BGs),either based on silica(SBGs)or phosphate(PBGs),is currently envisaged as a proficient path for facilitating bone regeneration.Inconjunction with this view,the single and complementary structural and bio-functional roles of CuO andGa_(2)O_(3)(in the 2e5 mol%range)were assessed,by deriving a series of SBG and PBG formulations startingfrom the parent glass systems,FastOs®BG e 38.5SiO2d36.1CaOd5.6P2O5d19.2MgOd0.6CaF2,and50.0P2O5d35.0CaOd10.0Na_(2)Od5.0 Fe2O_(3)(mol%),respectively,using the process of melt-quenching.The inter-linked physico-chemistry e biological response of BGs was assessed in search of bio-functional triggers.Further light was shed on the structural role e as network former or modifier e ofCu and Ga,immersed in SBG and PBG matrices.The preliminary biological performance was surveyedin vitro by quantification of Cu and Ga ion release under homeostatic conditions,cytocompatibility assays(in fibroblast cell cultures)and antibacterial tests(against Staphylococcus aureus).The similar(Cu)anddissimilar(Ga)structural roles in the SBG and PBG vitreous networks governed their release.Namely,Cuions were leached in similar concentrations(ranging from 10e35 ppm and 50e110 ppm at BG doses of 5and 50 mg/mL,respectively)for both type of BGs,while the release of Ga ions was 1e2 orders ofmagnitude lower in the case of SBGs(i.e.,0.2e6 ppm)compared to PBGs(i.e.,9e135 ppm).This wasattributed to the network modifier role of Cu in both types of BGs,and conversely,to the network former(SBGs)and network modifier(PBGs)roles of Ga.All glasses were cytocompatible at a dose of 5 mg/mL,while at the same concentration the antimicrobial efficiency was found to be accentuated by the coupledrelease of Cu and Ga ions from SBG.By collective assessment,the most prominent candidate material forthe further development of implant coatings and bone graft substitutes was delineated as the38.5SiO2d34.1CaOd5.6P2O5d16.2MgOd0.6CaF2d2.0CuOd3.0Ga_(2)O_(3)(mol%)SBG system,w展开更多
Malaria is a major problem for European travelers to endemic regions.In Romania during 1980-2007 approximately 20 imported cases were detected annually.The aim of our short communication is to present 2 interesting ca...Malaria is a major problem for European travelers to endemic regions.In Romania during 1980-2007 approximately 20 imported cases were detected annually.The aim of our short communication is to present 2 interesting cases of imported malaria detected in Western Romania.The first patienl was a 20-year female who traveled to India and acquired an infection with Plasmodium vivax(P.vivax).The second patient,a 60-year female,contracted an infection with Plasmodium falciparum(P.falciparum) during a trip to Ghana:the evolution of the disease was severe with many complications and the patient finally died.The cases presented revealed the difficulties in establishing a correct diagnosis of malaria in a non-endemic country, consequences of an incomplete taken anamnesis.Travel history should always represent a mandatory part of a well conducted investigation.At the same time,we must underline the importance of a correct and complete prophylaxis prior to every departure to tropical countries.展开更多
文摘Gastric cancer is a common neoplastic disease and, more precisely, is the third leading cause of cancer death in the world, with differences amongst geographic areas. The definition of advanced gastric cancer is still debated. Different stadiating systems lead to slightly different stadiation of the disease, thus leading to variations between the single countries in the treatment and outcomes. In the present review all the possibilities of treatment for advanced gastric cancer have been analyzed. Surgery, the cornerstone of treatment for advanced gastric cancer, is analyzed first, followed by an investigation of the different forms and drugs of chemotherapy and radiotherapy. New frontiers in treatment suggest the growing consideration for intraperitoneal administration of chemotherapeutics and combination of traditional drugs with new ones. Moreover, the necessity to prevent the relapse of the disease leads to the consideration of administering intraperitoneal chemotherapy earlier in the therapeutical algorithm.
文摘AIM To investigate the epidemiology,treatment and outcomes of acute appendicitis(AA) in a large population study.METHODS This is a retrospective cohort study derived from the administrative dataset of the Bergamo district healthcare system(more than 1 million inhabitants) from 1997 to 2013.Data about treatment,surgery,length of stay were collected.Moreover for each patients were registered data about relapse of appendicitis and hospital admission due to intestinal obstruction.RESULTS From 1997 to 2013 in the Bergamo district we collected 16544 cases of AA,with a crude incidence rate of 89/100000 inhabitants per year; mean age was 24.51 ± 16.17,54.7% were male and the mean Charlson's comorbidity index was 0.32 ± 0.92.Mortality was < 0.0001%.Appendectomy was performed in 94.7% of the patients and the mean length of stay was 5.08 ± 2.88 d; the cumulative hospital stay was 5.19 ± 3.36 d and 1.2% of patients had at least one further hospitalization due intestinal occlusion.Laparoscopic appendectomy was performed in 48% of cases.Percent of 5.34 the patients were treated conservatively with a mean length of stay of 3.98 ± 3.96 d; the relapse rate was 23.1% and the cumulative hospital stay during the study period was 5.46 ± 6.05 d.CONCLUSION The treatment of acute appendicitis in Northern Italy is slowly changing,with the large diffusion of laparoscopic approach; conservative treatment of non-complicated appendicitis is still a neglected option,but rich of promising results.
基金supported by Universitas Tanjungpura Pontianak,Indonesia(No.2377/UN22.9/PG/2022,2022)。
文摘Objective:Evidence-based practices(EBPs)have been taught to students by identifying the best evidence/evidence from research results.However,the experiences of Indonesian nurse preceptors in helping students implement research findings have not been explored thoroughly.This study aimed to explore Indonesian nurse preceptors in guiding nursing students to use research findings.Methods:This study used interpretive phenomenology analysis that involves 9 nurse preceptors from hospitals in West Kalimantan,Indonesia.Semi-structured in-depth interviews were recorded and then transcribed verbatim.Results:Three themes were generated during the analysis:“types of student supervision,”“issues during supervision,”and“the need for research literacy and supervision.”Conclusions:Nurse preceptors need support to supervise the nursing students to use research findings.In addition to upgrading nursing skills,nurse preceptors must receive training in research and its utilization.Developing an appropriate strategy to assist students in using research findings will enhance the promotion of evidence-based nursing practices on a daily basis.
基金National Institutes of Health T32 Training Grant
文摘Pancreatic adenocarcinoma is a low-incident but highly mortal disease. It accounts for only 3% of estimated new cancer cases each year but is currently the fourth common cause of cancer mortality. By 2030, it is expected to be the 2nd leading cause of cancer death. There is a clear need to diagnose and classify pancreatic cancer at earlier stages in order to give patients the best chance at a definitive cure through surgery. Three precursor lesions that distinctly lead to pancreatic adenocarcinoma have been identified, and we have increasing understanding the non-genetic and genetic risk factors for the disease. With increased understanding about the risk factors, the familial patters, and associated accumulation of genetic mutations involved in pancreatic cancer, we know that there are mutations that occur early in the development of pancreatic cancer and that improved genetic risk-based strategies in screening for pancreatic cancer may be possible and successful at saving or prolonging lives. The remaining challenge is that current standards for diagnosing pancreatic cancer remain too invasive and too costly for widespread screening for pancreatic cancer. Furthermore, the promises of noninvasive methods of detection such as blood, saliva, and stool remain underdeveloped or lack robust testing. However, significant progress has been made, and we are drawing closer to a strategy for the screening and early detection of pancreatic cancer.
文摘Powered by the mitochondrial membrane potential,Ca2+ permeates the mitochondria via a Ca2+ channel termed Ca2+ uniporter and is pumped out by a Na+/Ca2+ exchanger,both of which are located on the inner mitochondrial membrane.Mitochondrial Ca2+ transients are critical for metabolic activity and regulating global Ca2+ responses.On the other hand,failure to control mitochondrial Ca2+ is a hallmark of ischemic and neurodegenerative diseases.Despite their importance,identifying the uniporter and exchanger remains elusive and their inhibitors are non-specific.This review will focus on the mitochondrial exchanger,initially describing how it was molecularly identified and linked to a novel member of the Na+/Ca2+ exchanger superfamily termed NCLX.Molecular control of NCLX expression provides a selective tool to determine its physiological role in a variety of cell types.In lymphocytes,NCLX is essential for refilling the endoplasmic reticulum Ca2+ stores required for antigen-dependent signaling.Communication of NCLX with the store-operated channel in astroglia controls Ca2+ influx and thereby neuro-transmitter release and cell proliferation.The refilling of the Ca2+ stores in the sarcoplasmic reticulum,which is controlled by NCLX,determines the frequency of action potential and Ca2+ transients in cardiomyocytes.NCLX is emerging as a hub for integrating glucose-dependent Na+ and Ca2+ signaling in pancreatic β cells,and the specific molecular control of NCLX expression resolved the controversy regarding its role in neurons and β cells.Future studies on an NCLX knockdown mouse model and identification of human NCLX mutations are expected to determine the role of mitochondrial Ca2+ efflux in organ activity and whether NCLX inactivation is linked to ischemic and/or neurodegenerative syndromes.Structure-function analysis and protein analysis will identify the NCLX mode of regulation and its partners in the inner membrane of the mitochondria.
基金supported by the National Natural Science Foundation of China(Grant No.42030508)the Second Tibetan Plateau Scientific Expedition and Research Program(Grant No.2019QZKK0301)+3 种基金supported by CAS-TWAS President’s Fellowship Program for International Ph.D.studentssupported by Spanish Government(Grant Nos.PID2019-110521GB-I00 and TED2021-132627B-I00)the Catalan Government(Grant No.SGR 2017-1005)and the Fundación“Ramón Areces”(Grant No.CIVP20A6621)supported by the Spanish Government(Grant No.RTI2018-096884-B-C31)。
文摘Plants require a number of essential elements in different proportions for ensuring their growth and development.The elemental concentrations in leaves reflect the functions and adaptations of plants under specific environmental conditions.However,less is known about how the spectrum of leaf elements associated with resource acquisition,photosynthesis and growth regulates forest biomass along broad elevational gradients.We examined the influence of leaf element distribution and diversity on forest biomass by analyzing ten elements(C,N,P,K,Ca,Mg,Zn,Fe,Cu,and Mn)in tree communities situated every 100 meters along an extensive elevation gradient,ranging from the tropical forest(80 meters above sea level)to the alpine treeline(4200 meters above sea level)in the Kangchenjunga Landscape in eastern Nepal Himalayas.We calculated communityweighted averages(reflecting dominant traits governing biomass,i.e.,mass-ratio effect)and functional divergence(reflecting increased trait variety,i.e.,complementarity effect)for leaf elements in a total of 1,859 trees representing 116 species.An increasing mass-ratio effect and decreasing complementarity in leaf elements enhance forest biomass accumulation.A combination of elements together with elevation explains biomass(52.2%of the variance)better than individual elemental trait diversity(0.05%to 21%of the variance).Elevation modulates trait diversity among plant species in biomass accumulation.Complementarity promotes biomass at lower elevations,but reduces biomass at higher elevations,demonstrating an interaction between elevation and complementarity.The interaction between elevation and mass-ratio effect produces heterogeneous effects on biomass along the elevation gradient.Our research indicates that biomass accumulation can be disproportionately affected by elevation due to interactions among trait diversities across vegetation zones.While higher trait variation enhances the adaptation of species to environmental changes,it reduces biomass accumulation,especially at higher elevat
基金This work was supported by the French Agence Nationale de la Recherche(ANR),through the project NEO(ANR 19-CE30-0030-01).
文摘High-entropy concept introduced with a promising paradigm to obtain exotic physical properties has motivated us to explore the thermoelectric properties of Sr-substituted high-entropy rare-earth cobaltates i.e.,(LaNdPrSmEu)_(1-x)Sr_(x)CoO_(3)(0≤x≤0.10).The structural analysis of the samples,synthesized using the standard solid-state route,confirms the orthorhombic structure with the Pbnm space group.The Seebeck coefficient and electrical resistivity decrease with rising Sr concentration as well as with an increase in temperature.The multiple A-site ions in high-entropy rare-earth cobaltates result in an improved Seebeck coefficient(α)compared to La_(0.95)Sr_(0.05)CoO_(3),associated with a decrease in the Cosingle bondOsingle bondCo bond angle,which further enhances the power factor.The random distribution of cations at the rare-earth site results in a significant lowering of phonon thermal conductivity.As a result,a maximum figure of merit(zT)of 0.23 is obtained at 350K for(LaNdPrSmEu)_(0.95)Sr_(0.05)CoO_(3),which is one of the highest values of zT reported at this temperature for oxide materials.This study shows promise to decouple thermoelectric parameters using the high-entropy concept in several materials.
文摘An epidemic model is a simplified means of describing the transmission of infectious diseases through individuals. The modeling of infectious diseases is a tool which has been used to study the mechanisms by which diseases spread, to predict the future course of an outbreak and to evaluate strategies to control an epidemic. Epidemic models are of many types. Here, SEIR model is discussed. We first discuss the basics of SEIR model. Then it is applied for vector borne diseases. Steady state conditions are derived. A threshold parameter R0 is defined and is shown that the disease will spread only if its value exceeds 1. We have applied the basic model to one specific diseases-malaria and did the sensitivity analysis too using the data for India. We found sensitivity analysis very important as it told us the most sensitive parameter to be taken care of. This makes the work more of practical use. Numerical simulation is done for vector and host which shows the population dynamics in different compartments.
基金Supported by Alves de Queiroz Family Fund for Research
文摘AIM: To evaluate the epidemiological, clinical, laboratory and histological variables capable of predicting the progression of hepatic structural disturbances in chronic hepatitis C patients during the time interval between two liver biopsies. METHODS: Clinical charts of 112 chronic hepatitis C patients were retrospectively analyzed, whereas liver biopsies were revised. Immunohistochemical detection of interferon receptor was based on the Envision-Peroxidase System. RESULTS: In the multivariate analysis, the variables in the age at first biopsy, ALT levels, presence of lymphoid aggregates and siderosis were the determinants of the best model for predicting the severity of the disease. The direct progression rate of hepatic structural lesions was significantly higher in untreated patients, intermediate in treated non-responders and lower in treated responders to antiviral therapy (non-treated vs responders, 0.22 ± 0.50 vs -0.15 ± 0.46, P = 0.0053). Immuno-expression of interferon receptor is not a relevant factor. CONCLUSION: The best predictors of the progression of fibrosis are age at the first liver biopsy, extent of ALT elevation, inflammation at liver histology and hepatic siderosis. Antiviral treatment is effective in preventing the progression of liver structural lesions in chronic hepatitis C patients.
基金This work was supported by grants from the NIH(K12HD085817)the Susan G.Komen Foundation(KG111460)to NJM.
文摘The human epidermal growth factor receptor 2(HER2)is overexpressed in 25%e30%of breast cancer patients.Anti-HER2 therapies have changed the aggressive course of HER2t breast cancer.In spite of the therapeutic benefits,their cardiotoxicities are major concerns,especially when used concurrently with anthracyclines.Here we present an elderly patient with relapsed HER2t breast cancer.Her presentation for relapsed disease was unusual for the physical finding as well as the history of trastuzumabinduced severe cardiotoxicity while requiring additional anti-HER2 therapy.She received neoadjuvant anti-HER2 treatment for stage III breast caner.Due to severe reduction of cardiac ejection fraction(EF),she only received five doses of adjuvant transtuzumab.Unfortunately her disease relapsed one year later with chest wall lesions and a persistent low EF.We treated the patient with lapatinib combined with capecitabine which resulted rapid resolution of her chest wall lesion.More importantly,the patient had one year of disease control without deterioration in her ejection fraction.We discussed the management of recurrent HER2t breast cancer with chest wall disease and the choice of anti-HER2 therapy in patients with a history of transtuzumab-induced cardiac dysfunction.
文摘Objective:This study aimed to identify the influence of predisposing,enabling,and reinforcing factors and the adherence to medication behavior among tuberculosis patients in Selogiri Wonogiri Public Health Center.Methods:This study employed a descriptive cross-sectional research design.A questionnaire was used to collect primary data.Secondary data were obtained from patient treatment cards(Form TB 01).This research was carried out at Selogiri Health Center from November to December 2017.The participants were patients,both new and old patients,who had completed their treatment in the last 2 months or more,recorded from January 2016 to December 2017.A total sampling technique was used in this study.Logistic regression analysis was used to analyze the influence of predisposing,enabling,and reinforcing factors and the adherence to medication among tuberculosis patients.Results:The results of logistic regression analysis indicated that there were four independent variables that have a significant relationship with treatment variables,namely education(odds ratio(OR)=0.025;95%confidence interval(CI)=0.001-0.039);knowledge(OR=3.37;95%CI=0.19-57.71);type of drug(OR=0.448;95%CI=0.012-16.07),and means of transportation(OR=25.77;95%CI=1.33-500.47).Conclusions:Education,knowledge,type of drug,and means of transportation influence medication compliance among tuberculosis patients.Therefore,supporting patients during medication program of tuberculosis is needed to improve their adherence medication during multidrug therapy.
基金Supported by The Medical University of Silesia, contracts No. NN-1-106-06, KNW-1-043/08 and KNW-1-154/09
文摘AIM: To find the most reproducible quantitative parameter of a standard 13C-methacetin breath test (13C-MBT). METHODS: Twenty healthy volunteers (10 female, 10 male) underwent the 13C-MBT after intake of 75 mg 13C-methacetin p.o. on three occasions. Short-and medium-term reproducibility was assessed with paired examinations taken at an interval of 2 and 18 d (medians), respectively. RESULTS: The reproducibility of the 1-h cumulative 13C recovery (AUC0-60), characterized by a coefficient of variation of 10%, appeared to be considerably better than the reproducibility of the maximum momentary 13C recovery or the time of reaching it. Remarkably, as opposed to the short gap between consecutive examinations, the capacity of the liver to handle 13C-methacetin increased slightly but statistically significantly when a repeat dose was administered after two to three weeks.Regarding the AUC0-60, the magnitude of this fixed bias amounted to 7.5%. Neither the time gap between the repeat examinations nor the gender of the subjects affected the 13C-MBT reproducibility. CONCLUSION: 13C-MBT is most reproducibly quantified by the cumulative 13C recovery, but the exactitude thereof may be modestly affected by persistent stimulation of CYP1A2 on repeat examinations.
文摘BACKGROUND:Though gallbladder carcinoma is asso- ciated with early lymphatic and hematogenous spread, the only common extra-abdominal site of metastasis is lung.Gallbladder carcinoma metastasizing to breast and subcutaneous tissue is not known. METHOD:This report describes an interesting and unusual case of asymptomatic gallbladder carcinoma presenting with subcutaneous and breast metastasis. RESULTS:A 42-year-old woman presented with multiple subcutaneous nodules over the abdominal wall,anterior chest wall,back and in bilateral breasts.Fine needle aspiration cytology(FNAC)of these nodules revealed metastatic adenocarcinoma.The patient was investigated for a primary neoplasm.An ultrasound of the abdomen followed by a contrast-enhanced CT scan showed a growth in gallbladder,infiltrating the liver with multiple hepatic metastases.CT-guided FNAC from the growth in the gallbladder revealed adenocarcinoma.She was diagnosed as a case of metastatic adenocarcinoma of the gallbladder and palliative combination chemotherapy with gemcitabine and carboplatin was given.But she developed jaundice and deteriorated dramatically in a short span of time.No specific therapy could be started and she was given supportive treatment.She died within three weeks of diagnosis due to hepatic encephalopathy. CONCLUSIONS:This report highlights an unusual metastasis of gallbladder carcinoma to the breast and subcutaneous tissue presenting as multiple lesions,which has never been reported in the English literature.These were unknown sites of metastasis for carcinoma of the gallbladder.Moreover,bilateral multiple metastatic lesions to breast are also very rare.
文摘New research suggests that gut microbiota helps adenoma colon cancer spread worldwide.This study seeks therapeutic microbiota changes to prevent adenoma colon cancer and discusses their drawbacks.Prebiotics feed good bacteria and promote the formation of short-chain fatty acids,which have anti-inflammatory and anti-cancer properties.To promote healthy gut bacteria and reduce adenoma risk,fiber-rich diets and particular dietary interventions are being researched..FMT(fecal microbiota transplantation)may help restore gut flora and prevent adenoma colon cancer,according to the study.FMT transfers healthy donor feces to patients to restore microbial diversity.Different gut flora,persons,and therapies make it tricky to draw conclusions.Personalizing therapeutic approaches to each person's microbiota,host features,and genetic factors can improve treatment.Changing microorganisms may prevent adenoma colon cancer.Probiotics,prebiotics,dietary modifications,FMT,and bacteria metabolites may assist.More research is needed to determine the best ways to aid,solve difficulties,and personalize methods.We can prevent adenoma colon cancer and improve public health by learning more about gut flora and optimizing treatment methods.
文摘The incorporation of therapeutic-capable ions into bioactive glasses(BGs),either based on silica(SBGs)or phosphate(PBGs),is currently envisaged as a proficient path for facilitating bone regeneration.Inconjunction with this view,the single and complementary structural and bio-functional roles of CuO andGa_(2)O_(3)(in the 2e5 mol%range)were assessed,by deriving a series of SBG and PBG formulations startingfrom the parent glass systems,FastOs®BG e 38.5SiO2d36.1CaOd5.6P2O5d19.2MgOd0.6CaF2,and50.0P2O5d35.0CaOd10.0Na_(2)Od5.0 Fe2O_(3)(mol%),respectively,using the process of melt-quenching.The inter-linked physico-chemistry e biological response of BGs was assessed in search of bio-functional triggers.Further light was shed on the structural role e as network former or modifier e ofCu and Ga,immersed in SBG and PBG matrices.The preliminary biological performance was surveyedin vitro by quantification of Cu and Ga ion release under homeostatic conditions,cytocompatibility assays(in fibroblast cell cultures)and antibacterial tests(against Staphylococcus aureus).The similar(Cu)anddissimilar(Ga)structural roles in the SBG and PBG vitreous networks governed their release.Namely,Cuions were leached in similar concentrations(ranging from 10e35 ppm and 50e110 ppm at BG doses of 5and 50 mg/mL,respectively)for both type of BGs,while the release of Ga ions was 1e2 orders ofmagnitude lower in the case of SBGs(i.e.,0.2e6 ppm)compared to PBGs(i.e.,9e135 ppm).This wasattributed to the network modifier role of Cu in both types of BGs,and conversely,to the network former(SBGs)and network modifier(PBGs)roles of Ga.All glasses were cytocompatible at a dose of 5 mg/mL,while at the same concentration the antimicrobial efficiency was found to be accentuated by the coupledrelease of Cu and Ga ions from SBG.By collective assessment,the most prominent candidate material forthe further development of implant coatings and bone graft substitutes was delineated as the38.5SiO2d34.1CaOd5.6P2O5d16.2MgOd0.6CaF2d2.0CuOd3.0Ga_(2)O_(3)(mol%)SBG system,w
文摘Malaria is a major problem for European travelers to endemic regions.In Romania during 1980-2007 approximately 20 imported cases were detected annually.The aim of our short communication is to present 2 interesting cases of imported malaria detected in Western Romania.The first patienl was a 20-year female who traveled to India and acquired an infection with Plasmodium vivax(P.vivax).The second patient,a 60-year female,contracted an infection with Plasmodium falciparum(P.falciparum) during a trip to Ghana:the evolution of the disease was severe with many complications and the patient finally died.The cases presented revealed the difficulties in establishing a correct diagnosis of malaria in a non-endemic country, consequences of an incomplete taken anamnesis.Travel history should always represent a mandatory part of a well conducted investigation.At the same time,we must underline the importance of a correct and complete prophylaxis prior to every departure to tropical countries.
