Death in intensive care units (ICUs) may increase bereaved family members' risk for posttraumatic stress disorder (PTSD). However, posttraumatic stress-related symptoms (hereafter as PTSD symptoms) ...and their precipitating factors were seldom examined among bereaved family members and primarily focused on associations between PTSD symptoms and patient/family characteristics. We aimed to investigate the course and predictors of clinically significant PTSD symptoms among family members of deceased ICU patients by focusing on modifiable quality indicators for end-of-life ICU care.
In this longitudinal observational study, 319 family members of deceased ICU patients were consecutively recruited from medical ICUs from two Taiwanese medical centers. PTSD symptoms were assessed at 1, 3, 6, and 13 months post-loss using the Impact of Event Scale-Revised (IES-R). Family satisfaction with end-of-life care in ICUs was assessed at 1 month post-loss. End-of-life care received in ICUs was documented over the patient's ICU stay. Predictors for developing clinically significant PTSD symptoms (IES-R score ≥ 33) were identified by multivariate logistic regression with generalized estimating equation modeling.
The prevalence of clinically significant PTSD symptoms decreased significantly over time (from 11.0% at 1 month to 1.6% at 13 months post-loss). Longer ICU stays (adjusted odds ratio 95% confidence interval = 1.036 1.006, 1.066), financial insufficiency (3.166 1.159, 8.647), and reported use of pain medications (3.408 1.230, 9.441) by family members were associated with a higher likelihood of clinically significant PTSD symptoms among family members during bereavement. Stronger perceived social support (0.937 0.911, 0.965) and having a Do-Not-Resuscitate (DNR) order issued before the patient's death (0.073 0.011, 0.490) were associated with a lower likelihood of clinically significant PTSD symptoms. No significant association was observed for family members' satisfaction with end-of-life care (0.988 0.944, 1.034) or decision-making in ICUs (0.980 0.944, 1.018).
The likelihood of clinically significant PTSD symptoms among family members decreased significantly over the first bereavement year and was lower when a DNR order was issued before death. Enhancing social support and facilitating a DNR order may reduce the trauma of ICU death of a beloved for family members at risk for developing clinically significant PTSD symptoms.
Background The change of immune cell infiltration essentially influences the process of colorectal cancer development. The infiltration of immune cells can be regulated by a variety of genes. Thus, ...modeling the immune microenvironment of colorectal cancer by analyzing the genes involved can be more conducive to the in-depth understanding of carcinogenesis and the progression thereof. Methods In this study, the number of stromal and immune cells in malignant tumor tissues were first estimated by using expression data (ESTIMATE) and cell-type identification with relative subsets of known RNA transcripts (CIBERSORT) to calculate the proportion of infiltrating immune cell and stromal components of colon cancer samples from the Cancer Genome Atlas database. Then the relationship between the TMN Classification and prognosis of malignant tumors was evaluated. Results By investigating differentially expressed genes using COX regression and protein-protein interaction network (PPI), the candidate hub gene serine protease inhibitor family E member 1 (SERPINE1) was found to be associated with immune cell infiltration. Gene Set Enrichment Analysis (GSEA) further projected the potential pathways with elevated SERPINE1 expression to carcinogenesis and immunity. CIBERSORT was subsequently utilized to investigate the relationship between the expression differences of SERPINE1 and immune cell infiltration and to identify eight immune cells associated with SERPINE1 expression. Conclusion We found that SERPINE1 plays a role in the remodeling of the colon cancer microenvironment and the infiltration of immune cells. Keywords: Colon cancer, SERPINE1, Tumor microenvironment, Tumor-infiltrating immune cells
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Recent studies have indicated that bivalves are bioindicators for microplastic pollution since they are filter feeders and accumulate microplastics (MPs) during their feeding process. This study ...focused on the investigation of MPs in blood cockles (Tegillarca granosa) and green mussels (Perna viridis) from selected aquaculture farms and markets in Thailand. The abundance of MPs was identified by fluorescence microscopy with Nile Red tagging and the polymer detection by micro-Fourier Transform Infrared Spectroscopy (micro-FTIR). The number of MPs in blood cockle samples from the Khlong Dan market and the BangBo aquaculture farm was 11 ± 5 and 6 ± 1 particles/individual, respectively. For green mussel samples, the number of MPs from the Talaad Thai market and the Sriracha fisheries research station was 96 ± 19 and 11 ± 7 particles/individual, respectively. The results of the study indicate that the number of MPs in bivalve samples from the markets is much higher than in the aquaculture farms. This probably is due to the contamination of MPs in bivalves during the packaging and transportation processes. However, further studies are needed to confirm this. The predominant MPs were fragments and fibres with a size range of 0.05–0.3 mm. Most polymers were polypropylene, polyethylene, copolymer, polyester, and nylon. In brief, this study showed the contamination of MPs in bivalves cultivated for human consumption. The accumulation of MPs in these marine bivalves can lead to the biomagnification of MPs along the food chain. This can impact food safety and human health.
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•MPs were found in bivalves collected from selected farm and markets in Thailand.•MPs in blood cockles from Khlong Dan market was 11 ± 5 particles/individual.•MPs in blood cockles from BangBo aquaculture farm was 6 ± 1 particles/individual.•Most MPs were PP, PE with size of 0.05–0.3 mm and shapes of fragments, fibers.•Number of MPs in bivalve from markets is much higher than in aquaculture farms.
Many methods have been developed for analyzing survival data which are commonly right-censored. These methods, however, are challenged by complex features pertinent to the data collection as well as ...the nature of data themselves. Typically, biased samples caused by left-truncation (or length-biased sampling) and measurement error often accompany survival analysis. While such data frequently arise in practice, little work has been available to simultaneously address these features. In this paper, we explore valid inference methods for handling left-truncated and right-censored survival data with measurement error under the widely used Cox model. We first exploit a flexible estimator for the survival model parameters which does not require specification of the baseline hazard function. To improve the efficiency, we further develop an augmented nonparametric maximum likelihood estimator. We establish asymptotic results and examine the efficiency and robustness issues for the proposed estimators. The proposed methods enjoy appealing features that the distributions of the covariates and of the truncation times are left unspecified. Numerical studies are reported to assess the finite sample performance of the proposed methods.
Obstructive sleep apnea (OSA) is a disease with great cardiovascular risk. Interleukin-8 (IL-8), an important chemokine for monocyte chemotactic migration, was studied under intermittent hypoxia ...condition and in OSA patients. Monocytic THP-1 cells were used to investigate the effect of intermittent hypoxia on the regulation of IL-8 by an intermittent hypoxic culture system. The secreted protein and mRNA levels were studied by means of enzyme-linked immunosorbent assay and RT/real-time PCR. The chemotactic migration of monocytes toward a conditioned medium containing IL-8 was performed by means of the transwell filter migration assay. Peripheral venous blood was collected from 31 adult OSA patients and RNA was extracted from the monocytes for the analysis of IL-8 expression. The result revealed that intermittent hypoxia enhanced the monocytic THP-1 cells to actively express IL-8 at both the secreted protein and mRNA levels, which subsequently increased the migration ability of monocytes toward IL-8. The ERK, PI3K and PKC pathways were demonstrated to contribute to the activation of IL-8 expression by intermittent hypoxia. In addition, increased monocytic IL-8 expression was found in OSA patients, with disease severity dependence and diurnal changes. This study concluded the monocytic IL-8 gene expression can be activated by intermittent hypoxia and increased in OSA patients.
Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of childbearing age. The risk of pregnancy and neonatal complications in women with PCOS is debatable. In order to determine ...the risk of pregnancy and neonatal complications, evidence regarding these risks was examined.
Literature searches were performed in the electronic databases MEDLINE, EMBASE, and CENTRAL based on the established strategy and eligible tries were included according to inclusion and exclusion criteria. A systematic literature review looking at rates of gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), preeclampsia, premature delivery, neonatal birth weight, caesarean section and admission to a neonatal intensive care unit (NICU) was conducted in women with PCOS. Pregnancy outcomes between women with PCOS versus controls were included. Sensitivity analyses were performed to determine the reliability of the available evidence and to validate the results. The study was performed with the approval of the ethics committee of the First Affiliated Hospital of Guangxi Medical University.
A total of 27studies, involving 4982 women with PCOS and 119692 controls were eligible for the meta-analysis. Women with PCOS demonstrated a significantly higher risk of developing GDM (OR3.43; 95% CI: 2.49-4.74), PIH (OR3.43; 95% CI: 2.49-4.74), preeclampsia (OR2.17; 95% CI: 1.91-2.46), preterm birth (OR1.93; 95%CI: 1.45-2.57), caesarean section (OR 1.74; 95% CI: 1.38-2.11) compared to controls. Their babies had a marginally significant lower birth weight (WMD -0.11g; 95%CI: -0.19 - -0.03), and higher risk of admission to NICU (OR 2.32; 95% CI: 1.40-3.85) compared to controls.
Women with PCOS have increased risk of adverse pregnancy and neonatal complications. It is necessary to establish guidelines for supervision during pregnancy and parturition to prevent these complications.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Cardiac ischaemia/reperfusion (I/R) injury causes cardiomyocyte apoptosis and mitochondrial dysfunction. Ursolic acid (UA), as a pentacyclic triterpenoid carboxylic acid, exerts several bioactivities ...in animal models of different diseases, but the preventive role of UA in I/R-induced myocardial dysfunction remains largely unknown. Male wild-type mice were pre-administered with UA at a dosage of 80 mg/kg i.p. and then subjected to cardiac I/R injury for 24 h. Cardiac function and pathological changes were examined by echocardiography and histological staining. The protein and mRNA levels of the genes were determined using qPCR and immunoblotting analysis. Our results revealed that UA administration in mice significantly attenuated the I/R-induced decline in cardiac function, infarct size, myocyte apoptosis, and oxidative stress. Mechanistically, UA increased three immunoproteasome catalytic subunit expressions and activities, which promoted ubiquitinated PP2A degradation and activated AMPK-PGC1α signalling, leading to improved mitochondrial biosynthesis and dynamic balance. In vitro experiments confirmed that UA treatment prevented hypoxia/reperfusion (H/R)-induced cardiomyocyte apoptosis and mitochondrial dysfunction through activation of AMPK signalling. In summary, our findings identify UA as a new activator of the immunoproteasome that exerts a protective role in I/R-induced myocardial dysfunction and suggest that UA supplementation could be beneficial for the prevention of cardiac ischaemic disease.
In this paper, we introduce the R package NetDA, which aims to deal with multiclassification with network structures in predictors accommodated. To address the natural feature of network structures, ...we apply Gaussian graphical models to characterize dependence structures of the predictors and directly estimate the precision matrix. After that, the estimated precision matrix is employed to linear discriminant functions and quadratic discriminant functions. The R package NetDA is now available on CRAN, and the demonstration of functions is summarized as a vignette in the online documentation.
A series of low‐temperature firing ceramics with scheelite structure, Ca0.55(Sm1‐xBix)0.3MoO4 (x = 0.2–0.95), were prepared via solid‐state reaction. The sintering temperature ranges from 660 to ...760°C. A standard tetragonal scheelite phase was formed without secondary phase. When the x value was 0.95, the temperature coefficient of resonant frequency (τf) moved to a near zero value (−2.1 ppm/°C) with a dielectric constant 13.7 and the quality factor (Qf) of 33 200 GHz. The Raman spectra shows that the more vibration modes appeared with x value, which is due to the increasing of Bi concentration and results in increase in permittivities and decrease in Qf values. The classical harmonic oscillator model is used in the infrared spectra and extrapolate to the microwave range. The Ca0.55(Sm1‐xBix)0.3MoO4 ceramics show high‐performance microwave dielectric properties at low‐sintering temperature.
Abstract
Background
Bereaved ICU family surrogates are at risk of comorbid prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression. Knowledge about temporal relationships ...between PGD, PTSD, and depression is limited by a lack of relevant studies and diverse or inappropriate assessment time frames given the duration criterion for PGD. We aimed to determine the temporal reciprocal relationships between PGD, PTSD, and depressive symptoms among ICU decedents’ family surrogates during their first 2 bereavement years with an assessment time frame reflecting the PGD duration criterion.
Methods
This prospective, longitudinal, observational study examined PGD, PTSD, and depressive symptoms among 303 family surrogates of ICU decedents from two academic hospitals using 11 items of the Prolonged Grief Disorder-13, the Impact of Event Scale—Revised, and the depression subscale of the Hospital Anxiety and Depression Scale, respectively, at 6, 13, 18, and 24 months post-loss. Cross-lagged panel modeling was conducted: autoregressive coefficients indicate variable stability, and cross-lagged coefficients indicate the strength of reciprocal relationships among variables between time points.
Results
Symptoms (autoregressive coefficients) of PGD (0.570–0.673), PTSD (0.375–0.687), and depression (0.591–0.655) were stable over time. Cross-lagged standardized coefficients showed that depressive symptoms measured at 6 months post-loss predicted subsequent symptoms of PGD (0.146) and PTSD (0.208) at 13 months post-loss. PGD symptoms did not predict depressive symptoms. PTSD symptoms predicted subsequent depressive symptoms in the second bereavement year (0.175–0.278). PGD symptoms consistently predicted subsequent PTSD symptoms in the first 2 bereavement years (0.180–0.263), whereas PTSD symptoms predicted subsequent PGD symptoms in the second bereavement year only (0.190–0.214). PGD and PTSD symptoms are bidirectionally related in the second bereavement year.
Conclusions
PGD, PTSD, and depressive symptoms can persist for 2 bereavement years. Higher PGD symptoms at 6 months post-loss contributed to the exacerbation of PTSD symptoms over time, whereas long-lasting PTSD symptoms were associated with prolonged depression and PGD symptoms beyond the first bereavement year. Identification and alleviation of depression and PGD symptoms as early as 6 months post-loss enables bereaved surrogates to grieve effectively and avoid the evolution of those symptoms into long-lasting PGD, PTSD, and depression.
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