Education of Hospitalized Diabetic Patients: Analysis of Training Needs among Nurses in a Lebanese Hospital - A Secondary Publication

The design of diabetes inpatient educational preparation should be based on the needs of the nurses involved in terms of skills in this area. The objective of this qualitative study is to identify the preparatory needs of nurses working in the medical and surgical units of a Lebanese hospital in terms of Survival Skills Education for Hospitalized Diabetic Patients (SSEHDP). Method: The focus group method is used for data collection using a semi-structured interview guide. The needs expressed by the thirty-two participating nurses were classified into categories of the competency framework for providing self-management education to diabetic patients proposed by the American Diabetes Association. Results: By focusing on the themes of an SSEHDP, a list of preparatory needs was drawn up. The needs identified and analyzed are then translated into general and specific learning objectives for educational preparation. Conclusion: The needs analysis is only the first step in a work that will ideally continue into the implementation and eventual evaluation of an educational program developed to help nurses acquire skills in the education of diabetic patients.

A comparative study of pancreatic endocrine function and related metabolism after long-term survival between the patients with combined kidneypancreas transplantation vs those with combined en bloc ' liver-pancreas transplantation

Objective To compare the effects of combined en bloc liver - pancreas transplantation ( LPT) with portal vein drainage and simultaneous combined kidney - pancreas transplantation ( KPT) with systemic venous drainage on the pancreatic endocrine function and related me-

Long-term outcomes of pediatric liver transplantation in acute liver failure vs end-stage chronic liver disease:A retrospective observational study

BACKGROUND Children with acute liver failure(ALF)who meet the criteria are eligible for super-urgent transplantation,whereas children with end-stage chronic liver disease(ESCLD)are usually transplanted electively.Pediatric liver transplantation(PLT)in ALF and ESCLD settings has been well described in the literature,but there are no studies comparing the outcomes in these two groups.AIM To determine if there is a difference in post-operative complications and survival outcomes between ALF and ESCLD in PLT.METHODS This was a retrospective observational study of all primary PLTs performed at a single center between 2000 and 2019.ALF and ESCLD groups were compared for pretransplant recipient,donor and operative parameters,and post-operative outcomes including graft and patient survival.RESULTS Over a 20-year study period,232 primary PLTs were performed at our center;195 were transplanted for ESCLD and 37 were transplanted for ALF.The ALF recipients were significantly older(median 8 years vs 5.4 years;P=0.031)and heavier(31 kg vs 21 kg;P=0.011).Living donor grafts were used more in the ESCLD group(34 vs 0;P=0.006).There was no difference between the two groups concerning vascular complications and rejection,but there were more bile leaks in the ESCLD group.Post-transplant patient survival was significantly higher in the ESCLD group:1-,5-,and 10-year survival rates were 97.9%,93.9%,and 89.4%,respectively,compared to 78.3%,78.3%,and 78.3%in the ALF group(P=0.007).However,there was no difference in 1-,5-,and 10-year graft survival between the ESCLD and ALF groups(90.7%,82.9%,77.3%vs 75.6%,72.4%,and 66.9%;P=0.119).CONCLUSION Patient survival is inferior in ALF compared to ESCLD recipients;the main reason is death in the 1st year post-PLT in ALF group.Once the ALF children overcome the 1st year after transplant,their survival stabilizes,and they have good long-term outcomes.

Outcome of Renal Transplantation at Ahmed Gasim Cardiac and Renal Transplant Centre in Sudan-2014

Background: Although not life-saving procedures like liver or heart transplantation, renal transplantation is the preferred treatment for many patients with end-stage renal disease because it improves patients’ quality of life, while other forms of renal replacement therapy (RRT) such as haemodialysis (HDX) shown to regain only 10% of the patient’s renal function [1]. Transplantation releases patients from the dietary and fluid restrictions and the physical constraints imposed by other forms of (RRT), patients become able to return to their normal activities. Patient’s 5-year survival is higher post transplant. Patients and methods: This is Descriptive, retro-prospective, cross sectional analytic and multicentre study done in Ahmed Gasim Cardiac and Renal Transplant Centre including 105 patients. After meeting the Inclusion Criteria and exclusion Criteria, then cases were selected and written in constructed questionnaire. The aim of the study was to evaluate the outcome of renal transplantation in Sudan. Results: 105 cases were used with male predominate and ratio male to female ratio 3:1, the main age of presentation between 31 - 45 years, most of the patients discharge uneventful with good outcome. During one-year follow-up following renal transplantation. Patient survival 95.2 % graft survival 82.4%. Overall morbidity shows 70.5%. Conclusion: this study showed that the one-year patient survival of 95.2%. Actuarial one-year graft survival of 92.4%. Renal transplantation complications can be reduced by meticulous preoperative workup including good cardiovascular assessment, tissue mismatch and BMI good postoperative follow up for early detection of graft rejection and long-term complications and finally patient education.

CIB1 as a Potential Diagnosis and Prognosis Biomarker in Uveal Melanoma

Background: Uveal melanoma (UVM) is the most common primary intraocular tumor in adults. However, identification of the effective biomarker for the diagnosis and treatment of UVM remains to be explored. Calcium and integrin-binding protein 1 (CIB1) is emerging as an important factor in tumor progression. Purpose: To determine the contribution of CIB1 in the diagnosis of UVM. Method: Immunohistochemical staining is used to detect the CIB1 expression level, while Gene Expression Profiling Interactive Analysis 2 (GEPIA2) and UALCAN online tools were used to analyze patient survival and CIB1 correlation genes in UVM. Integrative analysis using STRING and GeneMANIA predicted the correlated genes with CIB1 in UVM. Results: CIB1 expression level in UVM was significantly enhanced when compared with that in paracancerous tissues. A higher CIB1 expression level resulted in a significantly worse disease-free survival as well as overall survival. Moreover, the survival probability of patients was associated with body weight and gender of the patients with UVM. The correlated genes with CIB1 in UVM, and the similarity of the genes in UVM expression and survival heatmap were verified. Furthermore, Gene ontology enrichment analysis revealed that CIB1 and its correlated genes are significantly enriched in ITGA2B-ITGB3-CIB1 complex, regulation of intracellular protein transport and regulation of ion transport. Conclusions: Our novel findings suggested that CIB1 might be a potential diagnostic predictor for UVM, and might contribute to the potential strategy for UVM treatment by targeting CIB1.

Exocrine drainage in pancreas transplantation:Complications and management

The aim of this minireview is to compare various pancreas transplantation exocrine drainage techniques i.e.,bladder vs enteric.Both techniques have different difficulties and complications.Numerous comparisons have been made in the literature between exocrine drainage techniques throughout the history of pancreas transplantation,detailing complications and their impact on graft and patient survival.Specific emphasis has been made on the early postoperative management of these complications and the related surgical infections and their consequences.In light of the results,a number of bladder-drained pancreas grafts required conversion to enteric drainage.As a result of technical improvements,outcomes of the varied enteric exocrine drainage techniques(duodenojejunostomy,duodenoduodenostomy or gastric drainage)have also been discussed i.e.,assessing specific risks vs benefits.Pancreatic exocrine secretions can be drained to the urinary or intestinal tracts.Until the late 1990s the bladder drainage technique was used in the majority of transplant centers due to ease of monitoring urine amylase and lipase levels for evaluation of possible rejection.Moreover,bladder drainage was associated at that time with fewer surgical complications,which in contrast to enteric drainage,could be managed with conservative therapies.Nowadays,the most commonly used technique for proper driving of exocrine pancreatic secretions is enteric drainage due to the high rate of urological and metabolic complications associated with bladder drainage.Of note,10%to 40%of bladder-drained pancreata eventually required enteric conversion at no detriment to overall graft survival.Various surgical techniques were originally described using the small bowel for enteric anastomosis with Roux-en-Y loop or a direct side-to-side anastomosis.Despite the improvements in surgery,enteric drainage complication rates ranging from 2%-20%have been reported.Treatment depends on the presence of any associated complications and the condition of the patient.Intra-abdominal infection represents a potentially very serious problem.Up to 30%of deep wound infections are associated with an anastomotic leak.They can lead not only to high rates of graft loss,but also to substantial mortality.New modifications of established techniques are being developed,such as gastric or duodenal exocrine drainage.Duodenoduodenostomy is an interesting option,in which the pancreas is placed behind the right colon and is oriented cephalad.The main concern of this technique is the challenge of repairing the native duodenum when allograft pancreatectomy is necessary.Identification and prevention of technical failure remains the main objective for pancreas transplantation surgeons.In conclusion,despite numerous techniques to minimize exocrine pancreatic drainage complications e.g.,leakage and infection,no universal technique has been standardized.A prospective study/registry analysis may resolve this.

Survival without common toxicity criteria grade 3/4 toxicity following second-line treatment with pemetrexed for nonsquamous non-small cell lung cancer in Chinese patients

Background The efficacy of pemetrexed in the second-line treatment of Chinese patients with advanced non-small cell lung cancer （NSCLC） has been shown to be similar to that of docetaxel in a recent study; additionally, pemetrexed was associated with much better safety and toxicity profiles. Here, the survival without common toxicity criteria grade 3/4 toxicity （SWT） data from a post hoc analysis of this recent prospective NSCLC study in Chinese patients is reported. This post hoc analysis differs from the main study; it focuses on the nonsquamous population to align with the current approval for pemetrexed in China. Methods A total of 154 patients with nonsquamous NSCLC received either pemetrexed （500 mg/m2 intravenously （IV）） or docetaxel （75 mg/m2 IV） on day 1 of 21-day cycles. SWT was analyzed using Kaplan-Meier and univariate Cox methods. Results Patients treated with pemetrexed had a longer median SWT than patients treated with docetaxel （7.4 months versus 1.2 months; unadjusted hazard ratio =0.59, 95% confidence interval CCI}： 0.41-0.84; P=0.003）. At 12 and 18months, the SWT event-free probability for pemetrexed patients （18 months： 24.5%, 95%C/ 13.9%-36.6%, vs. 12.3%, 95% CI 4.8%-23.6%） was greater than that for docexatel patients （12 months： 37.3%, 95% CI 26.5%- 48.0%, vs. 23.3%, 95% CI 14.4-33.4）. The progression- free survival without common toxicity criteria grade 3/4 toxicity （PFS-WT） was also statistically significantly longer for patients treated with pemetrexed than patients treated with docetaxel （1.9 months vs. 1.1 months, P=0.002）. Conclusions Chinese patients with nonsquamous NSCLC disease treated with pemetrexed had improved SWT beyond 6 months than those receiving docetaxel. This analysis supports a benefit-to-risk profile that favors pemetrexed over docetaxel in the second-line treatment of Chinese nonsquamous NSCLC patients.

Longer Overall Survival in A Patient with Advanced Non-small Cell Lung Cancer Treated with Chinese Medicine and Chemotherapy

Non-small cell lung cancer （NSCLC） is the leading cause of cancer death in the industrialized world. Despite significant progress in early stage of the disease, the overall survival rates for advanced disease remain low. Herein we present a case of NSCLC who was treated with Chinese medicine and chemotherapy with a longer overall survival.

An Elderly Patient with Advanced Lung Cancer Achieved Long-Term Survival Using Chinese Medicine:An Alternative Treatment Strategy for Cancer Patients Aged 80 or Older without A Tissue Confirmed Diagnosis

Lung cancer is the leading cause of cancerrelated mortality in China.（1＇2） Meanwhile, the average life expectancy in the aging population has increased from 46 years in 1950 to 75 years in 2010.

Cancer chemotherapy and beyond:Current status,drug candidates,associated risks and progress in targeted therapeutics

Cancer is an abnormal state of cells where they undergo uncontrolled proliferation and produce aggressive malignancies that causes millions of deaths every year.With the new understanding of the molecular mechanism(s)of disease progression,our knowledge about the disease is snowballing,leading to the evolution of many new therapeutic regimes and their successive trials.In the past few decades,various combinations of therapies have been pro-posed and are presently employed in the treatment of diverse cancers.Targeted drug therapy,immunotherapy,and personalized medicines are now largely being employed,which were not common a few years back.The field of cancer discoveries and therapeutics are evolving fast as cancer type-specific biomarkers are progressively being identified and several types of cancers are nowadays undergoing systematic therapies,extending patients’disease-free survival thereafter.Although growing evidence shows that a systematic and targeted approach could be the future of cancer medicine,chemotherapy remains a largely opted therapeutic option despite its known side effects on the patient’s physical and psychological health.Chemother-apeutic agents/pharmaceuticals served a great purpose over the past few decades and have remained the frontline choice for advanced-stage malignancies where surgery and/or radiation therapy cannot be prescribed due to specific reasons.The present report succinctly reviews the existing and contemporary advancements in chemotherapy and assesses the status of the enrolled drugs/pharmaceuticals;it also comprehensively discusses the emerging role of specific/targeted therapeutic strategies that are presently being employed to achieve better clinical success/survival rate in cancer patients.

Scaffold protein MAPK8IP2 expression is a robust prognostic factor in prostate cancer associated with AR signaling activity

Mitogen-activated protein kinase-8-interacting protein 2(MAPK8IP2)is a scaffold protein that modulates MAPK signal cascades.Although MAPK pathways were heavily implicated in prostate cancer progression,the regulation of MAPK8IP2 expression in prostate cancer is not yet reported.We assessed MAPK8IP2 gene expression in prostate cancer related to disease progression and patient survival outcomes.MAPK8IP2 expression was analyzed using multiple genome-wide gene expression datasets derived from The Cancer Genome Atlas(TCGA)RNA-sequence project and complementary DNA(cDNA)microarrays.Multivariable Cox regressions and log-rank tests were used to analyze the overall survival outcome and progression-free interval.MAPK8IP2 protein expression was evaluated using the immunohistochemistry approach.The quantitative PCR and Western blot methods analyzed androgen-stimulated MAPK8IP2 expression in LNCaP cells.In primary prostate cancer tissues,MAPK8IP2 mRNA expression levels were significantly higher than those in the case-matched benign prostatic tissues.Increased MAPK8IP2 expression was strongly correlated with late tumor stages,lymph node invasion,residual tumors after surgery,higher Gleason scores,and preoperational serum prostate-specific antigen(PSA)levels.MAPK8IP2 upregulation was significantly associated with worse overall survival outcomes and progression-free intervals.In castration-resistant prostate cancers,MAPK8IP2 expression strongly correlated with androgen receptor(AR)signaling activity.In cell culture-based experiments,MAPK8IP2 expression was stimulated by androgens in AR-positive prostate cancer cells.However,MAPK8IP2 expression was blocked by AR antagonists only in androgen-sensitive LNCaP but not castration-resistant C4-2B and 22RV1 cells.These results indicate that MAPK8IP2 is a robust prognostic factor and therapeutic biomarker for prostate cancer.The potential role of MAPK8IP2 in the castration-resistant progression is under further investigation.

Qualifying the suitability of living donor livers for pediatric liver transplantation:are we doing the right thing?

Over the last decades,liver transplantation has become the standard care for many forms of end-stage liver disease,both in adults and in children.The prognosis after pediatric liver transplantation(pLT)has steadily increased up to a patient survival at 5 years of 85%and an estimated graft half life of 31 years(1,2).In the early days of pLT,the transplanted organ originated from deceased donors.Since 1990,adult-to-child living donor liver transplantation(LDLT)programs have developed,which rapidly gained popularity,particularly in Europe and Asia(2,3).A major stimulus for LDLT has been the limited availability of deceased donors.The indications for liver transplantation have expanded,particularly for adult patients,at a higher rate than the availability of donor organs.Moreover,the quality of donor organs has steadily declined,resulting in a decreased utilization of livers from deceased donors for transplantation(4).The limited availability of qualified deceased donor livers has further stimulated LDLT:in Europe,for example,the percentage of living donor organs used for pLT increased from 7%before 2000 to 40%since 2010(1).

Spectrum of EGFR aberrations and potential clinical implications:insights from integrative pan-cancer analysis

Background:Human epidermal growth factor receptor(EGFR)is an oncogenic gene and one of top targets of precision therapy in lung cancer with EGFR mutations.Although there are many reports for some individual cancers,comprehensive profiling of EGFR mutations,overexpression,amplification,DNA methylation,and their clinical associations across many different cancers simultaneously was not available.This study aimed to fill the gap and provide insights to the alteration spectrum of EGFR and its therapeutic and prognostic implications.Methods:The Cancer Genome Atlas(TCGA)datasets for 32 cancer types involving 11,314 patients were analyzed for alterations(mutations and amplification/deletion),abnormal expression and DNA methylation in EGFR gene.Mutation frequency,genomic location distribution,functional impact,and clinical targeted therapy implication were compared among different cancer types,and their associations with patient survival were analyzed.Results:EGFR alteration frequency,mutation sites across functional domains,amplification,overexpression,and DNA methylation patterns differed greatly among different cancer types.The overall mutation frequency in all cancers combined was relatively low.Targetable mutations,mainly in lung cancer,were primarily found in the Pkinase_Tyr domain.Glioblastoma multiforme had the highest rate of alterations,but it was dominated by gene amplification and most mutations were in the Furin-like domain where targeted therapy was less effective.Low-grade glioma often had gene amplification and increased EGFR expression which was associated with poor outcome.Colon and pancreatic adenocarcinoma had very few EGFR mutations;however,high EGFR expression was significantly associated with short patient survival.Squamous cell carcinoma regardless of their sites(the head and neck,lung,or esophagus)exhibited similar characteristics with an alteration frequency of about 5.0%,was dominated by gene amplification,and had increased EGFR expression generally associated with short patient survival.DNA methylation was highly associated with EGFR expression and patient outcomes in some cancers.Conclusions:EGFR aberration type,frequency,distribution in functional domains,and expression vary from cancer to cancer.While mutations in the Pkinase_Tyr domain are more important for treatment selection,increased expression from amplification or deregulation affects more tumor types and leads to worse outcome,which calls for new treatment strategies for these EGFR-driven tumors.

Portal vein thrombosis in liver transplantation: radiologic evaluation, risk factors, and occult diagnosis

Aim:Portal vein thrombosis(PVT)in the liver transplant recipient poses many challenges.Unfortunately,the risk factors and effects on outcomes of PVT are not well-defined.Methods:This study analyzed the experience with PVT in liver transplant program from 2007 to 2013.This included the effectiveness of PVT diagnostics and its risk factors using logistical regression.The primary endpoints were Kaplan-Meir patient and graft survival.The secondary endpoints were the length of stay(LOS),transfusion rate,and overall morbidity.Independent predictors of survival were identified using a Cox’s proportional hazards model.Results:Two hundred and sixteen consecutive liver transplant recipients were examined,and 30(13.8%)had either a total or partial PVT.Two hundred and five patients had imaging within 1 year of liver transplantation with only 7(23.3%)of the 30 PVTs identified pre-operatively.Calculated sensitivity(4.8-50%)and negative predictive values(10.5-22.2%)were poor.Only,age significantly predicted PVT[P=0.037/hazard ratio(HR)=0.95].Ninety-day-patient and graft survival for PVT was similar at 6 months,although 1-year survival was significantly lower.“Occult”PVT was not associated with inferior survival.Model for end-stage liver disease score>25(P=0.001,HR=0.49/P=0.004,HR=0.52)and age>60 years(P=0.017,HR=0.64/P=0.013,HR=0.67)were significant predictors of patient and graft survival.Although the transfusion rate was significantly greater with PVT,LOS,and morbidity were not.Conclusion:Older recipients had a greater likelihood of PVT.Diagnostic studies were not effective at excluding PVT,and occult diagnosis did not affect the outcome.PVT was not an independent predictor of mortality or graft loss,but was associated with greater blood loss but not increased LOS or morbidity.