Knowledge,Attitude and Practice(K-A-P)of Cancer Nutrition in Chinese Medical Staff

Objective The present study was designed to investigate knowledge,attitude,and practice(K-A-P)toward cancer nutrition among medical staff in China,and to provide a basis for nutritional oncology training in clinical oncology practice in China in order to improve clinical treatment outcomes.Method This was a multicenter,cross-sectional study involving 3036 clinicians selected from 138 hospitals in 13 provinces across China.KAP scores were collected via questionnaires.Results The overall mean K score was 41.26±23.68,with a pass rate of 35.31%and honoring rate of 12.48%,respectively.The overall mean A score was 82.23±12.63,with pass rate of 96.57%and honoring rate of 69.37%,respectively.The overall mean P score was 73.03±15.06,with a pass rate of 85.64%and honoring rate of 39.86%,respectively.The correlation coefficient between K and A scores was 0.136(P<0.05).The correlation coefficient between K and P scores was 0.179(P<0.05).These results suggested positive correlations between K and A,and K and P scores.While the pass rate for K score in male staff was higher than that in female(P<0.05),there was no significant difference for A and P scores between the two groups(P >0.05).The K-A-P scores,and their associated pass rates and honoring rates among doctors were higher than that among nurses and medical technicians(P<0.05).Senior medical technicians had higher K and P scores than their junior counterparts(P<0.05).However,there was no significant difference in A scores among medical technicians with different ranks(P >0.05).Mean K-A-P scores and their associated pass rates and honoring rates in clinicians with higher degrees were superior,compared with those with lower degrees(P<0.05).Surgeons had higher K-A-P scores,pass rates,and honoring rates than others(P<0.05).Those who worked in teaching hospitals showed higher K-A-P scores,pass rates,and honoring rates than their counterparts in other work settings.There were no significant differences in K and P scores,and associated pass rates and good rates between medical staff from general hospitals and those from specialized oncology hospitals(P >0.05).However,higher P scores and associated pass rates were observed in staff from general hospitals than that from other settings(P<0.05).Over half(58.41%)of the medical staff spent less than 10%of their work time on nutritional education.About half(52.71%)of the medical staff expressed desires to work on nutritional research projects.Nutritional knowledge of medical staff primarily came from work experience(66.22%),reference textbooks and journals(65.40%),and formal education(61.25%).Conclusion While medical staff in China demonstrated positive attitude and good practice in nutritional therapy,they need more training to improve nutritional knowledge.

Significance of ultrasound evaluation of carotid atherosclerotic plaque for diagnosing ischemic cerebrovascular disease

BACKGROUND： Carotid artery is the main source for craniocerebral blood supply. Its intimal plaque formation and arterial stenosis degree both are the risk factors for ischemic cerebrovascular disease.Therefore, the close relationship of carotid atherosclerotic plaque and ischemic cerebrovascular disease, and ultrasound evaluation of carotid atherosclerotic plaque have become the hot spot in studying ischemic cerebrovascular disease.OBJECTIVE： This study was to detect the degree of carotid atherosclerosis of ischemic cerebrovascular disease patients by ultrasonography, and to analyze the situation of carotid atherosclerosis and its relationship with clinic.DESIGN： Clinical randomized concurrent control experiment.SETTING： Lintong Convalescent Hospital of Lanzhou Military Area Command of Chinese PLA.PARTICIPANTS： Totally 60 outpatients and inpatients with ischemic cerebrovascular disease, 42 males and 18 females, admitted to Lintong Convalescent Hospital of Lanzhou Military Area Command of Chinese PLA between January 2006 and December 2006 were involved in the patient group. They met the diagnosis criteria of ischemic cerebrovascular disease constituted by the 4th Cerebrovascular Disease Conference in 1996, and were confirmed to suffer from ischemic cerebrovascular disease by skull CT and MRI. Another 20 subjects who received healthy examination concurrently in the same hospital, 12 males and 8 females, were involved in the control group. Informed consents of detected items were obtained from involved subjects.METHODS： The plaque thickness of mid portion, distal end and crotch of common carotid artery （CCA）,internal carotid artery （ICA）, external carotid artery （ECA） and vertebral artery （VA） of involved subjects,who received health examination was separately detected with color Doppler ultrasonograph （HDI-5000）.Then, total integral of plaque was calculated. The intima-media thickness （IMT） was measured with two-dimensional ultrasonography. The inner diameter stenosis degree of subjects who had plaque was measured. Blood flow parameters were recorded, and stenosis degree and plaque area were calculated. Blood flow volume of bilateral carotid artery and VA was separately measured with ultrasound equipment software,and brain blood flow volume was calculated.MAIN OUTCOME MEASURES： Atherosclerotic degree and blood flow volume of patients of two groups.RESULTS： Sixty patients with ischemic cerebrovascular disease and twenty subjects who received health examination participated in the final analysis. ①The IMT thickness, total plaque score, and total plaque area of patient group was significantly superior to that of control group, respectively（ t=5.216 - 10.158, P 〈 0.05 ）.② There were significant differences in the stenosis degree of CCA, ICA and VA between patient group and control group （t=6.720 - 12.816, P 〈 0.05 ） . ③ The blood flow volume of CCA, ICA, VA and brain of patient group was significantly lower than that of control group, respectively （t=2.872 - 10.860, P 〈 0.05）.CONCLUSION： Ischemic cerebrovascular disease patients have different degrees of changes in atherosclerosis and arterial blood flow.

Damage to Hippocampus of Rats after Being Exposed to Infrasound

Objective The objective was to observe damage of hippocampus in rats after exposure to infrasound, and to assess HSP70 expression in hippocampus. Methods SD rats in the experimental group were exposed to 140 d B（8 Hz） infrasound for 2 h per day for 3 days. The morphology of the hippocampus was examined by transmission electronic microscopic（TEM）. Cell apoptosis was observed by TUNEL staining at 0 h, 24 h, 48 h, and 2 w after exposure. HSP70 expression was detected by immunohistochemistry（IHC） and Western blotting（WB）. Results TEM showed that hippocampus was significantly damaged by exposure, and exhibited recovery 1 week after exposure. The TUNEL data showed that neuronal apoptosis after exposure was significantly higher than in the control rats at 24 h and 48 h, and the apoptotic cells decreased one week after exposure. IHC and WB showed HSP70 expression was significantly higher in the exposed rats, peaked at 24 h. Conclusion Exposure to 140 d B（8 Hz） infrasound for 2 h per day for 3 days appeared to induce damage to the hippocampus of rats, based on changes in ultrastructure and increased cell apoptosis. However, recovery from the damage occurred overtime. HSP70 expression also increased after the exposure and decreased by 48 h.

Defensive mechanism of increasing expression of coonexin43 for neurons in cerebral astrocyte of rats with andiogenic seizure

Objective To observe the alteration of the expression of Cx43in cerebral astrocyte caused by audiogenic seizure.Method Genetic epilepsy prone rat P77PMC was used as a model and immunohistochemical method was applied to detect the time-co urse alteration of Cx43ex-pression in P77PMC rat ’ s cerebral astrocyte.Result After audiogenic seizure,Cx43expression was detected in cerebral cortex and hippocampus and appeared time-dependent increa sing.Conclusion Astrocytes in cerebral cortex and hi ppocampus might be activated by audi ogenic seizure,which might be beneficial to keep the stability of neuron’ s peripheral environment and thus protect the neurons.

Practice guidelines for ultrasound-guided percutaneous microwave ablation for hepatic malignancy

Primary liver cancer and liver metastases are among the most frequent malignancies worldwide,with an increasing number of new cases and deaths every year.Traditional surgery is only suitable for a limited proportion of patients and imaging-guided percutaneous thermal ablation has achieved optimistic results for management of hepatic malignancy.This synopsis outlines the first clinical practice guidelines for ultrasoundguided percutaneous microwave ablation therapy for hepatic malignancy,which was created by a joint task force of the Society of Chinese Interventional Ultrasound.The guidelines aim at standardizing the microwave ablation procedure and therapeutic efficacy assessment,as well as proposing the criteria for the treatment candidates.

SMAD7 expression in CAR-T cells improves persistence and safety for solid tumors

Despite the tremendous progress of chimeric antigen receptor T(CAR-T)cell therapy in hematological malignancies,their application in solid tumors has been limited largely due to T-cell exhaustion in the tumor microenvironment(TME)and systemic toxicity caused by excessive cytokine release.As a key regulator of the immunosuppressive TME,TGF-βpromotes cytokine synthesis via the NF-κB pathway.Here,we coexpressed SMAD7,a suppressor of TGF-βsignaling,with a HER2-targeted CAR in engineered T cells.These novel CAR-T cells displayed high cytolytic efficacy and were resistant to TGF-β-triggered exhaustion,which enabled sustained tumoricidal capacity after continuous antigen exposure.Moreover,SMAD7 substantially reduced the production of inflammatory cytokines by antigen-primed CAR-T cells.Mechanistically,SMAD7 downregulated TGF-βreceptor I and abrogated the interplay between the TGF-βand NF-κB pathways in CAR-T cells.As a result,these CAR-T cells persistently inhibited tumor growth and promoted the survival of tumor-challenged mice regardless of the hostile tumor microenvironment caused by a high concentration of TGF-β.SMAD7 coexpression also enhanced CAR-T-cell infiltration and persistent activation in patient-derived tumor organoids.Therefore,our study demonstrated the feasibility of SMAD7 coexpression as a novel approach to improve the efficacy and safety of CAR-T-cell therapy for solid tumors.

Role of nitric oxide during early phase myocardial ischemic preconditioning in rats

Background To date, there have been no reports on altered nitric oxide （NO） content in ischemia/reperfusion with regard to in vivo preconditioning procedures. These studies are important for understanding the mechanisms of NO during early myocardial ischemic preconditioning. The aim of the present study was to investigate the mechanisms of NO during early myocardial ischemic preconditioning by measuring levels of NO and cyclic guanosine monophosphate （cGMP）, as well as activity of nitric oxide synthase （NOS） in ischemia/reperfusion with respect to preconditioning in rats. Methods Sixty-six female Sprague-Dawley rats were randomly divided into four groups： ischemic preconditioning group （IP）, ischemia/reperfusion group （I/R）, control group （CON）, and preconditioning procedure group （PC）. In the PC group, rats were further divided into PC1-, PC1＋, PC2-, PC2＋, PC3-, and PC3＋ subgroups. Rats underwent left coronary artery occlusion and reperfusion, and subsequently, NOS activity and levels were assessed with spectrophotometric analysis. cGMP contents were measured with radioimmunoassay. Results The level of NO and cGMP, as well as the activity of NOS, were significantly higher in the IP group compared to the I/R and CON groups （P 〈0.05）. During preconditioning prior to prolonged ischemia, NO and cGMP levels varied markedly with ischemia and reperfusion. The levels of NO repeatedly increased when the heart was exposed to three episodes of 5-minute ischemia, and were almost completely reversed during each reperfusion period. NO and cGMP levels were significantly different between the 5-minute period of ischemia and the same period of reperfusion during preconditioning. Conclusions NO plays an important role during early phase myocardial ischemic preconditioning in rats. NO and cGMP could be triggers and mediators of early phase myocardial ischemic preconditioning. Altered NOS activity following ischemic stress could be the primary inducer of higher NO levels detected. NO and cGMP fluctuations might be the trigger for protection during early phase myocardial ischemic preconditioning.

Comparison of parathyroid hormone （1-34） and elcatonin in postmenopausal women with osteoporosis： an 18-month randomized, multicenter controlled trial in China

Background Recombinant human parathyroid hormone （1-34） （rhPTH （1-34）） is the first agent in a unique class of anabolic therapies acting on the skeleton. The efficacy and safety of long-term administration of rhPTH （1-34） in Chinese postmenopausal women had not been evaluated. This study compared the clinical efficacy and safety of rhPTH （1-34） with elcatonin for treating postmenopausal women with osteoporosis in 11 urban areas of China. Methods A total of 453 postmenopausal women with osteoporosis were enrolled in an 18-month, multi-center, randomized, controlled study. They were randomized to receive either rhPTH （1-34） 20 μg （200 U） daily for 18 months, or elcatonin 20 U weekly for 12 months. Lumbar spine （L1-4） and femoral neck bone mineral density （BMD）, fracture rate, back pain as well as biochemical markers of bone turnover were measured. Adverse events were recorded. Results rhPTH （1-34） increased lumbar BMD significantly more than did elcatonin after 6, 12, and 18 months of treatment （4.3% vs. 1.9%, 6.8% vs. 2.7%, 9.5% vs. 2.9%, P 〈0.01）. There was only a small but significant increase of femoral neck BMD after 18 months （2.6%, P 〈0.01） in rhPTH groups. There were larger increases in bone turnover markers in the rhPTH （1-34） group than those in the elcatonin group after 6, 12, and 18 months （serum bone-specific alkaline phosphatase （BSAP） 93.7% vs. -3.6%; 117.8% vs. -4.1%; 49.2% vs. -5.8%, P 〈0.01; urinary C-telopeptide/creatinine （CTX/Cr） 250.0% vs. -29.5%; 330.0% vs. -41.4%, 273.0% vs. -10.6%, P 〈0.01）. rhPTH （1-34） showed similar effect of pain relief as elcatonin. The incidence of clinical fractures was 5.36% （6/112） in elcatonin group and 3.2% （11/341）in rhPTH （1-34）group （P=0.303）. Both treatments were well tolerated. Hypercaluria （9.4%） and hypercalcemia （7.0%） in rhPTH （1-34） group were transient and caused no clinical symptoms. Pruritus （8.2% vs. 2.7%, P=0.044） and redness of injection site （4.4% vs. 0,P=0.024） were more frequent in rhPTH （1-34）. Nausea/vomiting （16.1% vs. 6.2%, P=0.001） and hot flushes （7.1% vs. 0.6%, P 〈0.001） were more common in elcatonin group. Conclusions rhPTH （1-34） was associated with greater increases in lumbar spine BMD and bone formation markers. It could increase femoral BMD after 18 months of treatment, rhPTH could improve back pain effectively. The results of the present study indicate that rhPTH （1-34） is an effective, safe agent in treating Chinese postmenopausal women with osteoporosis. （ChiCTR- TRC-10000924）

Asymptomatic patients of chronic obstructive pulmonary disease in China

Background Chronic obstructive pulmonary disease （COPD） has a variable natural history and not all individuals follow the same course. This study aimed to identify the prevalence and characteristics of asymptomatic COPD patients from a population-based survey in China.Methods A multistage cluster sampling strategy was used in a population from seven different provinces/cities. All residents （over 40 years old） were interviewed with a standardized questionnaire and spirometry.Post-bronchodilator forced expiratory volume in 1 second （FEV1）/forced vital capacity （FVC） of less than 70% was defined as the diagnostic criterion of COPD. All COPD patients screened were divided into symptomatic group and asymptomatic group according to the presence or absence of chronic respiratory symptoms. Socio-demographic,personal and exposure variables were collected and analyzed.Results Among the 1668 patients who were diagnosed with COPD from the 25 627 sampling subjects, 589 （35.3%）were asymptomatic. The age, sex, body mass index （BMI）,rural and urban distributions, smoking habit and education levels were similar in the two groups. A total of 64.7% of the asymptomatic patients had no comorbidities. Cardiovascular diseases and lung cancer were more common among symptomatic COPD patients than asymptomatic group.Asymptomatic COPD group were less likely to present with poor ventilation in the kitchen, a family history of respiratory disease and recurrent childhood cough. Asymptomatic COPD patients had significantly higher FEV1 （73.1% vs. 61.0%）, FVC （91.9% vs. 82.0%）, and a higher ratio of FEV1/FVC （62.9% vs.58.7%） （all P 〈0.001） than symptomatic group. More asymptomatic patients were underdiagnosed （91.9% vs.54.3%, P〈0.001） than symptomatic patients.Conclusions This large population-based survey confirmed a high prevalence of asymptomatic COPD patients in China. More use of spirometry screening test may be important to the early detection of COPD.

A randomized, multicenter controlled trial to compare the efficacy of recombinant human parathyroid hormone （1-34） with elcatonin in postmenopausal women with osteoporosis in China

Background Recombinant human parathyroid hormone （1-34） （rhPTH （1-34）） given by injection is a new seventh class drug of biological products, which is prepared by adopting gene recombination technique, rhPTH （1-34） is mainly used to treat osteoporosis, especially for postmenopausal women. This study compared the clinical efficacy and safety of rhPTH （1-34） with elcatonin for treating postmenopausal women with osteoporosis in 11 urban areas of China. Methods Two hundred and five women with osteoporosis were enrolled in a 6-month, multicenter, randomized, controlled study. They were randomized to receive either rhPTH （1-34） 20 ug （200 U） daily or elcatonin 20 U weekly. Lumbar spine （L1-4） and femoral neck bone mineral density （BMD）, as well as biochemical markers of bone turnover were measured. Adverse events were recorded. Results rhPTH （1-34） increased lumbar BMD significantly more than did elcatonin at 3 months and 6 months （2.38% vs 0.59%, P 〈0.05; 5.51% vs 1.55%, P 〈0.01）, but there were no significant increases of BMD in these two groups at femoral neck. There were larger mean increases in bone markers in the rhPTH （1-34） group than in the elcatonin group at 3 months and 6 months （serum bone-specific alkaline phosphatase （BSAP） 36.79% vs 0.31%; 92.42% vs -0.17%; urinary N-telopeptide/creatinine （NTX/Cr） 48.91% vs -5.32%; 68.82% vs -10.86%）. Both treatments were well tolerated and there were no significant differences detected between the two groups in the proportion of any adverse events and any serious adverse events （67.0% vs 59.0%; 0 vs 0）. Conclusions rhPTH （1-34） has more positive effects on bone formation, as shown by the larger increments of lumbar BMD and bone formation markers, than elcatonin, with only mild adverse events and no significant change in the liver, kidney or hematological indices.

Expert consensus on clinical standardized application of high-flow nasal cannula oxygen therapy in adults

High-flow nasal cannula oxygen therapy(HFNC)is a novel respiratory support technology and has been extensively applied in clinics in recent years.This therapeutic equipment mainly includes an air-oxygen blender,an active humidifier,a high-flow nasal cannula,and a connecting inspiratory circuit.It provides patients a humidified high-flow gas(8-80 L/min)with relatively stable oxygen concentration(21-100%),temperature(31-37℃)and performs oxygen therapy via a nasal cannula,which is very comfortable.