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Impacts of evidence-based nursing combined with enteral nutrition on nutritional status and quality of life in acute cerebral infarction patients: A randomized controlled trial.
Dang, J, Li, G, Wu, Q, Pian, G, Wang, Z
Perfusion. 2023;:2676591231223910
Abstract
OBJECTIVE To explore the impacts of evidence-based nursing (EBN) combined with enteral nutrition (EN) on nutritional status as well as quality of life in acute cerebral infarction (ACI) patients. METHODS In this randomized controlled cluster trial, 80 ACI patients admitted to our hospital from January 2021 to December 2022 were selected and randomly separated into study group (SG) and control group (CG), with 40 patients in each group. Patients in CG received routine nursing, and patients in the SG received EBN combined with EN. The neurological function, limb movement ability, nutritional status, anxiety and depression, incidence of complications and quality of life between two groups were compared. RESULTS After intervention, the NIHSS score in the SG was lower than that in the CG (CG = 5.62 ± 0.56, SG = 3.27 ± 0.33. p < .001). The FMA score in the SG was higher compared with the CG (CG = 52.58 ± 5.32, SG = 68.85 ± 6.87. p < .001). The Hb level, TP level and ALB level in the SG were higher relative to the CG (p < .001). The Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores in the SG were lower in comparison with the CG (SAS score: CG = 42.32 ± 4.25, SG = 36.28 ± 3.64; SDS score: CG = 48.27 ± 4.85, SG = 40.06 ± 4.05. p < .001). The incidence of complications in SG was lower than that in CG. Finally, we found that SF-36 scores in the SG in all dimensions were higher than those in the CG (Physiological function: CG = 70.23 ± 7.05, SG = 82.71 ± 8.26. Role function: CG = 66.28 ± 6.64, SG73.39 ± 7.36. Physical pain: CG = 70.67 ± 7.06, SG = 82.69 ± 8.29. General health: CG = 58.74 ± 5.86, SG66.62 ± 6.65. Mental health: CG = 53.68 ± 5.37, SG = 62.39 ± 6.31. Energy: CG = 60.75 ± 6.08, SG = 67.87 ± 6.78. Social function: CG = 76.25 ± 7.25, SG = 85.78 ± 8.59. Emotional function: CG = 61.23 ± 6.15, SG = 75.74 ± 7.56. p < .001). CONCLUSION EBN combined with EN can improve the nutritional status and the quality of life in ACI patients compared with the traditional routine nursing, and is suggested as a valuable strategy for clinical management of ACI.
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Pharmacokinetic Comparison of Chitosan-Derived and Biofermentation-Derived Glucosamine in Nutritional Supplement for Bone Health.
Kang, HE, Kim, SJ, Yeo, EJ, Hong, J, Rajgopal, A, Hu, C, Murray, MA, Dang, J, Park, E
Nutrients. 2022;(15)
Abstract
Glucosamine and chondroitin sulfate have been used as nutritional supplementation for joint tissues and osteoarthritis (OA). Biofermented glucosamine is of great interest in the supplement industry as an alternative source of glucosamine. The purpose of this study is to compare the pharmacokinetics of chitosan-derived glucosamine and biofermentation-derived glucosamine as nutritional supplementation. In a randomized, double-blind and cross-over study design, we recruited subjects of healthy men and women. The pharmacokinetics of glucosamine were examined after a single dose of glucosamine sulfate 2KCl (1500 mg) with two different sources of glucosamine (chitosan-derived glucosamine and biofermentation-derived glucosamine) to male and female subjects fitted with intravenous (iv) catheters for repeated blood sampling up to 8 h. According to plasma concentration-time curve of glucosamine after an oral administration of 1500 mg of glucosamine sulfate 2KCl, AUC0-8h and AUC0-∞ values of glucosamine following oral administration of chitosan-derived and biofermentation-derived glucosamine formulations were within the bioequivalence criteria (90% CI of ratios are within 0.8-1.25). The mean Cmax ratios for these two formulations (90% CI of 0.892-1.342) did not meet bioequivalence criteria due to high within-subject variability. There were no statistically significant effects of sequence, period, origin of glucosamine on pharmacokinetic parameters of glucosamine such as AUC0-8h, AUC0-∞, Cmax. Our findings suggest that biofermentation-derived glucosamine could be a sustainable source of raw materials for glucosamine supplement.
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Comparative risk of serious and fatal treatment-related adverse events caused by 19 immune checkpoint inhibitors used in cancer treatment: a network meta-analysis.
Liu, T, Jin, B, Chen, J, Wang, H, Lin, S, Dang, J, Li, G
Therapeutic advances in medical oncology. 2020;:1758835920940927
Abstract
BACKGROUND This network meta-analysis assessed the comparative risk of grade 3-5 and grade 5 treatment-related adverse events (TRAEs) for immune checkpoint inhibitors (ICIs), either alone or in combination with other modalities, for cancer treatment. METHODS PubMed, Embase, Cochrane Library, Web of Science, and recent predominant oncology congresses were searched for relevant phase II and phase III randomized controlled trials (RCTs). As outcomes, grade 3-5, and grade 5 TRAE outcomes were reported as odds ratios and 95% confidence intervals. RESULTS In 67 RCTs involving 36,422 patients and 19 ICIs, the incidence of grade 3-5 and grade 5 TRAEs was 17.9% and 0.8% with ICI monotherapy and 46.3% and 1.4%, respectively, with combinatorial therapy. Pneumonitis was the most common cause of grade 5 TRAEs following either monotherapy (16.3%) or combinatorial therapy (11.4%). Regarding grade 3-5 TRAEs, atezolizumab + chemotherapy (CT) and antiangiogenic therapy (AT) (atezolizumab + CAT), pembrolizumab + CT, ipilimumab + CT, and atezolizumab + CT were more toxic than any ICI monotherapy, pembrolizumab or nivolumab + radiotherapy (RT), and ICIs dual therapy (durvalumab + tremelimumab and nivolumab + ipilimumab). Tremelimumab, ipilimumab, durvalumab, and pembrolizumab were, however, associated with higher grade 5 TRAEs than combinatorial treatments. Atezolizumab + CAT was the most toxic and nivolumab + RT was the least toxic of combinatorial treatments; among monotherapies, tremelimumab and avelumab were the most and least toxic, respectively. The toxicity ranking changed with type of grade 3-5 TRAEs. CONCLUSIONS Compared with combinatorial therapy, ICI monotherapy caused lower grade 3-5 TRAEs, but some monotherapies resulted in a higher incidence of fatal TRAEs. Atezolizumab + CAT and nivolumab + RT were the most and least toxic of combinatorial treatments, respectively, and tremelimumab and avelumab were the most and least toxic of the monotherapies, respectively.
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First-line immune checkpoint inhibitors for advanced non-small cell lung cancer with wild-type epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK): a systematic review and network meta-analysis.
Liu, T, Ding, S, Dang, J, Wang, H, Chen, J, Li, G
Journal of thoracic disease. 2019;(7):2899-2912
Abstract
BACKGROUND To assess the comparative efficacy and safety of first-line immune checkpoint inhibitors (ICIs) for advanced non-small cell lung cancer (NSCLC) with wild-type epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK). METHODS PubMed, Embase, Cochrane Library, Web of Science, and major international scientific meetings were searched for relevant randomized controlled trials. Overall survival (OS) and progression-free survival (PFS) were the primary outcomes and serious adverse events (SAEs) were the secondary outcome of interests and were reported as hazard ratio (HR) or odds ratio (OR) with 95% confidence intervals (CIs). RESULTS Fourteen trials with 9,570 patients randomized to receive ten ICI-based treatments (including PD-1/PD-L1 and CTLA-4 antibodies and PD-1/PD-L1 with CTLA-4 combination therapies) were included in the meta-analysis. Pembrolizumab combined with chemotherapy (Pem + CT) (HR =0.56, 95% CI: 0.42-0.74) and Pem (HR =0.75, 95% CI: 0.62-0.91) were more effective than CT in terms of OS; Pem + CT was also superior to Pem (HR =0.74, 95% CI: 0.56-0.98), atezolizumab + CT (HR =0.65, 95% CI: 0.50-0.85), ipilimumab + CT (HR =0.65, 95% CI: 0.47-0.89), and nivolumab (HR =0.52, 95% CI: 0.31-0.87). In subgroup analyses, Pem + CT was more effective than CT regardless of PD-L1 expression, while Pem was superior to CT only for PD-L1 with expression ≥50%; Pem + CT showed significant OS advantage over other treatments in patients with non-squamous cell carcinoma (NSCC); ICIs had a comparable efficacy in younger vs. older patients. Based on treatment ranking in terms of OS, Pem + CT had the highest probability (98%) of being the most effective treatment, followed by Pem (70%), with acceptable toxicity limit. CONCLUSIONS Pem + CT seemed to be more effective first-line regimen for advanced NSCLC with wild-type EGFR or ALK, especially for patients with NSCC. However, limitations of the study including methodological quality and immature OS data need to be considered.
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Impact of Fecal Microbiota Transplantation on Obesity and Metabolic Syndrome-A Systematic Review.
Zhang, Z, Mocanu, V, Cai, C, Dang, J, Slater, L, Deehan, EC, Walter, J, Madsen, KL
Nutrients. 2019;11(10)
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Plain language summary
Fecal microbiota transplantation (FMT) is a relatively new field of scientific exploration where patients receive faeces from a healthy donor to help repopulate their intestinal tract with healthful bacteria. The gut microbiome is an ecosystem of an estimated 10~100 trillion microorganisms and there is increasing research on the important role these bacteria play in supporting our health and weight. This study reviews all trials involving faecal transports in patients with either clinical obesity or Metabolic syndrome to see if it helped improve weight, bmi or other metabolic parameters. Three studies with 76 male patients were included in this review and the results showed that FMT recipients had improved insulin sensitivity and reduced HbA1c glucose levels after 6 weeks, but these improvements were short-term only. There were no differences in bmi, cholesterol, markers and fasting glucose levels. The conclusion is that whilst FMT may confer benefits there is still much to understand about the fecal microbial preparation, dosing, and method of delivery, as well as the host patient’s response.
Abstract
Fecal microbiota transplantation (FMT) is a gut microbial-modulation strategy that has been investigated for the treatment of a variety of human diseases, including obesity-associated metabolic disorders. This study appraises current literature and provides an overview of the effectiveness and limitations of FMT as a potential therapeutic strategy for obesity and metabolic syndrome (MS). Five electronic databases and two gray literature sources were searched up to 10 December 2018. All interventional and observational studies that contained information on the relevant population (adult patients with obesity and MS), intervention (receiving allogeneic FMT) and outcomes (metabolic parameters) were eligible. From 1096 unique citations, three randomized placebo-controlled studies (76 patients with obesity and MS, body mass index = 34.8 ± 4.1 kg/m2, fasting plasma glucose = 5.8 ± 0.7 mmol/L) were included for review. Studies reported mixed results with regards to improvement in metabolic parameters. Two studies reported improved peripheral insulin sensitivity (rate of glucose disappearance, RD) at 6 weeks in patients receiving donor FMT versus patients receiving the placebo control. In addition, one study observed lower HbA1c levels in FMT patients at 6 weeks. No differences in fasting plasma glucose, hepatic insulin sensitivity, body mass index (BMI), or cholesterol markers were observed between two groups across all included studies. While promising, the influence of FMT on long-term clinical endpoints needs to be further explored. Future studies are also required to better understand the mechanisms through which changes in gut microbial ecology and engraftment of microbiota affect metabolic outcomes for patients with obesity and MS. In addition, further research is needed to better define the optimal fecal microbial preparation, dosing, and method of delivery.
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Elective nodal irradiation versus involved-field irradiation in patients with esophageal cancer receiving neoadjuvant chemoradiotherapy: a network meta-analysis.
Liu, T, Ding, S, Dang, J, Wang, H, Chen, J, Li, G
Radiation oncology (London, England). 2019;(1):176
Abstract
BACKGROUND To assess the comparative efficacy and safety of elective nodal irradiation (ENI) and involved-field irradiation (IFI) in patients with esophageal cancer (EC) receiving neoadjuvant chemoradiotherapy plus surgery (nCRTS). MATERIAL AND METHODS PubMed, Embase, Cochrane Library, Web of Science and major meetings were searched for randomized controlled trials (RCTs) that compared at least two of the following treatment regimens: nCRTS, neoadjuvant chemotherapy plus surgery (nCTS), and surgery (S) alone. Overall survival (OS) was the primary outcomes of interest, reported as hazard ratio (HR) and 95% confidence intervals (CIs). A Bayesian network meta-analysis was performed to compare all regimens simultaneously. RESULTS Twenty-nine RCTs with a total of 5212 patients were included in the meta-analysis. Both nCRTS adopting ENI (nCRTS-ENI) (HR = 0.63, 95% CI: 0.48-0.83) and nCRTS adopting IFI (nCRTS-IFI) (HR = 0.75, 95% CI: 0.66-0.86) significantly improved OS compared to S alone. No significant differences in OS, locoregional recurrence, distant metastases, R0 resection and postoperative mortality were observed between nCRTS-ENI and nCRTS-IFI. In subgroup analyses, nCRTS-IFI showed a significant OS advantage over nCTS (HR = 0.78, 95% CI: 0.63-0.96) and S alone (HR = 0.50, 95% CI: 0.38-0.68) for esophagus squamous cell carcinoma (ESCC), but nCRTS-ENI did not; nCRTS-ENI using three-dimensional radiotherapy (3D-RT) resulted in an improved OS compared to that with 2D-RT (HR = 0.58, 95% CI: 0.34-0.99). Based on treatment ranking in term of OS, nCRTS-IFI (0.90) and nCRTS-ENI (0.96) was ranked the most effective treatment for ESCC and esophagus adenocarcinoma (EAC), respectively. CONCLUSION Either adopting ENI or IFI, nCRTS is likely to be the optimal treatment for resectable EC, and nCRTS-IFI and nCRTS-ENI seem to be more effective for patients with ESCC and EAC, respectively. Future head to head comparison trials are needed to confirm these findings.
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7.
Tumor Lysis Syndrome: A Unique Solute Disturbance.
Strauss, PZ, Hamlin, SK, Dang, J
The Nursing clinics of North America. 2017;(2):309-320
Abstract
Tumor lysis syndrome (TLS) is a life-threatening disorder that is an oncologic emergency. Risk factors for TLS are well-known, but the current literature shows case descriptions of unexpected acute TLS. Solid tumors and untreated hematologic tumors can lyse under various circumstances in children and adults. International guidelines and recommendations, including the early involvement of the critical care team, have been put forward to help clinicians properly manage the syndrome. Advanced practice nurses may be in the position of triaging and initiating treatment of patients with TLS, and need a thorough understanding of the syndrome and its treatment.
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Highly selective ratiometric peptide-based chemosensors for zinc ions and applications in living cell imaging: a study for reasonable structure design.
Yang, J, Rong, H, Shao, P, Tao, Y, Dang, J, Wang, P, Ge, Y, Wu, J, Liu, D
Journal of materials chemistry. B. 2016;(36):6065-6073
Abstract
Recently, fluorescent peptide-based chemosensors have been reported and used to detect series of metal ions in both aqueous solutions and living cells. In order to explore and indicate the structural regulations of "fluorophore-(His)n-Pro-Gly-(His)n-fluorophore (H2L peptide sensor)", we predict the relationship between the number of histidine molecules and the coordination activity, as well as the preferred coordination site, through computational studies. Ln=3 was modeled as showing the highest activity with the lowest calculated ΔEtotal, and inner histidine residues bonding with the "Pro-Gly" core structure always provided essential coordination sites for zinc ions. A predicted structural regulation mechanism was studied and verified experimentally. Three Zn2+ sensors with the number of histidine molecules set as 2 (Ln=2), 3 (Ln=3) and 4 (Ln=4) were synthesized and tested. The Ln=3 sensor shows the highest fluorescence intensity by specific binding with Zn2+. The key coordination site was identified by mutating the histidine residues of the Ln=3 sensor. The inner histidine bonding with the "Pro-Gly" core structure was proved as the vital coordination site, and at least one extra histidine had to be provided to assist the coordination process according to the experimental results. Both computational and experimental studies reveal the same relationship between the structure and activity for H2L peptides in the fluorescent sensing of zinc ions. The results give fundamental information for the reasonable design and optimization of all similar classes of peptide sensors.
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Improving Patient to Patient CT Value Uniformity with an Individualized Contrast Medium Protocol Tailored to Body Weight and Contrast Medium Concentration in Coronary CT Angiography.
Xing, Y, Azati, G, Pan, CX, Dang, J, Jha, S, Liu, WY
PloS one. 2015;(7):e0132412
Abstract
To determine whether body weight and concentration dependent contrast medium (CM) injection protocols can improve patient to patient CT value uniformity more than the conventional injection protocols with fixed injection parameters in coronary CT angiography (CCTA), one hundred and sixty patients who underwent CCTA were prospectively randomized into two groups. Group A (n = 80) used individualized-protocol with adjusted injection rate based on patient weight and contrast medium concentration to obtain constant iodine load of 280 mgI/kg while group B (n = 80) followed the conventional contrast injection protocol with total injection volume of 80ml and constant injection rate of 5.5ml/s. For both groups, patients were further divided into four subgroups with different CM concentrations: A1, B1 (300 mg I/ml); A2, B2 (320 mg I/ml); A3, B3 (350 mg I/ml) and A4 and B4 (370 mg I/ml). For each patient, the CT values of the ascending aorta, left ventricle and coronary arteries were measured. One-way analysis of variance was used to compare CT values among subgroups. Among the subgroups of A, sufficient attenuation of greater than 300HU was obtained in all target vessels with no difference among them. Among the subgroups of B, the CT values had significant difference in left ventricle, left circumflex branch, proximal and distal segment of the right coronary artery (all p < 0.05), and the attenuation with 300 mg I/ml CM concentration was significantly lower than that with 370 mg I/ml. Compared with group B, group A used less volume (62.83 ml vs. 80.00 ml, P<0.001) and lower rate (5.21 ml/s vs. 5.50 ml/s, P<0.001) of CM. Compared with the conventional contrast medium injection protocol with fixed volume and injection rate, the individualized-protocol based on patient weight and contrast concentration provides overall contrast dose reduction and achieves more homogenous attenuation among different coronary vessels and patients.
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Exome sequencing reveals a heterozygous DLX5 mutation in a Chinese family with autosomal-dominant split-hand/foot malformation.
Wang, X, Xin, Q, Li, L, Li, J, Zhang, C, Qiu, R, Qian, C, Zhao, H, Liu, Y, Shan, S, et al
European journal of human genetics : EJHG. 2014;(9):1105-10
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Abstract
Split-hand/foot malformation (SHFM) is a congenital limb deformity due to the absence or dysplasia of central rays of the autopod. Six SHFM loci have already been identified. Here we describe a Chinese family with autosomal-dominant SHFM1 that has previously been mapped to 7q21.2-21.3. The two affected family members, mother and son, showed deep median clefts between toes, ectrodactyly and syndactyly; the mother also showed triphalangeal thumbs. Exome sequencing and variant screening of candidate genes in the six loci known to be responsible for SHFM revealed a novel heterozygous mutation, c.558G>T (p.(Gln186His)), in distal-less homeobox 5 (DLX5). As DLX5 encodes a transcription factor capable of transactivating MYC, we also tested whether the mutation could affect DLX5 transcription acitivity. Results from luciferase reporter assay revealed that a mutation in DLX5 compromised its transcriptional activity. This is the first report of a mutation in DLX5 leading to autosomal-dominant SHFM1.