Geertsenkaplan5654

BACKGROUND There are variations in the use of adjuvant chemotherapy (AC) in stage II colon cancer (CRC). click here We sought to determine which patients received chemotherapy, what factors were associated with receipt of AC, and how this impacted overall survival. METHODS Using the National Cancer Database, patients with stage II CRC who underwent surgical resection were selected; patients who received radiation or neoadjuvant chemotherapy were excluded. High-risk features (HRFs) were defined as pathological tumor stage IV, positive surgical margins, and perineural or lymphovascular invasion. Multivariable and subgroup analysis with eight subgroups stratified in the presence of HRFs, age, and the Charlson-Deyo score was performed. RESULTS Of 77,739 patients identified with stage II CRC, 18.3% received AC. Younger, healthier patients with HRFs had the highest chemotherapy receipt rate (46.7%), whereas patients without HRFs, ≥ 75 y, and with the Charlson-Deyo score of 2+ had the lowest rate (2.1%). Community cancer centers were more likely to initiate AC (odds ratio = 1.24 P  less then  0.01) especially among healthy HRF-negative patients and younger patients. No significant racial differences in AC use were observed. AC was associated with improved overall survival in subgroups with HRFs (hazard ratio [HR] 0.81 P  less then  0.001; HR 0.75 P  less then  0.001; HR 0.65 P = 0.03; HR 0.55, P  less then  0.001) but not in patients without HRFs. CONCLUSIONS AC receipt rates differed depending on patient age and type of institution delivering care. AC was associated with survival benefits only in patients with HRFs regardless of age. These findings are clinically relevant to inform appropriate use of AC in stage II CRC. The first phytochemical investigation on the steroidal saponins from the stems and leaves of Paris polyohylla var. chinensis led to the discovery and characterization of six new spirostanol saponins, named polyphyllosides A-F (1-6), along with four known analogues (7-10). Their structures were unambiguously established via extensive spectroscopic data and chemical methods. Both polyphyllosides A and B had a rare aglycone with a C-4/C-5 double bond and a C-6 hydroxy group moiety, whereas polyphylloside C represents the first saponin with a unique aglycone sharing a C-6/C-7 double bond and a C-5 hydroxy group unit. All these saponins were evaluated for their cytotoxic activities against five selected human cancer cell lines. Among these, the known saponins 7 and 10 exhibited significant cytotoxic effects on HeLa cells with IC50 values of 4.16 and 4.45 μM, respectively. The structure-activity relationships (SAR) of these isolates were also discussed. Flow cytometric analysis indicated that 7 could induce MDA-MB-231 cell death in a concentration-dependent manner. Saponin 7 was proved to affect the cell cycle distribution and induced G2/M phase arrest in MDA-MB-231 cells. OBJECTIVES The objective of this systematic review was to identify, critically appraise and synthesise evidence for the effectiveness of communication skills training interventions in nursing practice. DESIGN A systematic review of literature. DATA SOURCES Randomised controlled trials published in English from 1998 to 2018, identified in five computerised databases (Medline, Cinahl, Embase, Psychinfo and Cochrane Database). Studies were included if they reported an educational intervention to enhance nurses' communication with patients and contained an objective measure of communication skills and/or patient outcome measures. REVIEW METHODS The Preferred reporting Items for Systematic reviews and Meta-Analyses guided the review. Data were extracted regarding study design and effectiveness on nurses' communication skills. Trial quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The heterogeneity of the included studies prohibited meta-analysis. RESULTS Of the 7811 papers identified, seven trials met the eligibility criteria. The quality was modest. Training programs varied significantly in duration, structure, location and use of outcome measurement tools. Five trials focused on communication with cancer patients using simulated patients. All trials found at least one statistically significant improvement for nurses' communication skills. CONCLUSIONS Educational interventions to enhance nurses' capacity to communicate with patients show promise. The paper reports the first systematic review of randomised controlled trials concerning the effect of communication skills training on nurses' abilities to communicate with patients, inclusive of non-cancer settings. The direct impact of educational interventions on nurses' communication skills is difficult to measure arising from non-standardised outcome measurement tools. Further research is particularly needed in acute, chronic illness, aged care and community settings. BACKGROUND Lower work readiness is tied to anxiety, high turnover and nurse transition failure. An assessment of work readiness is necessary. To date, no relative scale exists in China. Thus, a work readiness related scale is urgently needed. OBJECTIVES To assess the psychometric properties of the scale, and look into the status of Chinese graduate nurse work readiness and factors associated with work readiness. DESIGN, SETTINGS, AND PARTICIPANTS Both psychometric assessment and associated factors are designed with cross-sectional studies. 832 and 435 graduate nurses were recruited in the above two studies, respectively. METHODS Brislin's transition model was utilized for the transition process, and a six-expert panel and preliminary survey were conducted for face validity and testing the transition version respectively. Exploratory factor analysis, confirmatory factor analysis, internal consistency reliability and test-retest reliability were applied for reliability and validity testing. Additionally, a lines, educators and hospital managers could help graduate nurses having a smooth transition for a stable nursing workforce. The increase of gaseous ammonia (NH3) concentration in the atmosphere significantly impacts the regional air quality, human health, and the nitrogen cycle of ecosystems. This study aims to verify the reanalyzed product of IASI NH3 (the ANNI-NH3-v2.1R-I, hereafter referred to as IASI_NH3_R) and to analyze the spatial and temporal characteristics of atmospheric NH3 during 2008-2016 and its underlying influencing factors. Our results show a good agreement between spatial pattern and temporal (annual and monthly) trend of the satellite-derived surface NH3 concentrations and the measured near-ground NH3 measurements over different land covers in Eastern China, suggesting the IASI_NH3_R product can be used to investigate spatial and temporal trends of atmospheric NH3 concentration. The annual mean NH3 column concentrations peaked in the North China Plain (averaged 12 × 1015 mol cm-2 yr-1) and showed a significant increasing trend at a rate of 0.6 × 1015 mol cm-2 yr-1 during the entire period, which can be ascribed to densely populated, intensive agricultural activities and substantial reduction of SO2 and NO2 emissions since 2011. The NH3 column concentrations show a slight increase in winter in most regions of China, probably due to less precipitation amount and increased uncertainty for lower NH3 columns and the thermal contrast (TC). A large seasonal variation of NH3 column concentrations was observed, with the highest values in summer and the lowest in autumn. Such seasonal variation is mainly affected by seasonal differences in NH3 emissions and meteorological conditions. Our results suggest that the current control measures effectively decreased SO2 and NO2 pollution but are not yet apparent in the mitigation of atmospheric NH3 pollution, which also merits more attention considering that no effective measures are being implemented for NH3 emission control at a regional or national scale in China. Lipid metabolism could be used as a biomarker for environmental monitoring of metal pollution, including Cu. Given the potential role of the Wnt/β-catenin signaling pathway and acetylation in lipid metabolism, the aim of this study was to investigate the mechanism of Wnt signaling and acetylation mediating Cu-induced lipogenesis. Grass carp Ctenopharyngodon idella, widely distributed freshwater teleost, were used as the model. We found that waterborne Cu exposure increased the accumulation of Cu and lipid, up-regulated lipogenesis, suppressed Wnt signaling, reduced β-catenin protein level and its nuclear location, reduced the sirt1 mRNA levels and up-regulated the β-catenin acetylation level. Further investigation found that Cu up-regulated lipogenesis through Wnt/β-catenin pathway; Cu regulated the β-catenin acetylation, and K311 was the key acetylated residue after Cu incubation. SIRT1 mediated Cu-induced changes of acetylated β-catenin and played an essential role in nuclear accumulation of β-catenin and Cu-induced lipogenesis. Cu facilitated lipid accumulation via the regulation of Wnt pathway by SIRT1. For the first time, our study uncovered the novel mechanism for Wnt/β-catenin pathway and β-catenin acetylation levels mediating Cu-induced lipid deposition, which provided insights into the association between Cu exposure and lipid metabolism in fish and had important environmental implications for monitoring metal pollution in the water by using new biomarkers involved in lipid metabolism. Tetrabromobisphenol-A (TBBPA) is an emerging organic pollutant and a commonly used brominated flame retardant that has received much attention owing to its toxicity. Although TBBPA is ubiquitously detected in atmospheric particulate matter and dust, few studies have investigated the sub-chronic inhalation exposure to TBBPA. To further understand the excretion characteristics and tissue accumulation of TBBPA after inhalation exposure, we used the rat model to conduct a sub-chronic inhalation exposure study. Male rats were administered with different doses of aerosol TBBPA (12.9, 54.6, 121.6, and 455.0 mg/m3). TBBPA was found in the excretion (feces and urine) and all the target tissues (lung, liver, heart, thymus gland, spleen, testicles, muscles, kidneys, brain and serum). Feces were the main route of excretion, which contributed 19.18% to 72.54% (urine less then 0.10%). TBBPA excretion through feces following inhalation administration was much higher than that following oral and dermal exposure, thereby indicating lower bioavailability of TBBPA under inhalation exposure. Liver and serum showed higher levels of TBBPA compared with those of other tissues, thereby suggesting tissue-specific accumulation of TBBPA in rats. Owing to the relative non-invasiveness of serum sampling and greatest TBBPA concentration among the tissues, serum is a suitable matrix for estimation of TBBPA bioaccumulation after inhalation exposure. The widespread usage of plastic film increased the content of phthalic acid esters (PAEs) in the environment, causing PAE residue in vegetables and subsequently increasing health risks to humans when consuming them. In this work, the presence, distribution and risk assessment of 15 PAEs in soils and peppers from suburban plastic film pepper-growing greenhouses were investigated. The total PAE contents in soil and pepper samples ranged from 320.1 to 971.2 μg/kg (586.3 μg/kg on average) and from 196.6 to 304.2 μg/kg (245.4 μg/kg on average), respectively. Di (2-ethyl)hexyl, dibutyl and diisobutyl phthalates (DEHP, DnBP and DiBP, respectively) were the most abundant in both soil and pepper samples. Specifically, DEHP showed the highest content in soils, while the DnBP content was the highest in peppers. The total PAE content in soils from pepper-greenhouses was much lower than in the agricultural soils mulched with plastic films, but significantly higher than in the agricultural soils from open uncovered fields.