Efficacy of nonpharmacological interventions for severe radiation-induced oral mucositis among head and neck cancer patients: A network meta-analysis of randomised controlled trials.

AIMS AND OBJECTIVES: To assess the effectiveness of different nonpharmacological treatments for severe radiation-induced oral mucositis in patients with head and neck cancer. BACKGROUND: Radiation-induced oral mucositis is highly prevalent in patients with head and neck cancer. Current medications for radiation-induced oral mucositis are limited in effectiveness and susceptible to side effects, and while there is an increasing adoption of nonpharmacological interventions, the optimal one remains unclear. DESIGN: Systematic review and network meta-analysis based on the PRISMA-NMA guidelines. METHODS: Six databases were searched. Two authors independently performed the literature screening, data extraction and methodological quality assessment of the included studies. Traditional pairwise meta-analysis was performed by R Studio. A network meta-analysis was then conducted to assess the effects of nonpharmacological interventions for severe radiation-induced oral mucositis in patients with head and neck cancer. RESULTS: Fifty-two studies involving seven types of nonpharmacological interventions were enrolled. The network meta-analysis indicated that natural plant-based therapies might be the most effective, health education interventions might be the second most effective, and honey might be the third most effective interventions for reducing the incidence of severe radiation-induced oral mucositis. For reducing the incidence of severe oral mucositis-related pain, the pairwise meta-analysis showed that only natural plant-based therapies and health education interventions were effective. CONCLUSIONS: Nonpharmacological interventions are effective in the management of severe radiation-induced oral mucositis among patients with head and neck cancer. RELEVANCE TO CLINICAL PRACTICE: Nonpharmacological interventions are a category of safe and effective adjunctive therapies that should be encouraged in clinical practice. TRIAL REGISTRATION DETAILS: CRD42023400745.

Asymmetric adhesive SIS-based wound dressings for therapeutically targeting wound repair.

Severe tissue injuries pose a significant risk to human health. Conventional wound dressings fall short in achieving effective tissue regeneration, resulting in suboptimal postoperative healing outcomes. In this study, an asymmetric adhesive wound dressing (marked as SIS/PAA/LAP) was developed, originating from acrylate acid (AA) solution with laponite (LAP) nanoparticles polymerization and photo-crosslinked on the decellularized extracellular matrix small intestinal submucosa (SIS) patch. Extensive studies demonstrated that the SIS/PAA/LAP exhibited higher tissue adhesion strength (~ 33 kPa) and burst strength (~ 22 kPa) compared to conventional wound dressings like Tegaderm and tissue adhesive products. Importantly, it maintained favorable cell viability and demonstrated robust angiogenic capacity. In animal models of full-thickness skin injuries in rats and skin injuries in Bama miniature pigs, the SIS/PAA/LAP could be precisely applied to wound sites. By accelerating the formation of tissue vascularization, it displayed superior tissue repair outcomes. This asymmetrically adhesive SIS-based patch would hold promising applications in the field of wound dressings.

Symptom clusters and their impact on quality of life among Chinese patients with lung cancer: A cross-sectional study.

PURPOSE: To investigate the symptom clusters of Chinese patients with lung cancer, and explore their impact on quality of life (QoL) and each of its functioning. METHOD: A cross-sectional study was conducted between October 2022 and April 2023 among 219 lung cancer patients at a general hospital in Sichuan Province. Data were collected using a general information questionnaire, the MD Anderson Symptom Inventory, and the EORTC QLQ-C30. R within the RStudio platform was used to conduct descriptive statistics, exploratory factor analysis and multiple regression analysis. RESULTS: Psychoneurological, respiratory, gastrointestinal and fatigue-related symptom clusters were identified, each of which was significantly negatively correlated with overall QoL, global health status/QoL and each functioning. The respiratory (ß = -0.60, P = 0.02) and fatigue-related symptom cluster (ß = -0.86, P = 0.02) were predictors of global health status/QoL; the fatigue-related symptom cluster predicted physical (ß = -1.68, P < 0.01), role (ß = -1.63, P < 0.01) and cognitive functioning (ß = -1.45, P < 0.01); the psychoneurological symptom cluster was a predictor of patients' emotional functioning (ß = -1.26, P < 0.01); and the psychoneurological (ß = -0.81, P < 0.01) and gastrointestinal symptom cluster (ß = -0.60, P = 0.05) predicted social functioning. CONCLUSIONS: Respiratory and fatigue-related symptom clusters were strong predictors of global health status/QoL; fatigue-related, psychoneurological and gastrointestinal symptom clusters had a negative impact on patients' functioning. Nurse practitioners should pay more attention to monitoring respiratory and fatigue-related symptom clusters to identify high-risk populations in time, and tailored interventions based on symptom clusters are needed to synergistically reduce the symptom burden, thereby improving patients' QoL.

The effectiveness of symptom management interventions based on electronic patient-reported outcomes (ePROs) for symptom burden, quality of life, and overall survival among patients with cancer: A meta-analysis of randomized controlled trials.

OBJECTIVE: To explore the effectiveness of ePRO-based symptom management interventions on symptom burden, quality of life, and overall survival among patients with cancer for the first time and to explore the effects of different types of these interventions. BACKGROUND: Since advances in screening and treatment have transformed cancer into a chronic illness rather than a fatal disease, symptom management has become increasingly critical in oncology nursing. In recent decades, ePROs have been increasingly used in the symptom management of cancer patients to improve their symptom burden, quality of life and overall survival, but the existing findings are still inconsistent and equivocal. METHODS: A literature search was conducted in PubMed, Web-of-Science, CENTRAL, and CINAHL-Plus-with-Full-Text from inception to January 31, 2023. The quality of methodology and evidence were evaluated by the revised Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development, and Evaluation framework. All data were analyzed using R within the RStudio platform, and the effects of interventions were determined by calculating SMD, HR and 95 %CI. Subgroup analysis, sensitivity analysis and cumulative meta-analysis were performed, and statistical heterogeneity was examined by I2 statistic, P value, and Egger's or arcsine test. Statistical significance was defined as a two-tailed P value <0.05. RESULTS: A total of 23 randomized controlled trials with 7231 patients were included. The results indicated that ePRO-based symptom management interventions could improve the symptom burden (SMD = -0.19, 95 % CI [-0.33, -0.05], P < 0.01), quality of life (SMD = 0.16, 95 % CI [0.06, 0.25], P < 0.01) and overall survival (HR = 0.84, 95 % CI [0.73, 0.97], P = 0.02) of cancer patients. Subgroup analysis showed that targeted interventions for patients undergoing specific treatments were effective in relieving the symptom burden and enhancing quality of life. Short-term (≤3 months) interventions or reporting via telephone call contributed to alleviating the symptom burden, while quality of life improved when the intervention was more than three months in duration or not reported by telephone call. The pooled results of symptom burden and quality of life were stable, and the beneficial trends of all three outcomes were steady. The overall quality of methodology and evidence was moderate. CONCLUSIONS: We found that ePRO-based symptom management interventions are conducive to improving symptom burden, quality of life, and overall survival of cancer patients. In addition to encouraging the integration of ePRO-based interventions into routine oncology care, interventions with tailored plans, proper intensity and multidimensional supports need to be developed in the future to optimize the symptom management of cancer patients. REGISTRATION: CRD42023393330.

Effectiveness of acceptance and commitment therapy on psychological flexibility, fatigue, sleep disturbance, and quality of life of patients with cancer: A meta-analysis of randomized controlled trials.

BACKGROUND: Current studies have revealed that acceptance and commitment therapy (ACT) can alleviate the adverse effects of cancer; however, its effectiveness on the psychological flexibility, fatigue, sleep disturbance, and quality of life of patients with cancer remains unclear. AIMS: The aims of this study were to identify the effectiveness of ACT on psychological flexibility, fatigue, sleep disturbance, and quality of life of patients with cancer, and to explore moderators. METHODS: PubMed, Embase, Web of Science, CENTRAL, PsycINFO, CINAHL, CNKI, VIP, and Wanfang electronic databases were searched from inception to September 29, 2022. The Cochrane Collaboration's risk-of-bias assessment tool II and the Grading of Recommendations Assessment, Development, and Evaluation approach were used to evaluate evidence certainty. The data were analyzed using R Studio. The study protocol was registered with PROSPERO (CRD42022361185). RESULTS: The study included 19 relevant studies (1643 patients) published between 2012 and 2022. The pooled results showed that ACT significantly improved psychological flexibility (mean difference [MD] = -4.22, 95% CI [-7.86, -0.58], p = .02) and quality of life (Hedges' g = 0.94, 95% CI [0.59, 1.29], Z = 5.31, p < .01) but did not significantly improve fatigue (Hedges' g = -0.03, 95% CI [-0.24, 0.18], p = .75) or sleep disturbance (Hedges' g = -0.26, 95% CI [-0.82, 0.30], p = .37) in patients with cancer. Additional analyses revealed a 3-month sustainable effect on psychological flexibility (MD = -4.36, 95% CI [-8.67, -0.05], p < .05), and moderation analysis showed that intervention duration (ß = -1.39, p < .01) and age (ß = 0.15, p = .04) moderated the effects of ACT on psychological flexibility and sleep disturbance, respectively. LINKING EVIDENCE TO ACTION: Acceptance and commitment therapy demonstrates effectiveness for psychological flexibility and quality of life of patients with cancer, but there is a lack of evidence regarding its effects on fatigue and sleep disturbance. In clinical practice, ACT should be designed in more detail and rounded to achieve better results.

Relationships Among Perceived Social Support, Family Resilience, and Caregiver Burden in Lung Cancer Families: A Mediating Model.

OBJECTIVES: To identify the factors associated with caregiver burden in Chinese lung cancer families and to detect whether family resilience mediates the effect of perceived social support on caregiver burden. DATA SOURCES: From October 2021 to March 2022, a total of 213 family caregivers of patients with lung cancer from a public hospital in Sichuan Province, China, completed the Zarit Burden Interview (ZBI), the Perceived Social Support Scale (PSSS), and the Family Resilience Assessment Scale (FRAS). The Mann-Whitney U test and the Kruskal-Wallis H test were used to identify the influencing factors of family caregiver burden, and the bootstrapping method was conducted to detect the mediating role of family resilience. CONCLUSION: In this study, family caregiver burden could be influenced by caregiver age, caregivers' relationships with patients, and patients' self-care degree; family resilience was found to mediate the relationship between caregivers' perceived social support and caregiver burden. IMPLICATION FOR NURSING PRACTICE: Our study manifested that factor from both the patients' and caregivers' sides could influence caregiver burden of lung cancer family caregivers. The results provide further evidence that lung cancer care should be family-centered, and relevant family-supportive systems should be further developed in this field.

The effectiveness of e-Health interventions on caregiver burden, depression, and quality of life in informal caregivers of patients with cancer: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: With the increasing incidence and survival rate of cancer, there are more people living with cancer, which increases the responsibilities of informal caregivers and results in a significant caregiver burden, depression, and low quality of life. The efficacy of e-Health interventions has already been proven in decreasing caregiver burden, addressing psychosocial concerns, and increasing quality of life among caregivers of patients with chronic diseases. However, the utilization of e-Health interventions on the informal caregivers of cancer patients is still limited and the effectiveness is unclear. OBJECTIVES: To assess the impact of e-Health interventions on the caregiver burden, depression, and quality of life of informal caregivers of cancer patients. METHODS: A literature search was conducted in six electronic databases (PubMed, EMBASE, Web of Science, CENTRAL, PsycInfo, and CINAHL Plus with Full Text) from the inception of the databases to 31 May 2021. Two authors independently screened the studies and extracted the data. Cochrane's bias risk tool for randomized controlled trials was used to examine the methodological quality of the included studies. The intervention effect was estimated by calculating the standard mean difference (SMD) and 95% confidence interval (CI) with Review Manager 5.3. A sensitivity analysis was conducted to test the robustness of the pooled results. RESULTS: Seven randomized controlled trials with 326 participants were included in the review. The results of the meta-analysis showed that e-Health interventions could significantly improve the depression (SMD = -0.90, 95% CI [-1.76∼-0.04], P = 0.04) and quality of life (SMD = 0.45, 95% CI [0.13∼0.77], P = 0.006), but not caregiver burden (SMD = -0.29, 95% CI [-0.61∼0.02], P = 0.07) in informal caregivers. Sensitivity analysis showed that only the caregiver burden was stable. CONCLUSION: e-Health interventions are a convenient method to support the informal caregivers of cancer patients, and can mitigate depression and enhance the quality of life of informal caregivers, but had no significant effect on easing the caregiver burden. In future, tailored e-Health intervention, based on informal caregivers' demographic characteristics and cultural context, is warranted to improve informal caregivers' well-being. REGISTRATION NUMBER: CRD42021250253 (PROSPERO).

Preparation and performance of random- and oriented-fiber membranes with core-shell structures via coaxial electrospinning.

The cells and tissue in the human body are orderly and directionally arranged, and constructing an ideal biomimetic extracellular matrix is still a major problem to be solved in tissue engineering. In the field of the bioresorbable vascular grafts, the long-term functional prognosis requires that cells first migrate and grow along the physiological arrangement direction of the vessel itself. Moreover, the graft is required to promote the formation of neointima and the development of the vessel walls while ensuring that the whole repair process does not form a thrombus. In this study, poly (l-lactide-co-ε-caprolactone) (PLCL) shell layers and polyethylene oxide (PEO) core layers with different microstructures and loaded with sodium tanshinone IIA sulfonate (STS) were prepared by coaxial electrospinning. The mechanical properties proved that the fiber membranes had good mechanical support, higher than that of the human aorta, as well as great suture retention strengths. The hydrophilicity of the oriented-fiber membranes was greatly improved compared with that of the random-fiber membranes. Furthermore, we investigated the biocompatibility and hemocompatibility of different functional fiber membranes, and the results showed that the oriented-fiber membranes containing sodium tanshinone IIA sulfonate had an excellent antiplatelet adhesion effect compared to other fiber membranes. Cytological analysis confirmed that the functional fiber membranes were non-cytotoxic and had significant cell proliferation capacities. The oriented-fiber membranes induced cell growth along the orientation direction. Degradation tests showed that the pH variation range had little change, the material mass was gradually reduced, and the fiber morphology was slowly destroyed. Thus, results indicated the degradation rate of the oriented-fiber graft likely is suitable for the process of new tissue regeneration, while the random-fiber graft with a low degradation rate may cause the material to reside in the tissue for too long, which would impede new tissue reconstitution. In summary, the oriented-functional-fiber membranes possessing core-shell structures with sodium tanshinone IIA sulfonate/polyethylene oxide loading could be used as tissue engineering materials for applications such as vascular grafts with good prospects, and their clinical application potential will be further explored in future research.

Inhibition of Obtusifolin on retinal pigment epithelial cell growth under hypoxia.

AIM: To explore the effect of Obtusifolin on retinal pigment epithelial cell growth under hypoxia. METHODS: In vitro chemical hypoxia model of ARPE-19 cells was established using cobalt chloride (CoCl2). Cell viability was tested by cell counting kit-8 (CCK-8) assay. Western blot and real-time quantitative polymerase chain reaction were applied to detect proteins and mRNAs respectively. Flow cytometry was used to examine the cell cycle. Secretion of vascular endothelial growth factor (VEGF) was tested by using enzyme linked immunosorbent assay (ELISA). RESULTS: Under the chemical hypoxia model established by CoCl2, hypoxia inducible factor-1α (HIF-1α) mRNA and protein levels was up-regulated. Cell viability was increased and the proportion of S phase was higher. Obtusifolin could reduce cell viability under hypoxic conditions and arrest cells in G1 phase. Obtusifolin reduced the expression of Cyclin D1 and proliferating cell nuclear antigen (PCNA) in the hypoxic environment and increased the expression of p53 and p21. The levels of VEGF, VEGFR2 and eNOS proteins and mRNA were significantly increased under hypoxia while Obtusifolin inhibited the increasing. CONCLUSION: Obtusifolin can inhibit cell growth under hypoxic conditions and down-regulate HIF-1/VEGF/eNOS secretions in ARPE-19 cells.

Comparison of effectiveness between complete internal limiting membrane peeling and internal limiting membrane peeling with preservation of the central fovea in combination with 25G vitrectomy for the treatment of high myopic foveoschisis.

Vitrectomy combined with internal limiting membrane peeling (ILMP) treats high myopic foveoschisis with good results, but there is a risk of iatrogenic macular holes, which may be reduced by preserving the internal limiting membrane of the central fovea. This study compared complete ILMP with partial ILMP, both combined with 25G vitrectomy, for the treatment of high myopic foveoschisis.Thirty-three cases (33 eyes) of high myopic foveoschisis were retrospectively analyzed. They underwent 25G vitrectomy combined with C3F8 gas filling; Group A (20 patients, 20 eyes) underwent complete ILMP, while Group B (13 patients, 13 eyes) underwent partial ILMP to preserve the internal limiting membrane of the central fovea. Patients were followed up for 6 months and underwent best corrected visual acuity (BCVA), intraocular pressure, diopter, slit lamp microscopy, indirect ophthalmoscope, A-mode and/or B-mode ultrasound, and optical coherence tomography. Surgical complications were recorded.Up to the last follow-up, the BCVA improved and central fovea thickness (CFT) was lower compared with before surgery in both groups (All P < .05). There were no significant differences in BCVA and CFT at each time point between the groups (P > .05). Most of the postoperative retinas of the 2 groups were completely reattached, with disappearance of the macular retinoschisis cavity. Two patients in the Group A and none in the Group B developed a macular hole during follow-up (P = .508).The results did not support the superiority of partial ILMP over complete ILMP in reduced incidence of macular hole. Both methods had a similar curative effect.