Pre-hospital symptom clusters and symptom network analysis in decompensated cirrhotic patients: A cross-sectional study.

AIMS: To generate pre-hospital symptom networks, explore core, bridge and sentinel symptoms, identify pre-hospital symptom clusters and analyse relationship between influencing factors and symptom clusters in decompensated cirrhosis patients. DESIGN: A cross-sectional study design using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. METHODS: Demographical, physiological, psychological and sociological characteristics and the pre-hospital symptoms of 292 decompensated cirrhotic patients were collected from October 2021 to March 2023 in China. Frequencies, percentages, means, standard deviations, independent samples t-tests, one-way analysis of variance, exploratory factor analysis, multiple stepwise regression analysis and network analysis were used for data analysis. RESULTS: 'I don't look like myself' and itching were core and bridge symptoms, while bloating and lack of energy were sentinel symptoms in decompensated cirrhotic patients. Monthly family income, anxiety, depression, social support and disease duration influenced the neuropsychological symptom cluster, with worrying as the strongest predictor symptom. Influential factors for cirrhosis-specific symptom cluster included Child-Pugh class, monthly family income, disease duration, anxiety and depression, with itching being the strongest predictor symptom. Monthly family income, disease duration and depression were influential factors for gastrointestinal symptom cluster, with loss of appetite as the strongest predictor symptom. CONCLUSIONS: Neuropsychological, cirrhosis-specific and gastrointestinal symptom clusters were formed in decompensated cirrhotic patients. Through network analysis, direct connections between symptoms, symptom clusters and their influencing factors were revealed, thereby offering clinicians a foundation for effectively managing patients' pre-hospital symptoms. IMPACT: Decompensated cirrhosis patients commonly have multiple symptoms, while the management of pre-hospital symptoms is often suboptimal. This study identified neuropsychological, cirrhosis-specific, gastrointestinal symptom clusters and recognized core, bridge and sentinel symptoms in these patients. It also revealed the most prominent symptoms within each cluster. This provides insight into the hierarchy of symptoms, improving symptom management in decompensated cirrhosis. PATIENT AND PUBLIC INVOLVEMENT: There was no patient or public involvement.

Effects of BOPPPS combined with TBL in surgical nursing for nursing undergraduates: a mixed-method study.

BACKGROUND: Surgical Nursing is a core subject for nursing undergraduates that requires active and effective learning strategies to cultivate students' autonomous learning competencies and critical thinking. The effects of BOPPPS (Bridge-in, Objectives, Pretest, Participatory Learning, Post-test and Summary) model combined with team-based learning (TBL) have rarely been explored in Surgical Nursing courses. OBJECTIVE: To explore the effects of BOPPPS combined with TBL in Surgical Nursing for nursing undergraduates. METHODS: A mixed research method of quasi-experimental study design and descriptive qualitative research was used. The control group included 27 nursing undergraduates who had finished the Surgical Nursing course using traditional learning. The experimental group included 36 nursing undergraduates were enrolled in to receive the Surgical Nursing course in the teaching mode of BOPPPS combined with TBL. The quantitative data of students' Surgical Nursing final scores, autonomous learning competencies and critical thinking ability of the two groups were collected and compared by t-test. Qualitative results were obtained through semi-structured interviews and data were analyzed by thematic analysis method. RESULTS: Compared with the traditional learning mode, BOPPPS combined with TBL significantly improved nursing students' final examination scores, autonomous learning competencies and critical thinking ability (p < 0.05). Qualitative results from 14 undergraduate nursing students' interviews were summarized into five themes: (1) stimulating learning interest; (2) improving autonomous learning ability; (3) improving the sense of teamwork; (4) exercising critical thinking; and (5) suggestions for improvement. CONCLUSIONS: The combination of BOPPPS and TBL positively impacted nursing students by improving their autonomous learning competencies and critical thinking ability. The study suggests BOPPPS combined with TBL learning as an effective, alternative learning mode.

Research Hotspots and Global Trends of Transcranial Direct Current Stimulation in Stroke: A Bibliometric Analysis.

Purpose: Transcranial direct current stimulation has been widely used in the clinical treatment of stroke. The purpose of this study was to perform a bibliometric analysis of scientific literature in this field. Methods: Articles and reviews regarding transcranial direct current stimulation in stroke from January 01, 2004 to May 31, 2022 were identified from the Science Citation Index-Expanded of the Web of Science Core Collection database. CiteSpace 6.1.R2, Bibliometrix and the Bibliometric Online Analysis Platform were used to analyze data. Results: A total of 905 papers were obtained, with the highest number of publications coming from the USA. The institutions and authors with the most publications were Harvard Medical School and Fregni F respectively. Nitsche MA had the most co-citations, followed by Fregni F. Neurosciences was the most fruitful research area and Brain Stimulation had the highest H-index. The research topics could be divided into three sections: mechanisms of treatment, comparison of efficacy with transcranial magnetic stimulation, clinical application of post-stroke dysfunction. The field of "walking", "strength" and "virtual reality therapy" are the future research hotspots of transcranial direct current stimulation. Conclusion: The overall research showed a slow growth trend, and the outstanding contribution of the USA in this field cannot be ignored. Relevant researchers are suggested to focus on international collaboration and actively conduct high-quality randomized controlled clinical trials on research hotspots and frontiers in order to identify the optimal stimulation paradigm for clinical purposes.

Sandwich teaching improved students' critical thinking, self-learning ability, and course experience in the Community Nursing Course: A quasi-experimental study.

The youngest generation of students prefers a more active learning style. Sandwich teaching may suit their learning style by alternating between active individual learning and passive collective learning. Sandwich teaching has been rarely applied to the Community Nursing Course for nursing students, and its teaching effects on this course remain unclear. This study applied Sandwich teaching to the Community Nursing Course for Chinese nursing undergraduates and investigated its effects on students' critical thinking, self-learning ability, course experience, and academic performance. This is a quasi-experimental study with 72 Chinese nursing undergraduates. Students receiving traditional teaching were enrolled in the control group (n = 36), and those who received Sandwich teaching were recruited into the experimental group (n = 36). Both groups received the 12-week, 90-min Community Nursing Course. Our main outcome variable, including students' critical thinking, self-learning ability, and course experience, was assessed by specific questionnaire. The paired t-tests were applied to compare the differences of the same group in the pre-test and the post-test, and the independent-sample t-tests were used to compare the differences between the two groups. We observed that nursing students' critical thinking ability and self-learning ability were significantly improved after receiving Sandwich teaching. Students' course experience of Sandwich teaching was significantly better than that of traditional teaching. The final exam score in the experimental group was not significantly higher than that in the control group. These results suggest that Sandwich teaching in Community Nursing Course improved Chinese nursing undergraduates' critical thinking, self-learning ability, and course experience, but failed in improving academic performance.

Analysis of the association between Fc receptor family gene polymorphisms and ocular Behçet's disease in Han Chinese.

Fc receptors are known to have a pivotal role in the initiation and regulation of many immunological and inflammatory processes. This study aimed to investigate the association of Fc receptor family gene polymorphisms with ocular Behçet's disease (BD) in Han Chinese. A two stage case-control study was performed in 1022 BD cases and 1803 healthy controls. Twenty-three SNPs were genotyped using the MassARRAY system (Sequenom), TaqMan SNP Genotyping Assay and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The expression of FCGR3A was examined by real-time PCR and cytokine production was measured by enzyme linked immunosorbent assay (ELISA). A significantly higher frequency of the FCGR3A/rs428888 CT genotype (Pc = 1.96 × 10-7, OR = 1.897) and a lower frequencies of CC genotype and C allele (Pc = 1.96 × 10-7, OR = 0.527; Pc = 7.22 × 10-7, OR = 0.554 respectively) were found in ocular BD as compared with controls. Functional experiments showed an increased FCGR3A expression (P = 0.005) and increased cytokine protein expressions of MCP-1, IL-1ß and TNF-α by LPS stimulated PBMCs in CT carriers of FCGR3A rs428888 compared to CC carriers (P = 0.034; P = 0.025; P = 0.04; respectively). Our findings demonstrate that FCGR3A/rs428888 confers genetic susceptibility for ocular BD in Han Chinese.

Genetic analysis of innate immunity in Behcet's disease identifies an association with IL-37 and IL-18RAP.

Interleukin-1 (IL-1) and the IL-1 receptor (IL-1R) family play an important role in the pathogenesis of inflammatory diseases. This study aimed to investigate the association between single nucleotide polymorphisms (SNP) of IL-1 and IL-1R family genes with Vogt-Koyanagi-Harada (VKH) and Behcet's disease (BD) in Han Chinese. The case-control study was divided into two stages and included 419 VKH cases, 1063 BD cases and 1872 healthy controls. The MassARRAY platform (Sequenom), iPLEX Gold Assay and TaqMan SNP assays were used to score genotypes of 24 SNPs. The expression of IL-37 and IL-18Rap was measured by ELISA and real-time PCR in genotyped healthy individuals. A significantly lower frequency of the AG genotype, and a higher frequency of the GG genotype and G allele of IL-37/rs3811047 were observed in BD as compared to controls. AA genotype and A allele frequency of IL-18RAP/rs2058660 was significantly decreased in BD as compared to controls. Functional studies performed in healthy controls showed that rs3811047 AG genotype carriers had a higher IL-37 gene expression in peripheral blood mononuclear cells (PBMCs) than GG carriers. GG carriers showed a higher cytokine expression as compared to AG carriers. No association was detected between the tested SNPs and VKH.

Analysis of receptor tyrosine kinase genetics identifies two novel risk loci in GAS6 and PROS1 in Behçet's disease.

The TAM kinase (Tyro3, Axl, Mer) and its two ligands (Gas6 and protein S) have been shown to play an important regulatory role in the innate immune response. The present study aimed to investigate whether the tag single-nucleotide polymorphisms (tag SNPs) of these 5 protein-coding genes are associated with Behçet's disease (BD). A two-stage association study was performed in a total of 907 BD patients and 1780 healthy controls. Altogether 32 polymorphisms were tested, using a Sequenom MassARRAY genotyping method in the first stage and a PCR-restriction fragment length polymorphism (PCR-RFLP) assay in the replication phase. Real-time PCR was performed to test the relative mRNA expression level of GAS6 and PROS1 from different SNP genotyped healthy individuals. The frequency of the C allele and CC genotype of rs9577873 in GAS6 (Pc = 4.92 × 10(-5), Pc = 1.91 × 10(-5), respectively) and A allele and AA genotype of rs4857037 in PROS1 (Pc = 1.85 × 10(-6), Pc = 4.52 × 10(-7), respectively) were significantly increased in BD. GAS6 expression in CC carriers of rs9577873 was significantly lower than that in CT/TT individuals (P = 0.001). Decreased expression of GAS6 and increased pro-inflammatory cytokines (IL-6 and IFN-γ: P = 4.23 × 10(-4), P = 0.011, respectively) in individuals carrying the CC genotype suggest that the TAM-GAS6/PROS1 signal pathway may be involved in the pathogenesis of BD.

Association of a NOS3 gene polymorphism with Behçet's disease but not with Vogt-Koyanagi-Harada syndrome in Han Chinese.

PURPOSE: Previous studies have identified that nitric oxide synthase (NOS) genes are associated with several immune-mediated diseases. This study aimed to investigate whether NOS2 and NOS3 gene polymorphisms are associated with Behçet's disease (BD) and Vogt-Koyanagi-Harada (VKH) syndrome in a Han Chinese population. METHODS: An association analysis of NOS2/rs4795067, NOS3/rs1799983 and NOS3/rs1800779 was performed in 733 patients with BD, 800 patients with VKH syndrome, and 1,359 controls using PCR restriction fragment length polymorphism (PCR-RFLP) assay. Statistical analysis was performed with the chi-square test followed by the Bonferroni correction. RESULTS: The result showed a decreased frequency of the NOS3/rs1799983 GG genotype and an increased frequency of NOS3/rs1799983 GT genotype in the patients with BD (Bonferroni correction test [Pc]=0.02, odds ratio [OR]=0.74; Pc=2.1×10(-3), OR=1.57, respectively). No significant association was found between rs1799983 and VKH syndrome. NOS2/ rs4795067 and NOS3/rs1800779 were not associated with either BD or VKH syndrome. CONCLUSIONS: Our findings suggest that a NOS3/rs1799983polymorphism is associated with susceptibility to BD in Han Chinese.

No association between Bach2 gene polymorphisms with Vogt-Koyanagi-Harada syndrome (VKH) and Behcet's disease (BD) in a Chinese Han population.

BACKGROUND: Bach2 was reported to play a key role in T lymphocyte development and maturation to mediate immunological homeostasis. Several autoimmune and immune-related diseases were shown to be associated with Bach2 gene polymorphisms. The current study was designed to explore the association between Bach2 gene polymorphism with Vogt-Koyanagi-Harada (VKH) syndrome and Behcet's disease (BD) in a Chinese Han population. METHODS: -427 patients with BD, 422 patients with VKH and 623 controls were recruited for the first stage from a Chinese Han population. The second stage included another set of 388 patients with BD and 460 healthy subjects. PCR fragment length polymorphism methodology was used for genotyping. Frequencies of genotypes and alleles were measured by direct counting and compared between cases and controls by χ(2) test. RESULTS: No difference could be detected between patients suffering from BD or VKH with healthy controls concerning allele and genotype frequencies of rs11755527, rs3757247, rs12212193 and rs2474619. Although in the first stage the frequencies of genotype CC and AC of rs2474619 showed a weak statistical difference between BD and the control group (Pc=0.02), the difference was lost after the second stage and combined stage experiment. CONCLUSIONS: The investigated Bach2 gene polymorphisms (rs11755527, rs3757247, rs12212193 and rs2474619) are not related to the susceptibility to either VKH or BD in our investigated Chinese Han population. CLINICAL TRIAL REGISTRY: This project was registered in the Chinese Clinical Trial Registry (registration number: ChiCTR-CCC-12002184).