Changes of transcutaneous oxygen pressure in compressed areas of surgical patients: A prospective study of influencing factors.

OBJECTIVE: To compare the transcutaneous oxygen pressure (tcpO2) measurement values and changes in compressed areas of surgical patients before and after surgery and to explore the related factors influencing the tcpO2 changes before and after surgery. METHODS: Researchers selected 100 patients who underwent elective surgery in a tertiary comprehensive hospital from November 2021 to September 2022. A self-designed general information questionnaire was used to collect patient general information and disease-related data, including gender, age, smoking and drinking history, hypertension, diabetes, local skin temperature and humidity, related biochemical indicators, and activities of daily living score. Researchers used a transcutaneous oxygen pressure meter to measure and record the tcpO2 of the compressed areas (sacrococcygeal area, scapula area, and heel area) before and after surgery. RESULTS: Among the 100 patients, 37.00 % (37/100) developed type I/II pressure ulcers after surgery, and 30 patients (81.08 %) showed regression within 2 h after surgery. There was no statistically significant difference in the preoperative tcpO2 measurement values of the scapula and heel areas between the group with and without pressure ulcers, but the preoperative tcpO2 measurement value of the sacrococcygeal area in the group without pressure ulcers was higher than that in the group with pressure ulcers (P < 0.01). The factors affecting the preoperative tcpO2 measurement value of the sacrococcygeal area were smoking and surgical type. After surgery, the tcpO2 measurement values of the three areas in the group with pressure ulcers were significantly lower than those in the group without pressure ulcers (P < 0.01). Comparing the tcpO2 values of different areas, it was found that the tcpO2 value was lowest in the sacrococcygeal area, followed by the heel area, and the tcpO2 value in the scapula area was highest both before and after surgery (P < 0.01). The main factors affecting the postoperative tcpO2 measurement value were diabetes, Glassgow score, surgical time, and intraoperative red blood cell transfusion. CONCLUSION: The measurement of tcpO2 is related to the incidence of surgically acquired pressure ulcers, and this technology may become an important tool for quantitative assessment of the risk of pressure ulcers.

Addressing the ACGME Competency of Communicating with the Public through the Use of TEDx Talks.

OBJECTIVES: Competency-based public communication skills are not systematically taught in most medical curricula, reflecting a gap between medical knowledge and holistic patient care as trainees transition into clinicians. We sought to investigate the efficacy of technology, entertainment, and design (TED) talks in postgraduate year (PGY) training programs. METHODS: The authors organized an official internal TEDx event in which six PGY trainees volunteered as speakers. Two experienced physicians and two administrators also participated as speakers to provide trainees a didactic shadow learning experience. The remaining PGY trainees, along with clerks, physicians, nurses, pharmacists, and administrators, attended the conference. Before the event, speakers undertook individual training sessions and learned the principles of the presentation structure and storytelling mode. At the end of the event, a survey evaluating overall satisfaction in communication skills and professionalism was administered to all of the attendees. RESULTS: Survey participants totaled 104, with a response rate of 97.2%. TEDx talks improved trainees' levels of patient care, communication, and professionalism. Speakers reported the high level of satisfaction with the event (mean 4.96 on a 5-point Likert scale; standard deviation 0.20). Participants agreed that the shadowing experience was useful and that the event encouraged them to pursue interests outside the medical field. CONCLUSIONS: This study highlights that TED is successful in terms of participant satisfaction and training in communication and professionalism. Engaging and training PGY trainees through TED-style events could bridge the gap between acquired knowledge and professional competencies. The authors recommend the implementation of TED-style events in medical training programs.

Sense of Coherence and Health-Related Quality of Life in Patients With Brain Metastases.

With improvements in treatments for primary tumor and brain metastases (BM), the life expectancy of patients with advanced cancers is increasing; thus, helping patients with BM maintain quality of life is becoming increasingly important. Sense of coherence (SOC) has been found to be closely related to health-related quality of life (HRQoL) in patients with chronic diseases, however, this relationship has not been validated in patients with BM. This study first examined the relationship between SOC and HRQoL in patients with BM, and further identified factors associated with SOC in these patients. Patients with BM reported lower scores for most of the functioning subscales and for the general rating of quality of life, and higher scores for most of the symptom subscales, compared with a normative sample. SOC was significantly correlated with most aspects of HRQoL in patients with BM. Further, SOC in the patients was associated with awareness of the disease, possession of religious belief, and type of primary cancer. These results validate the close relationship between SOC and HRQoL in patients with BM, and indicate that SOC is associated with awareness of illness and religious belief.

Correlation between early clinical exposure environment, attitudes toward basic medicine, and medical students' basic science learning performance.

BACKGROUND: Early clinical exposure (ECE) is viewed as a way to provide contexts of basic science and highlight its relevance to medical practice. However, very few studies have specifically looked into how the ECE experience contributes to students' academic performance. The purpose of this study was to investigate whether ECE experiences (external cause) or students' learning attitudes (internal cause) more closely correlated with medical students' academic performance. METHODS: Subjects who participated in the study comprised 109 s-year students at Taipei Medical University. Fifty of the 109 study participants were enrolled in an elective ECE program. The dependent variable in this study was the test score of a systems-based basic sciences (SBBS) course. Independent variables of the study included students' attitudes and test anxiety towards the SBBS course, engagement/length of time spent in ECE, and the ECE learning environment. Data of students' engagement in ECE, levels of their motivational beliefs and test anxiety, differences in the ECE learning environment, and the SBBS final test scores of these 109 respondents were collected for hierarchical multiple regression (HMR) analyses. RESULTS: Results of the HMR analyses revealed that students' test anxiety towards basic science and also the learning environment of the ECE had significant positive predictive power on their SBBS test scores. CONCULSION: This study discovers that medical students' academic performance in basic science correlates not only with their anxiety to testing, but even more so with the clinical environment they are exposed to. Hence we suggest including further investigations about different learning environments on ECE experiences in future studies.

Percent Body Fat Change in Chinese Women After Adjuvant Chemotherapy for Breast Cancer.

BACKGROUND Weight gain is a common side effect observed in breast cancer (BC) patients undergoing adjuvant chemotherapy, although the characteristics and mechanism are not been fully understood. This study aimed to investigate percent body fat (%BF) change, and identify the associated risk factors among Chinese women receiving chemotherapy for BC. MATERIAL AND METHODS A prospective longitudinal study was conducted on a cohort of 140 Chinese female patients with BC between June 2016 and October 2017. Data on demographic and clinical features were collected using a standard protocol. Anthropometric parameters including body weight and %BF were measured before and after chemotherapy. Multiple logistic analysis was performed to identify the risk factors for %BF change. RESULTS A total of 52.9% and 58.6% of the 140 patients experienced gains in weight and %BF after chemotherapy, respectively, with mean increases of 2.1±1.9 kg and 1.3±2.2%, respectively. Fifty-eight patients gained %BF over 2.5% of the baseline value. Moreover, premenopausal women had a greater mean %BF gain than postmenopausal women (P=0.018). Logistic analysis showed that premenopausal status, younger age, multi-agent chemotherapy regimen, high-calorie diet, and decreased physical activity were independent variables that inducted %BF gain. CONCLUSIONS %BF gain occurred frequently in Chinese women after adjuvant chemotherapy for BC, especially in premenopausal women. An effort should be made to the management of %BF.

Neutrophil-to-lymphocyte ratio, obesity, and breast cancer risk in Chinese population.

Breast cancer (BC), obesity, and metabolic syndrome (MetS) shared a common mechanism of dysregulated metabolism and inflammatory response in disease initiation. Neutrophil-to-lymphocyte ratio (NLR) is associated with adverse survival of BC patients. The aim of this study is to identify risk effect between NLR and BC in Chinese population with or without obesity and MetS. BC and age-matched breast benign disease (BBD) patients were retrospectively analyzed from Comprehensive Breast Health Center, Shanghai Ruijin Hospital. MetS was defined using AHA/NHLBI criteria. Individuals were classified into very low (0-1.30), low (1.31-1.67), intermediate (1.68-2.20), and high (>2.20) NLR subsets by each NLR quartile. In all, 1540 BC and 1540 BBD patients were included. Univariate and multivariate analysis found that NLR (OR: 1.27, 95% CI: 1.16-1.39, P < .001) and obesity (OR: 1.19, 95% CI: 1.00-1.42, P = .046) but not MetS (P = .060) were significantly associated with increased BC risk. Intermediate or high NLR substantially increased BC risk compared to very low NLR group (OR: 1.57, 95% CI: 1.29-1.92, P < .001; OR: 1.84, 95% CI: 1.50-2.25, P < .001; respectively) in whole population. Subgroup analysis found that the impact of higher NLR on BC risk was more obvious in patients without obesity (intermediate NLR, OR: 1.72, 95% CI: 1.37-2.16, P < .001; high NLR, OR: 1.92, 95% CI: 1.53-2.41, P < .001) or without MetS (intermediate NLR, OR: 1.70, 95% CI: 1.35-2.14, P < .001; high NLR, OR: 1.98, 95% CI: 1.57-2.51, P < .001). Higher preoperative NLR was found in BC patients compared with BBD patients. Intermediate to high NLR level substantially increased BC risk, which was more relevant for those without obesity or MetS.

Clinical application of subjective global assessment in Chinese patients with gastrointestinal cancer.

AIM: To investigate the role of subjective global assessment (SGA) in nutritional assessment and outcome prediction of Chinese patients with gastrointestinal cancer. METHODS: A total of 751 patients diagnosed with gastrointestinal cancer between August 2004 and August 2006 were enrolled in this study. Within 72 h after admission, SGA, anthropometric parameters, and laboratory tests were used to assess the nutritional status of each patient. The outcome variables including hospital stay, complications, and in-hospital medical expenditure were also obtained. RESULTS: Based on the results of SGA, 389 (51.8%), 332 (44.2%), and 30 (4.0%) patients were classified into well nourished group (SGA-A), mildly to moderately malnourished group (SGA-B), and severely malnourished group (SGA-C), respectively. The prevalence of malnutrition classified by SGA, triceps skinfold thickness (TSF), mid-upper arm muscle circumference (MAMC), albumin (ALB), prealbumin (PA), and body mass index (BMI) was 48.2%, 39.4%, 37.7%, 31.3%, 21.7%, and 9.6%, respectively. In addition, ANOVA tests revealed significant differences in body mass index (BMI), TSF, PA, and ALB of patients in different SGA groups. The more severely malnourished the patient was, the lower the levels of BMI, TSF, PA, and ALB were (P < 0.05). Chi2 tests showed a significant difference in SGA classification between patients receiving different types of treatment (surgery vs chemotherapy/radiotherapy). As the nutritional status classified by SGA deteriorated, the patients stayed longer in hospital and their medical expenditures increased significantly. Furthermore, multiple regression analysis showed that SGA and serum ALB could help predict the medical expenditures and hospital stay of patients undergoing surgery. The occurrence of complications increased in parallel with the increasing grade of SGA, and was the highest in the SGA-C group (23.3%) and the lowest in the SGA-A group (16.8%). CONCLUSION: SGA is a reliable assessment tool and helps to predict the hospital stay and medical expenditures of Chinese surgical gastrointestinal cancer patients.

[Reappraisal of the impacts of human Runt-related transcription factor gene 3 expression on differentiation and prognosis of gastric cancer].

OBJECTIVE: To investigate the expression of Runt-related transcription factor gene 3(RUNX3) in gastric cancer and its impact on the outcome of gastric cancer patients. METHODS: By using immunohistochemistry staining and western blot assay, the expression of RUNX3 protein in 66 cases of gastric cancer with various clinicopathologic characteristics were detected, and the effects of RUNX3 protein expression on the outcome of patients undergone surgical resection were evaluated. RESULTS: (1) The expression rate of RUNX3 protein in gastric cancer lesions was 60.6% (40/66), and RUNX3 protein was mainly expressed in the cytoplasm of cancer cells. RUNX3 protein expression in tumor tissues was significantly higher than that in non-tumor tissues. (2) RUNX3 protein expression was correlated with tumor differentiation (P=0.025) and Lauren's classification (P=0.034), but had no relationship with the TNM stage (P=0.085). (3) In sharp contrast, the median survival time of patients who had tumors with negative and positive RUNX3 protein expression were 2478 and 2187 days respectively (P=0.016). CONCLUSIONS: RUNX3 protein influences the differentiation of gastric cancer. The role of RUNX3 protein as a tumor-suppressor in tumorigenesis and differentiation of gastric carcinoma need to be further evaluated.