Journey towards resiliency: A systematic review and meta-synthesis of cancer patients' experiences.

PURPOSE: This systematic review and meta-synthesis seeks to explore cancer patients' journey towards resiliency. The secondary aim of this review is to identify unique resilience protective factors among cancer patients. METHODS: A thorough search was conducted in eight electronic databases and the grey literature for published or unpublished qualitative and mixed methods studies. Studies that explored resilience among cancer patients were included. The studies were appraised using the Critical Appraisal Skill Programme Checklist. The overall certainty of evidence was further evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation's Confidence in Evidence from Reviews of Qualitative Research. Themes identified were synthesized using Sandelowski and Barroso's meta-synthesis method. RESULTS: A total of 34 studies comprising 987 cancer patients were included in this review. Three themes and nine subthemes were generated from the meta-synthesis. The themes were: (1) Confronting the cancer diagnosis, (2) personal adaptations to cancer, and (3) drawing strength from others. The findings highlighted how individuals overcame cancer adversities through resilience, which is influenced by various factors, including life experiences, social-cultural stigmas, spirituality, social support networks, coping strategies, motivation, acceptance of illness, positive mindset, and engagement with healthcare facilities. CONCLUSIONS: This review highlights the role of resilience in a cancer patient's journey. It emphasizes on the importance of building resilience in both cancer patients and survivors to effectively overcome the challenges of their cancer diagnosis. These insights are essential for developing interventions that promote resilience and improve existing psychosocial oncology services. Future research should focus on longitudinal studies to better understand how resilience evolves and pinpoint factors that can further influence one's resilience.

High-tolerance reconfigurable MZI racetrack resonator on a 3-µm-thick SOI photonics platform.

Integration of resonators impacts the utilization of the 3-µm-thick silicon-on-insulator (SOI) platform in photonics integrated circuits (PICs). We propose an integrated resonator leveraging a deep-etch silicon waveguide. Through the utilization of a tunable coupler based on multimode interferometers (MMIs), the resonator achieves high fabrication tolerance and reconfigurability. In a critical-coupling state, it serves as a filter with an extinction ratio (ER) of 23.5 dB and quality (Q) factor of 3.1×105, operating within the range of 1530-1570 nm. In an extreme over-coupling state, it functions as a large-bandwidth delay line, offering continuous change in delay time of 22 ps, nearly wavelength-independent. This work provides devices to the 3-µm-thick silicon photonics device library, enriching the potential applications of this technology platform.

Epidemiology of neonatal pneumothorax developed spontaneously and during respiratory supports in neonatal intensive care units.

BACKGROUND: Information on incidence and risk factors associated with different types of neonatal pneumothorax were lacking globally. OBJECTIVES: To determine incidences of pneumothorax developed spontaneously and during different modes of respiratory support, and risk factors associated with each type of pneumothorax. STUDY DESIGN: Retrospective observational study of neonates in the Malaysian National Neonatal Registry. SETTING: 44 Malaysian neonatal intensive care units (NICUs). PARTICIPANTS: All neonates born in 2015-2020 and admitted to NICUs. RESULTS: Pneumothorax developed in 3265 neonates: 37.5% occurred spontaneously, 62.5% during respiratory support. The incidence of all types of pneumothorax was 1.75 per 1000 livebirths, and of spontaneous pneumothorax was 0.58 per 1000 livebirths. Pneumothorax developed in 0.6% (450/70512) of neonates during continuous positive air way pressure therapy (nCPAPt), 1.8% (990/54994) of neonates during conventional mechanical ventilation (CMV), and 7.0% (599/8557) of neonates during high frequency ventilation (HFV). Term neonates had significantly higher pneumothorax rate than preterms (p<0.001). Multiple logistic regression analyses show that exposure to intermittent positive pressure ventilation and chest compression at birth were significant independent factors associated with increased risk of spontaneous pneumothorax and CMV, and persistent pulmonary hypertension was associated with increased risk of spontaneous pneumothorax and pneumothorax during CMV and HFV. CONCLUSIONS: The most common type of pneumothorax was spontaneous in-onset. Neonates on HFV had the highest and those on nCPAPt the lowest rate of pneumothorax. Improving training of resuscitation techniques at birth and strategies of use of invasive modes of respiratory support may reduce incidences of all types of pneumothorax.

Fiber-optic integrated aerodynamic three-hole vector probe for high-velocity flow field measurement.

An integrated aerodynamic three-hole pressure probe (THP) based on a fiber-optic tip sensor array for high-velocity flow field vector measurement is developed and demonstrated in wind tunnel testing. The sensor array consisting of three miniature pressure fiber-tip sensors is integrated into three pressure conduits inside top area of the THP, which serves to mitigate pneumatic pressure loss and is expected for a more reliable analysis of flow characteristics. Fast real-time data acquisition is implemented by a compact self-developed multichannel white light interferometry (WLI) interrogator. Well-calibrated maps of the fiber-optic THP are developed in a subsonic free-jet wind tunnel to derive the velocity vectors in a yaw angular range of ±15° at Mach numbers of 0.2 Ma (∼70 m/s), 0.5 Ma (∼170 m/s), and 0.8 Ma (∼300 m/s) while related flow characteristics are analyzed. This work is desired to provide a potential candidate for turbomachinery experimental investigation in fluid mechanics community.

All-silica fiber-optic temperature-depth-salinity sensor based on cascaded EFPIs and FBG for deep sea exploration.

Using fusion splicing and hydroxide catalysis bonding (HCB) technology, an all-silica inline fiber-optic sensor with high-pressure survivability, high-resolution salinity measurement capability, and corrosion resistance for deep sea explorations is proposed and experimentally demonstrated. Two extrinsic Fabry-Perot interferometers (EFPIs) and a fiber Bragg grating (FBG) are cascaded in one single-mode fiber (SMF), enabling structural integration of single lead-in fiber and versatility of the sensing probe for temperature, depth, and salinity monitoring. The HCB technology offers a polymer adhesive-free assembly of one open-cavity EFPI for refractive index (RI) (salinity) sensing under normal pressure and temperature (NPT) conditions, showing obvious advantages of strong bonding strength, reliable effectiveness, and no corrosive chemicals requirements. The other EFPI formed by a fused structure is designed for pressure (depth) measurement. The cascading of EFPIs, especially the open-cavity EFPI immersed in water, will result in large light transmission loss and bring challenges to signal interrogation. Graded-index fiber (GIF) micro-collimators and reflective films are added to prevent dramatic degradations of signal intensity and fringe visibility underwater. Thereby, a Fabry-Perot (FP) cavity of several hundreds of microns in length and an open cavity of a thousand microns can be cascaded for underwater applications, effectively enhancing sensitivities and underwater signal readout simultaneously. Results show that the proposed sensor can well operate in the deep-sea pressure range of 0∼2039.43 mH2O, RI range of 1.33239∼1.36885 RIU, and temperature range of 23∼80 °C, with resolutions of 0.033 MPa, 4.16×10-7 RIU, and 0.54 °C, respectively. With the multi-parameter measurement capability, all-silica construction, and inline compact structure, the proposed sensor could be a potential candidate for deep sea exploration.

Gallic Acid Improves Diabetic Steatosis by Downregulating MicroRNA-34a-5p through Targeting NFE2L2 Expression in High-Fat Diet-Fed db/db Mice.

Type 2 diabetes mellitus (T2DM) has become epidemic worldwide and is strongly associated with nonalcoholic fatty liver disease (NAFLD). The molecular mechanisms of microRNAs in NAFLD and T2DM development and the corresponding therapies remain unclear. We performed microRNA microarray validation to determine whether hepatic miR-34a-5p was significantly upregulated in db/db mice fed with a high-fat diet (HFD), a mouse model of T2DM with steatohepatitis. The potential role of miR-34a-5p and gallic acid (GA) in regulating hepatic lipid metabolism and diabetic steatosis was explored. GA improved the activities of antioxidant enzymes and suppressed lipid accumulation in the HFD-induced steatotic liver of db/db mice. In vitro, the silencing of miR-34a-5p in hepatocyte HepG2 cells ameliorated high glucose + oleic acid/palmitic acid mixture-induced accumulation of cellular triglycerides. We identified nuclear factor erythroid-derived 2-like 2 (NFE2L2) as a direct target of miR-34a-5p. Reduction in intracellular triglyceride and the expression levels of sterol regulatory element-binding protein 1 and fatty acid synthase by GA were mediated by the inhibition of miR-34a-5p expression in HepG2 cells. The findings suggest that GA improves hepatic lipogenesis by downregulating miR-34a-5p by suppressing NFE2L2 expression, indicating the potential therapeutic role of GA or an NFE2L2-activating agent in diabetic fatty liver disease.

Differential-pressure fiber-optic airflow sensor for wind tunnel testing.

A differential-pressure fiber-optic airflow (DPFA) sensor based on Fabry-Perot (FP) interferometry for wind tunnel testing is proposed and demonstrated. The DPFA sensor can be well coupled with a Pitot tube, similar to the operation of the differential diaphragm capsule in the airspeed indicator on the aircraft. For differential pressure sensing between total pressure and static pressure in the airflow, an FP cavity is formed between the sensing diaphragm and a fiber end-face, and a tubule is inserted into the FP cavity. According to the principle of differential pressure derived from Bernoulli's equation, the airflow velocity can be determined by monitoring the change of the FP cavity length. The experimental results demonstrate that a DPFA sensor with 0∼11 kPa measurable range, 826.975 nm/kPa sensitivity, and 0.008% (0.89 Pa) resolution can be realized. Combined with a 100 Hz-sweep frequency self-developed white light interferometric (WLI) interrogator and a Pitot tube, the DPFA sensor can be used for measuring the airflow velocity of 2.0∼119.24 m/s with an accuracy of 0.61%. The system is applied to the analysis of the flat-plate boundary layer, a wind tunnel experimental model, where the results are consistent with those of the theoretical analysis and from the standard electronic pressure transducer. With the large measurable range, high sweep frequency, and high precision, the system has potential application value for wind tunnel experimental investigation and in-flight measurement of airspeed.

Nontraumatic Subdural Hematoma and Intracystic Hemorrhage Associated with a Middle Fossa Arachnoid Cyst.

Intracranial arachnoid cysts (ACs) are relatively common findings that can be seen in up to 2% of patients. They are generally found incidentally with a benign clinical course and can be usually managed by observation. We report an unusual case of a middle fossa AC presenting with spontaneous intracystic hemorrhage along with subdural hematoma (SDH) causing significant mass effect and midline shift requiring surgical treatment. Even though the risk of hemorrhage in patients with AC is very low, the presence of AC is a known risk factor for SDH. Fortunately, the clinical outcome of patients who present with hemorrhage associated with AC is generally favorable with early recognition and prompt surgical treatment. Our case highlights the fact that both intracystic hemorrhage and SDH can occur in association with AC even in the absence of trauma and should be kept in mind when counseling patients with incidental AC about the natural history of these lesions.

Effects of statins on all-cause mortality at different low-density-lipoprotein cholesterol levels in Asian patients with type 2 diabetes.

OBJECTIVE: To investigate the effects of statins on all-cause mortality risk at different low-density lipoprotein cholesterol (LDL-C) levels, and to compare the mortality risk between statin users and non-users with identical LDL-C levels in a type 2 diabetes cohort. METHODS: In total, 10,582 outpatients aged ≥18 years with type 2 diabetes mellitus (T2DM) between 2009 and 2012 were enrolled in this retrospective cohort study in central Taiwan. All-cause mortality events were followed up until the end of 2014. According to the medical records during the follow-up period, the patients were classified into statin (+) and statin (-) groups. Patients were categorized into different LDL-C segments based on their mean LDL-C levels during the 2.8-year follow-up. RESULTS: Non-cardiovascular mortality accounted for more than half the deaths. Overall, statin therapy significantly reduced the all-cause mortality risk in both univariable and multivariable models (hazard ratios = 0.39 and 0.38, respectively). Sub-group analyses showed that the lowest mortality risk occurred in the 80-89 mg/dL segment in the statin (-) group and in the 90-99 mg/dL segment in the statin (+) group. Statin therapy significantly reduced the mortality risk at all LDL-C levels except for low LDL-C (<60 mg/dL). CONCLUSIONS: In addition to reducing LDL-C levels, statin therapy reduced all-cause mortality risk in Taiwanese patients with T2DM. Statins further reduced the mortality risk at most LDL levels. However, at low LDL-C levels, the positive effects of statins may have been nullified.

Diet and Sleep Physiology: Public Health and Clinical Implications.

This mini-review examines the complex relationship between diet and sleep and explores the clinical and public health implications of the current evidence. Dietary quality and intake of specific nutrients can impact regulatory hormonal pathways to alter sleep quantity and quality. Sleep, in turn, affects the intake of total energy, as well as of specific foods and nutrients, through biological and behavioral mechanisms. Initial research in this field focused primarily on the effects of short sleep duration on nutritional quality. However, more recent studies have explored the dynamic relationship between long sleep duration and diet. Current evidence suggests that extremes of sleep duration alter sleep patterns, hormonal levels, and circadian rhythms, which contribute to weight-related outcomes and obesity, and other risk factors for the development of chronic disease such as type 2 diabetes and cardiovascular disease. These patterns may begin as early as childhood and have impacts throughout the life course. Given that non-communicable diseases are among the leading causes of death globally, deeper understanding of the interactions between sleep and nutrition has implications for both public health and clinical practice.

Perceptions of Pediatric Critical Care Nurses on the Initiation of a Nursing-Led Feeding Protocol.

BACKGROUND: Critically ill children frequently receive inadequate nutritional support. Feeding protocols have been shown to facilitate optimal nutritional care. PURPOSE: We aim to determine the perceptions of critical care nurses with regard to the implementation of a feeding protocol as well as to their preferred teaching methods before introducing this protocol in our pediatric intensive care unit (PICU). We hypothesize that nursing experience and educational level are factors that predict readiness to adopt this protocol. METHODS: All PICU nurses were invited to participate in an online survey to investigate their perceptions on protocol implementation and on preferred teaching methods. Statistical analysis was performed using simple logistic regression and the Fisher exact test. Statistical significance was taken as p < .05. RESULTS: Seventy-four nurses completed the survey. Fifty-four (73%) had nursing degrees. Mean duration of PICU experience was 6.2 years (5th, 95th percentile: 1, 15). Three quarters of participants (74%, n = 55) felt that they did not have sufficient knowledge regarding feeding protocols, and 86% (n = 64) expressed that they were keen to implement a feeding protocol. There was no association between readiness to adopt the feeding protocol with years of ICU experience (OR = 0.99, 95% CI [0.84, 1.18]) and educational level (OR = 1.43, 95% CI [0.31, 6.68]). The preferred teaching methods were bedside teaching (61%), didactic lectures (51%), and the distribution of protocol manuals (50%). PICU nurses felt that the advantages of a feeding protocol included standardization of practice, optimization of patient's nutritional intake, earlier initiation of feeding, increased patient safety, and the extension of nursing roles. Perceived disadvantages included inapplicability of the feeding protocol to all patients, lack of flexibility in feeding management, increased confusion, and doctors placing little value on the feeding protocol. CONCLUSIONS: This study found that nursing experience and level of education do not significantly affect the readiness of nurses to adopt a feeding protocol. Medical and nursing teams should not shy away from introducing a new protocol although their nurses have little experience or prior knowledge of that protocol. Future studies to investigate the impact of tailoring of educational needs before introduction of a new protocol are necessary to study the overall effectiveness of this teaching before introducing a new protocol in the ICU.

Higher serum total bilirubin concentration is associated with lower risk of renal insufficiency in an adult population.

BACKGROUND: Chronic inflammation is proposed to play a central role in the pathogenesis of chronic kidney disease (CKD), and serum bilirubin has antioxidant and anti-inflammatory effects. We investigated the association between serum total bilirubin (Tb) concentration and renal function in an adult population. METHODS: We conducted a cross-sectional study and collected anthropometric measurements, fasting blood tests, lifestyle habits and medical history of 3876 subjects attending a health examination. Renal insufficiency was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) calculated by using the CKD-EPI equation. RESULTS: Serum Tb concentrations were higher in subjects without renal insufficiency than in those with renal insufficiency. Multivariable linear regression analysis showed that Tb concentration was positively associated with eGFR after adjusting for important CKD risk factors (P=0.04). Multivariable logistic regression analysis also revealed that higher Tb concentration (each increment of 1.71 µmol/L) (0.1 mg/dL) was associated with a reduced risk of renal insufficiency: odds ratios were 0.94 (P=0.005) for men and 0.90 (P=0.015) for women, respectively. When subjects were divided into quartiles of serum Tb, multivariable-adjusted odds ratios for renal insufficiency comparing the fourth to the first Tb quartile were 0.49 (P=0.001) for men and 0.35 (P=0.003) for women. A stepwise exclusion of subjects, first those with possible liver disease and second, those with CKD stage 4 and 5, showed consistent results. CONCLUSION: Higher serum Tb concentration was associated with lower risk of renal insufficiency, regardless of other conventional CKD risk factors.

Genetic improvement of butanol tolerance in Escherichia coli by cell surface expression of fish metallothionein.

Cysteine-rich metallothioneins (MTs) have been reported to possess the capacity to scavenge reactive oxygen species in vitro and in vivo. Recombinant strains of Escherichia coli expressing outer membrane protein C (OmpC) fused with MTs from human, mouse and tilapia displayed the ability for such surface-localized MTs to scavenge extracellular free radicals, but the benefits of the possible applications of this capacity have not yet been demonstrated. Because the intrinsic butanol tolerance of microbes has become an impediment for biological butanol production, we examined whether surface-displayed MTs could contribute to butanol tolerance. The results show that strains expressing OmpC-MT fusion proteins had higher butanol tolerance than strains with cytoplasmically expressed MTs. Furthermore, the OmpC-tilapia MT fusion protein enhanced butanol tolerance more strongly than other recombinant constructs. Although the enhanced level of tolerance was not as high as that provided by OmpC-tilapia MT, over-expression of OmpC was also found to contribute to butanol tolerance. These results suggest that free-radical scavenging by MT and OmpC-related osmoregulation enhance butanol tolerance. Our results shed new light on methods for engineering bacteria with higher butanol tolerance.

The effectiveness of a magnetic nanoparticle-based delivery system for BCNU in the treatment of gliomas.

This study describes the creation and characterization of drug carriers prepared using the polymer poly[aniline-co-N-(1-one-butyric acid) aniline] (SPAnH) coated on Fe(3)O(4) cores to form three types of magnetic nanoparticles (MNPs); these particles were used to enhance the therapeutic capacity and improve the thermal stability of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU), a compound used to treat brain tumors. The average hydrodynamic diameter of the MNPs was 89.2 ± 8.5 nm and all the MNPs displayed superparamagnetic properties. A maximum effective dose of 379.34 µg BCNU could be immobilized on 1 mg of MNP-3 (bound-BCNU-3). Bound-BCNU-3 was more stable than free-BCNU when stored at 4 °C, 25 °C or 37 °C. Bound-BCNU-3 could be concentrated at targeted sites in vitro and in vivo using an externally applied magnet. When applied to brain tumors, magnetic targeting increased the concentration and retention of bound-BCNU-3. This drug delivery system promises to provide more effective tumor treatment using lower therapeutic doses and potentially reducing the side effects of chemotherapy.

Novel magnetic/ultrasound focusing system enhances nanoparticle drug delivery for glioma treatment.

Malignant glioma is a common and severe primary brain tumor with a high recurrence rate and an extremely high mortality rate within 2 years of diagnosis, even when surgical, radiological, and chemotherapeutic interventions are applied. Intravenously administered drugs have limited use because of their adverse systemic effects and poor blood-brain barrier penetration. Here, we combine 2 methods to increase drug delivery to brain tumors. Focused ultrasound transiently permeabilizes the blood-brain barrier, increasing passive diffusion. Subsequent application of an external magnetic field then actively enhances localization of a chemotherapeutic agent immobilized on a novel magnetic nanoparticle. Combining these techniques significantly improved the delivery of 1,3-bis(2-chloroethyl)-1-nitrosourea to rodent gliomas. Furthermore, the physicochemical properties of the nanoparticles allowed their delivery to be monitored by magnetic resonance imaging (MRI). The resulting suppression of tumor progression without damaging the normal regions of the brain was verified by MRI and histological examination. This noninvasive, reversible technique promises to provide a more effective and tolerable means of tumor treatment, with lower therapeutic doses and concurrent clinical monitoring.

In vivo assessment of macrophage CNS infiltration during disruption of the blood-brain barrier with focused ultrasound: a magnetic resonance imaging study.

Focused ultrasound has been discovered to locally and reversibly increase permeability of the blood-brain barrier (BBB). However, inappropriate sonication of the BBB may cause complications, such as hemorrhage and brain tissue damage. Tissue damage may be controlled by selecting optimal sonication parameters. In this study, we sought to investigate the feasibility of labeling cells with superparamagnetic iron oxide particles to assess the inflammatory response during focused-ultrasound-induced BBB opening. We show that infiltration of phagocytes does not occur using optimal parameters of sonication. Taken together, the results of our study support the usefulness and safety of focused-ultrasound-induced BBB opening for enhancing drug delivery to the brain. These findings may have implications for the optimization of sonication parameters.

Spectroscopic study of the B (1)Pi state of (39)KH.

The B (1)Pi excited electronic state of (39)KH has been observed for the first time by a pulsed fluorescence excitation spectroscopic technique. We have found only one vibrational level, in which seven e-parity and seven f-parity sublevels are identified. The Dunham-type coefficients A(00), A(01), and A(02) and the mean internuclear separation for the B (1)Pi state have been derived. Their numeric values are separately 27 682.64(1) cm(-1), 1.533(1) cm(-1), -0.001 25(2) cm(-1), and 3.345(1) A for the B (1)Pi(+) state; 27 682.66(2) cm(-1), 1.532(2) cm(-1), -0.001 20(3) cm(-1), and 3.347(2) A for the B (1)Pi(-) state. The dissociation energy D(0) is determined to be 131.4(7) cm(-1). The vibrational frequency and the dissociation energy for the B (1)Pi state have also been estimated and the results are compared with recent ab initio calculations.