Acoustic Imaging Method for Gas Leak Detection and Localization Using Virtual Ultrasonic Sensor Array.

An acoustic imaging method for detecting and locating gas leaks based on a virtual ultrasonic sensor array is proposed and experimentally demonstrated. A scanning sensor array of only two sensors is used to collect the acoustic signals generated by the leakage hole. The matrix of the leakage signal is processed by the cross-power spectrum method to achieve time consistency, afterward, the location of the leakage source can be calculated by the virtual beamforming method. The influence of the number of sensors and the distance between adjacent sensors on the effect of the proposed method are compared and discussed. To verify the effectiveness and operability of the detection and localization method, several experiments were carried out. Furthermore, a series of experiments were conducted to assess the accuracy and stability of this method. The experimental results demonstrate that the proposed method based on a virtual sensor array can achieve highly accurate localization of gas leaks and performs well regarding stability.

Brain connectomics improve prediction of 1-year decreased quality of life in breast cancer: A multi-voxel pattern analysis.

PURPOSE: Whether brain connectomics can predict 1-year decreased Quality of Life (QoL) in patients with breast cancer are unclear. A longitudinal study was utilized to explore their prediction abilities with a multi-center sample. METHODS: 232 breast cancer patients were consecutively enrolled and 214 completed the 1-year QoL assessment (92.2%). Resting state functional magnetic resonance imaging was collected before the treatment and a multivoxel pattern analysis (MVPA) was performed to differentiate whole-brain resting-state connectivity patterns. Net Reclassification Improvement (NRI) as well as Integrated Discrimination Improvement (IDI) were calculated to estimate the incremental value of brain connectomics over conventional risk factors. RESULTS: Paracingulate Gyrus, Superior Frontal Gyrus and Frontal Pole were three significant brain areas. Brain connectomics yielded 7.8-17.2% of AUC improvement in predicting 1-year decreased QoL. The NRI and IDI ranged from 20.27 to 54.05%, 13.21-33.34% respectively. CONCLUSION: Brain connectomics contribute to a more accurate prediction of 1-year decreased QoL in breast cancer. Significant brain areas in the prefrontal lobe could be used as potential intervention targets (i.e., Cognitive Behavioral Group Therapy) to improve long-term QoL outcomes in breast cancer.

Alkaloids from the stems of Fissistigma maclurei Merr. inhibit the proliferation of synoviocytes.

Two new aporphine-derived alkaloids, aporaloids C and D (1 and 2), along with eight known biogenetically related alkaloids (3-10) were isolated from the stems of Fissistigma maclurei Merr. Their structures were elucidated by detailed analysis of NMR, HRESIMS, MS, IR, UV and Optical rotations data. Compounds 1 and 2 represent a rare example of N-methylol aporphine-derived alkaloids from natural sources. The inhibitory effect of all compounds on the proliferation of primary synovial cells was evaluated. Compound 3 showed potent inhibitory effect on the proliferation of synoviocytes with an IC50 value of 4.8 µM. Compounds 1, 2, 6-9 and 10 exhibited moderate inhibitory activity on synoviocytes, with IC50 values of 36.8, 37.1, 31.2 µM, 32.5, 36.3, 36.8 and 18.2 µM, respectively.

Heterogeneity in resilience patterns and its prediction of 1-year quality of life outcomes among patients with newly diagnosed cancer: An exploratory piecewise growth mixture model analysis.

PURPOSE: This study was designed to explore the impact of a new cancer diagnosis on resilience of patients and whether the resilience patterns could predict Quality of Life (QoL) in the first year. METHODS: An exploratory linear piecewise growth mixture modeling (PGMM) with one hypothetical dot (3 months since diagnosis, T1) was employed to identify different resilience patterns and growth in 289 patients with different cancer diagnoses at five assessment occasions (T0-T4). Logistic regression analysis was performed to select potential predictors and receiver operating characteristic (ROC) curve analysis was utilized to test PGMM's discriminative ability against 1-year QoL. RESULTS: Five discrete resilience trajectories with two growing trends were identified, including "Transcendence" (7.3%), "Resilient" (47.4%), "Recovery" (18.7%), "Damaged" (14.9%) and "Maladaption" (11.8%). Advanced stage, colorectal cancer, and receiving surgery therapy were significant predictors of negative resilience trajectories ("Damaged" or "Maladaption"). Discriminative ability was good for PGMM (AUC = 0.81, 95%CI, 0.76-0.85, P < 0.0001). CONCLUSION: Heterogeneity is identified in resilience growth before and after 3 months since diagnosis. 26.7% newly diagnosed patients need additional attention especially for those with advanced colorectal cancer and receiving surgery therapy.

Sensitivity-enhanced Fabry-Perot interferometric fiber-optic microphone using hollow cantilever.

Transducer components are crucial in optimizing the sensitivity of microphones. Cantilever structure is commonly used as a structural optimization technique. Here, we present a novel Fabry-Perot (F-P) interferometric fiber-optic microphone (FOM) using a hollow cantilever structure. The proposed hollow cantilever aims to reduce the effective mass and spring constant of the cantilever, thereby enhancing the sensitivity of the FOM. Experimental results demonstrate that the proposed structure outperforms the original cantilever design in terms of sensitivity. The sensitivity and minimum detectable acoustic pressure level (MDP) can reach 91.40 mV/Pa and 6.20 µPa/Hz at 1.7 kHz, respectively. Notably, the hollow cantilever provides an optimization framework for highly sensitive FOMs.

Measuring resilience by cognitive diagnosis models and its prediction of 6-month quality of life in Be Resilient to Breast Cancer (BRBC).

Objective: The application of advanced Cognitive Diagnosis Models (CDMs) in the Patient Reported Outcome (PRO) is limited due to its complex statistics. This study was designed to measure resilience using CDMs and its prediction of 6-month Quality of Life (QoL) in breast cancer. Methods: A total of 492 patients were longitudinally enrolled from Be Resilient to Breast Cancer (BRBC) and administered with 10-item Resilience Scale Specific to Cancer (RS-SC-10) and Functional Assessment of Cancer Therapy-Breast (FACT-B). Generalized Deterministic Input, Noisy "And" Gate (G-DINA) was performed to measure cognitive diagnostic probabilities (CDPs) of resilience. Integrated Discrimination Improvement (IDI) and Net Reclassification Improvement (NRI) were utilized to estimate the incremental prediction value of cognitive diagnostic probabilities over total score. Results: CDPs of resilience improved prediction of 6-month QoL above conventional total score. AUC increased from 82.6-88.8% to 95.2-96.5% in four cohorts (all P < 0.001). The NRI ranged from 15.13 to 54.01% and IDI ranged from 24.69 to 47.55% (all P < 0.001). Conclusion: CDPs of resilience contribute to a more accurate prediction of 6-month QoL above conventional total score. CDMs could help optimize Patient Reported Outcomes (PROs) measurement in breast cancer.

Resilience index improves prediction of 1-year decreased quality of life in breast cancer.

BACKGROUND: Resilience is important in cancer survivorship and has great potential to predict long-term quality of life (QoL) in breast cancer. The study was designed to develop a new prediction model to estimate pretest probability (PTP) of 1-year decreased QoL combing Resilience Index (RI) and conventional risk factors. METHODS: RI was extracted from 10-item Resilience Scale Specific to Cancer (RS-SC-10) based on the Principal Component Analysis (PCA). Patients were enrolled from Be Resilient to Breast Cancer (BRBC) and the prediction model was developed based on a sample of 506 consecutive patients and validated in an internal cohort (N1 = 314) and two external cohorts (N2 = 223 and N3 = 189). Integrated Discrimination Improvement (IDI) and Net Reclassification Improvement (NRI) were utilized to estimate the incremental value of RI. RESULTS: RI improved prediction above conventional risk factors. AUC increased from 0.745 to 0.862 while IDI and NRI were 8.39% and 18.44% respectively (P < 0.0001 for all). Five predictors were included in the final model: RI, age, N stage, M stage, and baseline QoL. The new model demonstrated good calibration ability in the internal and external cohorts resulting in C-indexes of 0.862 (95%CI, 0.815-0.909), 0.828 (95%CI, 0.745-0.910), 0.880 (95%CI, 0.816-0.944), and 0.869 (95%CI, 0.796-0.941). CONCLUSION: RI contributed to a more accurate estimation for PTP of 1-year decreased QoL above conventional risk factors and could help optimize decision making of treatment for breast cancer. IMPLICATIONS FOR CANCER SURVIVORS: A promising prognostic indicator of RI could improve QoL-related management in Chinese patients with breast cancer.

New resilience instrument for family caregivers in cancer: a multidimensional item response theory analysis.

OBJECTIVE: Resilience instruments specific to family caregivers (FCs) in cancer are limited. This study was designed to validate the 10-item Resilience Scale Specific to Cancer (RS-SC-10) in FCs using multidimensional item response theory (MIRT) analysis. METHODS: 382 FCs were enrolled from Be Resilient to Cancer Program (BRCP) and administered with RS-SC-10 and 36-item Short Form Health Survey (SF-36). MIRT was performed to evaluate item parameters while Generalized Additive Model (GAM) and Latent Profile Analysis (LPA) were performed to test the non-linear relationship between resilience (RS-SC-10) and Quality of Life (QoL, SF-36). RESULTS: RS-SC-10 retained 10 items with high multidimensional discrimination, monotonous thresholds and its original two-factor structure (Generic and Shift-Persist). Four latent resilience subgroups were identified and a non-linear dose-response pattern between resilience and QoL was confirmed (per-SD increase OR = 1.62, 95% CI 1.16-2.13, p = 0.0019). CONCLUSION: RS-SC-10 is a brief and suitable resilience instrument for FCs in cancer. The resilience screening of patients and FCs can be performed simultaneously in clinical practice.

Resilience patterns and transitions in the Be Resilient To Breast Cancer trial: an exploratory latent profile transition analysis.

OBJECTIVE: Be Resilient to Breast Cancer (BRBC), a theoretically-derived, resilience-based, culturally-tailored, supportive-expressive group therapy (SEGT), has been developed to help promote patients' resilience in breast cancer. Data from patients receiving BRBC intervention was utilized to explore and define characteristics of resilience patterns and their transitions over time. METHODS: Resilience was used as a primary outcome and 391 patients completed Resilience Scale Specific to Cancer at enrollment (T0), 2 months (T1), 6 months(T2), and 12 months (T3) after intervention. latent profile transition analysis was performed to model the change in resilience and predict positive transitioning probabilities between resilience patterns (from one pattern to another pattern with a higher level) over time. RESULTS: One hundred and forty four resilience patterns were identified after BRBC intervention. 33.1%, 50.3%, and 40.5% of patients experienced positive resilience transitions from T0 to T1, T1 to T2, and T2 to T3, respectively. Patients with middle age, unmarried status, higher education level, and less advanced tumor stage were more likely to experience positive resilience transitions. CONCLUSION: Different transitions of resilience patterns are observed after BRBC intervention. Age, marital status, education, and tumor stage may be four factors affecting the efficacy of SEGT intervention in breast cancer.

Treatment Decision Making and Regret in Parents of Children With Incurable Cancer.

BACKGROUND: The treatment-related decision-making process is a highly emotional time for parents of children with incurable cancer, and they tend to continue the cancer-directed treatment even when they realize that there is no cure for their child. OBJECTIVE: To evaluate whether parents involved in different treatment decisions regretted their treatment decision after their child's death. METHODS: We collected prospective data from 418 parents of children who died of incurable cancer after receiving cancer care at 1 of 4 hospitals. We assessed parent decisional regret and its association with the type of treatment decision made (non-cancer-directed vs cancer-directed). Propensity score-matched analysis (at a ratio of 1:1) was performed. RESULTS: One hundred forty-eight parents (35.4%) reported heightened regret. Two isonumerical arms with 103 (non-cancer-directed) and 103 (cancer-directed) resulted after propensity score matching. Parents with a cancer-directed treatment decision (relative risk, 1.53; 95% confidence interval, 1.24-1.90; P = .002) were more likely to report decisional regret compared with those with a non-cancer-directed decision. CONCLUSION: Bereaved parents with a cancer-directed treatment decision are more likely to experience increased regret for their decision than bereaved parents involved in a non-cancer-directed treatment decision. IMPLICATIONS: Shared-decision aids should be prepared for young parents with low education to improve disease-related knowledge, accurate risk perceptions, and options congruent with parents' values.

Epidural block associated with improved long-term survival after surgery for colorectal cancer: A retrospective cohort study with propensity score matching / 北京大学学报(医学版)

OBJECTIVE@#To investigate the effect of epidural anesthesia on the long-term prognosis of patients after selective colorectal cancer resection surgery.@*METHODS@#This was a retrospective cohort study and approved by local institution review board. Patients who underwent selective colorectal cancer resection surgery from August 2011 to December 2012 in Peking University First Hospital were enrolled. The patients were divided into general anesthesia (GA) group and combined epidural-general anesthesia (EGA) group according to anesthesia type. Primary outcome was patient's long-term survival status. Secondary outcome included the overall incidence of in-hospital complications and length of postoperative in-hospital stay. Propensity score was used to match cases between the two groups based on the probability of receiving EGA. Survival was analyzed by Kaplan-Meier analysis and compared by Log-rank test between the two groups. Multivariate Cox regression analysis was used to investigate the relationship between epidural anesthesia and other variables with long-term survival status.@*RESULTS@#A total of 264 patients were entered into final analysis, including 166 cases in GA group and 98 cases in EGA group. Mean age of the patients was (63.3±12.1) years and mean survival time was 47.2 (95%CI 45.7-48.7) months. Before the propensity score match, the mortality in EGA group was 16.9% (28/166) and 9.2% (9/98) in GA group. But comparison between the two groups had no statistical significance (P=0.091). After the propensity score match, 87 paired cases were matched and analyzed. The risk of long-term mortality in EGA group was lower than that of GA group by Kaplan-Meier analysis (5.7% vs.16.1%, HR=0.344, 95%CI 0.124-0.955, P=0.041). Mean survival time of EGA group was longer than that of GA group (50.3 months vs. 42.9 months, P=0.032). Multivariate Cox regression ana-lysis showed that EGA, in comparison with GA, was related with lower risk of long-term mortality (HR=0.326, 95%CI 0.117-0.909, P=0.032). Age (HR=1.042, 95%CI 1.001-1.085, P=0.046) and preoperative lymph node metastasis (HR=2.924, 95%CI 1.162-7.356, P=0.023) were also related with increased risk of long-term mortality.@*CONCLUSION@#Present study found that perioperative use of epidural anesthesia and analgesia was associated with improvement of the patient's long-term survival. Well-designed studies are needed to verify this hypothesis.

Minimum clinical important difference for resilience scale specific to cancer: a prospective analysis.

BACKGROUND: The minimum clinical important differences (MCIDs) of resilience instruments in patients with cancer have not been comprehensively described. This study was designed to evaluate MCIDs of 10-item and 25-item resilience scales specific to cancer (RS-SC-10 and RS-SC-25). METHODS: From June 2015 to December 2018, RS-SCs were longitudinally measured in 765 patients with different cancer diagnoses at baseline (T0) and 3 months later (T1). The EORTC QLQ-C30, Connor-Davidson Resilience Scale, Hospital Anxiety and Depression Scale, and Allostatic Load Index were measured concurrently as anchors. Anchor-based methods (linear regression, within-group), distribution-based methods(within-group), and receiver operating characteristic curves (ROCs, within-subject) were performed to evaluate the MCIDs. RESULTS: 623 of 765 (84.1%) patients had paired RS-SCs scores. Moderate correlations were identified between the change in RS-SCs and change in anchors (r = 0.38-0.44, all p < 0.001). Linear regression estimated + 8.9 and - 6.7 as the MCIDs of RS-SC-25, and + 3.4 and - 2.5 for RS-SC-10. Distribution-based methods estimated + 9.9 and - 9.9 as the MCIDs of RS-SC-25, and + 4.0 and - 4.0 for RS-SC-10. ROC estimated + 5.5 and - 4.5 as the MCIDs of RS-SC-25, and + 2.0 and - 1.5 for RS-SC-10. CONCLUSIONS: The most reliable MCID is around 5 points for RS-SC-25 and 2 points for RS-SC-10. RS-SCs are more responsive to the worsening status of resilience in patients with cancer and these estimates could be useful in future resilience-based intervention trials.

State or trait? Measuring resilience by generalisability theory in breast cancer.

PURPOSE: Whether resilience should be conceptualised as a state or trait is debated. The precise distinction between state versus trait aspects of resilience can help identify dynamic targets for resilience-based intervention trials involving cancer patients. This study was designed to disentangle the state and trait components of resilience in patients with breast cancer with the help of Generalisability Theory (GT) methods. METHODS: The relative contributions of state (temporary) and trait (enduring) aspects of resilience were calculated using a 10-item Resilience Scale Specific to Cancer (RS-SC-10) and GT methods. In all, 391 patients were enrolled from the 'Be Resilient to Breast Cancer ' (BRBC) trial, and data from 317 patients (81.7%) were collected at baseline, 3 months, 6 months, and 12 months after the intervention. RESULTS: The subscale of Generic Elements demonstrated high generalisability value (relative G-coefficient = 0.81) across different occasions and captured 79% of the variance attributed to enduring aspects of resilience. The subscale of Shift-Persist showed low generalisability value (relative G-coefficient = 0.31) and identified 59% of the variance attributed to temporary aspects of resilience. The GT studies suggested that 5-7 items per scale and three measurement occasions were adequate for score reliability evaluation. CONCLUSION: Resilience should be conceptualised as a state-trait mixed psychological variable in breast cancer patients. The subscale of Shift-Persist in RS-SC-10 is amenable to intervention and could be utilised as a primary outcome in resilience-based intervention trials. CLINICAL TRIAL REGISTRATION: None.

Effectiveness of adjuvant supportive-expressive group therapy for breast cancer.

PURPOSE: Randomized control trials exploring adjuvant supportive-expressive group therapy (SEGT) for breast cancer have yielded conflicting survival results. This retrospective cohort study was designed to explore the association of adjuvant SEGT performed at diagnosis with survival in real-world patients. METHODS: 3327 patients with breast cancer were divided between those who received oncologic treatment combined with SEGT-based intervention (referred to as BRBC [n = 354]) and those who only received oncologic treatment (referred to as OT [n = 2973]). Primary outcome was overall survival (OS) at 1-year, 3-year, 5-year. Propensity score-matched analysis (at a ratio of 1:3) and instrumental variable analysis (IVA) were performed. RESULTS: The median overall survival was 7.3 years (95% CI 7.0-7.7 years) in BRBC and 7.1 years (95% CI 6.9-7.4 years) in OT. BRBC was not significantly associated with improved 1-year (HR 0.74, 95% CI 0.49-1.10, P = 0.1748; NNT = 44.8, 95% CI - 118.5 to 22.6), 3-year (HR 0.98, 95% CI 0.75-1.27, P = 0.8640; NNT = 273.7, 95% CI - 21.0 to 21.3), or 5-year survival (HR 0.79, 95% CI 0.61-1.02, P = 0.0908; NNT = 36.0, 95% CI - 384.5 to 19.1) compared with OT. IVA indicated that BRBC had a survival benefit over OT in the 1-year, 3-year, and 5-year of 1.5% (95% CI 1.2-1.9%), 0.7% (95% CI 0.6-0.8%), and 2.6% (95% CI 2.0-3.4%), respectively. CONCLUSION: Adjuvant SEGT cannot significantly prolong 5-year survival in breast cancer, though a longer observation period is warranted according to the marginal survival benefit identified at the end of the follow-up.

Impact of oliguria during lung surgery on postoperative acute kidney injury / 北京大学学报(医学版)

OBJECTIVE@#To explore the influence of intraoperative urine volume on postoperative acute kidney injury (AKI) and the independent risk factors of AKI.@*METHODS@#This was a retrospective cohort study recruiting patients who received selective pulmonary resection under general anesthesia in Peking University First Hospital from July, 2017 to June, 2019. The patients were divided into the AKI group and the control group according to whether they developed postoperative AKI or not. Firstly, univariate analysis was used to analyze the relationship between perioperative variables and postoperative AKI. Secondly, receiver operating characteristic (ROC) curve was used to explore the predictive value of intraoperative urine output for postoperative AKI. The nearest four cutoff values [with the interval of 0.1 mL/(kg·h)] at maximum Youden index were used as cutoff values of oliguria. Then univariate analysis was used to explore the relationship between oliguria defined by these four cutoff values and the risk of AKI. And the cutoff value with maximum OR was chosen as the threshold of oliguria in this study. Lastly, the variables with P < 0.10 in the univariate analysis were selected for inclusion in a multivariate Logistic model to analyze the independent predictors of postoperative AKI.@*RESULTS@#A total of 1 393 patients were enrolled in the study. The incidence of postoperative AKI was 2.2%. ROC curve analysis showed that the area under curve (AUC) of intraoperative urine volume used for predicting postoperative AKI was 0.636 (P=0.009), and the cutoff value of oliguria was 0.785 mL/(kg·h) when Youden index was maximum (Youden index =0.234, sensitivity =48.4%, specificity =75.0%). Furthermore, 0.7, 0.8, 0.9, 1.0 mL/(kg·h) and the traditional cutoff value of 0.5 mL/(kg·h) were used to analyze the influence of oliguria on postoperative AKI. Univariate analysis showed that, when 0.8 mL/(kg·h) was selected as the threshold of oliguria, the patients with oliguria had the most significantly increased risk of AKI (AKI group 48.4% vs. control group 25.3%, OR=2.774, 95%CI 1.357－5.671, P=0.004). Multivariate regression analysis showed that intraoperative urine output < 0.8 mL/(kg·h) was one of the independent risk factors of postoperative AKI (OR=2.698, 95%CI 1.260－5.778, P=0.011). The other two were preoperative hemoglobin ≤120.0 g/L (OR=3.605, 95%CI 1.545－8.412, P=0.003) and preoperative estimated glomerular filtration rate < 30 mL/(min·1.73 m2) (OR=11.009, 95%CI 1.813－66.843, P=0.009).@*CONCLUSION@#Oliguria is an independent risk fact or of postoperative AKI after pulmonary resection, and urine volume < 0.8 mL/(kg·h) is a possible screening criterium.

Development and psychometric analysis of the 10-item resilience scale specific to cancer: A multidimensional item response theory analysis.

PURPOSE: Resilience is an important concept in the cancer literature and is a salient indicator of cancer survivorship. Classic theory test (CTT) and item response theory (IRT) were performed to develop and validate the 25-item Resilience Scale Specific to Cancer (RS-SC). This study was designed to develop and validate a short form of RS-SC (RS-SC-10) with a multidimensional IRT (MIRT) analysis. METHODS: MIRT analysis was performed to test two models (three- and five-factor) derived from previous studies and assess the item parameters of RS-SC and RS-SC-10. RESULTS: A total of 451 Chinese patients with different cancer diagnoses were analyzed. The three-factor structure showed better goodness of fit compared with the five-factor structure in RS-SC. RS-SC-10 retained 10 items with high discriminative parameters from RS-SC and consisted of two factors, Generic and Shift-Persist. Item information function indicated that RS-SC-10 had the highest discrimination ability among patients with low to moderate levels of resilience. CONCLUSIONS: MIRT provided useful information on RS-SC and RS-SC-10 by combining the approaches of CTT and IRT. RS-SC-10 showed great potential in clinical settings owing to the low scale of burden on patients. More studies on the Minimum Clinically Important Difference of RS-SC-10 are warranted.

Curcumin attenuates hypoxia/reoxygenation­induced cardiomyocyte injury by downregulating Notch signaling.

Recovery of the blood supply is the most effective treatment against ischemic heart disease; however, it is also a major cause of myocardial ischemia/reperfusion injury in clinical therapy. Curcumin has been reported to possess beneficial effects against hypoxia/reoxygenation (H/R)­induced cardiomyocyte injury by regulating cell proliferation, apoptosis and antioxidant enzyme activity. The aim of the present study was to investigate the molecular mechanisms underlying the effects of curcumin on H/R­injured cardiomyocytes. H9C2 cardiomyocytes were pretreated with curcumin, and then cultured under H/R conditions. The viability of H9C2 cells was measured using a Cell Counting kit­8 assay, and the levels of intracellular lactate dehydrogenase (LDH), malondialdehyde (MDA) and superoxide dismutase (SOD) were measured to assess cell injury. Levels of reactive oxygen species (ROS) and apoptosis were evaluated by flow cytometry. The expression levels of Notch intracellular domain (NICD) and numerous downstream genes were analyzed via reverse transcription­quantitative polymerase chain reaction and western blotting. The results revealed that curcumin protected H9C2 cells against H/R­induced injury, reversing the H/R­induced increases in LDH and MDA levels, and decreases in SOD levels. ROS levels in H/R­induced cells were also significantly downregulated by curcumin treatment (P<0.01), and the apoptotic rate was significantly decreased from 15.13% in the H/R group to 7.7% in the H/R + curcumin group (P<0.01). The expression levels of NICD, hairy and enhancer of split (Hes)­1, Hes­5 and hairy/enhancer­of­split related with YRPW motif protein 1 (Hey­1) were significantly decreased in H/R­treated cells following curcumin treatment. Treatment with Jagged1 attenuated the effects of curcumin on cell viability, ROS levels and apoptosis; the Notch pathway was also reactivated. The present study indicated that there was a role for the Notch pathway in the protective effects of curcumin against H/R­induced cardiomyocyte injury, suggesting that downregulation of the Notch pathway may alleviate H/R­induced injury in H9C2 cells.

Symptoms and management of children with incurable cancer in mainland China.

PURPOSE: This study was designed to report information regarding symptomology of incurable pediatric cancer to promote proactive medicine and support for children and their families in the palliative phase in Mainland China. METHOD: A multi-center retrospective cohort study including 205 children who died from incurable cancer between June 2008 and September 2013 were analyzed. RESULTS: An incurable diagnosis was confirmed between 0 and 1726 (median, 279) days from initial diagnosis with death occurring between 1 and 239(median, 83) days. The most frequent symptoms were fatigue (93.7%), pain (87.3%), and poor appetite (76.1%). The earliest symptoms were pain and fatigue. Children with leukemia and lymphoma also complained early of nausea/vomiting, and children with solid tumors complained early of disturbed sleep. Later in the palliative phase, altered consciousness and seizures were found in children with central nervous system tumors and solid tumors, while children with leukemia and lymphoma were found to have fever, diarrhea, and bleeding. However, these symptoms only persisted for a short time. DNR discussions were held in 89 cases (43.4%) at a median of 37 (range, 4-178) days before death. A total of 154 patients (75.1%) died at home and 51 patients (24.9%) in the hospital. CONCLUSIONS: This study provides new knowledge about symptomology to health care professionals and parents of children in Mainland China. Given our results, an improved alternative care plan should be developed and implemented earlier to facilitate end-of-life planning.