Circ_0017639 facilitates proliferative, migratory, and invasive potential of non-small cell lung cancer (NSCLC) cells via PI3K/AKT signaling pathway.

Non-small cell lung cancer (NSCLC) has increased morbidity and mortality rate worldwide. The current NSCLS therapies are associated with poor outcomes and need further improvement. CircRNAs were shown to regulate NSCLC progression. However, little is known re garding the functions and mechanisms of circ_0017639 in NSCLC, which requires further extensive studies. The circ_0017639 expression in NSCLC tissues and cell lines was evaluated via qRT-RCR. Moreover, using ectopic plasmid incorporation and shRNA assays, we analyzed the circ_0017639-mediated cellular proliferative, migratory and invasive processes in NSCLC cell lines, using CCK-8, EdU, and transwell assays. Furthermore, the core proteins (p-PI3K, PI3K, p-AKT, and AKT) levels of the PI3K/AKT signaling cascade were investigated via immunoblotting. Finally, we tested the functional role of circ_0017639 by examining its regulation of xenograft tumor growths in nude mice in vivo. Circ_0017639 expression was remarkably high in the NSCLC tissues and cell lines. The transfection experiments showed that circ_0017639 overexpression was able to promote proliferative, migratory, and invasive properties of NSCLC cells, while sh-circ_0017639 showed opposing effects. We further showed that circ_0017639 knockdown suppressed the cellular development via PI3K/AKT cascade inactivation. Additionally, in-vivo experiment in nude mice demonstrated that sh-circ_0017639 could reduce the tumor growth of NSCLC. Circ_0017639 may promote the development of NSCLC by accelerating NSCLC metastasis through stimulating the PI3K/AKT cascade.

Parents as practitioners in preterm care.

The very preterm birth of an infant is physiologically traumatic for the infant and physiologically and psychologically traumatic for the parents. The manner of care delivery in the first few days and weeks of the infant's life plays a large role in determining the impact of that trauma. For optimal outcomes parents need to be integrated into the care process as the primary practitioners of their infant's care in the neonatal intensive care unit. Supporting and enabling parents to be central to the care process establishes a consistent care environment where parents are in control and able to support their infant's physiological and psychological needs, thereby improving infant outcomes and reducing parent stress and anxiety. This article reviews the role of parents in the optimal development of preterm neonates, and discusses the elements crucial to promoting parent involvement in the neonatal intensive care unit and supporting parents following discharge.

Acute Care of At-Risk Newborns (ACoRN): quantitative and qualitative educational evaluation of the program in a region of China.

BACKGROUND: The Acute Care of at-Risk Newborns (ACoRN) program was developed in Canada for trained health care providers for the identification and management of newborns who are at-risk and/or become unwell in the first few hours or days after birth. The ACoRN process follows an 8-step framework that enables the evaluation and management of babies irrespective of the experience or expertise of the caregiving individual or team. This study assesses the applicability of the program to Chinese pediatric practitioners. METHODS: Course content and educational materials were translated from English into Chinese by bilingual neonatal practitioners. Confidence and knowledge questionnaires were developed and reviewed for face and content validity by a team of ACoRN instructors. Bilingual Chinese instructors were trained at the tertiary perinatal centre in Hangzhou Zhejiang to deliver the course at 15 level II county hospitals. Participants completed pre- and post-course confidence and knowledge questionnaires and provided feedback through post-course focus groups. RESULTS: 216 physicians and nurses were trained. Confidence and knowledge relating to neonatal stabilization improved significantly following the courses. Participants rated course utility and function between 4.2 and 4.6/5 on all items. Pre/post measures of confidence were significantly correlated with post course knowledge. Focus group data supported the perceived value of the program and recommended course adjustments to include pre-course reading, and increased content related to simulation, communication skills, and management of respiratory illness and jaundice. CONCLUSIONS: ACoRN, a Canadian educational program, appears to be well received by Chinese health care providers and results in improved knowledge and confidence. International program adaptation for use by health care professionals requires structured and systematic evaluation to ensure that the program meets the needs of learners, reflects their learning styles, and can be applied in their setting.

Neonatal outcomes of small for gestational age preterm infants in Canada.

To compare the effect of small for gestational age (SGA) on mortality, major morbidity and resource utilization among singleton very preterm infants (<33 weeks gestation) admitted to neonatal intensive care units (NICUs) across Canada. Infants admitted to participating NICUs from 2003 to 2008 were divided into SGA (defined as birth weight <10th percentile for gestational age and sex) and non-small gestational age (non-SGA) groups. The risk-adjusted effects of SGA on neonatal outcomes and resource utilization were examined using multivariable analyses. SGA infants (n = 1249 from a cohort of 11,909) had a higher odds of mortality (adjusted odds ratio [AOR] 2.46; 95% confidence interval [CI], 1.93-3.14), necrotizing enterocolitis (AOR 1.57; 95% CI, 1.22-2.03), bronchopulmonary dysplasia (AOR 1.78; 95% CI, 1.48-2.13), and severe retinopathy of prematurity (AOR 2.34; 95% CI, 1.71-3.19). These infants also had lower odds of survival free of major morbidity (AOR 0.50; 95% CI, 0.43-0.58) and respiratory distress syndrome (AOR 0.79; 95% CI, 0.68-0.93). In addition, SGA infants had a more prolonged stay in the NICU, and longer use of ventilation continuous positive airway pressure, and supplemental oxygen (p < 0.01 for all). SGA infants had a higher risk of mortality, major morbidities, and higher resource utilization compared with non-SGA infants.

Comparison of singleton and multiple-birth outcomes of infants born at or before 32 weeks of gestation.

OBJECTIVE: To compare the outcomes of multiple-birth and singleton very preterm infants who were admitted to neonatal intensive care units (NICUs). METHODS: Three-level hierarchical generalized linear and hierarchical linear model analyses were used to compare the risk-adjusted outcomes of 3,242 infants born at or before 32 weeks of gestational age who were admitted to 24 Canadian NICUs in 2005. RESULTS: With the exception of respiratory distress syndrome (RDS), multiple-birth infants were not at a higher risk than singleton birth infants for death, patent ductus arteriosus, necrotizing enterocolitis, chronic lung disease, severe intraventricular hemorrhage, severe (stages 3 or higher) retinopathy of prematurity, or nosocomial infection, after adjusting for perinatal risks and neonatal illness severity. In addition, multiple-birth infants did not have a more prolonged duration of neonatal intensive care unit stay, duration of length of continuous positive airway pressure use, duration of ventilation, or duration of oxygen use than did singletons. Multiple-birth infants had a higher incidence of RDS (adjusted odds ratio 1.3, 95% confidence interval 1.0-1.6) and a lower incidence of severe retinopathy of prematurity (adjusted odds ratio 0.5, 95% confidence interval 0.3-0.9) than did singletons. CONCLUSION: Multiple-birth and singleton very preterm infants had similar outcomes, except for a higher incidence of RDS among multiple-birth infants. LEVEL OF EVIDENCE: II.