Objective To analyse the concept of subjective financial distress in cancer patients.Methods Papers in regarding the subjective financial distress were retrieved from the databases such as China National Knowledge Infrastructure(CNKI),Wangfang Database,PubMed,Cochrane Library,Web of Science,CINAHL,and Embase from the inceptions to 16th October,2022.Walker and Avant's concept analysis was performed to analyse the acquired articles.Results A total of 48 articles were retrieved and included in the study.Walker and Avant's concept analysis showed that the subjective financial distress in the patients was subject to the 3 defining attributes:perceived economic risk,coping behaviours,and negative emotional reactions.The antecedents of this distress included individual factors,disease and treatment factors,and social factors.The consequences of them were the increase in negative health behaviours and poorer quality of life.Conclusions The attributes,antecedents and consequences of subjective financial distress,as identified through the conceptual analysis,can serve as a reference for subsequent researches.In future studies,it would be beneficial by further exploring the connotation by considering China's healthcare system.

Objective:To explore the optimal pulse oxygen saturation (SpO 2) range during hospitalization for patients with sepsis. Methods:A case-control study design was employed. Demographic information, vital signs, comorbidities, laboratory parameters, critical illness scores, clinical treatment information, and clinical outcomes of sepsis patients were extracted from the Medical Information Mart for Intensive Care-Ⅳ (MIMIC-Ⅳ). A generalized additive model (GAM) combined with a Loess smoothing function was employed to analyze and visualize the nonlinear relationship between SpO 2 levels during hospitalization and in-hospital all-cause mortality. The optimal range of SpO 2 was determined, and Logistic regression model along with Kaplan-Meier curve were utilized to validate the association between the determined range of SpO 2 and in-hospital all-cause mortality. Results:A total of 5?937 patients met the inclusion criteria, among whom 1?191 (20.1%) died during hospitalization. GAM analysis revealed a nonlinear and U-shaped relationship between SpO 2 levels and in-hospital all-cause mortality among sepsis patients during hospitalization. Multivariable Logistic regression analysis further confirmed that patients with SpO 2 levels between 0.96 and 0.98 during hospitalization had a decreased mortality compared to those with SpO 2 < 0.96 [hypoxia group; odds ratio ( OR) = 2.659, 95% confidence interval (95% CI) was 2.190-3.229, P < 0.001] and SpO 2 > 0.98 (hyperoxia group; OR = 1.594, 95% CI was 1.337-1.900, P < 0.001). Kaplan-Meier survival curve showed that patients with SpO 2 between 0.96 and 0.98 during hospitalization had a higher probability of survival than those patient with SpO 2 < 0.96 and SpO 2 > 0.98 (Log-Rank test: χ2 = 113.400, P < 0.001). Sensitivity analyses demonstrated that, with the exception of subgroups with smaller sample sizes, across the strata of age, gender, body mass index (BMI), admission type, race, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, respiratory rate, body temperature, myocardial infarction, congestive heart failure, cerebrovascular disease, chronic liver disease, diabetes mellitus, sequential organ failure assessment (SOFA), simplified acute physiology score Ⅱ (SAPSⅡ), systemic inflammatory response syndrome score (SIRS), and Glasgow coma score (GCS), the mortality of patients with SpO 2 between 0.96 and 0.98 was significantly lower than those of patients with SpO 2 < 0.96 and SpO 2 > 0.98. Conclusions:During hospitalization, the level of SpO 2 among sepsis patients exhibits a U-shaped relationship with in-hospital all-cause mortality, indicating that heightened and diminished oxygen levels are both associated with increased mortality risk. The optimal SpO 2 range is determined to be between 0.96 and 0.98.

Danshen, the dried roots and rhizomes of Salvia miltiorrhiza Bunge (S. miltiorrhiza), is widely used in the treatment of cardiovascular and cerebrovascular diseases. Tanshinones, the bioactive compounds from Danshen, exhibit a wide spectrum of pharmacological properties, suggesting their potential for future therapeutic applications. Tanshinone biosynthesis is a complex process involving at least six P450 enzymes that have been identified and characterized, most of which belong to the CYP76 and CYP71 families. In this study, CYP81C16, a member of the CYP71 clan, was identified in S. miltiorrhiza. An in vitro assay revealed that it could catalyze the hydroxylation of four para-quinone-type tanshinones, namely neocryptotanshinone, deoxyneocryptotanshinone, and danshenxinkuns A and B. SmCYP81C16 emerged as a potential broad-spectrum oxidase targeting the C-18 position of para-quinone-type tanshinones with an impressive relative conversion rate exceeding 90%. Kinetic evaluations andin vivo assays underscored its highest affinity towards neocryptotanshinone among the tested substrates. The overexpression of SmCYP81C16 promoted the accumulation of (iso)tanshinone in hairy root lines. The characterization of SmCYP81C16 in this study accentuates its potential as a pivotal tool in the biotechnological production of tanshinones, either through microbial or plant metabolic engineering.
Humans ; Salvia miltiorrhiza/metabolism* ; Biosynthetic Pathways ; Quinones/metabolism* ; Plant Roots/metabolism* ; Gene Expression Regulation, Plant

Objective:To explore the predictive value of systemic immune inflammation index (SII) for the risk of hospital death in critically ill patients.Methods:The basic information and clinical data of critically ill patients were extracted from the Medical Information Mart for Intensive Care database-Ⅳ (MIMIC-IV) database, including demographic data, vital signs, blood routine, Logistic organ dysfunction score (Lods), Oxford acute severity of illness score (Oasis), simplified acute physiology score (Saps-Ⅱ), acute physiology score Ⅲ (APS-Ⅲ), sequential organ failure score (SOFA) and outcome. The main outcome was hospital death, and the secondary outcomes were length of hospital stay, continuous renal replacement therapy (CRRT), invasive ventilation and 1-year mortality. Patients were divided into two groups according to in-hospital death, and the differences between the groups were compared. According to the SII tripartite for inter-group comparison, the patients were further divided into three groups for comparison, and Logistic regression model was used to analyze the odd ratio ( OR) of the three groups. Results:A total of 32 450 critically ill patients were included in the study, of which 3765 died in hospital, with a mortality rate of 11.6%. ① Compared with the survival group, the SII in the death group were significantly higher ( P < 0.05). ② The mortality for the SII tripartite grouping (<817; 817~2 151; >2 151) were 8.4%, 10.2% and 16.3%, respectively, and the differences between groups were statistically significant. ③ Further, Logistic regression model analysis showed that the risk of death increased gradually with the increase of groups (the first group was the reference group, OR of the second group was 1.38, 95% CI 1.24-1.54, and OR of the third group was 2.03, 95% CI 1.83-2.24 ( P < 0.05). Conclusions:SII has a certain value in predicting hospital death in critically ill patients. It is easy to obtain and can be used for risk stratification of critically ill patients.

Financial toxicity is widely present among caregivers of cancer patients and has adverse effects on the health outcomes of patients and their caregivers. This article reviews the relevant concepts, current status and impacts, evaluation tools, influencing factors, and interventions of financial toxicity of caregivers for cancer patients, aiming to provide a basis for the research on financial toxicity of caregivers for cancer patients.

Objective:To evaluate the predictive value of sequential organ failure assessment (SOFA) for 28-day mortality in patients with post-cardiac arrest syndrome (PCAS).Methods:Retrospective analysis of 125 patients with PCAS who were treated in Emergency Intensive Care Unit (EICU) of Wenzhou People's Hospital from July 2016 to July 2021. Clinical data were collected, including age, gender, underlying diseases, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), SOFA score on admission to EICU and 28-day mortality. Univariate and multivariate Logistic regression model was constructed to analyze the influencing factors of PCAS patients, which was used to examine the independent correlation between SOFA score and 28-day mortality. Receiver operator characteristic curve (ROC curve) was used to determine the best predictive value of SOFA score and 28-day mortality in PCAS patients.Results:Among the 125 PCAS patients, there were 91 males and 34 females with an average age of (58.7±15.1) years old, and 97 died and 28 survived within 28 days. The overall SOFA score ranged from 7 to 15 points, with an average of 10.9 (10.0, 12.0) points. The SOFA score of non-survival group was significantly higher than that of the survival group [points: 11.0 (10.0, 12.0) vs. 9.5 (9.0, 10.0), P < 0.05]. This difference between SOFA score mainly caused by the neurological and cardiovascular systems. After excluding neurological factors, the SOFA score of the non-survival group was still significantly higher than that of the survival group [points: 8.0 (6.0, 8.0) vs. 6.5 (6.0, 7.0), P < 0.05]. SOFA score was found to be an independent risk factor for 28-day mortality in PCAS patients by multifactorial Logistic regression analysis [odds ratio ( OR) = 1.97, 95% confidence interval (95% CI) was 1.24-3.04]. The correlation between neurological score and mortality was the highest in subgroups ( OR = 3.47, 95% CI was 1.04-11.52). The area under the ROC curve (AUC) predicted by SOFA score was 0.81 (95% CI was 0.73-0.89). When SOFA score cut-off value was 10.5 points (10 or 11 points), the sensitivity and specificity of SOFA score for predicting 28-day mortality in patients with PCAS were 67.0% and 82.1%, respectively. Conclusions:The SOFA score is quite accurate in predicting 28-day mortality in patients with PCAS.

Objective:To examine the differences of local functional connectivity in male and female children with autism spectrum disorders (ASD), and analyze the correlation of local functional connectivity with severity of clinical symptoms in ASD children.Methods:In the International Autism Brain Imaging Exchange Database, resting-state functional MR imaging (rs-fMRI) and T1WI data were extracted from 72 children with ASD (36 male and 36 female) and 72 normal controls (36 male and 36 female) who met the inclusion criteria at 5 sites. Regional homogeneity (ReHo) method was used to evaluate the local functional connectivity of the 4 groups. A covariance analysis (gender and diagnosis as factors; age, total intelligence quotient, and head movement parameters as concomitant variables) was used to find out the differences of ReHo in the 4 groups. Pearson correlation analysis was used to examine the correlation between ReHo values with significant differences in covariance analysis and revised autism diagnostic interview (ADI-R) scale scores in children with ASD.Results:(1) Regarding the main effect of diagnosis, significantly decreased ReHo values in the right posterior cerebellar lobe, and significantly increased ReHo values in the left anterior central gyrus and the left precuneus of the ASD children were noted as compared with those in the normal controls (GRF calibration, voxel level: P<0.01, cluster level: P<0.05); regarding the main effect of gender, the male subjects had significantly higher ReHo value in the right middle temporal gyrus, and significantly lower ReHo values in the left inferior frontal gyrus, the left precuneus, the right angular gyrus, and the right supramarginal gyrus than the female subjects (GRF calibration, voxel level: P<0.01, cluster level: P<0.05); interaction effect (diagnosis×gender) results showed that there was significant difference in ReHo values of the left middle frontal gyrus among the 4 groups (GRF calibration, voxel level: P<0.01, cluster level: P<0.05). (2) The results of Pearson correlation analysis showed that the ReHo value in the right middle temporal gyrus was positively correlated with the verbal performance scores measured by ADI-R scale ( r=0.387, P=0.026), and the ReHo value in the right posterior cerebellar lobe was positively correlated with the social dimensionality scores ( r=0.364, P=0.037) in male patients with ASD; the ReHo value in the right supramarginal gyrus was negatively associated with the social dimensionality scores ( r=-0.395, P=0.031), and the ReHo value in the left middle frontal gyrus was negatively associated with the repetitive behavior scores in female patients with ASD ( r=-0.398, P=0.029). Conclusion:There are brain regions with abnormal local functional connectivity in ASD children, and there are differences in local functional connectivity between male and female patients with ASD, which may be the brain functional basis of the differences in the clinical manifestations of male and female patients with ASD, and local functional connectivity in some brain regions is related to the severity of clinical symptoms of the children with ASD.

This paper is to clarify the concept of caregiver mutuality,introduce the main measuring tools of caregiver mutuality,analyze its influencing factors and its impact on caregivers. It elaborates the intervention measures of caregiver mutuality,in order to provide basis for better research.

Objective:To explore the mutuality among main caregivers of pancreatic cancer patients with surgery, and its correlations with the perceived social support and resilience.Methods:From March to July 2019, this study selected 150 main caregivers of pancreatic cancer patients with surgery of the First Affiliated Hospital with Nanjing Medical University as subjects by convenience sampling. All of patients were investigated with the General Information Questionnaire, the Mutuality Scale (MS) , Perceived Social Support Scale (PSSS) and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10) . A total of 150 questionnaires were sent out and 144 valid of them were collected.Results:Among 144 main caregivers of pancreatic cancer patients after surgery, the total average score of MS was (2.75±0.73) . Pearson correlation analysis results showed that the mutuality of main caregivers had positive correlations with the perceived social support and resilience with statistical differences ( P<0.05) . Hierarchical regression analysis showed that the genders, income, perceived social support and resilience went into the regression equation; except for the general information, the perceived social support and resilience could explain 24.5% of the variation. Conclusions:Main caregivers of pancreatic cancer patients with surgery have the above medium level of mutuality which has close correlations with the perceived social support and resilience. Medical staff should pay attention to maintaining the positive relations between caregivers and patients so as to promote the physical and mental health of caregivers.

Objective:To systematically evaluate and summarize the real care experience of family caregivers of pancreatic cancer patients.Methods:We searched The Cochrane Library, Joanna Briggs Institute (JBI) , PubMed, Embase, Institute for Scientific Information (ISI) Web of Science, PsycINFO, CINAHL, China Biology Medicine, China National Knowledge Infrastructure (CNKI) and VIP databases through computer systems to collect qualitative studies on care experience of family caregivers of patients with pancreatic cancer, and the search time was from the database establishment to October 2019. With reference to the Critical Appraisal Tool of Australian JBI Evidence-based Health Care Center (2016) for qualitative research, the collection integration method was used to integrate the existing conclusions.Results:A total of 7 literatures were included, and 44 complete and defined findings were extracted. The similar results were summarized into 10 new categories, and were combined into two integrated results including that the family caregivers of patients with pancreatic cancer experienced self-adjustment and showed positive feelings and responses during care, and they still faced difficulties and challenges in care which affecting their life trajectory.Conclusions:Family caregivers of patients with pancreatic cancer have both negative and positive experiences throughout the care process. Medical staff should be committed to promoting the growth of the personal role of caregivers, adapting and coping, and addressing the existing unmet needs.