041455   LIJIMOL A S, KRISHNAN A, RAJAGOPAL M R, GOPAL B K, BOOTH C M (Trivandrum Institute of Palliative Sciences and Pallium India, Thiruvananthapuram - 695 009, Kerala, Email: chairman@palliumindia.org) : Improving access and quality of palliative care in Kerala: A cross sectional study of providers in routine practice. Indian J Palliat Care 2020, 26(4), 500-5.

Expanding access and improving quality of palliative care in low‑middle income countries is a pressing priority. The objective of the study was to describe structure and processes of care across government (GO) and non‑GO (NGO) palliative care providers(PCPs) in Kerala, India. This was a cross‑sectional telephone survey. This study consisted of 200 randomly selected PCPs across Kerala. The survey explored organizational structure, patient assessment, opioid availability, and explored elements considered essential to palliative care delivery in the Indian context. One hundred GO and 100 NGO PCPs agreed to participate (100 % response rate). The annual median number of new patients was 183 and 159 in GO and NGO PCPs, respectively. The median number of annual home visits in GO PCPs was 1398 and in NGO PCPs was 979. Median number of outpatient visits in GO PCPs was 600 and in NGO PCPs was 520. Only 24 % (47/200) of the PCPs had full‑time physicians with training in palliative care; 60 % of GO PCPs had no full time physician with training in palliative care. Patient‑reported pain was routinely documented by 21 % (21/100) and 65 % (65/100) of the GO and NGO sites, respectively (P < 0.001). None of the GO and only 36 % (36/100) of NGO PCPs were able to prescribe oral morphine. Psychosocial and spiritual issues were documented routinely in only 4 % (4/100) and 48 % (47/99) of the GO and NGO PCPs, respectively (P < 0.001). Caution is needed against potential challenges to quality care in any new initiative. Kerala has achieved remarkable success in the coverage of palliative care through hundreds of locally active NGOs through GO machinery involving every primary health center. Yet, there are gaps such as absence of full‑time physicians. This study highlights the need for periodic review to identify gaps in care.

2 illus, 3 tables, 11 ref

043254   HIRAMOTO K, YAMATE Y (Pharmaceutical Sciences Dep, Suzuka Univ of Medical Science, Suzuka, Mie 513-8670, Japan, Email: hiramoto@suzuka-u.ac.jp) : Long-term UVA exposure to the eye compromises memory and learning ability in mice via corticotropinreleasing hormone type 2 receptor. Int J Biol Sci 2020, 16(12), 2170-9.

Long-term eye exposure to ultraviolet (UV)A can effect memory and learning ability. However, the underlying mechanism behind these effects remain unknown. In this study, we used HR-1 mice to study effects of long-term UVA eye irradiation. The eyes or dorsal skin of the mice were exposed to UVA at the dose of 110kj/m2 using an FL20SBLB-A lamp three times a week over 12 months. We measured the levels of reactive oxygen species, corticotropin-releasing hormone (CRH), urocortin 2, and CRH type 2 receptor (CRHR-2) in the brain of treated and control animals. Their memory and learning ability following exposure to UVA was analyzed by the standard water maze test. Our results showed that the levels of reactive oxygen species, CRH, urocortin 2, and CRHR-2 increased significantly following long-term UVA irradiation, and the effects were more pronounced in animals subjected to eye irradiation than those subjected to dorsal skin irradiation. Furthermore, the UVA exposure led to an increase in the levels of β-amyloid and microglia in the brain. These results indicated that UVA eye irradiation potentially mediated a decline in memory and learning ability via enhancing levels of urocortin 2, microglia, and β-amyloid in the brain.

7 illus, 29 ref

043253   CHEN S, XU M, ZHAO J, SHEN J, LI J, LIU Y, CAO G, MA J, HE W, CHEN X, et al. (General Surgery Dep, Second Affiliated Hospital of Xi'an Jiaotong Univ, PR China, Email: chenxijiaoda@163.com) : MicroRNA-4516 suppresses pancreatic cancer development via negatively regulating orthodenticle homeobox 1. Int J Biol Sci 2020, 16(12), 2159-69.

Pancreatic cancer remains one of the most lethal human cancers without efficient therapeutic strategy. MicoRNAs (miRNAs) are a group of small non-coding RNAs involved in multiple biological processes including tumor development and progression. In this study, we investigated the expression and function of miR-4516 in pancreatic cancer. MiR-4516 was low-expressed in pancreatic cancer tissues and cell lines. Overexpression of miR-4516 inhibited pancreatic cancer cell proliferation, migration and invasion, while promoted cell apoptosis in vitro. Further, overexpression of miR-4516 suppressed xenograft pancreatic tumor growth in vivo. Bioinformatics analysis was performed and miR-4516 was predicted to negatively regulate orthodenticle homeobox 1 (OTX1) expression by binding to its 3’-UTR. Consistently, OTX1 was highly expressed in pancreatic cancer tissues and cell lines. Knockdown of OTX1 expression suppressed pancreatic cancer cell migration and invasion, with down-regulated MMP2 and MMP9 expression. Moreover, we demonstrated that miR-4516 regulated pancreatic cancer cell growth, migration, invasion and apoptosis via targeting OTX1. Overexpression of OTX1 could partially abrogate the inhibitory effect of miR-4516. Taken together, we conclude that miR-4516 could function as a tumor suppressor via targeting OTX1. These findings suggest that miR-4516/OTX1 axis might be a novel therapeutic target for miRNA-based therapy for pancreatic cancer patients.

6 illus, 28 ref

041454   SARMA R, SIROHIYA P, RATRE B K, BHATNAGAR S (Anaesthesia Dep, ABVIMS and Dr. RML Hospital, Delhi - 110 001, Email: sirohiyaprashant@gmail.com) : Breaking the barrier: Challenges of methadone use – an introductory observation. Indian J Palliat Care 2020, 26(4), 495-9.

Palliative care physicians in India have achieved access to methadone for pain relief in cancer patients. Despite being an effective drug in terms of analgesia, there are a number of reasons why this opioid medication is not as much as popular as morphine. We identified and tried to overcome a few such barriers in treating cancer pain with methadone. The clinical information of ten adult cancer patients (six males and four females), who voluntarily received methadone for their severe pain in the month of August 2019 were analysed retrospectively. We converted morphine to methadone in all ten patients under the supervision of an experienced practitioner. During the methadone therapy, eight out of ten patients who were given methadone exclusively for their pain had adequate pain relief initially. The barriers identified included difficult titration methods due to distinct pharmacology, patient selection, clinical inertia, communication and co-ordination among physicians, communication among patient and physician, and patient and caregivers, and vigilant monitoring. Methadone is still finding its place in India for cancer pain management. As the drug is new to Indian practitioners, we have to overcome these barriers and facilitate its judicious use in cancer pain management.

2 illus, 3 tables, 23 ref

043252   PENG S, SUN Y , LUO Y, MA S, SUN W, TANG G, LI S, ZHANG N, REN J, XIAO Y, et al. (Radiation and Medical Oncology Dep, Zhongnan Hospital of Wuhan Univ, Wuhan, Hubei 430071, China, Email: chxie_65@whu.edu.cn) : MFP-FePt-GO nanocomposites promote radiosensitivity of non-small cell lung cancer via activating mitochondrial-mediated apoptosis and impairing DNA damage repair. Int J Biol Sci 2020, 16(12), 2145-58.

Recent advances in nanomedicine provided promising alternatives for tumor treatment to improve the survival and life quality of cancer patients. This study was designed to explore the insight mechanisms of the anti-tumor effects of the novel nanocomposites (NCs) MFP-FePt-GO with non-small cell lung cancer (NSCLC). A chemical co-reduction method was applied to the synthesis process of MFP-FePt-GO NCs. The chemical synthesis efficiency and morphology of the NCs were measured with spectroscope and transmission electron microscope. Colony formation assay and cell apoptosis were conducted to assess the radiosensitivity effect of NCs with radiation. Then, we detected cell mitochondrial membrane potential and reactive oxygen species (ROS) level by flow cytometry to further explore the cause of cell death. Immunofluorescence staining and Confocal were carried out to determine the DNA damage repair. A Lewis lung carcinoma animal model was used to measure safety and anti-tumor efficiency in vivo. The novel NCs MFP-FePt-GO designed on a lamellar-structure magnetic graphene oxide and polyethylene glycol drug delivery system was synthesized and functionalized for co-delivery of metronidazole and 5-fluorouracil. While no severe allergies, liver and kidney damage, or drug-related deaths were observed, MFP-FePt-GO NCs promoted radiosensitivity of NSCLC cells both in vivo and in vitro. It improved the effects of radiation via activating intrinsic mitochondrial-mediated apoptosis and impairing DNA damage repair. This NCs also induced a ROS burst, which suppressed the antioxidant protein expression and induced cell apoptosis. Furthermore, MFP-FePt-GO NCs prevented NSCLC cell migration and invasion. MFP-FePt-GO NCs showed a synergistic anti-tumor effect with radiation to eliminate tumors. With good safety and efficacy, this novel NCs could be a potential radiosensitive agent for NSCLC patients.

7 illus, 38 ref

041453   NAGARATHNAM M, LATHEEF S A A, SIVAKUMAR V (Hyderabad Univ, Hyderabad, Telangana, Email: yakheen@gmail.com) : Effect of variables on quality of life among caregivers of patients undergoing peritoneal dialysis. Indian J Palliat Care 2020, 26(4), 490-4.

Most of the studies carried out abroad showed the effect of one or two variables on the constructs of burden, coping strategies, and quality of life (QOL) but nil in India context. These constructs change by cultural factors. The evaluation of variables influencing these constructs may be helpful in fine tuning the interventions to reduce the burden and to improve the QOL of caregivers of patients undergoing peritoneal dialysis (PD). The aim of this study was to investigate the impact of demographic, social and clinical variables on burden, coping strategies, and QOL in caregivers of patients undergoing PD. In this prospective study, we recruited 100 caregivers of patients undergoing PD and made assessment on burden, coping strategies, and QOL and evaluated the effect of demographic, social, and clinical variables on these constructs. None of the studied variables showed effect on burden and coping strategies. Age, gender, duration of caregiving, presence of chronic disease, and duration of the presence of chronic disease showed a significant effect on QOL. The impact of demographic and clinical variables on QOL suggests these variables should be given adequate attention while developing interventions for alleviating the burden and improving the QOL of caregivers of patients undergoing PD.

3 tables, 22 ref

041452   WALIA A, SHARMA K K, GARG R, DAS S (Onco-Anaesthesia and Palliative Medicine Dep, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029, Email: drrgarg@hotmail.com) : A descriptive study to assess the knowledge, attitude, practices, perceived barriers, and support regarding palliative care and end-of-life care among critical care nurses of tertiary care medical institute. Indian J Palliat Care 2020, 26(4), 479-89.

The role of nurses working in critical care setup is one of the key members for optimal provision of the palliative care and endof-life care (EOLC). This study aims to assess knowledge, attitude, practices, and perceived barriers regarding palliative and EOLC among critical care nurses. A cross-sectional study was conducted among 386 critical care nurses of a tertiary care center, selected through convenience sampling technique. Data related to knowledge, attitude, practices, and perceived barriers were collected using a standardized tool. The collected data were analyzed using SPSS version 24. We observed that mean knowledge, attitude, and practice scores of critical care nurses were 9.83 ± 2.50 of 20, 104.91 ± 13.04 of 150, and 17.61 ± 4.36 of 27, respectively. One of the major barriers in providing palliative and EOLC was being called for attending to other newly admitted patients. The mean knowledge score of nurses was found to be significantly higher among female nurses (P = 0.016). Nurses who had additional training pertaining to palliative and EOLC had significantly higher mean knowledge (P = 0.001) and attitude scores (P = 0.02) than those who did not have such training. The mean practice (P = 0.02) and attitude score (P = 0.002) was significantly higher among postgraduate nurses as compared to nurses with lower qualification. The mean attitude score was significantly higher among nurses of lower age group (P = 0.04) along with a negative correlation of age of nurses with attitude (P = 0.01). Nurses’ practice was positively correlated to the attitude (P = 0.001) and knowledge (P = 0.01). There is a considerable gap between critical care nurses’ knowledge and practices, in spite of having a good attitude regarding palliative and EOLC. This necessitates the strengthening of both preservice and in-service education for nurses.

1 illus, 4 tables, 10 ref

041451   LOVE R R, PAUDEL B D, AHSAN G M T, AHAMED S I (Computer Science Dep, Marquette Univ, Milwaukee, WI, USA, Email: richardibcrf@gmail.com) : Symptoms in Nepali patients with incurable cancers: Implications for interventions. Indian J Palliat Care 2020, 26(4), 476-8.

The poor quality and limited extent of palliative care services are of concern across the globe. To identify and measure patients’ symptoms in Nepal, using a cell phone questionnaire platform, the investigators conducted and previously reported a cross‑sectional study of Nepali adults. The unreported details of pain and other symptoms in these study data are here considered together with possible explanations and implications for interventions to lessen these symptoms. In a “snapshot” cross‑sectional study of patients under regular care in three tertiary care Nepalese centers, we questioned 383 patients with incurable cancers using a 15‑item cell phone‑validated instrument to describe their major current symptoms and their intensities. The distributions of 11 symptom‑level scores and the correlations between pain and different symptom scores were determined. Thirty‑eight percent of the population (142/383) had maximal pain scores which were in the severe range, and 25 % (97/383) had such scores where they were evaluated. Patients reported moderate‑to‑severe tiredness 48 % (183/383), depression 45 % (172/383), anxiety 56 % (217/383), poor appetite 64 % (246/383), sleep quantity 64 % (246/383), and sleep quality 64 % (247/383). The significant fractions of patients with severe maximal and at‑evaluation pain scores suggest that inadequate recognition and treatment of such symptoms characterized care of these regularly seen patients. The high fractions of patients with mood and sleep disturbances support this reading, suggesting helplessness and hopelessness, all addressable with psychosocial, environmental, and nontoxic, inexpensive pharmacological interventions.

1 illus, 6 ref

041450   AROOGH M D, NOROUZI K, SHAHBOULAGHI F M, NEGARANDEH R (Nursing Dep, Social Welfare and Rehabilitation Sciences Univ, Tehran, Iran, Email: dr.kian_nourozi@yahoo.com) : Families’ experiences of end of life care at home for Iranian older adults: A qualitative study. Indian J Palliat Care 2020, 26(4), 468-75.

While the care of dying elderly patients at home is very complex and ambiguous, it has not been studied in Iran so far. Hence, this study aimed to explore the experience of a representative sample of the Iranian family caregivers from the end‑of‑life (EOL) care for their elderly relatives. The present study was conducted using a qualitative content analysis method. Twelve family caregivers caring for the chronically ill dying elderly were selected using purposeful sampling. The purposive sampling method was applied with an extreme variation in sampling, and data gathering was pursued until data saturation was achieved. Semi‑structured interviews were utilized for data collection. Interviews were recorded and instantly transcribed verbatim. Inductive content analysis was used to analyze the data. Four core themes and 13 subthemes emerged from the experiences of family’s caregiver as fallow: (1) Committed to care: This is related to encounter with the end of stage disease of the relative, accepting the care role and priority of care, (2) challenges of Care: Caregivers, despite their efforts, provided ineffective care, so they sought to empower themselves and at the same time provide compassionate care, (3) the crisis of care including the complexity of care, fear, and wandering, helplessness, devastating tension, and vacuum of supporting, and (4) conditions after death that family members involved with a sense of loss and Tension control. When families had to take care of their elderly patients at home, although their wish to give the best care, they are completely powerless to provide care, and in an atmosphere of the vacuum of supporting, they encounter severe challenges and crisis. It is vital that palliative care centers in the society are arranged to care for EOL elderly with comprehensive insurance services.

2 tables, 38 ref

041449   RAFII F, TALEGHANI F, KHATOONI M (Iran Univ of Medical Sciences, Tehran, Iran, Email: khatoni.m@iums.ac.ir) : The process of pain management in cancer patients at home: Causing the least harm – a grounded theory study. Indian J Palliat Care 2020, 26(4), 457-67.

Cancer pain management at home is a complicated and multidimensional experience that affects the foundational aspects of patients and their families’ lives. Understanding the pain relief process and the outcomes of palliative care at home is essential for designing programs to improve the quality of life of patients and their families. To explore family caregivers and patients’ experiences of pain management at home and develop a substantive theory. The study was carried out using a grounded theory methodology. Twenty patients and 32 family caregivers were recruited from Oncology wards and palliative medicine clinics in the hospitals affiliated to Iran University of Medical Sciences using Purposeful and theoretical sampling. The core category in this study was “pain relief with the least harm.” Other categories were formed around the core category including “pain assessment, determining the severity of pain, using hierarchical approaches to pain relief, assessing the results of applied approaches, determining the range of effectiveness, and barriers and facilitators of pain relief.” The substantive theory emerged from these categories was “Pain management process in cancer patients at home: Causing the least harm” that explains the stages of applying hierarchical approaches to pain relief, family care givers try to make decisions in a way that maximize pain relief and minimize damage to the patient. Along with using a hierarchical pattern, the process is featured with a circular pattern at broader perspective, which reflects dynamism of the process. The inferred categories and theory can expand knowledge and awareness about the stages of pain relief process, the pattern of using pain relief approaches, and the barriers and facilitators of pain relief process at home. Health‑care professionals may use these findings to assess the knowledge, skill, capability, problems, and needs of family caregivers and patients and develop supportive and educational programs to improve the efficiency of pain relief process at home and improve the patients’ quality of life.

1 illus, 1 table, 50 ref

041448   KUMAR J, ALAM M M, JOHNSON K C (Preventive Medicine Dep, Tennessee Health Science Center Univ, Memphis, TN 38163, USA, Email: jkumar7@uthsc.edu) : Nonpharmacological interventions for pain management in lung cancer patients: A systematic review. Indian J Palliat Care 2020, 26(4), 444-56.

The presence of lung cancer is almost always associated with pain, a symptom that causes severe distress in patients. Although many pharmacological methods are available to manage pain in this oncologic population, the medications often cause undesirable sideeffects and inadequate relief. Nonpharmacological interventions can be used as adjuvants to pharmacological interventions in reducing pain and increasing quality of life. The purpose of this review is to compare the efficacy of nonpharmacological interventions in reducing pain in lung cancer patients. This is a systematic review study guided by the Preferred Reporting Items of Systematic reviews and Meta-Analysis Protocol. Interventions identified in the present systematic review have been categorized as physical treatment, technologybased, cognitive behavioral, coping, and coaching. Results indicate that the nonpharmacological interventions such as physical treatment interventions, selfmanagement and coaching interventions, cognitive behavioral interventions, and technologybased interventions or coping skills interventions had limited and shortterm effects on alleviating pain among the patients. However, previous studies have provided limited evidence regarding nonpharmacologic therapy due to the lack of a comparison group, small sample sizes, and lack of longterm followup periods to determine whether sustained effects are feasible. Healthcare professionals should consider additional research on the added advantage of utilizing the nonpharmacological interventions as an adjunct option while managing pain in lung cancer patients.

1 illus, 1 table, 59 ref

041447   ANANDHI P, SHARIEF R M, RAHILA C (Dental Surgery Dep, Government Arignar Anna Memorial Cancer Institute, Kanchipuram ? 631 552, Tamil Nadu, Email: mudassarsharief@rediffmail.com) : The benefit of zinc sulfate in oropharyngeal mucositis during hyperfractionated accelerated concomitant boost radiotherapy with concurrent cisplatin for advanced stage oropharyngeal and hypopharyngeal cancers. Indian J Palliat Care 2020, 26(4), 437-43.

Radiation‑induced oropharyngeal mucositis is a major problem causing widespread clinical symptoms and may interfere with treatment plans, ultimately jeopardizing patient outcome. Zinc supplementation may be considered beneficial in preventing acute toxicity during chemoradiation. The aim of the study is to determine the effect of zinc supplementation on radiation‑induced oropharyngeal mucositis in Stage III and IV‑A oropharynx and hypopharynx cancers treated by hyperfractionated accelerated concomitant boost radiotherapy with weakly cisplatin. The objective behind the study is to know any changes in the onset, duration, and severity of oropharyngeal mucositis by implementation of oral zinc sulfate. The study is double‑blinded randomized controlled assessment involving 120 patients (60 – control and 60 – experimental) treated with chemoradiation for oropharyngeal and hypopharyngeal cancers. The experimental group received oral zinc sulfate 150 mg once daily during and after treatment, whereas the control group patients were given placebo. The categorical data were analyzed using the Chi‑square test and Pearson correlation. The Friedman test was used for comparison of oral mucositis grading between the groups. A statistically significant difference was found in the zinc‑supported experimental group showing delay in onset, decrease in severity, and duration of oropharyngeal mucositis. Zinc supplementation could be beneficial in managing oropharyngeal mucositis during chemoradiation of head‑and‑neck cancers with no untoward side effects.

2 illus, 4 tables, 31 ref

043251   TANG Z, WU X, HU L, XIAO Y, TAN J, ZUO S, SHEN M, YUAN X (Nanjing Medical Univ, Nanjing, China, Email: mingshen85@yahoo.com) : Circ-100290 positively regulates angiogenesis induced by conditioned medium of human amnion-derived mesenchymal stem cells through miR-449a/eNOS and miR-449a/VEGFA Axes. Int J Biol Sci 2020, 16(12), 2131-44.

The powerful pro-angiogenic capacity of human amnion-derived mesenchymal stem cells (hAMSCs) could be a valuable therapeutic angiogenesis strategy for bone regeneration. However, the molecular mechanisms underlying this process remain largely unknown. Herein, we report upregulated expression of circular RNA 100290 (circ-100290) and an enhanced angiogenic phenotype of human umbilical vein endothelial cells (HUVECs) incubated with conditioned medium from hAMSCs (hAMSC-CM), whereas downregulation of circ-100290 reversed the pro-angiogenic capacity of HUVECs induced by hAMSC-CM. Circ-100290/microRNA 449a (miR-449a)/endothelial nitric oxide synthase (eNOS) and circ-100290/miR-449a/vascular endothelial growth factor A (VEGFA) axes were predicted by a bioinformatics method and subsequently verified by luciferase reporter assays in vitro. Gain- or loss-of-function assays were then performed using small interfering RNAs (siRNAs) targeting circ-100290, or a plasmid overexpressing circ-100290. As expected, downregulation of circ-100290 in HUVECs led to weakened tube formation and migration of HUVECs following hAMSC-CM treatment, along with decreased expression of eNOS and VEGFA. In contrast, upregulation of circ-100290 led to enhanced tube formation and migration of HUVECs following hAMSC-CM treatment, along with increased expression of eNOS and VEGFA. Furthermore, a miR-449a inhibitor could largely rescue the effect of circ-100290 silencing on HUVECs, whereas a miR-449a mimic could significantly rescue the effect of overexpressing circ-100290 on HUVECs. Functional assays using eNOS or VEGF receptor inhibitors indicated eNOS and VEGFA may be important targets of miR-449a. Finally, a Matrigel plug assay revealed weakened angiogenesis when circ-100290 was silenced in HUVECs, but enhanced angiogenesis when circ-100290 was overexpressed in vivo. Our results suggest that circ-100290 might function via miR-449a/eNOS and miR-449a/VEGFA axes in the pro-angiogenic role of hAMSC-CM on HUVECs.

7 illus, 43 ref

043250   ZENG J, CHEN J-Y, MENG J, CHEN Z (Pulmonary and Critical Care Medicine Dep, Tongji Univ School of Medicine, Shanghai 200065, China, Email: zhichen@tongji.edu.cn) : Inflammation and DNA methylation coregulate the CtBP-PCAF-c-MYC transcriptional complex to activate the expression of a long non-coding RNA CASC2 in acute pancreatitis. Int J Biol Sci 2020, 16(12), 2116-30.

Long non-coding RNAs (lncRNAs) are emerging as important regulators involved in the pathogenesis of many diseases. However, it is still unknown if they contribute to the occurrence of acute pancreatitis (AP). Here, we identified a lncRNA CASC2 (Cancer Susceptibility Candidate 2) was significantly upregulated in the pancreatic tissues from AP patients. Knockdown or overexpression of CASC2 in vitro could specifically repress or induce the expression of two proinflammatory cytokines including IL6 (Interleukin 6) and IL17, respectively. Changing the expression levels of several transcription factors that were predicted to bind to the promoter of CASC2, we found c-MYC could specifically regulate the expression of CASC2. Using immunoprecipitation, mass spectrometry, and co-immunoprecipitation assays, we proved that c-MYC assembled a transcriptional complex with PCAF (p300/CBP-associated Factor) and CtBP1/2 (C-terminal Binding Protein 1 and 2), terming as the CtBP-PCAF-c-MYC (CPM) complex. Further investigation revealed that CtBPs were amplified in the pancreatic tissues from AP patients and they functioned as coactivators to induce the expression of CASC2 and thus led to the upregulation of IL6 and IL17. Moreover, we identified that decreased DNA methylation levels in the promoters of CtBPs and inflammatory stimuli coactivated the expression of CtBPs. Collectively, we identified a new signaling pathway in which DNA methylation and inflammatory stimuli coregulate the CPM complex to activate CASC2 expression, whose induction further activates the expression of IL6 and IL17, eventually aggravating inflammation response and causing the pathology of AP.

9 illus, 49 ref

041446   MOHAMMED A A, AL ZAHRANI O, ELSAYED F M (Medical Oncology Dep, Zagazig Univ, Zagazig, Egypt, Email: amrallaabdelmoneem@yahoo.com) : Impact of prognostic nutritional index on terminal cancer patients. Indian J Palliat Care 2020, 26(4), 433-6.

In terminal cancer patients (TCPs), one of the most important things is to define the survival to help the main responsible physicians, patients, and main caregivers make decisions, set goals, and work across the end‑of‑life strategies. We retrospectively reviewed the medical files of TCPs, who died during September 2011 and December 2017, to recognize the correlation between prognostic nutritional indices (PNIs) and survival in those subtypes of patients. The receiver operating characteristic (ROC) curve was used to identify the cutoff value of PNI. A total of 858 TCPs were eligible and included, the median age was 62 years (range: 18–107). The most common primary cancer sites were colorectal cancer in 151 patients (17.6 %), hepatobiliary in 129 (15 %), lung cancer in 115 (13.4 %), breast cancer in 114 (13.3 %), and genitourinary in 80 (9.3 %). The mean value of PNI for all cancer types was 32.9 ± 6.7. The values showed different levels across cancer types. For patients who lived >2 weeks, PNI was 36.7 compared with that who died within 2 weeks was 29.3, which was a statistically significant (P < 0.001). By the ROC curve, the cutoff value of PNI was 32.3 and area under the curve was 0.888. The sensitivity, specificity, positive predictive value, and negative predictive value were 91.28 % (95 % confidence interval [CI]: 88.2–93.8), 71.09 % (95 % CI: 66.5–75.4), 76.5 % (95 % CI: 73.7–79.2), and 88.8 % (95 % CI: 85.3–91.5), respectively. The PNI is an easy and an applicable biomarker to estimate life expectancy in TCPs.

1 illus, 3 tables, 27 ref

043249   LU Q, DING Y, LI Y, LU Q (Immunology Dep, Soochow Univ, Suzhou, P.R. China, Email: yangli0226@suda.edu.cn) : 5-HT receptor agonist valerenic acid enhances the innate immunity signal and suppresses glioblastoma cell growth and invasion. Int J Biol Sci 2020, 16(12), 2104-15.

Glioblastoma multiform (GBM) continues to threaten people’s lives due to the limited therapeutic strategies. As a new drug, Valerenic Acid suppresses the progression of GBM, however, the mechanism is largely unknown. Here, we found that Valerenic Acid can inhibit cell proliferation, migration and invasion of GBM cells by increasing innate immune signals such as enhancing ROS levels and activating the AMPK pathway. Inhibition of ROS by N-acetylcysteine (NAC) or attenuation of AMPK by Compound C could block Valerenic Acid-induced cell death. Additionally, the xenograft mouse model also confirmed that Valerenic Acid had anti-tumor effect. Together, our results provide compelling rational to develop Valerenic Acid as an anti-tumor agent against GBM patients.

8 illus, 18 ref

043248   ZENG H, LI T, ZHAI D, BI J, KUANG X, LU S, SHAN Z, LIN Y (First Affiliated Hospital of Sun Yat-sen Univ, Guangzhou 510080 China, Email: linying3@mail.sysu.edu.cn) : ZNF367-induced transcriptional activation of KIF15 accelerates the progression of breast cancer. Int J Biol Sci 2020, 16(12), 2084-93.

Breast cancer (BC) is one of the most common female cancers, and its incidence has been increasing in recent years. Although treatments are continuously improving, the prognosis of patients in the advanced stage is still unsatisfactory. Thus, an in-depth understanding of its molecular mechanisms is necessary for curing breast cancer. KIF15 is a tetrameric spindle motor which can regulate mitosis in cellular process and exert the crucial functions in several cancers. The purpose of our research was to investigate the functions of KIF15 in breast cancer. We tested the expression of KIF15 in breast cancer tissues and the survival rate of breast cancer patients with high or low level of KIF15 through TCGA data. What’s more, western blot and immunohistochemistry assay were utilized to evaluate the protein level and mRNA level of KIF15 in breast cancer tissues. Then CCK-8, wound healing, transwell and flow cytometry experiments were adopted separately to test cell viability, migration, invasion and cell cycle distribution. We discovered that KIF15 was highly expressed in breast cancer tissues and high level KIF15 was associated with a low survival rate of breast cancer patients. Moreover, silence of KIF15 suppressed cell viability, migration, invasion and cell cycle distribution. Following, we discovered that ZNF367 was the upstream transcription factor of KIF15. In addition, silenced ZNF367 could also repress the growth of breast cancer cells. And rescue experiments indicated that overexpressed KIF15 could counteract the inhibition effect of silencing ZNF367 on the progression of breast cancer. Importantly, we discovered that KIF15 and ZNF367 were associated with the regulation of cell cycle. In short, ZNF367-activated KIF15 accelerated the progression of breast cancer by regulating cell cycle progress.

5 illus, 1 table, 23 ref

041445   JAYA P, THAKUR A (Physiotherapy Dep, Father Muller Medical Coll, Mangalore, Karnataka, Email: jayakulal55@gmail.com) : Effect of progressive muscle relaxation therapy on fatigue and psychological distress of cancer patients during radiotherapy: A randomized controlled trial. Indian J Palliat Care 2020, 26(4), 428-32.

Patients with cancer receiving radiotherapy experiences fatigue and psychological distress. Now a days there has been growing interest towards managing these symptoms with non-pharmacological treatments, But researches related to effect of progressive muscle relaxation therapy on fatigue and psychological distresses related to admitted patients are limited hence the aim of the study to evaluate the effect of progressive muscle relaxation therapy on fatigue and psychological distress in Cancer patients during Radiotherapy. Aim of the study to evaluate the effect of progressive muscle relaxation therapy on fatigue and psychological distress in Cancer patients during Radiotherapy. The study design was single blinded randomized control trial. Total of 50 patients, for both intervention and control group 25 patients were included. The intervention group patients received P.M.R. therapy of 20 min. given for 3 times/week of total period of 3 weeks, whereas the control group received conventional treatment with no added intervention. Fatigue symptom inventory and hospital anxiety and depression scale used as an outcome measures. Paired t-test used for FSI to compare among intervention and control group and results were showing statistical significant difference (P < 0.05), similarly pre and post improvement was observed in both the groups for HADS. Between group comparison showed no superior improvement one over the other. Based on the above findings, P.M.R. and conventional treatment were similarly efficacious in decreasing fatigue and psychological distress related to cancer patients who were hospitalized undergoing radiotherapy.

3 tables, 19 ref

041444   CHOUDHARY M, KAUR H (AIIMS, New Delh, Email: mamta24.c@gmail.com) : Experiences of living with intestinal ostomy: A qualitative meta synthesis. Indian J Palliat Care 2020, 26(4), 421-7.

The aim and objective of the study was to identify, compare, and synthesize published qualitative evidence to have in‑depth understanding of experiences of patients living with intestinal ostomy. Over the past two decades, there have been numerous qualitative studies published depicting intense experiences of stoma patients brought about by the need to adapt with changing conditions following stoma creation. Synthesizing the findings of these studies can improve the understanding among health‑care providers of needed support and care for ostomates. This was a qualitative meta‑synthesis. Published articles were identified from the Medline, CINAHL, SciELO, PsycINFO, PubMed, WOS, Google Scholar and a hand search through selected journals published since 2000, and from references lists. Thirteen articles were selected using the predefined criteria. A total of 222 patients, aged between 14 and 83 years from 13 studies, were identified for data collection. Ninety‑seven were male and the rest of them were female. The themes identified were physical problems, psychological issues, social relations, environmental impact, and coping and adaptation to stoma. The findings of the study identified numerous challenges and limitations in the life of patients with stoma. However, improving their skills of using problem‑solving coping strategies and their interactions with other ostomates can help them to live a better and well‑adjusted life.

1 illus, 2 tables, 25 ref

045158   JANANI K, TEJA K V, AJITHA P, SANDHYA R ( Conservative Dentistry and Endodontics Dep, Saveetha Institute of Medical and Technical Sciences, Chennai- 600 077, Tamil Nadu, Email: ajitharijesh@gmail.com) : Evaluation of tissue inflammatory response of four intracanal medicament – An animal study. J Conserv Dent 2020, 23(2), 216-20.

The aim of the study was to evaluate the tissue inflammatory response of origanum vulgarae, omeprazole, triple antibiotic paste (TAP), and calcium hydroxide in an animal model. Seventy Five male Wistar rats were randomly divided into four experimental groups and one control group: Group 1: control (n = 15), Group 2: 0.25 mg origanum vulgarae/1 ml of cellulose (n = 15), Group 3: 2 mg omeprazole/1 ml of distilled water (n = 15), and Group 4: 1 mg TAP/1 ml of distilled water (n = 15), Group 5: 16 mg calcium hydroxide/1 ml of distilled water (n = 15). A trough was made in the periapical bone and the medicament of the respective groups was placed. After the 7th, 14th, 28th and days, the animals were euthanized and tissue specimen was prepared for histological examination. The results were analyzed statistically. On the 7th and 14th days, all the experimental groups showed severe inflammatory response with no statistical significance, whereas on the 28th day, the inflammatory response was graded based on the mean value, in which omeprazole showed moderate inflammatory cells followed by TAP. Mild inflammatory response was seen in calcium hydroxide and origanum vulgarae, showing no statistical significance. Within the limitation of the study, severe inflammatory response was reported on the 7th and 14th days in all experimental groups, whereas on 28th day, there was a moderate inflammatory response seen in omeprazole, followed by TAP. Calcium hydroxide and origanum vulgarae showed a mild inflammatory response.

1 illus, 26 ref

041443   NIDHI V, BASAVAREDDY A (Pharmacology Dep, Sri Devaraj Urs Medical Coll, Kolar, Karnataka, Email: dr.ashareddy@gmail.com) : Perception and quality of life in family caregivers of cancer patients. Indian J Palliat Care 2020, 26(4), 415-20.

Cancer has been most feared among all the significantly increasing chronic diseases, and is widely assumed to be fatal. The quality of life (QOL) of the patient pertaining to physical, psychological, social, and spiritual well‑being is altered, which ultimately affects the QOL of the family caregivers. The study was conducted to assess the QOL among family caregivers of cancer patients and how cancer changes and alters the vision about life for the patient as well as the family caregivers. The objective was to assess the QOL among family caregivers of the cancer patients. A cross‑sectional, questionnaire‑based study was conducted after the protocol was approved by the institutional ethics committee and obtaining written informed consent from the participants. Two sets of validated questionnaire were used to assess the awareness and QOL of the family caregivers of the cancer patients. The filled questionnaires were received from the participants, and data were analyzed using descriptive statistics. Nearly 74 % (148/200) of the participants responded, with majority of the caregivers being females (71.62 %). Majority (72.9 %) expressed that cancer cannot spread from one person to another and were positive (70.9 %) toward cancer cure. The caregivers (76.3 %) opined that the diagnosis of cancer should be informed to the family members. Approximately 50 % of the participants were aware that environmental toxins and tobacco would predispose to cancer. Although most of them (87.8 %) believed that the cancer treatment cause ill effects, they (93.2 %) were satisfied with the hospital facilities. Among the QOL parameters, most of the participants had complaint of decreased general physical health, difficulty to cope, reduced concentration, anguish over the first treatment, disease, and interference in household activities. Among the spiritual parameters, the participants expressed sufficient support from religious activities, prayer, and general spiritual well‑being. Majority of the caregivers had awareness regarding the cancer and carcinogens from the environmental toxins. The QOL among caregivers of cancer patients is affected in all dimensions of life, with more emphasis on the social and psychological dimensions.

4 tables, 20 ref

041442   LANDA A S (Ferrybridge Medical Centre, England, UK, Email: amarjodh@doctors.org.uk) : What is the public opinion of advance care planning within the Punjabi Sikh community?. Indian J Palliat Care 2020, 26(4), 411-4.

The aim was to gain an understanding of what the United Kingdom (UK) Punjabi Sikh community understands and thinks about advance care planning (ACP). This is in response to evidence showing a lack of service usage by Black, Asian, and Minority Ethnic groups. Surveys containing questions about the impressions of terms, advance decisions for care, do‑not‑attempt‑resuscitation, and lasting power of attorney were taken to targeted community groups; these included community day centers, sporting groups, temples, and social media circles. Surveys were available in both Punjabi and English languages. A total of 311 surveys were received in total. There was a 50/50 gender split and a mixed group of ages; 75 % were born in the UK and 15 % were born in Punjab, India. Only a third had some understanding of what ACP meant. Nearly 50 % of the participants did express wishes toward the end of their life, however only a third of the respondents knew how to access services. Cardiopulmonary resuscitation was felt to be mandatory by 36 %. Sixty percent thought that their decision would be legally binding in relatives who do not have capacity. This study showed that wishes for religious rites were common, however many do not know how to make them known. If they do know about services, then people are highly likely to engage with the ACP process.

1 illus, 2 tables, 5 ref

045157   BHATNAGAR N B, MANTRI S P, DUBE K A, JAISWAL N U, SINGH V J (Conservative Dentistry and Endodontics Dep, Hitkarini Dental Coll, Jabalpur, Madhya Pradesh, Email: shivmantri24@gmail.com) : Pulpal-anesthesia of a mandibular first molar with irreversible pulpitis by inferior alveolar nerve block plus buccal infiltration using articaine or lignocaine. J Conserv Dent 2020, 23(2), 201-5.

This study aims to compare the efficacy of a combination of an inferior alveolar nerve block (IANB) plus buccal infiltration using 4 % articaine versus 2 % lignocaine in achieving anesthesia of lower first molar teeth with irreversible pulpitis. Seventy adult patients were selected. A random sequence list was employed to administer IANB plus buccal infiltration. After the onset of lip numbness, cold test and electric pulp testing were performed. Five patients, four missed blocks and one no bleeding, were excluded. Heft Parker Visual Analog Scale scores during pulp extirpation were recorded. The data of sixty‑five patients were statistically analyzed using Chi‑square and Mann–Whitney U‑test. The success rate after lip‑numbness for articaine is 91.42 % and for lignocaine is 94.28 %. The difference is statistically, not significant (P = 0.6425). During access, the success rate for lignocaine is 96.87 %, whereas 96.96 % for articaine. This difference is also not significant (P = 0.982366).  IANB plus buccal.

2 illus, 2 tables, 26 ref

041441   DOVAL D C, KUMAR P, TALWAR V, VAID A K, DESAI C, OSTWAL V, DATTATREYA P S, AGARWAL V, SAXENA V (Medical Oncology Dep, India Rajiv Gandhi Cancer Institute and Research Centre, Mumbai, Maharashtra, Email: kprabhash1@gmail.com) : Shared decision making and medicolegal aspects: Delivering high quality cancer care in India. Indian J Palliat Care 2020, 26(4), 405-10.

It is often difficult for people with cancer to make decisions for their care. The aim of this review is to understand the importance of shared decisionmaking (SDM) in Indian clinical scenario and identify the gaps when compared to practices in the Western world. A systematic search (2000-2019) was executed in Medline and Google Scholar using predefined keywords. Of the approximate 400 articles retrieved, 43 articles (Indian: 5; Western: 38) were selected for literature review. Literature review revealed the paucity of information on SDM in India compared to the Western world data. This may contribute to patientreported physical or psychological harms, life disruptions, or unnecessary financial costs. Western world data demonstrate the involvement and sharing of information by both patient and physician, collective efforts of the two to build consensus for preferred treatment. In India, involvement of patients in the planning for treatment is largely limited to tertiary care centers, academic institutes, or only when the cost of therapy is high. In addition, cultural beliefs and prejudices impact the extent of participation and engagement of a patient in disease management. Communication failures have been found to strongly correlate with the medicolegal malpractice litigations. Research is needed to explore ways to how to incorporate SDM into routine oncology practice. India has a high unmet need towards SDM in diagnosis and treatment of cancer. Physicians need to involve patients or their immediate family members in decision making, to make it a patient-centric approach as well. SDM enforces to avoid uninformed decisionmaking or a lack of trust in the treating physician’s knowledge and skills. Physician and patient education, development of tools and guiding policies, widespread implementation, and periodic assessments may advance the practice of SDM.

2 illus, 2 tables, 31 ref

041440   RAINE E, TAGHAVI M (Saint Mary’s Univ, Nova Scotia B3H 3C3, Canada, Email: majid.taghavi@smu.ca) : A narrative literature review on human resource planning for palliative care personnel. Indian J Palliat Care 2020, 26(4), 401-4.

A literature search was started with the objective of finding works pertaining to the use of operations research techniques in planning for human resources in palliative care. Since the search indicated that there is no such work, in this paper, we report on the literature on workforce planning and human resource planning for palliative care personnel. Using our findings, we discuss the factors that influence the supply and demand for the palliative care workforce. Our results show that the enhancement of efficiency, training more primary caregivers to deliver palliative care, and allowing for mid-career specialist training are practical ways to compensate for the gap between the supply and demand in the palliative care workforce.

1 illus, 1 table, 15 ref

045156   HEGGENDORN F L, PINTO L A T, GONÇALVES L S, LIONE V D O F, JUNIOR W B C, LUTTERBACH M T S (Corrosion and Degradation Dep, National Institute of Technology, CEP 20260-300, Brazil, Email: fabianohegg@gmail.com) : Biocorrosive behavior of sulphate-reducing bacteria in kerr endodontic files: Determination of the corrosion. J Conserv Dent 2020, 23(2), 196-200.

This study determined the corrosion rate by mass loss caused by oral strains of sulphate‑reducing bacteria (SRB) in Kerr endodontic files (KF), aiming the development of a biopharmaceutical that facilitates the removal of endodontic limb fragments from root canals. Nine new KF were analyzed after immersion in the modified Postgate E culture medium inoculated with Desulfovibrio desulfuricans oral (84 days), Desulfovibrio fairfieldensis in the consortium (84 days) and environmental D. desulfuricans (119 days). Optical microscopy revealed corrosion suggestive areas in all files submitted to immersion in SRB cultures, presenting a statistical difference (P < 0.05) between the samples environmental D. desulfuricans and KF control and between oral D. desulfuricans and KF control. Epifluorescence microscopy revealed an active SRB biofilm over the entire metal surface of the KF, as evidenced by the SYTO^® 9 fluorophore. SRB were capable of promoting biocorrosion in Kerr type endodontic files, but with low rate.

2 illus, 3 tables, 24 ref

046564   FITRYA, FITHRI N A, SEPTIANAH E (Pharmacy Dep, Sriwijaya Univ, South Sumatera, Indonesia, Email: fitrya@unsri.ac.id) : Optimization and characterization of solid lipid nanoparticles carrier ethanol extracts of Parkia speciosa pod. Med Plants 2020, 12(2), 301-8.

Parkia speciosa (Petai) contains phenolic and flavonoid components as an antioxidant. This function is not optimal because the biological membrane is lipophilic while the compounds is hydrophilic. The objective of this study was to prepare the ethanol extract of Parkia speciosa into Solid Lipid Nanoparticles (SLN) as an effort to overcome the difficulty of penetration of active compounds through biological membranes. The optimum formula was designed using factorial design 23 .Surfactant concentration, preparation temperature, and stirring speed were independent variable that act as factors. The influence of these factors on characteristics of SLN was analyzed by using Design Expert®10 (Stat-Ease Inc.) software. The test results showed that the optimum formula was obtained at a tween-80 concentration of 0.704 mL, a preparation temperature of 60^o C and a stirring speed of 1000 rpm. The optimum formula characteristic was % EE 88.81 ± 0.06 %, particle size of 393.8 nm, polydispersity index (PDI) of 0,421 and zeta potential of -1.7 mV, respectively. The percentage of diffused SLN was better (9.83 ± 0.011 %) than the percentage of diffused extract (4.48 ± 0.022 %). The results showed that the ability of SLN to penetrate membrane was greater than the extract but SLN showed instability due to the formation of aggregates in storage. The compartmental analysis with WinSAAMTM software revealed the optimum formula following the compartment lag model with a p-value <0.05.

4 illus, 4 tables, 22 ref

041439   KARAHAN I, YALCIN S (Internal Medicine Dep, Kirikkale Univ, Kirikkale 71450, Turkey, Email: irfan_karahan@yahoo.com) : Is C reactive protein/albumin ratio of advanced stage non small cell lung cancer patients able to predict mortality in the admission for palliative care?. Indian J Palliat Care 2020, 26(3), 365-8.

Lung cancer is frequent and mortal cancer. The predicting mortality may be helpful for cancer management. The purpose of the study was to evaluate the role of baseline C‑reactive protein (CRP)/albumin ratio (CAR) in relation to hospital mortality, the setting of advanced stage non‑small cell lung cancer (NSCLC). The present study is a retrospective analysis and included 77 adult patients with Stage IV NSCLC who were hospitalized for supportive care. All patients are divided into two groups as survivors and nonsurvivors. CAR on the admission was compared between groups. The correlation between CAR and the death time was investigated. The cutoff level of CAR was calculated, and patients with a high level were described in two groups. For all participants, the mean age was 63.0 ± 9.9 years, and the median values of CRP and albumin levels were 15.3 mg/dl (1–51.5) and 5.7 g/dl (0.02–22.7), respectively. CAR was significantly lower in the survivor group. By receiver operation curve analysis, the cutoff levels of CRP and CAR were determined as 10.8 and 3.5, respectively. The odds ratio of mortality was 3.85 (1.49–9.94 95 % confidence interval [CI], P = 0.006) for higher than cutoff levels of CAR. The odds ratio was 3.38 (1.32–8.65 95 % CI, P = 0.01) for higher CRP levels. There was a significant but weak negative correlation between the time of death and both CRP and CAR in the nonsurvivor group (r = −0.46, P = 0.002; r = −0.48, P = 0.001, respectively). The present study showed that CAR was significantly increased in nonsurvivors. CAR may be a cheap, easy, and effective tool for predicting the death and its time of hospitalized NSCLC patients.

2 illus, 3 tables, 22 ref

041438   AGOM D A, OMINYI J, ONYEKA T C, ANYIGOR C N (Health and Social Science Dep, Buckinghamshire New Univ, England, United Kingdom, Email: davidagom56@gmail.com) : Exploring organizational culture regarding provision and utilization of palliative care in a Nigerian context: An interpretive descriptive study. Indian J Palliat Care 2020, 26(3), 358-64.

Palliative care (PC) continues to be underutilized in Nigeria, but there is a lack of studies that explore organizational cultural dynamics regarding PC in Nigeria. The study aimed to understand the organizational culture in order to identify organizational enablers and inhibitors of the provision and utilization of PC in a Nigerian context. Identification of the organizational culture was developed using a qualitative interpretive descriptive design. Cultural enablers and inhibitors were mapped out using semi‑structured interviews with 38 participants, consisting of medical staff, patients, and their relatives. Thematic analysis was used to identify and analyze patterns within the collected data. Three themes were identified: cross‑departmental collaborative practice, financial support practice, and continuity of care. The findings suggest that fundamental cultural changes, such as a policy for intradepartmental referral practices, telemedicine, and a welfare support system, are typically required as remedies for the failure to use PC in Nigeria and other similar contexts. This study offered a new understanding that not revealing deeper shared assumptions, and a shared way of thinking that underpins the PC practice within an organization, will have a negative bearing on organizational PC outcomes.

1 illus, 1 table, 34 ref

041437   SADLER K, ABUDARI G, ALJAWI D, SNELLING D (Oncology and Liver Transplant Dep, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia, Email: kim.sadler@hotmail.ca) : Deaths in the emergency department: An assessment of patient’s end of life trajectory and quality of care. Indian J Palliat Care 2020, 26(3), 352-7.

A considerable proportion of deaths occur in the emergency department (ED), and yet a palliative care approach is not well integrated. End‑of‑life patients often either receive invasive care, or their care is neglected due to being perceived as not being “acutely” ill. While a small proportion of these deaths are of an unpredictable nature, most have identifiable dying trajectories: (a) advanced cancer, (b) organ failure, (c) chronic frailty, and (d) sudden death. This study aims (1) to determine the incidence, nature and illness trajectory of deaths in the ED; (2) to examine to which extent end of life discussions took place; (3) to analyze the aggressiveness of the care; and (4) to determine if palliative care services were being consulted. This retrospective study was conducted in a large tertiary hospital and cancer center in Saudi Arabia over a 1 year period. Data collection included demographics, clinical presentation, end‑of‑life care, and palliative care involvement. Our study included 103 patients. Cancer was the main diagnosis (45.7 %). Deaths were related to advanced cancer (45.6 %), followed by organ failure (29.1 %), sudden death (13.6 %), and chronic frailty (11.7 %,). 35.9 % had a documented Do‑Not‑Attempt‑Resuscitation (DNAR) status prior to admission. 51.5 % received aggressive treatments. Palliative care was consulted for 19.4 % of patients, among which 50 % of referrals occurred 1 day prior to death. End‑of‑life care discussions tend to occur late in the disease trajectory; a number of patients are subjected to aggressive treatments, and palliative care services remain underutilized. An early, integrated and collaborative approach is warranted to address the challenges of end of life care.

4 illus, 1 table, 20 ref

041436   GERONTOPOULOS A, MOSA E, ALONGI F, KOKAKIS L, SARAIREH H H, TSOUKALAS N, CHARALAMPAKIS N, TSANADIS K, TSAPAKIDIS K, ELENI M ET AL (Thessaly Univ, Larissa, Greece, Email: alexgerodopoulos@gmail.com) : Impact of radiation therapy on pain relief of cancer patients affected by on malignant psoas syndrome: 26 years of experience. Indian J Palliat Care 2020, 26(3), 348-51.

The malignant psoas syndrome (MPS) is a rare and complex cancer‑related clinical entity, with a significant impact on cancer patients’ quality of life. The literature describing malignant infiltration of the psoas muscle as well as its management is limited. The primary endpoint of the study was the assessment of pain relief in symptomatic terminal‑stage MPS patients. Patients underwent hypofractionated (two‑ or three‑dimensional conformal) radiotherapy as palliative treatment. A dose of 42.5 Gy in 17 daily fractions (2.5 Gy/fraction) was prescribed. Pain response was measured before 3 and 6 months after radiation delivery. Between May 1992 and April 2019, eight patients were treated. The median age was 75 years (range: 59–87 years). All patients had distant metastatic disease at the time of treatment. We found a significant pain relief (median duration of response of 105 days) and an improvement in health‑related quality of life. Radiotherapy had a favorable outcome and can be considered an effective analgesic treatment in case of painful MPS.

2 illus, 2 tables, 17 ref

045155   DIGOLE V R, WARHADPANDE M M, DUA P, DAKSHINDAS D (Dental Surgery and Oral Health Sciences Dep, AFMC, Pune, Maharashtra, Email: vasantadigole@gmail.com) : Comparative evaluation of clinical performance of two self-etch adhesive systems with total-etch adhesive system in noncarious cervical lesions: An in vivo study. J Conserv Dent 2020, 23(2), 190-5.

The growing demands for esthetic restorations have stimulated intensive research in the field of adhesive dentistry. Dental adhesive systems are used to promote adhesion between composite resins and dental structure. In the fundamental principles of adhesion, the primary mechanism contributing to the formation of adhesion is micromechanical bonding between the restoration and the tooth. The bond strength of self‑etching adhesives to dentin was found to be almost equal to that of total‑etch adhesives. The aim of the present prospective, double‑blind, randomized controlled clinical trial was to evaluate and compare the clinical performance of two self‑etch adhesive systems with total‑etch adhesive system in noncarious cervical lesions (NCCLs). In each patient, three teeth were randomly assigned according to the adhesive system used to Group A (total‑etch adhesive system), Group B (two‑bottle self‑etch adhesive system), and Group C (one‑bottle self‑etch adhesive system). The clinical efficacy of these adhesive systems was determined by evaluating the retention rate, marginal integrity, and postoperative sensitivity at the following three levels: baseline, 6 months, and 18 months by following the Modified USPHS criteria introduced by Vanherle et al.  In the present study, the retention rate at 18 month in Group A, Group B, and Group C of 96 %, 92 %, and 92 % was observed, respectively. A marginal integrity at 18 months was 88 %, 80 %, and 84 % for Group A, Group B, and Group C, respectively. Postoperative sensitivity at 18 months was 16 %, 12 %, and 12 % for Group A, Group B, and Group C, respectively. The clinical performance of total‑etch and self‑etch adhesive systems in NCCLs did not differ significantly with regard to the evaluated parameters – retention, marginal integrity, and postoperative sensitivity.

2 illus, 2 tables, 16 ref

041435   BISWAS S, ACHARYYA S, ROY P, SAMADDAR D, DASGUPTA C, JANA D (Radiotherapy Dep, R G Kar Medical Coll and Hospital, Kolkata - 700 004, West Bengal, Email: drsantanuacharyya1@gmail.com) : Efficacy of chronomodulated chemotherapy for palliation of hematemesis in inoperable gastric cancer: A single institutional retrospective study. Indian J Palliat Care 2020, 26(3), 342-7.

Aside abdominal discomfort and pain, upper gastrointestinal bleeding (UGIB) significantly disgraces the quality of life (QoL), especially in inoperable gastric cancer patients. Although, in early stages, it is infrequent and often ignored, but in advanced stages, its aggressiveness often deteriorates patient’s hemoglobin (Hb) level and performing status. The aim of this study is to correlate the change in (1) the frequency of episodes of UGIB, (2) its severity in terms of Common Terminology Criteria for Adverse Events (CTCAE) grade for UGIB, and (3) Hb level with the successful completion of successive cycles of palliative chemotherapy where it becomes invariably the only modality to palliate the cancer disease. This single‑institutional retrospective observational study included seventy gastric carcinoma patients with a chief complaint of frequent hematemesis. They were divided according to the cause behind inoperability or irresectability: (1) Metastatic disease, (2) locally advanced irresectable disease, (3) uncontrolled comorbidities, (4) poor GC (PGC), and (5) refused to give surgical consent. Following baseline evaluation and prechemotherapy workups, patients were subjected to three‑weekly chronomodulated modified EOX regimen. Relevant parameters, i.e.,(1) average episodes per‑week (AEP) score, (2) Hb, and (3) average CTCAE grade value for UGIB were recorded after every cycle. At 12‑week follow‑up, there was a significant decrease in mean AEP score from baseline (from 2.6691 ± 0.7047 to 1.5033 ± 0.6272) for the entire cohort (P < 0.001). Maximum benefit in terms of mean Hb (increase by 1.0737 % above baseline) took place for PGC group (P < 0.001). Mean CTCAE grade value for the entire cohort decreased from baseline by 0.6428, which was statistically significant with a P < 0.001. PGC group was maximally benefited considering all three parameters. Though surgery defines the mainstay of treatment for gastric carcinoma, yet in inoperable cases, only chronomodulated chemotherapy significantly affects the severity of UGIB and thus may improve QoL.

3 illus, 23 ref

041434   ANDRIASTUTI M, HALIM P G, KUSRINI E, BANGUN M (Child Health Dep, Faculty of Medicine Indonesia Univ, Jakarta, Indonesia, Email: pricilia.gh@gmail.com) : Correlation of pediatric palliative screening scale and quality of life in pediatric cancer patients. Indian J Palliat Care 2020, 26(3), 338-41.

Palliative care in children is used to be only intended for those in near end‑of‑life phase. Ideally, palliative intervention should be given since the first time of cancer diagnosis. Palliative care is introduced from the beginning of the treatment by acknowledging that it helps to ensure an ongoing focus on the quality of life (QOL) so that children still can enjoy their life. Several approaches have been used to identify children with the need of palliative care. The aim was to describe the use of Paediatric Palliative Screening Scale (PaPaS Scale) and its depiction to the QOL of children with malignancies. A cross‑sectional study was conducted in sixty children age 2–18 years with malignancies, who were consulted to the palliative team. Sixty participants were recruited randomly during the study. PaPaS Scale and QOL (using PedsQLTM cancer module 3.0) were assessed at the same time. Cutoff points of 67 for parent–proxy report and 68.9 for self‑report were used, those who have scores <67 and <68.9 were grouped as low QOL group. PaPaS scale was divided into three groups: (1) no palliative care needs (score 10–14), (2) considered palliative care (15–24), and (3) need for palliative (≥25). Differences between palliative score and QOL were analyzed using Chi‑square and Fisher test. Children who have lower QOL based on parent–proxy report (<67) included 25 children; they consist of 16 children (64 %) with score 10–14, four children (16 %) with score 15–24, and five children (20 %) with score ≥25. Children with higher QOL (16 children) consist of ten children (62.5 %) with score 10–14, four children (25 %) scores 15–24, and two children (12.5 %) with score ≥25. In the self‑report, children with low QOL (eight children) consist of four children (50 %) with score 10–14, four children (50 %) with score 15–24, and no children with score ≥ 25. Children with higher QOL(11 children) consist of eight children (72.2 %) with score 10–14, two children (18.2 %) with scores 15–24, and one child (9.1 %) with score ≥25. Statistical analysis showed no correlation between PaPaS score and QOL of children with malignancies in parent–proxy report (P = 0.89) and self‑report (P = 0.37). This study showed that children with malignancies already had lower QOL despite the low PaPaS scale they had. The results of this study support the provision of early palliative intervention, starting with a small proportion of intervention to improve the QOL of cancer child.

1 illus, 3 tables, 18 ref

041433   AMADO J P, VASQUEZ R, HUARI R, RIMACHE L, LIZONDE R (Emergency Dep, Rebagliati Hospital, Lince, Lima, Peru, Email: jpamadot@gmail.com) : Impact of applying palliative care on symptoms and survival of patients with advanced chronic disease admitted to the emergency department. Indian J Palliat Care 2020, 26(3), 332-7.

In the emergency department, there is a need to provide palliative care; however, they are not usually administered. The present study evaluates the evolution of the intensity of the symptoms when applying palliative care, in adult patients with advanced chronic disease admitted to the emergency room, and compares survival between those who receive this care and those who do not. A clinical intervention study was conducted including patients older than 18 years with advanced chronic disease admitted to the emergency room with an indication of palliative support according to the Supportive and Palliative Care Indicators Tool 2015. Three hundred and seven patients were studied (74 in the intervention group and 233 in the group not intervened). In the intervention group, the intensity of pre‑ and postintervention symptoms was compared (Wilcoxon test). The survival of both the groups were then compared (logrank test). There was a significant decrease in pain and dyspnea at 24 and 48 h postintervention (P < 0.01), respectively, while drowsiness increased significantly at 24 h (P < 0.01) but did not change at 48 h (P = 0.38). Excluding patients with better functional status, there was less survival at 3 months in the intervention group (P = 0.01). Dyspnea and pain decreased with the application of palliative care but not drowsiness. Survival in the intervention group was lower than in the nonintervention group. However, the reason for providing palliative care is to relieve suffering at the end of life.

2 illus, 3 tables, 40 ref

045154   NANGIA D, NAWAL R R, TALWAR S (Conservative Dentistry and Endodontics Dep, Maulana Azad Institute of Dental Sciences, New Delhi- 110 002, Email: dnangia3@gmail.com) : Evaluation of apical extrusion and cone-beam computed tomography assessment of irrigant penetration in oval-shaped canals, using XP Endo Finisher and EndoActivator. J Conserv Dent 2020, 23(2), 185-9.

Thorough cleaning of the pulp space is a challenging task. The mechanical instrumentation alone is usually not sufficient to completely debride the canals, and therefore, it requires the chemical action of irrigants also to disinfect the difficult to reach areas. The purpose of this study was to determine apical extrusion and assess irrigant penetration through cone‑beam computed tomography (CBCT) for EndoActivator (EA) and XP Endo Finisher (XP). Sixty single‑rooted mandibular premolars with oval‑shaped canals were equally divided into three groups after instrumentation, based on the final irrigation: Group‑1 syringe needle (30G Max‑I‑probe), Group‑2 EA, and Group‑3 XP. After the final irrigation, the weight of the extruded sodium hypochlorite was calculated. The prepared canals were then irrigated with a radiopaque contrast medium, which was activated according to the group of the sample (Group‑1, 2, or 3). The volume of irrigant filled in the canal, especially in the apical third was determined through special tools in CBCT imaging. Statistics: One‑way ANOVA test was used to compare the different groups. Significantly more apical extrusion was seen in XP (P < 0.001). Both XP and EA have shown complete penetration of irrigant in the canal (100 %).

2 illus, 2 tables, 26 ref

041432   PRAKASH K, SAINI S K, PUGAZHENDI S (Surgical Oncology Dep, Swami Rama Himalayan Univ, Dehradun - 248 140, Uttarakhand, Email: sunilsaini@srhu.edu.in) : Effectiveness of yoga on quality of life of breast cancer patients undergoing chemotherapy: A randomized clinical controlled study. Indian J Palliat Care 2020, 26(3), 323-31.

Cancer of breast is most common cancer among women in India and vast majority of countries worldwide. While undergoing chemotherapy for carcinoma management, women encounter side effects, which affects their quality of life (QOL). Arandomized controlled study with quantitative research approach and time series design was conducted, to study the effectiveness of yoga on QOL of breast cancer patients undergoing chemotherapy. One hundred breast cancer patients scheduled for 3‑weekly, day‑care adjuvant chemotherapy (CEF regimen) were enrolled with consecutive sampling technique, into control (n = 52) and experiment (n = 48) groups, by concealed randomization following written informed consent. Baseline data on QOL were collected before first‑cycle chemotherapy using the European Organization for Research and Treatment of Cancer QLQ C30. Patients in the experimental group were taught diaphragmatic breathing techniques, systematic relaxation, and alternate nostril breathing, and Joints and Glands neck and shoulder exercises were instructed to practice twice daily at home. They were supervised in practicing these techniques while they received second, third, fourth, fifth, and sixth cycles of chemotherapy in the day‑care facility. Participants in the control group received only routine care. All participants received standard post chemotherapy prescription. Data on QOL were collected from all patients during the second, third, fourth, fifth, and sixth cycles of chemotherapy. The analysis revealed that at the baseline (first chemotherapy cycle), breast cancer patients in control and experimental groups were homogeneous in terms of their sociodemographic and clinical variables and QOL score. Yoga practices were effective in improving the QOL of breast cancer patients in the experimental group in the areas of global health status, physical function, role function, and emotional function and decreasing the symptoms of fatigue, insomnia, loss of appetite, and constipation, during the period of chemotherapy. Yoga practices comprising of relaxation techniques reduce many side effects and improve the QOL of women undergoing chemotherapy for breast cancer.

14 illus, 3 tables, 13 ref

041431   JEBA J, PONISSERY J, RAMASWAMY A, JOHNSON J R, THELLY A S, BILIMORIA P J (Christian Medical Coll Hospital, Vellore - 632 004, Tamil Nadu, Email: jenifermugesh@yahoo.com) : Developing evidence based clinical guidelines in palliative care for home care setting in India. Indian J Palliat Care 2020, 26(3), 319-22.

Clinical guidelines can improve care and reduce variations in practice. With the growth of The Jimmy S Bilimoria Foundation’s PALCARE, a home‑based palliative care service launched in December 2015, the foundation felt a need for locally relevant, clinical guidelines to ensure consistency and reliabilty of its service. A Clinical Consultative Committee (CCC) comprising of experienced palliative care professionals, from within and outside India, was constituted to help with the development of robust, evidence‑based multidisciplinary clinical guidelines relevant to the delivery of palliative care for adults in a home care setting in Mumbai, India, which could be applied to other similar settings in India and elsewhere. The CCC developed 39 guidelines under eight categories; using a structured process from the initial draft to its finalization. The CCC vetted each of the guidelines over monthly Skype meetings for validity, relevance, local applicability and reproducibility. Feedback from the PALCARE team was also incorporated. Thirty‑nine clinical guidelines relevant to adult palliative care services in home care setting were developed. These have been discussed and found useful by the PALCARE team. The guidelines are available on the PALCARE website for use by wider professional audience. Development of clinical guidelines locally for palliative care in a home care setting in response to a felt need to ensure quality care and reduce variation in practice has been beneficial in clinical care. It has proved to be a good teaching resource too. Regular audits to measure practice against these guidelines will ensure better patient outcomes.

1 table, 8 ref

041430   RATTANI S A, KURJI Z, KHOWAJA A A, DIAS J M, ALISHER A N (Aga Khan Univ School of Nursing and Midwifery, Karachi, Pakistan, Email: rattani@ualberta.ca) : Effectiveness of high fidelity simulation in nursing education for end of life care: A quasi experimental design. Indian J Palliat Care 2020, 26(3), 312-8.

Providing end of life (EOL) care is a component of palliative care but dealing with dying patients and their family members is stressful for the healthcare providers. To prepare them for providing EOL care, the high‑fidelity simulation could be used as a pedagogy in which real‑life scenarios are used on the computerized manikins mimicking the real patients. The aim of this study was to measure the effectiveness of high‑fidelity simulation to teach EOL care in the palliative nursing course in the undergraduate nursing education program at the School of Nursing and Midwifery at Aga Khan University which is private university in Karachi, Pakistan. This study was approved by the ethics review committee of Aga Khan University. It was hypothesized that exposure to high‑fidelity simulation will lead to an increased positive attitude in participants towards the care of dying. A quasi‑experimental design was used. In line with the design, there was no control group. The same group of students (n = 42) were assessed through Frommelt Attitudes Toward Care of the Dying (FATCOD) Part B assessment tool. Permission for using this tool was obtained from Dr. Katherine Frommelt, the author of this tool. Research participants filled this tool before and after the intervention, i.e., providing EOL care to a patient in a high‑fidelity simulation lab. Out of 30‑FATCOD items, significant attitude change was detected on 11‑items of which 8 were positively worded statements and 3 were negatively worded statements. As per the hypothesis, it was expected for the positively worded statements that the mean score for the posttest would be significantly greater than the pretest mean score (pretest score < posttest score). The hypothesis was proved for items 1, 4, 10, 18, 22, 25, 27, and 30 as their t‑value was significant at 0.05 alpha value (one‑tailed). For the negatively worded statements, it was expected that the mean score for the posttest would be significantly lower than the pretest (pretest score > posttest score). The hypothesis was proved for items 5, 6, and 11 as their t‑value was significant at 0.05 alpha value (one‑tailed). In this research teaching, EOL care through high‑fidelity simulation had improved the attitudes of students toward providing care. This pedagogy also provided the participants with a learning opportunity to deal with their own emotions. These findings provide a way forward for teaching EOL and other complex skills of clinical practice.

2 tables, 31 ref

041429   PAUL A, FERNANDES E (Tata Institute of Social Sciences, Navi Mumbai - 400 703, Maharashtra, Email: aneka.sureshp@gmail.com) : Experiences of caregivers in a home based palliative care model – a qualitative study. Indian J Palliat Care 2020, 26(3), 306-11.

Family caregivers are of vital support to patients receiving home-based palliative care. This study sought to identify and comprehend the challenges that caregivers face while taking care of a terminally ill patient in a home-based palliative care setting and the mechanisms that facilitated their coping. A qualitative approach was employed to understand the perceptions of primary caregivers through 3 focus group discussions and 4 in-depth interviews, across 3 socioeconomic categories and 3 geographic zones of Mumbai. Caregivers expressed that they wished they had been introduced to palliative care earlier. Being trained on minor clinical procedures and managing symptoms, and receiving emotional support through counselling were found beneficial. Caregivers did not perceive the need for self-care as the period of active caregiving was often short. Bereavement counselling was felt to be of much help. The study helped understand the caregivers’ perceptions about the factors that would help them in patient as well as self-care. Recommendations for designing interventions for future caregivers and recipients were also made.

1 table, 14 ref

041428   DHANDE N, KUMAR S, BOLANE A (Medicine Dep, Jawaharlal Nehru Medical Coll, Wardha, Maharashtra, Email: sunilkumarmed@gmail.com) : Assessment of psychosocial distress among the palliative care patients in Wardha district of Maharashtra. Indian J Palliat Care 2020, 26(3), 302-5.

Palliative Care Outcome Scale (POS) is one of the various tools, available for the evaluation of the effectiveness of palliative services, having 10item multidimensional questionnaire, designed to assess the physical, psychosocial, spiritual, and practical aspects of patients with various sufferings. In this study, we had assessed psychosocial distress among the patients of a palliative care clinic of a rural teaching hospital at Wardha district. In this cross‑sectional study, a total of 118 patients attending the palliative care clinic under the medicine department were enrolled between July 2018 and March 2019. POS has 10 questions in Likert type of scale with a scoring of 0–4, 0 for no effect to 4 for overwhelming effect. Each question provides the information regarding how the patient feels in the past 3 days. : In the first assessment for anxiety about illness or treatment, 32 % of the participants reply that they occasionally feel the anxiety, whereas the same reply has been given in follow‑up assessment by 34 % of the participants, with an average mean score of 1.59 and 1.31, respectively. Approximately 48 % of the participants feel that their family or friends were occasionally anxious and worried for them in the first assessment of POS compared to follow‑up assessment where the feeling has been changed with approximately 46 % for not at all anxious or worried followed by 39 % occasionally. Participants were satisfied and accepted the palliative care treatment provided by the team with frequent visits, and also, the level of improvement fastens.

1 table, 8 ref

041427   WAGH M S, MATHEW A P, VEERABHADRAN B, MURALEE M, RAHUMAN S A, GEORGE P S, CHANDRAMOHAN K (Surgical Oncology Dep, Regional Cancer Centre, Thiruvananthapuram, Kerala, Email: drchandramohan@gmail.com) : Validation of malayalam translation of the European organization for the research and treatment of cancer quality of life instrument og25 for esophagogastric junction cancers. Indian J Palliat Care 2020, 26(3), 295-301.

Quality of life questionnaire (QLQ) OG25 is the questionnaire used for measuring quality of life (QOL) of patients with esophago‑gastric junction (OG) cancers. QLQ‑OG 25 is a disease‑specific tool to capture the QOL parameters of patients with OG junction cancers. OG 25 was developed by the European Organization for the Research and Treatment of Cancer (EORTC) using inspiration from their questionnaires for carcinoma stomach (STO22) and carcinoma esophagus (OES18). It is usually used along with QLQ‑C30, which is a general tool applicable for all cancers. This questionnaire is in the English language. In order to use this questionnaire in a non‑English speaking population, the English questionnaire has to be initially translated to the local languages. Malayalam is the language spoken by 38.5 million people residing in the South Indian state, Kerala, India. We have translated and validated the QLQ‑OG 25 to Malayalam language in an attempt of enabling it to be used for future studies at this geographic region. The translation was done by the standard protocol adopted by EORTC. QLQ‑C30 and QLQ‑OG25 questionnaires were then filled in by patients with OG junction cancers. These patients had cancers of various subsites of the OG junction and were at different stages of treatment, at the time of interview. The interview was done twice, at an interval ranging from 48 h to 1 week between the two interviews. A total of 46 patients with OG junction tumors at varying stages of treatment completed the questionnaire. There were no missing data. The average time to finish the interview was 12.12 min. The Cronbach’s alpha, which signifies the internal consistency of the questionnaire, was found to be >0.7 in all the domains studied, except in cognitive function. The intraclass correlation coefficients varied from 0.63 to 0.93. The Malayalam translation of the QOL tool QLQ‑OG25 has been found to be an acceptable and valid tool in assessing the QOL parameters of patients with OG junction cancers.

3 tables, 21 ref

043154   MUPPALLA J N K, HARIKUMAR V, SARATHCHANDRA P, REDDY S J, RAJANI P ( Conservative Dentistry and Endodontics Dep, Kamineni Institute of Dental Sciences, Nalgonda- 508 254, Telangana, Email: mjnkendo@gmail.com) : Effect of modulated photoactivation of bulkfill composite on microleakage in fluorosed and nonfluorosed teeth: A confocal laser scanning microscopy study. J Conserv Dent 2020, 23(2), 180-4.

The aim of this study is to compare the microleakage of bulkfill composite activated by modulated photoactivation between fluorosed and nonfluorosed teeth using the confocal laser scanning microscope. One hundred and twenty intact human premolar teeth with Thylstrup and Fejerskov index fluorosis index 0–4 were stored in 0.5 % thymol at the room temperature until further use. Standardized Class V preparations of 2 mm depth, 3 mm width, and 2 mm height were prepared on the buccal surface. The cavities were etched with 37 % phosphoric acid, rinsed and primed with Tetric N bond, cured for 20 s with Quartz Tungsten Halogen (QTH) variable intensity light‑curing unit spectrum‑800 operating at 450 mW/cm². Later, bulk fill composite was placed in the cavity and cured. Depending on the curing mode used, all the fluorosed and nonfluorosed teeth were divided into three subgroups each (n = 20) – Conventional light curing, stepped curing, and pulse delayed curing. All samples were stored in distilled water at the room temperature for 24 h and subjected to 500 thermocycles. The prepared teeth were placed in 0.6 % rhodamine solution for 48 h; sectioned longitudinally using a hard‑tissue microtome and scanned under a confocal laser scanning electron microscope. Data were analyzed using the one‑way ANNOVA, Wilcoxson signed‑rank test, and Kruskal–Wallis test. Significant differences were observed between fluorosed and nonfluorosed groups. Intragroup comparisons showed significant differences between fluorosed step and conventional subgroups.  Fluorosed teeth had higher microleakage values than nonfluorosed teeth. Pulse‑delayed subgroup had the least microleakage to that of conventional and stepped curing subgroups, in both fluorosed and nonfluorosed groups.

1 illus, 2 tables, 22 ref

041426   ASATSA S (Psychology Dep, The Catholic Univ of Eastern Africa, Nairobi, Kenya, Email: steveasatsa@gmail.com) : Death attitudes as possible predictors of death preparedness across lifespan among nonclinical populations in Nairobi County, Kenya. Indian J Palliat Care 2020, 26(3), 287-94.

Death is an important part of lifespan development, yet it remains trivialized or feared across many cultures. The perpetuation of death as a taboo subject continues to negatively affect the society. Death anxiety inhibits death preparedness which could affect the quality of dying. The pool of unclaimed assets held by different organizations continues to increase, intestate deaths remain high, and post death conflicts continue to affect many families. This study intended to examine death attitudes as possible predictors of death preparedness and explore the rationale for various death attitudes across lifespan in Nairobi, Kenya. The study adopted the mixed‑methods explanatory sequential research design combining cross‑sectional and phenomenological designs. The study targeted young adults, middle‑aged adults, and seniors with a sample of 335 participants selected using multistage, stratified, and extreme case sampling designs. Data were collected using the Death Attitude Profile‑Revised and interview guides. Data were analyzed using univariate and thematic analyses. The findings indicated that negative death attitudes declined with increase in age, whereas positive death attitudes increased with increase in age. Some of the reasons for negative death attitudes included threatening dying process, unfulfilled life goals, fear of hell, unresolved past deaths, and families with young children among others. The reasons for positive death attitude included reuniting with deceased loved ones and peers, meeting the creator, and end to a prolonged miserable life and fulfilled past life. This study implies that mental health practitioners need to target younger adults with death education programs to promote death preparedness and quality dying. For the older adults, addressing life regrets, family conflicts, and past unresolved deaths would significantly improve the quality of dying.

2 illus, 2 tables, 30 ref

041425   RAVINDRAN A, KUNNATH R P, SUNNY A, VIMAL B (Nephrology Dep, KMCT Medical Coll, Manassery, Kerala, Email: rajeshpkunnath@gmail.com) : Comparison of safety and efficacy of pregabalin versus gabapentin for the treatment of uremic pruritus in patients with chronic kidney disease on maintenance haemodialysis. Indian J Palliat Care 2020, 26(3), 281-6.

Uremic pruritus (UP) affects many patients suffering from chronic kidney disease (CKD) and has a negative impact on the quality of life. The severity of UP ranges from sporadic discomfort to complete restlessness during both day and night time. It has become increasingly evident that central transmission and sensitization processes similar to those observed in chronic pain are important mechanisms of pruritus. This was a randomized single-blind prospective-interventional study carried out for 6 weeks. Male and female patients aged between 20 and 85 years with end-stage renal disease undergoing maintenance hemodialysis and who had substantial pruritus defined as persistent were included in our study. Informed consent was obtained from each patient before enrolling in the study. Patients were randomly divided into two groups (Group A and B), with Group A receiving pregabalin 25 mg and Group B receiving gabapentin 100 mg. The efficacy and safety of drugs were assessed after 6 weeks using visual analog scale and 5D itch scale. We used gabapentin 100 mg or pregabalin 25 mg for 42 consecutive patients with CKD on maintenance hemodialysis with a mean age of patients in Group A (pregabalin 25 mg) 55.29 ± 14.58 and B (gabapentin 100 mg) 58.10 ± 11.09. Both gabapentin and pregabalin produced a significant difference in itching intensity with P < 0.001; however, there was no statistically significant difference between the effectiveness of two drugs in reducing itch. While receiving gabapentin, 11 of 21 patients (52.38%) reported fatigue, dizziness, somnolescence, which was statistically significant (P ≤ 0.001) and 4 of these patients discontinued use of the drug due to excessive somnolence, all after the first dose. A statistically significant difference was found in each domain of 5D-Pruritus scale after gabapentin and pregabalin therapy.

3 tables, 11 ref

041424   SADEGHPOUR F, HEIDARZADEH M, KOHI F, ASADI R, AGHAMOHAMMADI-KALKHORAN M, ABBASI F (Medical-Surgical Nursing Dep, Ardabil Univ of Medical Sciences, Ardabil, Iran, Email: m.mahda@gmail.com) : The relationship between “self-care ability” and psychological changes among hemodialysis patients. Indian J Palliat Care 2020, 26(3), 276-80.

The study investigates and analyzes the relationship among the concepts of demoralization, posttraumatic growth, and self‑care ability in patients undergoing hemodialysis. The cross‑sectional descriptive correlational study was conducted in 2017 on 150 hemodialysis patients selected through census in Buali Hospital, Ardabil, Iran. Demoralization scale, the posttraumatic growth inventory, and self‑care questionnaire were used for cross‑sectional data collection. Data were analyzed using descriptive statistics, Pearson and Spearman correlation coefficient. The mean and standard deviation of demoralization, posttraumatic growth, and self‑care were 36.25 ± 18.84, 63.17 ± 17.71, and 33.89 ± 6.40, respectively. Self‑care ability was positively associated with posttraumatic growth (r = 0.287) and negatively related to demoralization (r = −0.168). Self‑care ability was also found to be desirable in 84.7 % of the patients. Hemodialysis patients can experience both positive and negative psychological changes. Self‑care ability is associated with reductions in negative psychological problems and increases in positive psychological changes. Health‑care providers can, therefore, help hemodialysis patients to improve their psychological conditions by making plans for improving self‑care abilities.

1 illus, 3 tables, 29 ref

041423   KHARBTENG L, MONALIZA, KUMAR V, KAUR S, GHAI S (Nursing Dep, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012, Email: lasarakbteng@gmail.com) : Effectiveness of a breathing training program on quality of life in patients with predialysis chronic kidney disease: A randomized controlled trial. Indian J Palliat Care 2020, 26(3), 271-5.

Chronic kidney disease (CKD) patients have suboptimal quality of life (QOL). Various studies/researches have revealed that breathing exercises have a positive and favorable impact on different systems of the body. This study aims to assess the effect of a breathing training program on QOL in patients with predialysis CKD. The study was a single‑center study conducted at PGIMER, Chandigarh. Randomized controlled trial. Sixty individuals were enrolled and randomized using lottery method. QOL was assessed or evaluated by Kidney Disease and QOL questionnaire (KDQOL™‑36). Breathing exercises were taught to the intervention group. Patients included in control group continued with the routine care. Assessment of QOL was done after 4 weeks in both the groups.Change in KDQOL™‑36 scores showed significant difference between control and the intervention group. The mean scores of control group in the subscale effects of kidney disease, SF‑12 Physical functioning (Physical Health Composite) and SF‑12 Mental functioning (Mental Health Composite) were 84.79, 39.16 and 37.40, respectively, whereas in intervention group, the respective mean scores were 91.88, 43.92, and 44.16. The difference was statistically significant (P = 0.04, P = 0.01, and P = 0.003, respectively). Breathing training program improves QOL in patients with predialysis CKD.

1 illus, 3 tables, 20 ref

043247   XUE F, YU M, LI L, ZHANG W, MA Y, DONG L, SHAN W, ZHENG Y, WANG T, FENG D, et al. (Central Laboratory Dep, Affiliated Hospital of Jiangsu Univ, Zhenjiang 212001, China, Email: xuefengwang@ujs.edu.cn) : Elevated granulocytic myeloid-derived suppressor cells are closely related with elevation of Th17 cells in mice with experimental asthma. Int J Biol Sci 2020, 16(12), 2072-83.

Asthma is a complex and heterogeneous inflammatory response characterized by various immune cells, including myeloid-derived suppressor cells (MDSCs) and CD4⁺ T-cell subsets. However, few studies on MDSC subsets and the association between MDSCs and CD4⁺ T-cell subsets in asthma are reported. In the present study, we detected CD4⁺ T cells and MDSC subsets and evaluated the relationship of these cells in mice with ovalbumin-induced asthma. We found that asthmatic mice showed severe airway inflammatory response and inflammatory cell infiltration in the lungs and bronchoalveolar lavage fluid. We also noted increased numbers of Th2, Th17, and MDSCs; decreased proportion of Th1 and Treg cells in the splenocytes and lungs; and increased expression of pro-inflammatory cytokines in splenocytes and lungs. Granulocytic MDSCs (G-MDSCs) and Th17 cells were closely related. Gemcitabine treatment reduced the G-MDSC level and the iNOS expression, alleviated the inflammatory response, and decreased the proportion and number of Th2 and Th17 cells in asthmatic mice. Besides the increase in Th2 and Th17 cells, the findings indicate that G-MDSC elevation plays a crucial role in asthmatic mice.

7 illus, 43 ref

043246   ZHOU M, CHEN J, ZHANG H, LIU H, YAO H, WANG X, ZHANG W, ZHAO Y, NANG N (Infectious Diseases Dep, First Affiliated Hospital of Xi’an Jiaotong Univ, Yanta West Road No. 277, Xi’an 710061, China, Email: nan_yang@xjtufh.edu.cn) : KLF10 inhibits cell growth by regulating PTTG1 in multiple myeloma under the regulation of microRNA-106b-5p. Int J Biol Sci 2020, 16(12), 2063-71.

Krüppel-like factor 10 (KLF10) has been identified as an important regulator in carcinogenesis and cancer progression. However, the role of KLF10 in multiply myeloma (MM) development and progression remains unknown. In present study, we found that KLF10 mRNA and protein were down-regulated in MM tissues and cell lines. Notably, KLF10 inhibited cell proliferation, cell cycle progression and promoted apoptosis in vitro and in vivo. Furthermore, we confirmed that KLF10 inhibited β-catenin nuclear translocation and inhibited PTTG1 transcription. PTTG1 knockdown could mimic the biological effects of KLF10. Moreover, we demonstrated that KLF10 expression was regulated by miR-106b-5p. In MM tissues, miR-106b-5p has an inverse correlation with KLF10 expression. Conclusively, our results demonstrated that KLF10 functions as a tumor suppressor in regulating tumor growth of MM under regulation of miR-106b-5p, supporting its potential therapeutic target for MM.

7 illus, 28 ref

043245   REN L, ZHOU T, WANG Y, WU Y, XU H, LIU J, DONG X, YI F, GUO X, WANG Z, et al. (Anorectal Surgery Dep, First Affiliated Hospital of China Medical Univ, Shenyang, Liaoning Province, China, Email: czxing@cmu.edu.cn) : RNF8 induces β-catenin-mediated c-Myc expression and promotes colon cancer proliferation. Int J Biol Sci 2020, 16(12), 2051-62.

DNA damage signals transducer RING finger protein 8 (RNF8) is involved in maintaining genomic stability by facilitating the repair of DNA double-strand breaks (DSB) via ubiquitin signaling. By analyzing the TCGA database and colon cancer tissue microarrays, we found that the expression level of RNF8 was positively correlated with that of c-Myc in colon cancer, which were closely associated with poor survival of colon cancer patients. Furthermore, overexpressing and knocking down RNF8 increased and decreased the expression of c-Myc in colon cancer cells, respectively. In addition, RNF8 interacted with β-catenin and facilitated its nuclear translocation by conjugating K63 polyubiquitination on it. These observations suggested a de novo role of RNF8 in promoting the progression of colon cancer by inducing β-catenin-mediated c-Myc expression.

5 illus, 47 ref