bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Factors for Progression From Gestational Diabetes to Postpartum Type 2 Diabetes: A Review
Authors: BENGTSON ANGELA M. , RAMOS SEBASTIAN Z. , SAVITZ DAVID A. , WERNER ERIKA F.
Published: December 2020

Gestational diabetes mellitus (GDM) complicates 6% to 8% of pregnancies and up to 50% of women with GDM progress to type 2 diabetes mellitus (DM) within 5 years postpartum. Clinicians have little guidance on which women are most at risk for DM progression or when evidence-based prevention strategies should be implemented in a woman’s lifecycle. To help address this gap, the authors review identifiable determinants of progression from GDM to DM across the perinatal period, considering prepregnancy, pregnancy, and postpartum periods. The authors categorize evidence by pathways of risk including genetic, metabolic, and behavioral factors that influence progression to DM among women with GDM.
Screening for Aneuploidy in the Patient With Diabesity: Pearls and Pitfalls
Authors: HOPKINS MAEVE K. , DUGOFF LORRAINE
Published: December 2020

The American College of Obstetrics & Gynecology (ACOG) recommends offering aneuploidy screening to all pregnant women. Obesity and diabetes are not associated with an increased risk of aneuploidy; however, they can complicate and compromise testing options. As the prevalence of obesity and diabetes, or “diabesity” increases, counseling women regarding potential limitations in testing performance of aneuploidy screening is of paramount importance. This chapter reviews options for aneuploidy screening for women with diabesity including sonography/nuchal translucency, serum analyte screening, and cell-free DNA. Potential challenges associated with diagnostic testing with amniocentesis and chorionic villus sampling in women with obesity are also discussed.
If you say so
Authors: Westra Daan , Angeli Federica , Kemp Ron , Batterink Maarten , Reitsma Jan
Published: December 2020

Background

Despite a lack of supporting evidence, hospitals continue to merge in pursuit of quality improvements.

Purpose

We seek to develop a more thorough understanding of the quality effects of hospital mergers by integrating various theoretical perspectives using a mixed-methods design.

Methodology

Quantitatively, we tested the quality effect of all consummated hospital mergers in the Netherlands between 2008 and 2014 on 15 quality indicators (with 82 measurements at hospital, department, and disease levels) using a difference-in-difference approach with Bonferroni correction. Qualitatively, we conducted three comparative case studies to examine how hospital executives, managers, and medical professionals perceive the quality impact of hospital mergers.

Results

Our quantitative results reveal few significant effects of hospital mergers on quality of care at all levels. After applying Bonferroni correction, two quality indicators are negatively associated with hospital mergers. However, the qualitative results indicate that hospital staff have positive perceptions of the mergers’ quality implications, resulting from scale and shock effects.

Conclusion

The perceptions of hospital staff regarding mergers diametrically oppose their measurable effects. However, the operationalization of quality by hospital staff members differs considerably from the way it is quantitatively measured. The positive perceptions of hospital staff toward mergers could further contribute to the institutionalization of mergers as a quality improvement strategy.

Practice Implications

Hospital managers seeking measurable quality improvements should be wary of merging, despite potential positive perceptions toward it within the organization. In case they do decide to merge, mitigating difficulties in the postmerger integration processes seem most pertinent to achieve measurable effects.
Results of intrastromal corneal ring segment implanted alone or combined with same-day corneal crosslinking and their correlation with preoperative corneal biomechanical strain from finite element analysis
Authors: Serpe Crislaine C. , Mello Glauco R. , Seven Ibrahim , Dupps William J. , Santhiago M.R.
Published: December 2020

Purpose:

To compare the results of intrastromal corneal ring segment (ICRS) alone or combined with same-day corneal crosslinking (CXL) and investigate the relationship of preoperative corneal biomechanics data on the outcomes.

Setting:

Department of Ophthalmology of Federal University of Parana.

Design:

Prospective nonrandomized interventional comparative study.

Methods:

Forty-nine eyes of 44 keratoconus patients underwent ICRS only (n = 27, Group 1) or same day ICRS+CXL (n = 22, Group 2) and were followed up for at least 24 months. Visual acuity and preoperative and postoperative tomographic variables were compared between groups. Tomographic data were obtained with a dual Scheimpflug analyzer, and eye-specific finite-element models were used to derive 3 variables related to preoperative biomechanical strain (maximum principal strain [MPS]): mean MPS (mMPS), highest local MPS (hMPS), and position of the hMPS (hMPSx and hMPSy). The relationship between preoperative strain data and the change (∆, difference between postoperative and preoperative data) in tomographic parameters was also investigated.

Results:

Steepest (K2) and maximum keratometry (Kmax), inferior–superior (I–S) index, coma, and cone location magnitude index (CLMI) significantly improved in both groups. Corrected distance visual acuity was significantly better after ICRS alone (P = .03), whereas corneal asymmetry measured through the I–S index was better after CXL+ICRS (P = .04). In Group 1, hMPSy significantly correlated with K2, tomographical cylinder, mean keratometry, and ∆spherical aberration, whereas mMPS significantly correlated with ∆eccentricity. In Group 2, hMPS significantly correlated with K2, Kmax, I–S index, and ∆coma, and hMPSy significantly correlated with I–S index and ∆coma. The mMPS significantly correlated with ∆CLMI.

Conclusions

ICRS alone seems to be the most suitable option to improve visual acuity, whereas combined ICRS+CXL provided better corneal regularizing results. Preoperative peak strain (hMPS) was predictive of the extent of regularization and flattening after ICRS+CXL.
Thirty-three–gauge hypodermic needle–guided iris suturing technique
Authors: Safran Steven G. , Bonaffini Sarah G. , Chatha Usma
Published: December 2020

The purpose of this study was to describe a new 33-gauge hypodermic needle-guided iris suturing technique for repair of iris defects and its adaptation for use to address a wide range of iris pathology in complex anterior segment reconstruction cases. This approach uses a 33-gauge hypodermic needle loaded with a 10-0 Prolene suture within its lumen, which is then used to directly introduce and manipulate the suture within the anterior chamber. Eliminating the need for a needle holder, this technique provides surgeons improved ergonomics and minimizes risk for trauma to adjacent tissues. Improving on and addressing limitations of the original sewing machine technique described by Safran in 1995, iris repair using this technique has been applied successfully in 15 patients to achieve satisfactory visual and cosmetic outcomes without complications. Multiple iris suturing strategies can be combined on a given case to attain complex repair with this new approach.
Application of masticatory control in dental treatment for elderly individuals
Authors: Chen Ta-Chung , Cheng Dong-Hui , Hsu Ming-Lun , Lei Yen-Ping
Published: December 2020

Taiwan transitioned to an aged society in 2018. Appropriate dental treatment is important for elderly individuals. Previously, reconstruction of the dentition was thought to help regain chewing function. However, concerns of the elderly population, such as decline in learning ability and saliva secretion, complicate dental reconstruction. Overlooking the special needs of elderly individuals may lead to impaired chewing function, resulting in nutritional imbalances and increased burden on the digestive tract, causing more health disorders. For the elderly population, treatment must be aimed at restoring as much chewing function as possible with minimal changes. Additionally, regular oral hygiene care, proper design of fixed partial dentures, and implant placement greatly reduce the difficulty in adapting to a new prosthesis. These measures allow us to provide better quality of life for elderly individuals.
Knowledge, attitude, and barriers regarding prescribing long-term opioids among Taiwan physicians treating officially registered patients with chronic noncancer pain
Authors: Hsu Yung-Chi , Lin Shinn-Long , Sung Chun-Sung , Ger Luo-Ping , Liou Huei-Han , Lin Tso-Chou , Ho Shung-Tai
Published: December 2020

Background:

Prescribing opioids for patients with chronic noncancer pain (CNCP) remains controversial. This study surveyed Taiwanese physicians who were clinically treating CNCP outpatients with long-term opioids.

Methods:

Anonymous questionnaires investigating the clinical practices, opioid knowledge, attitude, and barriers regarding the prescription of long-term opioids were delivered to 66 physicians treating CNCP outpatients who were officially registered and monitored by the Taiwan Food and Drug Administration in 2011.

Results:

All 66 (100%) physicians responded to the survey, comprising 41 (62%) board-certified pain specialists and 25 (38%) nonpain board-certified physicians. Pain specialists treated a greater number of CNCP outpatients and attended more CNCP training courses than nonpain board-certified physicians (97.6% vs. 56.0%, p < 0.001). Most of pain specialists stated that they were familiar with the Taiwan’s narcotic regulations for CNCP patients (92.7% vs. 68.0%, p = 0.015). In addition, pain specialists were less likely to skip or reduce the dosage and duration of opioid prescriptions (22.0% vs. 36.0%, p < 0.001). By contrast, nonpain board-certified physicians had significantly less knowledge and a more negative attitude toward opioid prescription. The major perceived barriers were physician’s reluctance to prescribe opioids (78% vs. 92%) and an inadequate knowledge of pain management (73% vs. 84%) among all physicians.

Conclusion:

Among the Taiwanese physicians treating the officially registered CNCP patients, nonpain board-certified physicians had fewer patients, less knowledge, and an increased negative attitude toward long-term opioid prescriptions. Better education on chronic pain management is needed for improvement of clinical practice.
Interleukin-2 receptor alpha as a biomarker for nonalcoholic fatty liver disease diagnosis
Authors: Kao Wei-Yu , Lin Yuan-Feng , Chang I-Wei , Chen Chi-Long , Tang Jui-Hsiang , Chang Chun-Chao , Chang Yu-Jia , Wang Weu
Published: December 2020

Background:

Two recent studies in the adult and pediatric Nonalcoholic Steatohepatitis-Clinical Research Network (NASH-CRN) cohorts have shown that soluble interleukin-2 receptor alpha (IL2RA) levels increased with fibrosis severity. However, no hepatic study has been conducted in Asian morbidly obese patients who underwent bariatric surgery. In this study, we proposed IL2RA as a biomarker for nonalcoholic fatty liver disease (NAFLD) diagnosis and performed immunohistochemistry (IHC) staining of IL2RA.

Methods:

This prospective cohort study enrolled 123 morbidly obese patients who underwent bariatric surgery at Taipei Medical University Hospital from October 2016 to June 2018. During bariatric surgery, all patients underwent a wedge liver biopsy under laparoscopic guidance. The diagnoses of NASH and liver fibrosis were made histologically. In IHC of IL2RA, the number of lymphocytes with IL2RA immunoreactivity was counted in five high-power fields (×400, total: 1.19 mm2).

Results:

Among the 123 patients, the mean age was 35.5 years, mean body mass index (BMI) was 40.6 kg/m2, 87 (70.7%) were female, 25 (20.7%) had diabetes mellitus, and 57 (46.3%; 11 with non-NAFLD and 46 with steatosis) and 66 (53.7%) were included in the non-NASH and NASH groups, respectively. The NASH group had higher IHC of IL2RA than the non-NASH group. In multivariate analysis, IHC of IL2RA (odds ratio, 1.025; 95% confidence interval, 1.006–1.045; p = 0.011) and alanine aminotransferase (ALT; odds ratio, 1.045; 95% confidence interval, 1.018–1.073; p = 0.001) were the independent factors associated with NASH. The area under the receiver operating curve of IL2RA IHC for NASH was 0.627 at the cutoff value of 82 (p = 0.0113).

Conclusion:

IL2RA is significantly associated with NASH in morbidly obese patients and would be a useful biomarker for NASH diagnosis.
Factors Associated With Nonadherence to Antiretroviral Therapy Among Young People Living With Perinatally Acquired HIV in England
Authors: Judd Ali , Melvin Diane , Thompson Lindsay C. , Foster Caroline , Le Prevost Marthe , Evangeli Michael , Winston Alan , Arenas-Pinto Alejandro , Sturgeon Kate , Rowson Katie , Gibb Diana M. , Castro Hannah ,   on behalf of the Adolescents and Adults Living with Perinatal HIV (AALPHI) Steering Committee
Published: December 2020

Young people living with perinatally acquired HIV may be at risk of poor adherence to antiretroviral therapy; identification of predictors, using a conceptual framework approach proposed previously by others, is important to identify those at higher risk. In 261 young people with perinatally acquired HIV in England, 70 (27%) reported 3-day nonadherence, 82 (31%) last month nonadherence, and 106 (41%) nonadherence on either measure. Of those reporting nonadherence on both measures, 52% (23/44) had viral load of <50 copies/ml, compared with 88% (127/145) of those reported being fully adherent. In multivariable analysis, young person and medication theme factors were associated with nonadherence. The main predictors of 3-day nonadherence were antiretroviral therapy containing a boosted protease inhibitor and poorer quality of life. Predictors of last month nonadherence were having told more people about one's HIV status, worse self-perception about having HIV, and boosted protease inhibitor–based regimens. The consistency of individual young person and medication factors in predicting nonadherence gives insight into where interventions may best be targeted to improve adherence.
Nurse- and Midwife-Led HIV Services in Eastern and Southern Africa: Challenges and Opportunities for Health Facilities
Authors: MacKay Rebecca E. ,   ARC Study Group, Gross Jessica M. , Hepburn Kenneth W. , Spangler Sydney A.
Published: December 2020

In eastern and southern Africa, much is unknown about implementation of nurse-initiated and managed antiretroviral therapy (NIMART). The purpose of this study was to identify perceived barriers and facilitators of NIMART for the prevention of mother-to-child transmission and pediatric HIV services in high-volume, high HIV-burden health facilities across this region. A total of 211 nurses, midwives, and nurse midwives and 62 supervisors from 30 health facilities in 11 countries participated in this mixed-methods evaluation. The findings show that although nurses, midwives, and nurse midwives clearly had the authority to provide NIMART services, they did not necessarily feel that they were well prepared and supported to do so. Deficits in supportive supervision and clinical mentorship were viewed as substantial challenges to effective provision of NIMART for the prevention of mother-to-child transmission and pediatric HIV services—particularly with respect to pediatric HIV services. Health facilities have important opportunities to advance NIMART practice through strengthening these aspects of in-service support.
Assessing Tobacco Cessation Needs Among Persons Living With HIV in Brazil: Results From a Qualitative Interview Study
Authors: Scarinci Isabel C. , Ribeiro Marcos , Gibson Elena , Hansen Barbara , Kienen Nadia
Published: December 2020

With regard to tobacco cessation, persons living with HIV (PLWH) are an underserved population, given the high prevalence of use and lack of evidence-based cessation programs tailored to this population. This study examined barriers and facilitators to tobacco use and cessation among PLWH in southern Brazil. We interviewed a total of 36 PLWH: 26 current smokers, of whom eight had a previous diagnosis of pulmonary TB, and 10 former smokers. Motivations for smoking included anxiety relief, social influence, and habitual behaviors. Motivations to quit included bad smell/taste and consequences/symptoms. Barriers to cessation included cost of pharmacological aids, distance to treatment, and reluctance to seek tobacco cessation services at the public primary care clinics due to confidentiality concerns. Participants favored individual or group interventions, no-cost pharmacologic aids, and assured confidentiality. There are specific contextual factors associated with tobacco cessation among PLWH in Brazil, which have important clinical, research, and policy implications.
Cigarette Smoking and Cessation-Related Interactions With Health Care Providers in the Context of Living With HIV: Focus Group Study Findings
Authors: Pacek Lauren R. , Holloway Alicia D. , Cropsey Karen L. , Meade Christina S. , Sweitzer Maggie M. , Davis James M. , McClernon F. Joseph
Published: December 2020

Smoking is disproportionately prevalent among people living with HIV (PLWH) compared with the general population. We conducted five focus groups (n = 24) using semi-structured interview guides to explore perceptions and experiences of smoking and cessation-related interactions with health care providers among smokers with HIV. Major themes included a limited understanding of how smoking affects illness among PLWH and minimal discussion about cessation with providers. Findings highlight the need to educate smokers with HIV about the known impacts of smoking on illness among PLWH and to facilitate greater discussion of cessation between providers and smokers with HIV. Prior experiences with smoking cessation medications and desire for additional information regarding these medications should be considered when implementing medication regimens in research and clinical settings.
Asian American Women's Recall of Conversations With Their Mothers About Sexual Health: A Secondary Analysis of Qualitative Data
Authors: Kim BoRam , Aronowitz Teri
Published: December 2020

Between 2010 and 2016, Asian Americans (AA) had a 35% increase in HIV diagnosis. Although mother–daughter sexual communication was found to be protective in minority populations, the opposite is true among AAs. The purpose of this study was to explore AA women's experiences of sexual communication with their mothers. Secondary qualitative analysis using analytic expansion with a phenomenological approach was used. Thematic analysis was used to search for common patterns and themes that emerged using qualitative description methodology. Twenty East and Southeast AA cisgender women, ages 18–33 years, were interviewed. The primary finding was an intergenerational gap with two themes: (a) mothers' attitudes about sexual communication and (b) content of sexual communication. Indirect sexual communication included cautionary messages consistent with previous studies. AA mothers' strong cultural beliefs created a barrier to communication. Future research should focus on the young women who want open sexual communication and could influence the next generation.
Effects of Nurse-Delivered Cognitive Behavioral Intervention on Depression and Anxiety for Persons Living With HIV in China: A Clinical Controlled Trial
Authors: Han Shuyu , Hu Yan , Relf Michael V. , Mulawa Marta I. , Lu Hongzhou , Zhang Lin , Zhu Zheng , Luo Jianfeng , Pei Yaolin , Wu Bei
Published: December 2020

Depression and anxiety, which may influence antiretroviral therapy (ART) medication adherence, are prevalent among persons living with HIV (PLWH) in China. This parallel two-arm clinical controlled trial aimed to examine the effects of a nurse-delivered cognitive behavioral intervention (CBI) on depression, anxiety, and ART medication adherence in Chinese PLWH. Using in-person and online recruitment, 140 PLWH ages 18 years and older who were undergoing ART and had a Patient Health Questionnaire-4 score of ≥2 were assigned to the 10-week-long CBI group or the routine follow-up group according to their preference. Outcomes were measured at baseline, postintervention, and 6-month follow-up. Results showed significant intervention effects on depression maintained until the 6-month follow-up. Although anxiety and ART medication adherence did not show robust effects between conditions, amelioration trends for these outcomes were also found. Our study demonstrated that the nurse-delivered CBI could help Chinese PLWH ameliorate depression.
Facilitators and Barriers of HIV Self-Testing Among Chinese Men Who Have Sex With Men: A Qualitative Study
Authors: Zhang Ci , Li Xianhong , Heilemann MarySue V. , Chen Xi , Wang Honghong , Koniak-Griffin Deborah
Published: December 2020

HIV self-testing (HIVST) could increase HIV testing. However, HIVST uptake rate among Chinese men who have sex with men (MSM) is low. We conducted qualitative interviews with 23 MSM, 4 workers from community-based organizations, and 7 officials from both provincial Centers for Disease Control and Prevention and affiliated city-level Centers for Disease Control and Preventions to explore facilitators and barriers of HIVST among Chinese MSM. Eight barriers were identified, including fear of being duped by a fake test, concern for cost, fear of disclosing sexual orientation, limited access, lack of consulting services, biosafety concerns, lack of policy support, and concern for lost opportunities to link men to care. Five facilitators were identified, including convenience, confidentiality, easy operation, partner HIV testing, and peers' influence. Officials and scholars should urgently address structural barriers and provide accessible, affordable, and high-quality HIVST services that are accompanied by counseling to develop culturally appropriate HIVST guidelines.
Issues Associated With Prescribing HIV Pre-exposure Prophylaxis for HIV Anxiety: A Qualitative Analysis of Australian Providers' Views
Authors: Smith Anthony K. J. , Holt Martin , Haire Bridget , Newman Christy E.
Published: December 2020

HIV pre-exposure prophylaxis (PrEP) can alleviate anxiety about acquiring HIV, particularly for gay men and other men who have sex with men. However, research with PrEP providers has rarely examined HIV anxiety. We conducted 25 semistructured interviews in 2019-2020 with PrEP providers in New South Wales and Western Australia, and analyzed data thematically. Participants included general practitioners and sexual health nurses and doctors. Our analysis explores providers' views on providing PrEP to reduce HIV anxiety for gay men, serodiscordant couples where the partner with HIV has an undetectable viral load, and for “worried well” individuals who the providers speculated might have undisclosed risk. Although providers viewed PrEP as beneficial for many people's personal lives and relationships, they felt cautious about prescribing PrEP solely for HIV anxiety, while at the same time reporting that they prescribed PrEP if individuals insisted on it and had no medical contraindications.
The Role of Nurses and Midwives in Expanding and Sustaining Voluntary Medical Male Circumcision Services for HIV Prevention: A Systematic and Policy Review
Authors: Davis Stephanie M. , Baker Helen , Gross Jessica M. , Leslie Sharon L. , Chasokela Cynthia M. Z. , Samuelson Julia , Toledo Carlos
Published: December 2020

Male circumcision reduces men's risk of acquiring HIV through heterosexual sex, and voluntary medical male circumcision (VMMC) is central to HIV prevention strategies in 15 sub-Saharan African countries. Nurses have emerged as primary VMMC providers; however, barriers remain to institutionalizing nurse-led VMMC. Patient safety concerns have hindered task sharing, and regulations governing nurse-performed VMMC are not always supportive or clear. We performed a systematic review on VMMC safety by provider cadre and a desk review of national policies governing the VMMC roles of nurses and midwives. Also, VMMC by nurses is safe and has become standard practice. Countries had multiple policy combinations among different documents, with only one disallowing VMMC by these cadres. Countries with alignment between policies often ensured that nursing workforces were equipped with clinical competencies through national certification. Regulatory clarity and formalized certification for nurse-performed VMMC can increase program sustainability and build nursing capacity to meet other critical basic surgical needs.
Reconstruction of extensive plantar forefoot defects with free anterolateral thigh flap
Authors: Chen Lei , Zhang Zhixin , Li Ruijun , Liu Zhigang , Liu Yang
Published: December 2020

Purpose:

The aim of the soft tissue reconstruction of plantar forefoot should yield weight-bearing function and aesthetic contour, which poses a significant challenge for reconstructive surgeons to provide an appropriate flap according to the “like for like” reconstructive principle. Local flaps and pedicled flaps have been described for the reconstruction of small- to medium-sized defects of plantar forefoot and achieved optimal results. However, reconstruction of extensive defects of plantar forefoot is rarely investigated. In this study, we present our experience using the free anterolateral thigh (ALT) flap in the reconstruction of extensive defects of plantar forefoot.

Methods:

Between November 2011 and April 2017, 9 patients were treated for extensive soft tissue defects in the plantar forefoot areas with ALT flaps. The mean age at the time of surgery was 39.3 years (range, 25–64 years).

Results:

The follow-up period ranged from 12 to 77 months, with a mean of 31 months. All flaps survived well, and the patients were satisfied with the aesthetic and functional results. The size of the flaps ranged from 63 to 455 cm2, with a mean of 197.7 cm2. Seven patients with no bony involvement began to gradually weight-bear at 3 weeks postoperatively. During the follow-up time, postoperative ulceration at the reconstructed weight-bearing areas was not encountered.

Conclusion:

The ALT flap is a reliable option for treatment of extensive defects of plantar forefoot, resulting in an optimal functional and aesthetic outcome. Even when a total plantar loss exits, excellent results can be achieved.
Study on the new strategy and key techniques for accurate prevention and treatment of nonalcoholic steatohepatitis based on intestinal target bacteria
Authors: Zhuo Lili , Xu Jiali , You Ningning , Wang Liyan , Song Yu , Luo Yan , Shi Junping
Published: December 2020

Background:

Nonalcoholic fatty liver disease (NAFLD) has emerged as a major health problem worldwide; according to statistics, 10% to 25% of patients with NAFLD can progress to nonalcoholic steatohepatitis (NASH). A link between the composition and metabolites of intestinal microbiota and the development of NAFLD is becoming clearer. It is believed that microbiota factors are driving forces of hepatic steatosis and inflammation. The formulated food that contains prebiotics and dietary fiber may improve NAFLD by altering the intestinal flora and its metabolites.

Methods:

The study plan to recruit adult patients (18–75 years, n = 120) with NAFLD, range of alanine aminotransferase is 1.5 to 5 times upper limit of normal (ULN) or liver biopsy is confirmed as NASH. Participants will be randomly allocated into 2 groups: formulated food (n = 80) and a placebo group (n = 40) for 24 weeks. Both groups will receive lifestyle and nutritional advice. The primary endpoint is a decrease in MRS-PDFF by more than 30% from baseline at 24 weeks. The secondary endpoints include the change of anthropometric, liver function, glycolipid metabolism, and systemic inflammation at 4, 12, and 24 weeks. In addition, we consider the changes in intestinal microbiota as an exploration to assess the abundance and diversity at 24 weeks. Weeks 24 to 36 are the follow-up period of drug withdrawal.

Discussion:

This clinical trial will provide evidence of efficacy and safety of formulated food as a potential new therapeutic agent for NAFLD patients.

Trial Registration:

The trial is registered in the China Clinical Trial Center (ChiCTR1800016178).
Long non-coding RNAs expression profile and functional analysis of acute ischemic stroke
Authors: Li Jia , Hao Miao , Yang Ben , Shi Tianji , Zhang Yingyu , Feng Jingqi , Chen Jiajun
Published: December 2020

Long non-coding RNAs (lncRNAs) have been evidenced to be associated with the development of multiple diseases. However, the expression pattern and function of lncRNAs in acute ischemic stroke remain unclear. To determine the differential expression of lncRNAs in acute ischemic stroke, we analyzed the expression profile of lncRNAs by high-throughput sequencing analysis. Gene Ontology (GO) and pathway analyses were employed to analyze the gene function and identify enriched pathways of the differentially expressed lncRNAs. We also built an lncRNA-mRNA expression correlation network and verified the interactions of selected lncRNAs in acute ischemic stroke. To further confirm the results of the expression profile, 6 differentially expressed lncRNAs were randomly selected and quantitative RT-PCR (qRT-PCR) performed. We identified 44,578 aberrantly expressed lncRNAs, including 228 upregulated and 16 downregulated lncRNAs. The qRT-PCR results showed that ENSG00000269900, ENSG00000196559, ENSG00000202198, ENSG00000226482, ENSG00000260539 (up), and XLOC_013994_2 (down) were abnormally expressed, which was consistent with the sequencing results. The upregulated expression of lncRNA ENSG00000226482 may activate the adipocytokine signaling pathway, resulting in acute ischemia stroke. In summary, we analyzed the lncRNAs expression profile in acute ischemic stroke patients and identified the functions and enriched metabolic pathways, proposing new insights into the diagnostic and therapeutic biomarkers for this disease.
Application of Joanna Briggs Institute physical restraint standards to critical emergency department patients following CONSORT guidelines
Authors: Wen Xiaoli , Sun Wei , Wang Yushu , Zeng Dongmei , Shao Yanxia , Zhou Xiaoping
Published: December 2020

To explore the effect of Joanna Briggs Institute (JBI) physical restraint standards in improving physical restraint in critical and emergency department patients.

Enrolled 300 critical patients admitted in our hospital's emergency department from January to December 2019: 150 patients admitted January to June 2019 as control group and 150 patients admitted July to December 2019 as observation group. Routine restraints were applied in control group. Emergency department nurses in the observation group received thematic and practical JBI standardized training. This included pre-restraint assessment, principles of physical restraint, informed consent, using a restraint decision-making wheel, and alternatives to physical restraint. The incidence of restraint-associated adverse events (e.g., skin bruising, swelling) and restraint utilization rate were examined between 2 groups.

The incidence of adverse events and the restraint utilization rate were significantly lower in the observation group (P < .05).

The application of JBI physical restraint standards for emergency department patients can effectively reduce the incidence of adverse events and the restraint utilization rate.
A comparative study protocol of external fixation versus volar plate in treating distal radius fracture
Authors: Zhang Fuqiang , Yang Yang , Zhang Hui , Luo Xiangli
Published: December 2020

Background:

The superiority of the open reduction and internal fixation (ORIF) and external fixation remains uncertain owing to the limited sample size involved in the literature. This retrospective cohort research was implemented for the comparison of the efficiency of ORIF and external fixation utilizing the locked volar plating in treating the intra-articular fractures of distal radius. We hypothesized that compared with the external fixation, ORIF can improve the functional scores and reduce complications.

Methods:

We conducted a retrospective and single-center cohort trial that was approved by institutional review committee of Gansu Provincial Hospital. From June 2016 to July 2018, in our experiment, 178 patients with intra-articular fractures of the distal radius were recruited. Inclusion criteria in this cohort study were designed as follows: the age of patients is between 18 and 65 years, the patients with American Society of Anesthesiologists level I–III, and with the AO-type C3 or C2 fractures of distal radius confirmed by computed tomography scans, the patients with radiographic clinical follow-up for 1 year or >1 year. The patients participating in the trial would be divided into 2 groups: the patients treated via the external fixation and the patients treated by the ORIF utilizing volar plate. The main functional results were the grip strength and the range of motion of wrist. Radiographic measurement and complications were also evaluated in our study.

Results:

This study protocol will guide and clarify our assignments, and the final outcomes and conclusion will further enrich the clinical knowledge in the literature.

Trial registration:

This study protocol was registered in Research Registry (researchregistry6116).
Anaesthesia and ICU sedation with sevoflurane do not reduce myocardial injury in patients undergoing cardiac surgery
Authors: Guinot Pierre-Grégoire , Ellouze Omar , Grosjean Sandrine , Berthoud Vivien , Constandache Tiberiu , Radhouani Mohamed , Anciaux Jean-Baptiste , Aho-Glele Serge , Morgant Marie-Catherine , Girard Claude , Nguyen Maxime , Bouhemad Belaid
Published: December 2020

Background:

To evaluate the effect of anaesthesia and ICU sedation with sevoflurane to protect the myocardium against ischemia-reperfusion injury associated to cardiac surgery assessed by troponin release.

Methods:

We performed a prospective, open-label, randomized study in cardiac surgery with cardiopulmonary bypass. Patients were randomized to an algorithm-based intervention group and a control group. The main outcome was the perioperative kinetic of cardiac troponin I (cTnI). The secondary outcomes included composite endpoint, GDF-15 (macrophage inhibitory cytokine-1) value, arterial lactate levels, and the length of stay (LOS) in the ICU.

Results:

Of 82 included patients, 81 were analyzed on an intention-to-treat basis (intervention group: n = 42; control group: n = 39). On inclusion, the intervention and control groups did not differ significantly in terms of demographic and surgical data. The postoperative kinetics of cTnI did not differ significantly between groups: the mean difference was 0.44 ± 1.09 μg/ml, P = .69. Incidence of composite endpoint and GDF-15 values were higher in the sevoflurane group than in propofol group. The intervention and control groups did not differ significantly in terms of ICU stay and hospital stay.

Conclusion:

The use of an anaesthesia and ICU sedation with sevoflurane was not associated with a lower incidence of myocardial injury assessed by cTnI. Sevoflurane administration was associated with higher prevalence of acute renal failure and higher GDF-15 values.
Prognostic role of macrophage migration inhibitory factor in patients with clear cell renal cell carcinoma
Authors: An Hyo Jung , Koh Hyun Min , Lee Jong Sil , Song Dae Hyun
Published: December 2020

Macrophage migration inhibitory factor (MIF) is a cytokine that mediates the interaction between malignant cells and the innate immune system. Recently, MIF has received attention for its role in tumorigenesis. We evaluated the prognostic role of MIF in clear cell renal cell carcinoma (CCRCC).

A total of 152 patients, who underwent nephrectomy for CCRCC were enrolled in this study. Immunohistochemical staining of tissue microarray blocks containing 298 cores—2 cores per CCRCC patient was performed. The relationship between MIF expression and clinicopathological factors was evaluated. Total RNA and protein were extracted from 7 RCC (renal cell carcinoma) cell lines. MIF was knocked down in Caki-2 cells, and a wound healing assay was performed to evaluate migratory activity.

Among the 298 cores, 180 (60.4%) were positive for MIF. Multivariate analysis, showed that, CCRCC patients with negative MIF expression exhibited poor disease-free survival (hazard ratio: 2.087, 95% confidence interval: 0.821–5.307, P value: .023) and poor disease-specific survival (hazard ratio: 2.101, 95% confidence interval: 1.009–4.374, P value: .047). The wound healing assay revealed that cell confluence was lower in MIF-deficient Caki-2 cells than in control cells.

Negative MIF expression might be an independent prognostic marker for patients with CCRCC.
An open-label continuation trial of sirolimus for tocilizumab-refractory idiopathic multicentric Castleman disease
Authors: Koga Tomohiro , Takemori Sachiko , Hagimori Naoko , Morimoto Shimpei , Sumiyoshi Remi , Shimizu Toshimasa , Hosogaya Naoki , Fukushima Chizu , Yamamoto Hiroshi , Kawakami Atsushi
Published: December 2020

Background:

Interleukin 6 (IL-6) inhibitors are the first-line treatment for idiopathic multicentric Castleman disease (iMCD); however, there is no established treatment for cases that are resistant to IL-6 inhibitors. Although sirolimus, a mammalian target of rapamycin inhibitor, has been suggested to be effective in patients with iMCD, the long-term safety and efficacy of sirolimus on individuals with IL-6 inhibitor-resistant iMCD have not been evaluated.

Methods/Design:

In this investigator-initiated, multicenter, open-label trial, the long-term safety of sirolimus will be evaluated in patients participating in a placebo-controlled, randomized, double-blind, parallel-group trial on tocilizumab (TCZ)-resistant iMCD. The study will be conducted in 7 centers in Japan. This trial will be promptly started after the evaluation and examination for 16 weeks in the preceding study. The trial will be completed by the time the drug is approved for iMCD treatment in Japan. The primary endpoint is the incidence of adverse events. The secondary endpoints include the following: the levels of hemoglobin, albumin, and C-reactive protein; change in CHAP score; physician global assessment (100-mm visual analog scale); patient global assessment (100-mm visual analog scale); and lymph node changes in subjects with lymphadenopathy.

Discussion:

This clinical trial will provide evidence regarding the long-term safety of sirolimus as a potential novel therapeutic agent for patients with tocilizumab-resistant iMCD.

Trial Registration number:

jRCT2051200050
Efficacy and safety of Shufeng Jiedu capsule in the treatment of COVID-19
Authors: Ma Li , Song Ji-Ni , Song Yan-Ping , Zhao Lin-Tao , Chen Hao
Published: December 2020

Background:

Coronavirus disease 2019 (COVID-19) epidemic is spreading worldwide. Shufeng Jiedu capsule (SFJDC) is a commonly used drug in the treatment of COVID-19. However, there is insufficient evidence for clinical efficacy and safety.

Methods:

Two authors will independently search the Chinese National Knowledge Infrastructure (CNKI), VIP database, Wanfang database, the Cochrane Library, EMBASE, PubMed and Web of Science, in English and Chinese. All analysis will be performed based on the Cochrane Handbook for Systematic Reviews of Interventions. Review Manager 5.3 and Stata 16.0 software will be used to analyze the eligible data.

Results:

This protocol will conduct a systematic review and meta-analysis of literature listed above, and reliable outcomes about the clinical efficacy and safety of SFJDC in the treatment of COVID-19 will be obtained.

Conclusions:

These findings will provide guidance for clinicians and patients using SFJDC for COVID-19 treatment.

PROSPERO Registration Number:

CRD42020185764.
Co-expression of KIAA1199 and hypoxia-inducible factor 1α is a biomarker for an unfavorable prognosis in hepatocellular carcinoma
Authors: Wang Dan , Lu Shu , Zhang Xiaojing , Huang Linlin , Zhao Hui
Published: December 2020

Advanced studies demonstrated that hypoxic stress induced KIAA1199 expression leading to enhanced cell migration. KIAA1199 is a protein related with cancer metastasis. Hypoxia inducible factor 1α (HIF-1α) is a transcriptional factor that maintains oxygen homeostasis. Both KIAA1199 and HIF-1α were upregulated in many human cancers. In the present study, co-expression of KIAA1199 and HIF-1α was evaluated for the clinicopathological characteristics and survival in hepatocellular carcinoma (HCC). Clinical-pathological information and follow-up data were collected from 152 HCC patients. KIAA1199 and HIF-1α expression were scored based on the percentage and intensity of immunohistochemical staining in pathological slide. Correlations between clinical features and the expression of KIAA1199 and HIF-1α were evaluated by Chi-square test, Kaplan-Meier curves and multivariate Cox regression analysis. The frequency of KIAA1199 high expression was higher in HCC than adjacent tissue. KIAA1199(H)/HIF-1α(H) tumors were more frequently of TNM (P = .011), tumor size (P = .021), vascular invasion (P = .002) and HBV (P = .001). In survival analysis, KIAA1199(H)/HIF-1α(H) patients had the worst prognosis. Using the combination of the two parameters increased the prognostic value (P < .01 vs P = .03). KIAA1199 in combination with HIF-1α expression tends to indicate a more accurate prognosis.
Effect of large dosage of Prunella on Hashimoto's thyroiditis
Authors: Chen Pei , Li Chaomin , Zhao Siliang , Wang Lizhen , Liu Lingyu , Fan Qiuhong
Published: December 2020

Introduction:

Hashimoto's Thyroiditis (HT) is one of the common autoimmune diseases, which can lead to thyroid reduction, increase the risk of tumor, and seriously affect women's reproductive health. Many other autoimmune diseases are easy to occur, seriously harming people's health.large dose herb Prunella or compound prescription contain large dose Prunella for treatment of HT has already been confirmed. However, due to the lack of evidence, there is no specific method or suggestion, it is necessary to carry out a systematic evaluation on Prunella and provide effective evidence for further research.

Methods and analysis:

The following databases will be searched from their inception to October 2020: Electronic database includes PubMed, Embase, Cochrane Library, Web of Science, Nature, Science online, Chinese Biomedical Database WangFang, VIP medicine information, and China National Knowledge Infrastructure. Main results: serum thyroid peroxidase antibody (TPOAb), thyroid globulin antibody (TGAb), other results: serum thyroid stimulating hormone (TSH), serum free triiodothyronine (FT3), serum free thyroid hormone (FT4). Data will be extracted by 2 researchers independently, risk of bias of the meta-analysis will be evaluated based on the Cochrane Handbook for Systematic Reviews (SR)of Interventions. All data analysis will be conducted by data statistics software Review Manager V.5.3. and Stata V.12.0.

Results:

The results of this study will systematically evaluate the efficacy and safety of large dose prunella salicorrhizae in the intervention of people with HT.

Conclusion:

The systematic review of this study will summarize the current published evidence of large dose prunella for the treatment of HT, which can further guide the promotion and application of it.

Ethics and Communication:

This study is a systematic review, the outcomes are based on the published evidence, so examination and agreement by the ethics committee are not required in this study. We intend to publish the study results in a journal or conference presentations.

Open Science Fra mework (OSF) registration number:October 21, 2020.osf.io/fcyqp. (https://osf.io/fcyqp)
CD74 auto-antibodies display little clinical value in Chinese Han population with axial spondyloarthritis
Authors: Hu Chao-Jun , Li Meng-Tao , Li Xi , Peng Lin-Yi , Zhang Shang-Zhu , Leng Xiao-Mei , Su Jin-Mei , Zeng Xiao-Feng
Published: December 2020

The European cohort study has indicated about CD74 IgG-autoantibodies as potential marker for axial spondyloarthritis (axSpA) diagnosis. However, multiple studies have questioned the diagnostic value of various disease-specific autoantibodies in different ethnic groups. Here, we have tried to assess the diagnostic value of anti-CD74 IgG and IgA autoantibodies in axSpA patients from Chinese Han population.

The anti-CD74 IgG and IgA autoantibodies were analyzed using ELISA assay in a cohort of 97 axSpA patients, including 47 treatment-naïve axSpA patients never treated with steroids or immunosuppressants and 50 treated axSpA patients. The rheumatic disease control (RDC) group consisted of 40 rheumatoid arthritis, 25 systemic lupus erythematosus, 18 psoriatic arthritis patients, and 60 healthy controls (HC).

Our data demonstrated the presence of anti-CD74 IgA auto-antibodies in 25.8% of the axSpA patients, 30.1% of the RDC group patients and none in HC. Similarly, anti-CD74 IgG autoantibodies were observed in 23.7% of the axSpA patients, 18.1% of the RDC patients and 18.3% of the HC. The sensitivity, specificity, and accuracy of IgA autoantibodies were 21.3%, 82.5%, & 67.4%, respectively, while for IgG, it was 27.7%, 81.8%, and 68.4%, in treatment-naïve axSpA patients. Furthermore, weak positive relationship between anti-CD74 IgA autoantibodies and bath ankylosing spondylitis disease activity index ( r = 0.253, P = .012) and functional index (bath ankylosing spondylitis functional index; r = 0.257, P = .011) was observed.

Overall, our study demonstrated little clinical and predictive value of CD74 autoantibodies in the diagnosis of axSpA and its related manifestations, among Chinese Han population.
The associations of long non-coding RNA taurine upregulated gene 1 and microRNA-223 with general disease severity and mortality risk in sepsis patients
Authors: Li Ning , Wu Sisi , Yu Li
Published: December 2020

This study aimed to investigate the correlation of long non-coding RNA taurine upregulated gene 1 (lncRNA TUG1) with microRNA-223 (miR-223) as well as their associations with risk, severity, and mortality of sepsis.

Totally122 sepsis patients and 122 healthy controls were enrolled. Plasma lncRNA TUG1 and miR-223 levels were detected by reverse transcription quantitative polymerase chain reaction. General severity of sepsis was assessed within 24 hours after admission using acute pathologic and chronic health evaluation (APACHE) II score and sequential organ failure assessment (SOFA) score. Patients were intensively followed up until death or 28 days after enrollment to assess mortality.

LncRNA TUG1 expression was decreased (P < .001) but miR-223 expression (P < .001) was elevated in sepsis patients. Additionally, a negative correlation of lncRNA TUG1 expression with miR-223 expression was observed in sepsis patients (P < .001). Moreover, in sepsis patients, lncRNA TUG1 expression was negatively correlated with respiratory infection, serum creatinine (Scr), white blood cell (WBC), C-reactive protein (CRP), APACHE II score, and SOFA score but positively correlated with albumin (all P < .05); miR-223 expression was negatively correlated with skin and soft tissue infection and albumin but positively correlated with Scr, WBC, CRP, APACHE II score, and SOFA score (all P < 0.05). As to mortality, lncRNA TUG1 expression was decreased (P = .001) but miR-223 was elevated (P < .001) in 28-day sepsis deaths compared with 28-day sepsis survivors.

Our findings offer the potential of lncRNA TUG1 and miR-223 as biomarkers for progression and prognosis of sepsis.