bluuebunny/crossref_metadata_2025 huggingface dataset:
Does the mean 24-h pulse rate from ambulatory blood pressure monitoring reflect the mean 24-h ventricular rate from Holter electrocardiogram in atrial fibrillation patients?
Authors: Tong Hui-yu , Yu Jian-hua , Hong Kui , Chen Jing , Liu Hong-yu , Su Hai
Published: August 2020

Background

Ambulatory blood pressure monitoring (ABPM) on the oscillometric method is applicable in patients with atrial fibrillation, but the mean pulse rate is or not similar to the ventricular rate from the Holter in atrial fibrillation patients remains unknown.

Methods

This study included 228 persistent atrial fibrillation patients who received simultaneous 24-h ABPM and 24-h Holter. The mean 24-h pulse rate and the mean 24-h ventricular rate were calculated, and mVR-mPR was used to reflect the difference between them. The SD of 24-h pulse rate values was calculated as SD-pulse rate. Furthermore, according to the SD-pulse rate, the patients were divided into ≤5, 6–10, 11–15 and >15 bpm subgroups.

Results

For the total population, the mean 24-h pulse rate is positively correlated with the mean 24-h ventricular rate, and the Bland–Altman plot showed quite wide 95% limits. As the SD-pulse rate increased, the 24-h mVR-mPR also increased. The mean 24-h mVR-mPR was 0.5 bpm when SD-pulse rate ≤5, 3.5 bpm when SD-pulse rate of 6–10, 7.6 bpm when SD-pulse rate of 11–15, and 12.5 bpm when SD-pulse rate >15 bpm, respectively. Meanwhile, in the SD-pulse rate 0–10 subgroup, the 95% limits were only from −13.8 to 19.7 bpm, while in the >10 subgroup, these values were from −19.5 to 36.5 bpm.

Conclusion

The mean 24-h pulse rate should not be used to represent the true ventricular rate for all atrial fibrillation patients. However, when lower the SD-pulse rate, the mVR-mPR becomes smaller.
Self-reported practices of doctors and nurses for the measurement of blood pressure
Authors: Kirhan İdris , Kir Seher , Dilek Melda
Published: August 2020

Background

Hypertension is one of the most common health problems worldwide and can be diagnosed with an accurate blood pressure measurement (BPM). We aim to evaluate the self-reported practices of family physicians and nurses for BPM.

Methods

This study was conducted in the form of a survey administered through face-to-face interviews with 131 physicians and 371 nurses. The survey included questions about devices, patients, and BPM techniques.

Results

The mean age was 31 ± 7.4 years. The most commonly used device was the aneroid model (47.8%). The majority of participants reported that they had sufficient technical knowledge about the devices (81.1%), and the devices were regularly calibrated (77.5%). Only 44.8% reported that they had asked patients about caffeine or nicotine use. About half of those in both groups (54%) performed BPM only once during a presentation. The most commonly used position during BPM was sitting. BPM was performed mostly on one arm without preference for any side (67.5%). Approximately half of the respondents reported that they performed BPM by actively supporting the arm at the heart level.

Conclusion

We found physicians and nurses had lack of adherence to proper techniques related to the use of appropriate positions and other relevant situations that should be considered during BPM. Accurate BPM is the most important factor for proper diagnosis and treatment of hypertension. Thus, BPM should be performed in accordance with the designated guidelines and can be performed with accurate results only as a result of repeated comprehensive training programs.
Real-world Comorbidity Burden, Health Care Utilization, and Costs of Nonalcoholic Steatohepatitis Patients With Advanced Liver Diseases
Authors: Wong Robert J. , Kachru Nandita , Martinez Diane J. , Moynihan Meghan , Ozbay A. Burak , Gordon Stuart C.
Published: August 2020

Goals:

This study evaluates the real-world comorbidity burden, health care resource utilization (HRU), and costs among nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH) patients with advanced liver diseases [compensated cirrhosis (CC), decompensated cirrhosis (DCC), liver transplantation (LT), hepatocellular carcinoma (HCC)].

Background:

NAFLD/NASH is a leading cause of liver diseases.

Materials and Methods:

Adult NAFLD/NASH patients were identified retrospectively from MarketScan Commercial claims (2006-2016). Following initial NAFLD/NASH diagnosis, advanced liver diseases were identified using the first diagnosis as their index date. Mean annual all-cause HRU and costs (2016 USD) were reported. Adjusted costs were estimated through generalized linear models. Cumulative costs were illustrated for patient subsets with variable follow-up for each stage.

Results:

Within the database, 485,774 NAFLD/NASH patients met eligibility criteria. Of these, 93.4% (453,564) were NAFLD/NASH patients without advanced liver diseases, 1.6% (7665) with CC, 3.3% (15,833) with DCC, 0.1% (696) with LT, and 0.1% (428) with HCC. Comorbidity burden was high and increased as patients progressed through liver disease severity stages. Compared with NAFLD/NASH without advanced liver diseases (adjusted costs: $23,860), the annual cost of CC, DCC, LT, and HCC were 1.22, 5.64, 8.27, and 4.09 times higher [adjusted costs: $29,078, $134,448, $197,392, and $97,563 (P<0.0001)]. Inpatient admissions significantly drove increasing HRU.

Conclusion:

Study findings suggest the need for early identification and effective management of NAFLD/NASH patients to minimize comorbidity burden, HRU, and costs in the privately insured US population.
Prevalence and risk factors of low health literacy in residents of Anhui province
Authors: Wang Chao , Zhou Lan
Published: August 2020

This survey aimed to evaluate the prevalence of low health literacy and correlations of demographic characteristics with low health literacy risk in residents of Anhui province.

A total of 5120 residents of Anhui province were interviewed in this cross-sectional survey, and 4816 (94.1%) gave valid responses. Sociodemographic characteristics were collected. Health literacy and its 3 subscales, including basic knowledge and concepts, lifestyle, and health-related skill, were assessed. Low health literacy was defined as <80.0% of the total score or score of each subscale.

Mean total health literacy score was 62.7±17.2 (maximum 100 points), and was 31.5 ± 9.0 (maximum 47 points), 17.0 ± 4.8 (maximum 28 points), and 14.2 ± 4.1 (maximum 25 points) in terms of basic knowledge and concepts score, lifestyle score, and health-related skill score, respectively. The prevalence of low health literacy was 81.4%, and was 71.3% in terms of basic knowledge and concepts subscale, 87.9% with regard to lifestyle subscale, and 86.3% in view of health-related skill subscale. In addition, older age (P = .001), male (P < .001), decreased education level (P < .001), lower annual household income (P < .001), and location at rural area (P < .001) associated with increased risk of low health literacy. Moreover, multivariate logistic regression revealed that male, lower education level, and location at rural area were independent risk factors of low health literacy (all P < .05).

The prevalence of low health literacy is high in residents of Anhui province, and male, lower education level, as well as location at rural area are independent risk factors of low health literacy.
Correlation of microRNA-335 expression level with clinical significance and prognosis in non-small cell lung cancer
Authors: Huo Wen , Zhang Man , Li Chunhua , Wang Xinying , Zhang Xiuli , Yang Xiaona , Fei Haitao
Published: August 2020

Although treatments have improved significantly in recent years, the prognosis of patients with non-small cell lung cancer (NSCLC) remains poor. miR-335 has been demonstrated to play the antitumor role in several cancer types. Its expression was reduced in NSCLC tissues relative to noncancerous adjacent tissues. Furthermore, downregulation of miR-335 in A459 lung cancer cells promoted cell proliferation. In the present study, we aimed to investigate the clinical significance and prognostic value of miR-335 in NSCLC.

The lung cancer tissues and adjacent nontumor lung tissues were obtained from 131 patients who underwent the primary surgical resection at Lianyungang First People's Hospital. Student t test was used to distinguish differences between groups. χ
2 test was involved for analysis of clinicopathological data. The overall survival was analyzed by the Kaplan-Meier method and the log rank test. Multiple Cox proportional hazards regression analysis was carried out to identify the independent factors that had a significant impact on patient survival.

miR-335 was significantly lower in NSCLC samples compared to non-cancerous samples (P < .001). The expression level of miR-335 was significantly correlated with tumor histology (P = .028), lymph node metastasis (P = .002), differentiation degree (P < .001), and pathological TNM stage (P < .001). The log-rank test indicated that patients with decreased miR-335 expression experienced poor overall survival in NSCLC (P = .029).

The results of the present study indicated that miR-335 was down-expressed in NSCLC, and is associated with tumor progression and poor prognosis, suggesting that the expression of miR-335 might be an independent prognostic factor of overall survival in patients with NSCLC.
Value of plasma homocysteine to predict stroke, cardiovascular diseases, and new-onset hypertension
Authors: Feng Yuanyuan , Kang Kai , Xue Qiqi , Chen Yafen , Wang Wei , Cao Jiumei
Published: August 2020

The influences of hyperhomocysteinemia on cardiovascular diseases (CVDs), stroke and new-onset hypertension are unclear. The aim of the study is to explore the associations of homocysteine levels with stroke, CVDs, and new-onset hypertension in Chinese individuals.

This retrospective cohort study included outpatients and inpatients from the Department of Geriatrics at Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine from January to December 2000. They were divided based on their homocysteine (Hcy) levels in 2000: Q1 (<10 μmol/L), Q2 (10–15 μmol/L), and Q3 (>15 μmol/L) and according to whether they had hypertension at baseline. Information about stroke, mortality and major adverse cardiac events, and newly onset hypertension was gathered in December each year until 2017. The effects of Hcy levels on the risk for stroke and CVDs among all patients, and new-onset hypertension among patients without hypertension at baseline were evaluated.

After adjustment for confounders, compared with the Q1 group (Hcy <10 μmol/L), when the Hcy increased to 10 to 15 μmol/L, the risks for stroke, CVDs, and new-onset hypertension significantly increased, and the hazard ratio and 95% confidence interval were 2.02 (1.35–3.05, P = .001), 2.22 (1.32–3.76, P = .003), and 7.20 (4.52–11.48, P < .001), respectively. Hcy improved the predictive capability of traditional risk factors for stroke. The optimal cut-off value of Hcy for predicting stroke was 13.4 μmol/L (sensitivity: 70.9%, specificity: 62.2%).

Hcy 10 to 15 μmol/L is significantly associated with the risks for stroke, mortality and major adverse cardiac events, and hypertension. The best cut-off point of Hcy for predicting stroke is 13.4 μmol/L.
Comparison of tendon suture fixation and cortical screw fixation for treatment of distal tibiofibular syndesmosis injury
Authors: Song Liuhong , Liao Zhifu , Kuang Zhongqiang , Qu Shiyan , Zhang Wei , Yuan Yang , Fang Teng
Published: August 2020

This study aimed to investigate the effectiveness of tendon suture fixation versus cortical screw fixation for the treatment of distal tibiofibular syndesmosis injury.

This study recruited 42 patients with Danis-Weber type B, C1 and C2 fractures concomitant with lower tibiofibular syndesmosis injury, who were randomly assigned to 2 groups according to treatment with cortical screw fixation (n = 21) and tendon suture fixation (n = 21). Operation time, intraoperative blood loss, time to full weight-bearing activity, medical cost, ankle function, and ankle pain were compared between the 2 groups.

The operation time was significantly less with cortical screw fixation (57.1 ± 5.3 min) than with tendon suture fixation (63.3 ± 6.3 min; p = 0.01), but there was no significant difference in intraoperative blood loss. The time until full weight-bearing was possible was significantly longer after cortical screw fixation (10.9 ± 2.7 weeks) than after tendon suture fixation (7.1 ± 1.9 weeks; P < .001). The medical cost was much greater for cortical screw fixation (1861.6 ± 187.3 USD) than for tendon suture fixation (1209.6 ± 97.6 USD; P < .01). The rate of excellent and good ankle function at 3 months after surgery was significantly higher with tendon suture fixation (71.4%) than with cortical screw fixation (33.3%; P = .03).

Tendon suture fixation is associated with quicker recovery of ankle function, shorter time to full weight-bearing, and lower medical cost to the patient compared with screw fixation. Our findings suggest that tendon suture fixation is an effective method for the treatment of tibiofibular syndesmosis injury.
Comparing effectiveness of radical prostatectomy versus external beam radiotherapy in patients with locally advanced prostate cancer
Authors: Zhou Xianghong , Jin Kun , Qiu Shi , Jin Di , Liao Xinyang , Tu Xiang , Zheng Xiaonan , Li Jiakun , Yang Lu , Wei Qiang
Published: August 2020

Currently, the standard management for locally advanced prostate cancer (PCa) is still controversial. In our study, we aimed to compare the survival outcomes of radical prostatectomy (RP) versus external beam radiotherapy (EBRT).

We conducted analyses with a large cohort of 38,544 patients from the Surveillance, Epidemiology, and End Results (SEER) database (2004–2016). Propensity score matching, Kaplan-Meier method, and Cox proportional hazard regression were used to reduce the influence of bias and compare the overall survival (OS) and cancer specific survival (CSS). Several different sensitivity analyses including inverse probability of treatment weighting and standardized mortality ratio weighting were used to verify the robustness of the results.

Totally, 33,388 men received RP and 5,156 men received EBRT with cT3-4N0M0 PCa were included in this study. According to the Kaplan-Meier curves, RP performed better in both OS and CSS compared with EBRT (P < .0001). In the adjusted multivariate Cox regression, RP also showed better OS and CSS benefits (OS: HR=0.50; 95% confidence interval [CI]: 0.46–0.54; P < .0001 and CSS: HR=0.43; 95% CI: 0.38–0.49; P < .0001). After propensity score matching, RP is still the management that can bring more survival benefits to patients. (OS: HR=0.46; 95% CI: 0.41–0.51; P < .0001 and CSS: HR = 0.41; 95% CI: 0.34–0.48; P < .0001).

Our research demonstrated the significantly better survival benefits of RP over EBRT in patients with locally advanced PCa. The results of this study will provide more evidence to help clinicians choose appropriate treatment strategies.
Clinical features of 18 perivascular epithelioid cell tumor cases
Authors: Jia Rongfei , Jiang Ling , Zhou Yuhong , Wang Yan , Guo Xi , Ji Yuan , Ni Xiang , Yang Xiaoyan
Published: August 2020

To investigate the biological behavior and clinical characteristics of perivascular epithelioid cell tumor (PEComa).

Eighteen PEComa patients admitted to Zhongshan Hospital and the Central Hospital of Xuhui District in China from January 2006 to October 2018 were included. All patients were diagnosed based on pathological findings and treated with surgical resection or medication.

Among the 18 patients, 1 underwent lymph node biopsy for multiple enlarged lymph nodes and 17 underwent mass resection. The median disease-free survival was 22 months after the first resection and over 12 months following a second resection. Treatment with mechanistic target of rapamycin (mTOR) inhibitors was effective for patients with unresectable or metastatic lesions. The median progression-free survival was approximately 13 months.

Surgery is the predominant treatment approach for PEComa and patients can benefit from multiple operations. mTOR inhibitors are considered for patients with multiple lesions or intolerance to surgery. Anti-angiogenetic drugs can be selected when mTOR inhibitors fail to control the illness.
Anesthesia management of a premature neonate during minimally invasive sclerotherapy of a large chest wall mass
Authors: Luo Xi , Xie Min , Ma Yushan , Jiang Xiaoqin
Published: August 2020

Rationale:

The most common critical incidents in pediatric anesthesia are perioperative respiratory adverse events (PRAE), which occur more often in neonates and account for one-third of anaesthesia-related cardiac arrests. It is crucial to maintain an open stable airway during anesthesia in neonates, as this population has a low oxygen reserve, small airways, and the loss of protective airway reflexes under general anesthesia.

Patient concerns:

A 6-day-old premature newborn underwent minimally invasive sclerotherapy under general anesthesia. For high-risk premature neonates, the selections of the anesthesia and airway device are extremely important, as those factors directly affect the prognosis.

Diagnoses:

B ultrasound and computed tomography (CT) revealed a large mass from the left chest wall to axilla, which was suspected to be a lymphocele.

Interventions:

Minimally invasive sclerotherapy was performed under inhalation anesthesia. After the initiation of anesthesia, a laryngeal mask was placed to control airway. Anesthesia was maintained intraoperatively via sevoflurane inhalation with spontaneous breathing. No accidental displacements or PRAE occurred.

Outcome:

The operation and anesthesia process was stable and safe. The patient discharged at 2 days postoperatively.

Lessons:

Minimally invasive sclerotherapy in a premature neonate is an operation with an extremely short operation time and minimal trauma, but a very high anesthesia risk and risk of PRAE. Anesthesia management is very important in a premature neonate undergoing a very short surgery under general anesthesia. Total sevoflurane inhalation general anesthesia and laryngeal mask airway control with spontaneous breathing may be an ideal option to reduce PRAE during very short surgery in a premature neonate.
Malignancy in dermatomyositis
Authors: Chang Lili , Zhang Lina , Jia Haiquan , Nie Zhiyong , Zhang Lei
Published: August 2020

Dermatomyositis (DM) is an idiopathic inflammatory myopathy that is closely related to malignant diseases. Our study aims to investigate the incidence and predictive factors for occurrence of malignancy among DM patients from Central China.

We performed a retrospective, paired, case–control study of 736 DM patients admitted to the First Affiliated Hospital of Zhengzhou University between 2010 and 2017. We paired the 65 patients with malignancy with age-matched and sex-matched patients without malignancy in a ratio of 1:2. Two hundred two patients were finally enrolled and their clinical and laboratory data were collected.

The incidence of malignancy in DM patients was 8.83% (65/736). Most malignancies were detected in the most recent 1 year before (9/65, 13.85%) or within 3 years after (40/65, 61.54%) the onset of DM. Males (35/65, 53.85%) and patients aged between 50 and 69 years (43/65, 66.15%) were prone to develop malignancies. Lung cancer (n = 11, 31.43%) was the most common malignancy in male patients, while for females, thyroid, breast and cervical cancer (n = 4 each, 13.33%) were more prevalent. Adenocarcinoma and squamous cell carcinoma (both 18/65, 27.69%) were the top two most common pathological types. Univariate analysis demonstrated that Gottron's sign (P = .02), dysphagia (P = .04), albumin (ALB) reduction (P = .003), aspartate aminotransferase (AST, P = .03), creatine kinase-MB (P = .02), absence of fever (P = .02), arthralgia (P = .04) and interstitial lung disease (ILD, P = .05) were closely related to the occurrence of malignancy. Multivariate analysis revealed the independent risk factors of ALB reduction (odds ratio = 1.546, P = .04) and the protective factor of ILD (odds ratio = 0.349, P = .003). There was no significant difference in the follow-up period between patients with and without ILD (P = .38).

ALB reduction and the absence of ILD were the risk factors for malignancy in DM patients. The protective mechanism of ILD for DM patients needs further study.
Bilateral dilated nonreactive pupils secondary to rocuronium infusion in an ARDS patient treated with ECMO therapy
Authors: He Huaiwu , Yu Zhaoxia , Zhang Jiahui , Cheng Wei , Long Yun , Zhou Xiang , Yuan Siyi
Published: August 2020

Rationale:

Pupil monitoring for neurologic examination has become a regular clinical practice during extracorporeal membrane oxygenation (ECMO) therapy. Sudden dilation of pupils always indicates a severe cerebrovascular event. However, bilateral dilated nonreactive pupils secondary to neuromuscular blockade are uncommon and widely ignored in adult acute respiratory distress syndrome (ARDS) patients. This is the first case report of bilateral dilated nonreactive pupils caused by rocuronium in an ARDS patient receiving ECMO treatment.

Patient concerns:

Bilateral dilated nonreactive pupils were found in an ARDS patient who received V-V ECMO therapy. However, CT angiography did not indicate the occurrence of a cerebrovascular event. Drugs that could potentially result in dilated nonreactive pupils were checked.

Diagnosis:

Bilateral dilated nonreactive pupils were caused by rocuronium infusion.

Interventions:

Rocuronium infusion was stopped.

Outcomes:

Bilateral dilated nonreactive pupils were resolved 20 h after rocuronium infusion was stopped.

Lessons:

Neuromuscular blockade should be taken into consideration when bilateral dilated nonreactive pupils are found in ARDS patients treated with ECMO therapy.
Tongxinluo attenuates oxygen-glucose-serum deprivation/restoration-induced endothelial barrier breakdown via peroxisome proliferator activated receptor-α/angiopoietin-like 4 pathway in high glucose-incubated human cardiac microvascular endothelial cells
Authors: Qi Kang , Yang Yuejin , Geng Yongjian , Cui Hehe , Li Xiangdong , Jin Chen , Chen Guihao , Tian Xiaqiu , Meng Xianmin
Published: August 2020

Background:

Traditional Chinese medicine Tongxinluo (TXL) has been widely used to treat coronary artery disease in China, since it could reduce myocardial infarct size and ischemia/reperfusion injury in both non-diabetic and diabetic conditions. It has been shown that TXL could regulate peroxisome proliferator activated receptor-α (PPAR-α), a positive modulator of angiopoietin-like 4 (Angptl4), in diabetic rats. Endothelial junction substructure components, such as VE-cadherin, are involved in the protection of reperfusion injury. Thus, we hypothesized cell-intrinsic and endothelial-specific Angptl4 mediated the protection of TXL on endothelial barrier under high glucose condition against ischemia/reperfusion-injury via PPAR-α pathway.

Methods:

Incubated with high glucose medium, the human cardiac microvascular endothelial cells (HCMECs) were then exposed to oxygen-glucose-serum deprivation (2 hours) and restoration (2 hours) stimulation, with or without TXL, insulin, or rhAngptl4 pretreatment.

Results:

TXL, insulin, and rhAngptl4 had similar protective effects on the endothelial barrier. TXL treatment reversed the endothelial barrier breakdown in HCMECs significantly as identified by decreasing endothelial permeability, upregulating the expression of JAM-A, VE-cadherin, and integrin-α5 and increasing the membrane location of VE-cadherin and integrin-α5, and these effects of TXL were as effective as insulin and rhAngptl4. However, Angptl4 knock-down with small interfering RNA (siRNA) interference and PPAR-α inhibitor MK886 partially abrogated these beneficial effects of TXL. Western blotting also revealed that similar with insulin, TXL upregulated the expression of Angptl4 in HCMECs, which could be inhibited by Angptl4 siRNA or MK886 exposure. TXL treatment increased PPAR-α activity, which could be diminished by MK886 but not by Angptl4 siRNA.

Conclusion:

These data suggest cell-intrinsic and endothelial-specific Angptl4 mediates the protection of TXL against endothelial barrier breakdown during oxygen-glucose-serum deprivation and restoration under high glucose condition partly via the PPAR-α/Angptl4 pathway.
A novel nonsense mutation in TNNT2 in a Chinese pedigree with hypertrophic cardiomyopathy
Authors: Gao Guangyuan , Liu Guohui , Chen Weiwei , Tong Yaliang , Mao Cuiying , Liu Jinsha , Zhang Xing , He Max M. , Yang Ping
Published: August 2020

Rationale:

Hypertrophic cardiomyopathy (HCM) is an inherited myocardial disease and a common cause of sudden cardiac death, heart failure, atrial fibrillation and stroke. In families affected by HCM, genotyping is useful for identifying susceptible relatives. In the present study, we investigated the disease-causing mutations in a three-generation Chinese family with HCM using whole exome sequencing (WES).

Patient concerns:

The proband, a 50-year-old man, was diagnosed with HCM at the age of 41 years. He presented with an asymmetric hypertrophic interventricular septum and a maximum interventricular septum thickness of 18.04 mm. His third elder sister, niece and daughter were also clinically affected by HCM.

Diagnosis:

Autosomal dominant HCM.

Interventions:

Seven family members, including 4 affected members, accepted WES. The genetic variants were subsequently called using Genome Analysis Toolkit and annotated using the InterVar program. Following frequency filtration by the Genome Aggregation Database, the variants were evaluated using an in-house bioinformatics analysis pipeline.

Outcomes:

HCM was transmitted as an autosomal dominant trait in the family. An extremely rare stop gained mutation, rs796925245 (g.1:201359630G>A, c.835C>T, p.Gln279Ter) in the troponin T2 (TNNT2) gene was identified as the disease-causing mutation. The stop gained mutation was predicted to result in a truncated troponin T protein in cardiac sarcomere. An adolescent family member who had normal echocardiographic measurements was found to carry the same disease-causing mutation.

Lessons:

A novel nonsense TNNT2 mutation was identified as the HCM-causing mutation in this Chinese pedigree. Since HCM shows a low penetrance by clinical criteria in adolescents, the adolescent mutation carrier, who is still clinically unaffected, should be offered routine follow-ups and sport activity recommendations to prevent adverse events including sudden cardiac death in the future.
The efficacy of bidirectional barbed sutures for incision closure in total knee replacement
Authors: Ye Zijian , Zhu Wengang , Xi Xinhua , Wu Qiang
Published: August 2020

Background:

Barbed suture is a novel type of suture introduced in different surgical specialties. Nevertheless, its effect in total knee replacement is still unclear in terms of wound complications and cost effectiveness. The purpose of the present work is to evaluate the safety and efficacy of bidirectional barbed suture in reducing postoperative wound complications in the patients undergoing total knee replacement.

Methods:

This prospective, randomized, and controlled study was performed from January 2017 to December 2018. It was authorized via institutional review committee of Yuebei People's Hospital (GDYB1002189). Hundred participants were divided randomly into 2 groups, namely, control group (n = 50) and the study group (n = 50), respectively. All operations were performed using the Miller-Galante prosthesis (Zimmer; Warsaw, IN). For study groups, the joint capsule (Stratafix1-0) and subcutaneous (Stratafix2-0) and intracutaneous (Stratafix3-0) tissues were sutured by a bidirectional barbed suture. At the end, extra 4 to 5 stitches were made to avoid detachment and incision rupture. For control group: the joint capsule was sutured by a traditional absorbable suture (Ethicon VICRYL∗ Plus 1-0), and the subcutaneous tissue was sutured by an absorbable suture (Ethicon VICRYL∗ Plus 2-0). The skin was sutured by staples. Incision length, suture time, operation time, postoperative length of hospital stay, and incision complications (such as effusion, infection, hematoma, and skin necrosis) were recorded. All data analyses are implemented through utilizing SPSS for Windows Version 20.0.

Results:

The results will be shown in Table 1.

Conclusion:

This study can reach a reliable evidence for utilizing bidirectional barbed suture in wound closure in total knee replacement.

Trial registration:

This study protocol was registered in Research Registry (researchregistry5823).
Chronic obstructive pulmonary disease caused by inhalation of dust
Authors: Peng Cong , Yan Yongjian , Li Zhen , Jiang Yuxin , Cai Yu
Published: August 2020

Background:

A meta-analysis was performed to evaluate the relationship between chronic obstructive pulmonary disease (COPD) and occupational dust exposure, and to provide a scientific basis for the prevention and treatment of COPD caused by occupational factors.

Methods:

PubMed and Embase databases were used to search for original epidemiological literature related to theme. Both random and fixed effects models were used to calculate pooled odds ratios and their corresponding 95% confidence intervals. Review Manager was used to perform data analysis.

Results:

Nine studies were included in the meta-analysis in accordance with the inclusion criteria. There was a significantly obvious correlation between occupational dust exposure and COPD of the population-based studies assessed in this article. The risk of developing COPD for workers exposed to dust was 1.51 times higher than for controls (I
2 = 40%, 95% confidence interval: 1.27-1.79). The presence of publication bias was not found.

Conclusion:

The study provided evidence supporting the association between occupational dust exposure and the risk of developing COPD.
Electrical velocimetry has limited accuracy and precision and moderate trending ability compared with transthoracic echocardiography for cardiac output measurement during cesarean delivery
Authors: Feng S.M. , Liu Jin
Published: August 2020

We aimed to evaluate the accuracy and interchangeability of stroke volume and cardiac output measured by electrical velocimetry and transthoracic echocardiography during cesarean delivery.

We enrolled 20 parturients in this prospective observational study. We recorded the stroke volume and cardiac output using both methods and compared the values at seven specific time points. We analyzed the data using linear regression analysis for Pearson's correlation coefficients and Bland-Altman analysis to determine percentage errors. We conducted a trending ability analysis based on the four-quadrant plot with the concordance rate and correlation coefficient.

We recorded 124 paired datasets during cesarean delivery. The correlation coefficients of the measured cardiac output and stroke volume between the two methods were 0.397 (P < .001) and 0.357 (P < .001). The 95% limits of agreement were −1.0 to 8.1 L min−1 for cardiac output and −10.4 to 90.4 ml for stroke volume. Moreover, the corresponding percentage errors were 62% and 60%. The concordance correlation coefficients were 0.447 (95% CI: 0.313-0.564) for stroke volume and 0.562 (95% CI: 0.442-0.662) for cardiac output. Both methods showed a moderate trending ability for stroke volume (concordance rate: 82% (95% CI: 72–90%)) and cardiac output (concordance rate: 85% (95% CI: 78–93%)).

Our findings indicated that electrical velocimetry monitoring has limited accuracy, precision, and interchangeability with transthoracic echocardiography; however, it had a moderate trending ability for stroke volume and cardiac output measurements during cesarean delivery.
A novel algorithm to predict oxygen desaturation in sedated patients with obstructive sleep apnea utilizing polysomnography
Authors: Chiang Min-Hsien , Luo Sheng-Dean , Lin Hsin-Ching , Hou Shao-Yun , Ke Ting-Yu , Chen Chih-Chun , Hung Kuo-Chuan , Wu Shao-Chun
Published: August 2020

This retrospective study aimed at identifying the predictors of oxygen desaturation (OD) (i.e., SpO2 < 95%) in patients with obstructive sleep apnea (OSA) requiring deep sedation and developing an algorithm to predict OD.

We studied 66 OSA patients undergoing propofol-induced deep sedation for drug-induced sleep endoscopy (DISE). The patients were divided into prediction (n = 35) and validation (n = 31) groups. Patient characteristics and polysomnographic parameters were analyzed with receiver operating characteristic curve and Chi-squared test to identify significant predictors of OD for developing an algorithm in the prediction group. The predictive accuracy, sensitivity, positive predictive value, and negative predictive value of the algorithm were determined in the validation group.

Six polysomnographic predictors of OD were identified, including Apnea-Hypopnea Index of total sleep time (AHI-TST), AHI at the stage of rapid eye movement (AHI-REM), percentage of time with oxygen saturation <90% (mO2 < 90%), average SpO2, lowest SpO2, and desaturation index. Stepwise multiple logistic regression analysis demonstrated that low average SpO2 (<95.05%) and high AHI-REM (>16.5 events/h) were independent predictors of OD. The algorithm thus developed showed that patients with an average SpO2 < 95.05% and those with an average SpO2 ≥ 95.05% together with an AHI-REM > 16.5 events/h would be at risk of OD under sedation. The predictive accuracy, sensitivity, positive predictive value, and negative predictive value were 84%, 100%, 83%, 100%, respectively.

For patients with OSA, average SpO2 and AHI-REM may enable clinicians to predict the occurrence of oxygen desaturation under deep sedation. Future large-scale studies are needed to validate the findings.
Effect of sodium cantharidinate/vitamin B6 injection on survival, liver function, immune function, and quality of life in patients with hepatocellular carcinoma
Authors: Zhu Min , Liu Xiujing , Zhou Changhui , Li Juan
Published: August 2020

Background:

Sodium cantharidinate/vitamin B6 (SC/VB6) injection, a famous insect-derived traditional Chinese medicine preparation, has been widely applied as a promising adjunctive drug for hepatocellular carcinoma (HCC). However, its exact clinical efficacy and safety is still not well investigated. In this study, we aimed to summarize the efficacy of SC/VB6 injection on survival, liver function, immune function, and quality of life (QoL) in patients with HCC through the meta-analysis.

Methods:

All available randomized controlled trials (RCTs) and high-quality prospective cohort studies that investigated the efficacy and safety of SC/VB6 for patients with HCC were searched from ten electronic databases including PubMed, Google Scholar, Cochrane Library, Excerpt Medica Database (Embase), Medline, Web of Science (WOS), Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), China Scientific Journal Database (CSJ), and Wanfang Database. Papers in Chinese or English published from January 2000 to July 2020 will be included without any restrictions.

Study selection and data extraction will be performed independently by 2 researchers. The clinical outcomes including overall survival (OS), QoL, liver function, immune function, and adverse events, were systematically evaluated. Review Manager 5.3 and Stata 14.0 were used for data analysis, and the quality of the clinical trials was also evaluated.

Results:

The results of this study will be published in a peer-reviewed journal, and provide a helpful evidence for clinicians to formulate the best postoperative adjuvant treatment strategy for HCC patients.

Conclusion:

Our study will draw an objective conclusion of the efficacy of SC/VB6 on survival, liver function, immune function, and QoL in patients with HCC.

INPLASY registration number:

INPLASY202070121.
A comparison of three balance-assessment scales for patients after stroke with various levels of balance disorder
Authors: Rudolf Marko , Vidmar Gaj , Goljar Nika
Published: August 2020

It is often difficult for the clinician to choose the most appropriate balance-assessment measure. We wanted to facilitate this decision based on the stroke patient’s functional abilities. The aim of our study was to compare three established scales [Berg Balance Scale (BBS), mini-BESTest (MBT) and Functional Gait Assessment (FGA)] in terms of responsiveness, floor and ceiling effects at different levels of ambulation as defined by the Functional Ambulation Classification (FAC). The 18-month prospective study included 88 patients after cerebral stroke, who were able to walk independently or with assistance of one person (FAC 2–6). BBS showed the highest relative gain in the FAC 2–3 group (17% of maximum scale score); in the other two groups (FAC 4–5 and FAC 6), MBT showed the highest relative gain (16 and 13%, respectively), followed by FGA (11 and 10%, respectively). Among the patients with initial FAC 2–3, a floor effect occurred with FGA, while a ceiling effect occurred with BBS among patients with initial FAC 6. Gain in FGA correlated slightly more with improvement detected by MBT (r = 0.60) than with BBS (r = 0.50). We can conclude that BBS seems to be suitable for stroke patients with initial FAC 2–5, whereas MBT and FGA for those with FAC 4–6.
Acute Stress Disorder Among Frontline Health Professionals During the COVID-19 Outbreak: A Structural Equation Modeling Investigation
Authors: Wang YuanYuan , Duan Zhizhou , Peng Ke , Li Dan , Ou Jianjun , Wilson Amanda , Wang Nan , Si Lei , Chen Runsen
Published: August 2020

Objective

The outbreak of COVID-19 that commenced in December 2019 in Wuhan, China, has caused extensive public health concerns and posed substantial challenges to health professionals, especially for those in the center of the epidemic. The current study aimed to assess the prevalence, related factors, and mechanism of acute stress disorder (ASD) among health professionals in Wuhan during this critical period.

Methods

The study used a cross-sectional design. Self-administered questionnaires were distributed to the frontline health professionals in Wuhan hospitals from January 28 to February 1, 2020. Mental health–related measurements included ASD, depression, anxiety, conflict experiences, hostility, and psychosomatic symptoms. Structural equation modeling was used to analyze the factors associated with ASD among health professionals.

Results

A total of 332 frontline health professionals were included in the analysis (mean [standard deviation] age = 32.21 [8.77] years; 78.0% women). ASD was a prominent mental health problem in the health professionals surveyed, with a prevalence of 38.3%. Anxiety (24.7%) and depression (20.2%) were also common. Structural equation modeling analyses revealed that emotional distress (i.e., anxiety and depressive symptoms) fully mediated the association between conflicts with ASD (the standardized indirect coefficient β = 0.47, p = .016). The most common reported symptom was chest pain (51.2%). ASD was significantly associated with psychosomatic symptoms. The majority (67.8%) reported being easily annoyed or irritated, and ASD was associated with hostility.

Conclusions

During the COVID-19 outbreak, a substantial number of health professionals in Wuhan suffered from ASD. Furthermore, ASD was found to be associated with psychosomatic symptoms as well as the hostility. The poor mental health of health professionals has detrimental impacts both on the well-being of staff in health care systems and may adversely affect the quality of patient care. We call for interventions that aim to relieve the psychological and occupational stress. Considering that most of our participants were young, female frontline health professionals, the results may not be generalized to more heterogenous samples.
Pain in the default mode network: a voxel-based morphometry study on thermal pain sensitivity
Authors: Zhang Xilei , Chen Qunlin , Su Yanhua , Meng Jing , Qiu Jiang , Zheng Wenming
Published: August 2020

During nociceptive processing of pain, activated regions, specified as the ‘pain matrix’, have been proven not selectively or preferentially tied to pain. Counterintuitively, the deactivated regions, especially the default mode network (DMN), are recently revealed to be simultaneously and functionally involved. In this study, we searched for pain-specific structural correlates among pain-free young adults using the voxel-based morphometry (VBM) approach within regions of interest comprising the pain matrix and DMN. Variances in confounding factors, namely the thermal detection threshold, thermal pain tolerance threshold and pain-related psychological traits, were statistically controlled to obtain pain-specific structural correlates. As a result, we found that less grey matter volume (GMV) of a critical DMN region, the precuneus, predicts enhanced thermal pain sensitivity (i.e., lower threshold). In contrast, this relationship is absent in all regions within the pain matrix. Such a dissociation between pain matrix and precuneus highlights the significance of precuneus in processing of pain, and is discussed with a conception taking pain as a salience detection system for the body, rather than as a nociceptive-specific system restricted within the so-called pain matrix.
Generalizable fully automated multi-label segmentation of four-chamber view echocardiograms based on deep convolutional adversarial networks
Authors: Arafati Arghavan , Morisawa Daisuke , Avendi Michael R. , Amini M. Reza , Assadi Ramin A. , Jafarkhani Hamid , Kheradvar Arash
Published: August 2020

A major issue in translation of the artificial intelligence platforms for automatic segmentation of echocardiograms to clinics is their generalizability. The present study introduces and verifies a novel generalizable and efficient fully automatic multi-label segmentation method for four-chamber view echocardiograms based on deep fully convolutional networks (FCNs) and adversarial training. For the first time, we used generative adversarial networks for pixel classification training, a novel method in machine learning not currently used for cardiac imaging, to overcome the generalization problem. The method's performance was validated against manual segmentations as the ground-truth. Furthermore, to verify our method's generalizability in comparison with other existing techniques, we compared our method's performance with a state-of-the-art method on our dataset in addition to an independent dataset of 450 patients from the CAMUS (cardiac acquisitions for multi-structure ultrasound segmentation) challenge. On our test dataset, automatic segmentation of all four chambers achieved a dice metric of 92.1%, 86.3%, 89.6% and 91.4% for LV, RV, LA and RA, respectively. LV volumes' correlation between automatic and manual segmentation were 0.94 and 0.93 for end-diastolic volume and end-systolic volume, respectively. Excellent agreement with chambers’ reference contours and significant improvement over previous FCN-based methods suggest that generative adversarial networks for pixel classification training can effectively design generalizable fully automatic FCN-based networks for four-chamber segmentation of echocardiograms even with limited number of training data.
Establishment of a Rep′ protein antibody detection method to distinguish natural infection with PCV2 from subunit vaccine immunization
Authors: Chen Qingqing , Rong Jun , Li Guopan , Xu Baojuan , Wang Xi , Hu Jixiong , Rong Mingxuan , Li Huan
Published: August 2020

Introduction. PCV2 is a DNA virus that exists widely in pigs and has caused great economic losses to the pig industry worldwide. In the existing commercial PCV2 enzyme-linked immunosorbent assay (ELISA) kits both natural infection with PCV2 and vaccine immunization produce results that are positive for PCV2 Cap antibodies and therefore they cannot diagnose PCV2 infection in immunized pig farms.

Aim. To establish a PCV2 non-structural protein antibody detection method that distinguishes between antibodies resulting from natural prior exposure (infection) and those induced by subunit vaccine immunization.

Methodology. Based on the non-structural Rep′ protein, we established an indirect ELISA (iELISA) using sera from guinea pigs and piglets.

Results. The results for iELISA for guinea pig serum showed that animals vaccinated with a whole-virus inactivated PCV2 vaccine had 100 % (10/10) Cap antibody positivity and 100 % (10/10) Rep′ antibody positivity. Guinea pigs vaccinated with a recombinant subunit PCV2 vaccine had 100 % (10/10) Cap antibody positivity, while no (0/10) guinea pigs were Rep′ antibody-positive. The combined detection results for the Rep′ iELISA and a PCV2 Antibody Test kit (Commercial) showed that pigs vaccinated with a whole-virus inactivated PCV2 vaccine or PCV2 SD/2017 had 100 % (5/5) Cap antibody positivity and 100 % (5/5) Rep′ antibody positivity. Pigs vaccinated with a recombinant subunit PCV2 vaccine had 100 % (5/5) Cap antibody positivity, while no (0/10) pigs were Rep′ antibody-positive.

Conclusion. This paper describes an effective iELISA method that can distinguish natural infection with PCV2 (Cap and Rep positive) or inoculation with a whole-virus inactivated vaccine (Cap and Rep positive) from subunit vaccine immunization (Cap-positive, Rep-negative). These comparative assays could be very useful in the control of PCV2 in pig herds.
Detection and phylogenetic analysis of Human bocavirus in children diagnosed with acute respiratory tract infection
Authors: Abozahra Rania , Abdelhamid Sarah M. , Khairy Karim , Baraka Kholoud
Published: August 2020

Introduction.Human bocavirus (HBoV) is a recently discovered parvovirus; it has been shown to be a common cause of respiratory infections and gastroenteritis in children. Since its identification, HBoV has been detected worldwide in nasopharyngeal swabs, serum and stool samples particularly those obtained from young children suffering from respiratory or gastrointestinal tract infections.

Aim.The aim of this work was to determine HBoV prevalence among children with acute respiratory tract infection in Egypt, to detect the most prevalent HBoV genotype and to compare PCR and ELISA as diagnostic techniques for HBoV infection.

Methods.Nasopharyngeal swabs and blood samples were obtained within the first day of admission from 75 children diagnosed with acute respiratory tract infection in El-Shatby University Hospital for Children in Alexandria, Egypt from October 2018 to March 2019. Conventional PCR was used to detect HBoV DNA, ELISA was used to detect HBoV IgM antibodies and sequencing of the VP1/2 genes was used for genotyping.

Results.Seven (9.3%) of the 75 nasopharyngeal swabs obtained from patients with acute respiratory tract infection were positive for HBoV by PCR, while 5 (6.7 %) of the 75 serum samples were positive for HBoV IgM antibodies using ELISA. The correlation between PCR and ELISA results showed a highly significant association between PCR and ELISA techniques (X2=52.041,P<0.01) and a highly significant agreement between the two methods (Kappa=81.9 %,P<0.01). Phylogenetic analysis showed that all positive samples were related to the HBoV-1 genotype.

Conclusion.Human bocaviruswas detected at 9.3 % prevalence in nasopharyngeal swabs obtained from children with acute respiratory tract infection. The HBoV-1 genotype was the only genotype detected, suggesting that a single genetic lineage of HBoV is circulating in Egypt. PCR and ELISA are two reliable methods for detection and diagnosis of HBoV.