bluuebunny/crossref_metadata_2025 huggingface dataset:
Low Bone Mineral Density Could Predict Cognitive Impairment during the Acute and Recovery Phases of Ischemic Stroke
Authors: Lee Sang-Hwa , Jang Min Uk , Kim Yerim , Park So Young , Kim Chulho , Kim Yeo Jin , Sohn Jong-Hee
Published: February 2020

Background Little is known about the effect of osteoporosis at the acute and recovery phase of stroke on cognitive function. We evaluated the effect of osteoporosis on cognitive function in patients with ischemic stroke aged >50 years. Methods We retrospectively examined consecutive patients with acute stroke hospitalized between 2016 and 2018. Osteoporosis was defined as a T score of <-2.5 for the femoral neck or lumbar spine bone mineral density. The primary outcome was cognitive impairment measured by the Korean Mini-Mental State Examination in the acute phase and recovery phase of ischemic stroke. The association between osteoporosis and the severity of cognitive impairment was investigated using a multivariate analysis. Results Of the 260 included subjects (107 men and 153 women), 70 (26.9%) had osteoporosis. Cognitive impairment was more severe in the osteoporosis group than in the non-osteoporosis group (30.5% versus 47.1%, p=0.001). After recovery phase of stroke, the proportion of patients with cognitive impairment remained higher in the osteoporosis group. The multivariate analysis revealed a correlation between a low femoral neck bone mineral density and severe cognitive impairment in the acute and recovery phases of stroke (adjusted odds ratio [OR] 3.66, 95% confidence interval [CI] 1.05-12.79 in the acute phase and adjusted OR 11.17, 95% CI 1.12-110.98 in the recovery phase), whereas lumbar spine osteoporosis was not associated with cognitive impairment. Conclusions Low bone mineral density is associated with poor cognitive function in patients with acute stroke. Early bone mineral density assessments during acute stroke, particularly at the femoral neck, may be a useful marker of cognitive function.
Management of stretched scar– induced secondary strabismus
Authors: Farid Mohamed F , Mahmoud Mohamed R , Awwad Mohamed A
Published: February 2020

BACKGROUND: To determine characteristics and management of consecutive or recurrent strabismus secondary to stretched scar. METHODS: This is a retrospective review of all patients diagnosed with late secondary consecutive or recurrent strabismus due to stretched scar from 2012 to 2017. The diagnosis of stretched scar was made in any case of late (≥ 1 month) consecutive or recurrent strabismus associated with underaction of the previously operated muscle. The diagnosis was confirmed intraoperatively by negative forced duction test and the characteristic appearance of the scar tissue. Surgical correction involved excision of the scar tissue with muscle re-attachment to the sclera using non-absorbable sutures. Study parameters include improvement in secondary deviations, degree of muscle underaction and diplopia. RESULTS: 21 consecutive and 6 recurrent cases of stretched scar –induced strabismus were identified and all cases were associated with variable degrees of limited ocular duction. After surgical correction of the stretched scar, consecutive deviations in the form of consecutive esotropia and exotropia were corrected by means of 26.1PD and 65.6PD while recurrent deviations in the form recurrent exotropia and recurrent hypertropia were corrected by means of 34.3PD and 11PD respectively with significant improvement of limited ocular ductions. 21 patients had diplopia at presentation and all were improved after surgery. CONCLUSION: management of stretched scar –induced secondary strabismus by excision of the stretched scar and muscle fixation to the sclera using non-absorbable sutures significantly corrects secondary deviations and improves limitation of ocular duction.
Comparative genomics analysis of c-di-GMP metabolism and regulation in Microcystis aeruginosa
Authors: Chen Meng , Xu Chun-Yang , Wang Xu , Ren Chong-Yang , Ding Jiao , Li Li
Published: February 2020

Background : Cyanobacteria are of special concern because they proliferate in eutrophic water bodies worldwide and affect water quality. As an ancient photosynthetic microorganism, cyanobacteria can survive in ecologically diverse habitats because of their capacity to rapidly respond to environmental changes through a web of complex signaling networks, including using second messengers to regulate physiology or metabolism. A ubiquitous second messenger, bis-(3′,5′)-cyclic-dimeric-guanosine monophosphate (c-di-GMP), has been found to regulate essential behaviors in a few cyanobacteria but not Microcystis, which are the most dominant species in cyanobacterial blooms. In this study, comparative genomics analysis was performed to explore the genomic basis of c-di-GMP signaling in Microcystis aeruginosa . Results: Proteins involved in c-di-GMP metabolism and regulation, such as diguanylate cyclases, phosphodiesterases, and PilZ-containing proteins, were encoded in M. aeruginosa genomes. However, the number of identified protein domains involved in c-di-GMP signaling was not proportional to the size of M. aeruginosa genomes (4.97 Mb in average). Pan-genome analysis showed that genes involved in c-di-GMP metabolism and regulation are conservative in M. aeruginosa strains. Phylogenetic analysis showed good congruence between the two types of phylogenetic trees based on 31 highly conserved protein-coding genes and sensor domain-coding genes. Propensity for gene loss analysis revealed that most of genes involved in c-di-GMP signaling are stable in M. aeruginosa strains. Moreover, bioinformatics and structure analysis of c-di-GMP signal-related GGDEF and EAL domains revealed that they all possess essential conserved amino acid residues that bind the substrate. In addition, it was also found that all selected M. aeruginosa genomes encode PilZ domain containing proteins. Conclusions: Comparative genomics analysis of c-di-GMP metabolism and regulation in M. aeruginosa strains helped elucidating the genetic basis of c-di-GMP signaling pathways in M. aeruginosa. Knowledge of c-di-GMP metabolism and relevant signal regulatory processes in cyanobacteria can enhance our understanding of their adaptability to various environments and bloom-forming mechanism.
Chicken avian β-defensin 8 modulates immune response via the mitogen-activated protein kinase signaling pathways in a chicken macrophage cell line
Authors: Hong Yeojin , Pham Thu Thao , Lee Jiae , Lillehoj Hyun S. , Hong Yeong Ho
Published: February 2020

Background: Defensins are antimicrobial peptides composed of three conserved disulfide bridges, a β-sheet, and both hydrophobic and cationic amino acids. In this study, we aimed to demonstrate the immunomodulation role of avian β-defensin 8 (AvBD8) in a chicken macrophage cell line. Results: Chicken AvBD8 stimulated the expression of proinflammatory cytokines (interleukin (IL)-1β, interferon-γ, and IL-12p40) and chemokines (CCL4, CXCL13, and CCL20) in macrophages. Furthermore, by western blotting and immunocytochemistry, we confirmed that AvBD8 activated the mitogen-activated protein kinase (MAPK) signaling pathway via extracellular regulated kinases 1/2 (ERK1/2) and p38 signaling molecules. Conclusion: Overall, AvBD8 regulates host immune system as not only an antimicrobial peptide, but also an immunomodulator by activating the MAPK signaling pathway and inducing the expression of proinflammatory cytokines and chemokines.
Actor and partner effects of parenting stress and co-parenting on marital conflict among parents of children with atopic dermatitis
Authors: Han Jeong Won , LEE HANNA
Published: February 2020

Background: It is important for healthcare providers to pay attention to parents’ rearing style and children’s physical symptoms to promote a healthy quality of life among children with atopic dermatitis. We aimed to identify effects of parenting stress and co-parenting on marital conflict among parents of children with atopic dermatitis. Methods: Participants were 161 fathers and 161 mothers raising seven-year-old children treated for atopic dermatitis. To confirm the effects of parenting stress and co-parenting on marital conflict, the “actor-partner interdependence mediation model” was used. To verify goodness-of-fit, maximum likelihood method was used, and a confirmatory factor analysis was conducted to confirm the validity of latent variables for model analysis. Results: Fathers’ parenting stress had actor (β = -.46, p < .001) and partner (β = -.22, p < .001) effects on co-parenting, and mothers’ parenting stress had actor (β = -.20, p < .001) and partner (β = -.36, p < .001) effects on co-parenting. Fathers’ parenting stress only had an actor effect on marital conflict (β = .32, p < .001). Father’s co-parenting had actor (β = -.29, p < .001) and partner (β = -.22, p < .001) effects on marital conflict, and mothers’ co-parenting had actor (β = -.39, p < .001) and partner (β = -.19, p < .001) effects on marital conflict. There were significant differences between the two groups concerning three path coefficients: fathers’ parenting stress affected fathers’ marital conflict, fathers’ co-parenting affected fathers’ marital conflict, and mothers’ co-parenting affected fathers’ marital conflict. Conclusions: It is vital for healthcare providers to seek ways to reduce the marital conflicts of parents of children with atopic dermatitis, including further examination of the role of co-parenting, to address children’s physical symptoms and promote their health. Our findings inform management and intervention programs for the families of children with atopic dermatitis.
Point-of-Care Ultrasound May Be Useful for Detecting Pediatric Intussusception at an Early Stage
Authors: Lee Jeong-Yong , Kim Jung Heon , Choi Seung Jun , Lee Jong Seung , Ryu Jeong-Min
Published: February 2020

Background: This study aimed to verify the usefulness of point-of-care ultrasound (POCUS) performed by pediatric emergency physicians for detecting intussusception at an early stage.

Methods: This retrospective study included 1-month- to 6-year-old children with clinically suspected intussusception, who underwent POCUS in the pediatric emergency department between December 2016 and February 2018. The criteria for performing POCUS were set to broader standards: presenting any one of intermittent abdominal pain/irritability or bloody stool, or ≥2 symptoms among nonspecific abdominal pain/irritability, abdominal mass/distension, vomiting, or lethargy. POCUS results were interpreted and categorized as “negative” or “suspicious,” and a radiologist performed confirmatory ultrasound in “suspicious” cases.

Results: We analyzed 575 POCUS scans from 549 patients (mean age, 25.5 months). Among the 92 “suspicious” cases (16.0%), 70 (12.2%) were confirmed to have intussusception. POCUS showed 100% sensitivity, 95.6% specificity, and 97.8% accuracy. Patients with confirmed intussusception were mainly diagnosed in the early stages, with a mean symptom duration of 11.7 hours, and most patients (97.1%) were treated successfully via air enema reduction. Compared to the non-intussusception group, the intussusception group had more intermittent abdominal pain ( P < 0.001), but less vomiting ( P = 0.001); the other clinical features showed no intergroup differences.

Conclusion: POCUS performed using the criteria set to broader standards by pediatric emergency physicians may be useful for detecting intussusception at an early stage, which may present with obscure clinical symptoms.
On Sackin's original proposal: The variance of the leaves' depths as a phylogenetic balance index
Authors: Coronado Tomás Martínez , Mir Arnau , Rossello Francesc , Rotger Lucía
Published: February 2020

Background. The Sackin index S of a rooted phylogenetic tree, defined as the sum of its leaves' depths, is one of the most popular balance indices in phylogenetics, and Sackin's 1972 paper is usually cited as the source for this index. However, what Sackin actually proposed in his paper as a measure of the imbalance of a rooted tree was not the sum of its leaves' depths, but their ``variation''. This proposal was later implemented as the variance of the leaves' depths by Kirkpatrick and Slatkin in 1993, where they also posed the problem of finding a closed formula for its expected value under the Yule model. Nowadays, Sackin's original proposal seems to have passed into oblivion in the phylogenetics literature, replaced by the index bearing his name, which, in fact, was introduced a decade later by Sokal.
Results. In this paper we study the properties of the variance of the leaves' depths, V, as a balance index. Firstly, we prove that the rooted trees with $n$ leaves and maximum V value are exactly the combs with n leaves. But although V achieves its minimum value on every space of bifurcating rooted phylogenetic trees with at most 183 leaves at the so-called ``maximally balanced trees'' with n leaves, this property fails for almost every n larger than 184 We provide then an algorithm that finds the bifurcating rooted trees with n leaves and minimum V value in quasilinear time. Secondly, we obtain closed formulas for the expected V value of a bifurcating rooted tree with any number n of leaves under the Yule and the uniform models and, as a by-product of the computations leading to these formulas, we also obtain closed formulas for the variance under the uniform model of the Sackin index and the total cophenetic index of a bifurcating rooted tree, as well as of their covariance, thus filling this gap in the literature.
Circulating betatrophin/ANGPTL8 levels correlate with body fat distribution in individuals with normal glucose tolerance but not those with glucose disorders
Authors: zheng jing , Liu Juan , Hong Beverly S , Li Yanbing
Published: February 2020

Background: The relationship between betatrophin/ANGPTL8 and obesity has been investigated using body mass index (BMI); however, since BMI reflects overall adiposity rather than body fat distribution, it remains unclear whether fat deposition in different areas of the body affects betatrophin expression. Here, we investigated the correlation between circulating betatrophin levels and body fat distribution in patients with different glucose tolerance.Methods: ﻿We performed a cross-sectional study in 128 participants with impaired glucose tolerance (IGT; n = 64) or normal glucose tolerance (NGT; n = 64). Circulating betatrophin levels were detected by enzyme-linked immunosorbent assay. Body fat distribution (subcutaneous, visceral, and limb fat) was measured by magnetic resonance imaging (MRI) and a body fat meter.Results: After controlling for age, sex, and BMI, betatrophin was correlated positively with visceral adipose tissue-to-subcutaneous adipose tissue ratio ( VAT/SAT ratio; r = 0.339, p = 0.009) and negatively with body fat ratio (BFR; r = -0.275, p = 0.035), left lower limb fat ratio (LLR; r = -0.330, p = 0.011), and right lower limb fat ratio (RLR; r = -0.288, p = 0.027) in the NGT group, with these correlations remaining after controlling for triglycerides. VAT/SAT ratio (standardized β = 0.419, p = 0.001) was independently associated with serum betatrophin levels; however, betatrophin was not associated with body fat distribution variables in the IGT group.Conclusions: Circulating betatrophin levels correlated positively with VAT/SAT ratio and negatively with lower limb fat, but not subcutaneous or upper limb fat, in individuals with normal glucose tolerance. Thus, betatrophin may be a poten­tial biomarker for body fat distribution in individuals without glucose disorders.
Lactic acid level as an outcome predictor in pediatric patients with intussusception in the emergency department
Authors: Lee Jeong-Yong , Byun Young-Hoon , Park Jun-Sung , Lee Jong Seung , Ryu Jeong-Min , Choi Seung Jun
Published: February 2020

Background: Intussusception decreases blood flow to the bowel, and tissue hypoperfusion results in increased lactic acid levels. We aimed to determine whether lactic acid levels are associated with pediatric intussusception outcomes.

Methods: The electronic medical records of our emergency department pediatric patients diagnosed with intussusception, between January 2015 and October 2018, were reviewed. An outcome was considered poor when intussusception recurred within 48 hours of reduction or when surgical reduction was required due to air enema failure.

Results: A total of 249 patients were included in the study, including 39 who experienced intussusception recurrence and 11 who required surgical reductions; hence, 50 patients were included in the poor outcome group. The poor and good outcome groups showed significant differences in their respective blood gas analyses for pH (7.39 vs. 7.41, P = .001), lactic acid (1.70 vs. 1.30 mmol/L, P < .001), and bicarbonate (20.70 vs. 21.80 mmol/L, P = .036). Multivariable logistic regression analyses showed that pH and lactic acid levels were the two factors significantly associated with poor outcomes. When the lactic acid level cutoff values were ≥1.5, ≥2.0, ≥2.5, and ≥3.0 mmol/L, the positive predictive values for poor outcomes were 30.0%, 34.6%, 50.0%, and 88.9%, respectively.

Conclusion: Lactic acid levels affect outcomes in pediatric patients with intussusception; higher lactic acid levels are associated with higher positive predictive values for poor outcomes.
What hinders and facilitates the implementation of nurse-led interventions in dementia care? A scoping review
Authors: Karrer Melanie , Hirt Julian , Zeller Adelheid , Saxer Susi
Published: February 2020

Background The implementation of evidence-based interventions for people with dementia is complex and challenging. However, successful implementation might be a key element to ensure evidence-based practice and high quality of care. There is a need to improve implementation processes in dementia care by better understanding the arising challenges. Thus, the aim of this study was to identify recent knowledge concerning barriers and facilitators to implementing nurse-led interventions in dementia care. Methods We performed a scoping review using the methodological framework of Arksey and O’Malley. Studies explicitly reporting on the implementation process and factors influencing the implementation of a nurse-led intervention in dementia care in all settings were included. We searched eight databases from January 2015 until January 2019. Two authors independently selected the studies. For data analysis, we used an inductive approach to build domains and categories. Results We included 26 studies in the review and identified barriers as well as facilitators in five domains: policy (e.g. financing issues, health insurance), organisation (e.g. organisational culture and vision, resources, management support), intervention/implementation (e.g. complexity of the intervention, perceived value of the intervention), staff (e.g. knowledge, experience and skills, attitude towards the intervention), and person with dementia/family (e.g. nature and stage of dementia, response of persons with dementia and their families). Conclusions Besides general influencing factors for implementing nursing interventions, we identified dementia-specific factors reaching beyond already known barriers and facilitators. A pre-existing person-centred culture of care as well as consistent team cultures and attitudes have a facilitating effect on implementation processes. Furthermore, there is a need for interventions that are highly flexible and sensitive to patients’ condition, needs and behaviour.
Time evolution of β-lactoglobulin corona formation on gold nanoparticles and impact on allergy
Authors: Zhang Xiaoning , Li Meifeng , Lv Yuanping , Sun Xiaoling , Han Yao , Zhao Xiangzhong , Huang Xiaowen
Published: February 2020

Gold nanoparticles (AuNPs) are modified immediately by the adsorption of β-lactoglobulin (βlg) when designed as colorimetric probe in raw milk, leading to the formation of a protein corona. This adsorption results mainly from a fast electrostatic force and a slow formation of Au-S covalent bonds, which is a precondition for the use of AuNPs in biodetection. The proteins corona influences the structure and bioactivity of adsorbed protein, such as the allergy. In this study, the mechanism of βlg adsorbed on AuNPs was investigated in terms of stoichiometry, binding affinity (Ka), time evolution of Au-S bond, and general secondary structure changes to address the desensitization of AuNPs. The results show that about 3,600 βlg are adsorbed on a single AuNPs, and the Ka is 2.9 ± 0.7 × 10 6 M -1 . The formation of Au-S bonds takes about 9 h, which is the time needed for complete changes in secondary structure and the IgE combining capacity. The structure of allergenic epitopes assigned to β-sheet was destroyed by the formation of Au-S bond, then induced to the decrease allergy. Furthermore, Fourier transform infrared spectroscopy confirmed a decrease in β-sheet contents after conjugated with AuNPs.
Childhood Socioeconomic Status and Type 2 Diabetes Mellitus among Mid-late Chinese: A Structural Equation Modeling Analysis
Authors: zhang xiaoning , jiang xue , zhou qiong
Published: February 2020

Objectives This present study was aimed to examine the associations between childhood socioeconomic status (CSES) and type 2 diabetes mellitus (T2DM) among mid-late Chinese and disentangle the pathways using structural equation modelling (SEM). Methods Using cross-sectional data from China Health and Retirement Longitudinal Study (CHARLS), this study included 19767 participants aged 45 and over. SEM models were constructed to decompose the intricate relationships between CSES, childhood health history (CHH), adulthood socioeconomic status (ASES), health-related behaviors (HRB) and T2DM. Results The results showed that T2DM was significantly associated with CSES (sβ = -0.239; P = 0.001), CHH (sβ = -0.016; P = 0.005) and ASES (sβ = -0.180; P = 0.002) directly, While the indirect effect of CSES on T2DM was sβ = -0.111; P = 0.001with an acceptable goodness-of-fit. The model presented an acceptable goodness of fit: RMSA0.082, CFI 0.803, GFI 0.938, AGFI 0.904, and SRMR 0.060. Conclusions CSES had direct and indirect effects on later incidence of T2DM, which was mediated by ASES and CHH, supporting the life course theory, indicating that optimal interventions should be conducted in the early stages of life to narrow the socioeconomic and obtain maximal health benefits.
Clinical outcomes after small incision lenticule extraction versus femtosecond laser-assisted LASIK for high myopia: a Meta-analysis.
Authors: Fu Yanyan , Yin Yewei , Zhao Yang , Xiang Aiqun , Lu Ying , Hu Tu , Li Yuanjun , Du Kaixuan , Wu Xiaoying , Wen Dan
Published: February 2020

Background To compare postoperative clinical outcomes of high myopia after being treated by Small incision lenticule extraction (SMILE) and femtosecond laser in situ keratomileusis (FS-LASIK).Methods Comprehensive studies were conducted on the PubMed, MEDLINE, EMBASE, the Cochrane Library, and Chinese databases.Trials meeting the selection criteria were quality appraised, and the data were extracted by 2 independent authors, and the RevMan 5.3 version software were used in analyzing.Result Ten studies involving 637 patients (1093 eyes;575 eyes in the SMILE group and 518 eyes in the FS-LASIK group) were included in this meta-analysis. Pooled result revealed no significant differences in the following outcomes: the logMAR values of postoperative UDVA(WMD = -0.01, 95% CI: -0.02,0.00, I²=0%, P = 0.10 at postoperative 1mo; WMD =-0.01, 95% CI: -0.00 to 0.01, I²=0%,P = 0.35 at postoperative 3mo; WMD = -0.01, 95% CI:-0.02 to 0.01, I²=17%,P = 0.26 at long term), the logMAR values of postoperative CDVA(WMD = -0.02, 95% CI, -0.04 to 0.00, I²=0%, P = 0.11),and the postoperative mean refractive SE (WMD =0.02, 95% CI:0.04 to 0.08, I²=29%, P=0.60) . In the long-term observation, postoperative tHOA (WMD =-0.10, 95% CI:-0.13 to -0.07, I²=15%, P<0.00001)and postoperative spherical aberration (WMD =-0.13, 95% CI:--0.17 to -0.09, I²=38%, P<0.00001) were found to be less in the SMILE group compared with the FS-LASIK group, but no significant difference was found in postoperative coma (WMD =-0.02, 95% CI:-0.04 to 0.00, I²=98%, P=0.40).We also found greater PCE change post FS-LASIK than SMILE at long term follow-ups(WMD =-0.69, 95% CI:-1.36 to -0.01, I²=0%, P<0.05, however, there was no significant difference between the two groups at 3- or 6- months.(WMD =-0.19, 95% CI:-0.41 to 0.03, I²=31%, P=0.09;WMD =-0.20, 95% CI:-0.50 to 0.10, I²=17%, P=0.20)Conclusion For patients with high myopia, both SMILE and FS-LASIK are safe and efficacious. However, SMILE induced less tHOA and spherical aberration compared with FS-LASIK. Besides, FS-LASIK showed a greater increase in PCE than SMILE only at long term follow-ups. It remains to be seen whether the patients can get a better visual quality after SMILE and more comparative studies focused on high myopia is necessary.
Association of ABO Polymorphisms and Pancreatic Cancer/Cardiocerebrovascular Disease: a Meta-analysis
Authors: Li Yanxia , Liu Luyang , Huang Yubei , Zheng Hong , Li Lian
Published: February 2020

Background: ABO gene polymorphisms have been reported to be associated with the risk of multiple cancers and cardiocerebrovascular disease s. However, the results remained controversial. In this study, we conducted a systematic review and meta-analysis to clarify the association between two SNPs (rs505922 and rs657152) in ABO gene and cancers/ cardiocerebrovascular disease s.
Method: All eligible case-control studies come from PubMed, Embase and Web of Science up to Jan. 1, 2019. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the corresponding associations. Sensitivity analysis, publication bias assessment, and heterogeneity test were performed using STATA 12.0.
Results : A total of nineteen articles involving twenty-two case-control populations were included according to inclusion and exclusion criteria. Twelve populations (20,820 cases and 27,837 controls) were used to evaluate the relationship between rs505922 and overall cancers and nine populations (22,275 cases and 71,549 controls) were included to assess the association between rs505922 and cardiocerebrovascular diseases. The results showed a significant association between the rs505922 polymorphism and cancers (CvsT: OR=1.13, 95%CI=1.05-1.22, P =0.001), and cardiocerebrovascular diseases (OR=1.36, 95%CI=1.19-1.57, P <0.001). Five populations (8,660 cases and 10,618 controls) were included to evaluate association between rs657152 and cancers and five populations (8,105 cases and 6,712 controls) were included to estimate the relationship between rs657152 and cardiocerebrovascular diseases. The result of meta-analysis reveals that rs657152 was significantly associated with cancers (OR=1.18, 95%CI=1.13-1.23, P <0.001) and cardiocerebrovascular diseases (OR=1.54, 95%CI=1.24-1.92, P <0.001).
Conclusion: Our study suggested that ABO polymorphisms might serve as a risk factor of pancreatic cancers and cardiocerebrovascular diseases.
Segmental versus main renal artery clamping in nephron sparing surgery: an updated Meta-analysis
Authors: Xu Jinhong , Xu YuanGao , Xu Shuxiong , Sun Fa , Shi Hua
Published: February 2020

ObjectsIschemia-reperfusion injury is very harmful in partial nephrectomy (PN) in renal cell carcinoma (RCC). It is important to choose an appropriate surgical method to reduce ischemia-reperfusion injury. To compare the impact of segmental artery clamping (SAC) and main artery clamping (MAC) on some clinical data of the patients underwent PN. MethodsStudies from January 2008 to November 2019 were identified by electronical search of the English databases including PubMed, EMBASE, the Cochrane Library and Chinese database including Wanfang, VIP and CNKI without language restriction. Two reviewers were involved in the trial. The impact on operation time(OT), Warm ischemia time (WIT), length of stay in hospital (LOS), blood transfusion rate, postoperative complication rate, Clavien classification ≥3 and positive surgery margin (PSM) were evaluated using Stata software, and standardized mean difference (SMD)%(for the continuous data) and the pooled odds ratios (ORs) (used for counting data) with 95% confidence interval (CI) were used as effect indicators. ResultsThirty-two studies were eligible. SAC showed characteristics through decreasing 1 week post-operative percentage changes of renal function [SMD:-0.973, 95% CI (-1.414, -0.532), P=0.000], 1 month post-operative percentage change in eGFR [SMD:-0.411, 95CI (-0.769, -0.053), P=0.025] and percentage change of eGFR of the affected kidney 3 months postoperatively between SAC and MAC group [SMD:-0.914, 95%CI (-1.662, -0.617), P=0.000]. During sub-group analysis, SAC had longer OT [SMD:0.562, 95CI (0.252, 0.871), P=0.000] compared to MAC group. However, no difference was observed between the two groups in OT, WIT LOS, blood transfusion rate, postoperative complication rate, Clavien classification ≥3 and PSM%. ConclusionsSAC has more superiority with advantages in short term post-operative renal function recovery compared to MAC. Whether to use SAC or MAC depends on tumor size, location, surgical modality, and surgeon’s judgements.
Comparison of ED95 of Butorphanol with Sufentanil for Gastrointestinal Endoscopy Sedation: a randomized controlled trial
Authors: Zhu Xiaona , Chen Limei , Zheng Shuang , Pan Linmin
Published: February 2020

Background: Butorphanol, a synthetic opioid partial agonist analgesic, has been widely used for the control of perioperative pain. However, the ideal dose and availability of butorphanol for gastrointestinal (GI) endoscopy are not well known. The aim of this study was to evaluated the 95% effective dose (ED95) of butorphanol and sufentanil in GI endoscopy and compared their clinical efficacy, especially the recovery time. Methods: The study was divided into two parts. For the first part, voluntary patients who needed GI endoscopy anesthesia were recruited to measure the ED95 of butorphanol and sufentanil when they reached successful sedation during GI endoscopy using the sequential method (the Dixon up-and-down method). In the second part, this was a double-blind, randomized study. Two hundred cases of painless GI endoscopy patients were randomly divided into two groups (n=100), including group B (butorphanol at the ED95 dose) and group S (sufentanil at the ED95 dose). Propofol was infused intravenously to both groups as the sedative. The recovery time, VAS (visual analogue scale) score, hand grip strength, fatigue severity scores, incidence of nausea and vomiting, and incidence of dizziness were recorded. Results: The ED95 of butorphanol in painless GI endoscopy was 9.07μg/kg (95% confidence interval: 7.81-19.66μg/kg). The ED95 of sufentanil was 0.1μg/kg (95% CI, 0.079-0.422μg/kg). Both butorphanol and sufentanil provided a good analgesic effect in GI endoscopy. However, the recovery time for butorphanol was significantly shorter than sufentanil (P<0.05, group B versus group S:21.26±7.70 vs. 24.03±7.80, min). Conclusions: Butorphanol at 9.07μg/kg showed a better effect compared with sufentanil in GI endoscopy sedation, notably reduced the recovery time.
Efficacy of sugammadex in the prevention of postoperative residual curarisation and related complications in patients over 65 years of age undergoing general anaesthesia.
Authors: Pietraszewski Piotr , Gaszynski Tomasz
Published: February 2020

Background. Neuromuscular blocking drugs have contributed to advances in anaesthesiology. The first agent blocking neuromuscular transmission was curare. Alarming respiratory complications in patients recovering from anaesthesia were reported from the very beginning of curare use. The currently used non-depolarizing muscle relaxants are regarded as safe. However, postoperative residual curarisation may be associated with the risk of complications in the first few days after general anaesthesia, especially in patients older than 65 years. This study aims to investigate the effect of sugammadex on the incidence of postoperative residual curarisation, postoperative critical respiratory events, and postoperative cognitive dysfunction. Although recommended, neuromuscular monitoring is still not standard practice during general anaesthesia with the use of muscle relaxants. Methods. Overall, 351 patients aged 65-91 years were included in the observational study. Patients were anaesthetised at the M. Kopernik Provincial Multispeciality Centre of Oncology and Traumatology in Lodz. Spirometry and MMSE (Mini-Mental State Examination) were performed in patients one day before the surgery and one day postoperatively. Neuromuscular blockade was not monitored intraoperatively. One measurement was taken during recovery from anaesthesia. Anaesthetists made a decision to administer either a dose of 2mg/kg sugammadex (group S) or 0.05 mg/kg of neostigmine iv (group N) during recovery from anaesthesia. Results. There were significant differences (p<0.001) between the groups in postoperative TOF ratios. The percentage of patients with TOF ratios >0.9 was significantly higher in the S group than in the N group (83% vs 49%). The incidence of critical respiratory events was significantly lower in the S group compared to the N group (7.6% vs 17%). The study demonstrated significant differences in the postoperative scores of MMSE. Conclusions. Sugammadex effectively prevents postoperative residual curarisation in patients over the age of 65. It reduces the incidence of critical respiratory events in elderly patients. The study revealed a slight trend that full reversal of the neuromuscular blockade may correspond with the improvement of postoperative cognitive functions. Trial registration: Trial ID: ISRCTN17481425 Date registered: 27/01/2020, Link: https://www.isrctn.com/ISRCTN17481425
Characteristics of prescriptions and costs for acute upper respiratory tract infections in Chinese outpatient pediatric patients: a nationwide cross-sectional study
Authors: Wang Shan , Liu Lihua , Liu Jianchao , Miao Likun , Zhuang Qian , Guo Ning , Zhao Jing , Li Quanzheng , Ren Guoquan
Published: February 2020

Background To understand the characteristics of prescriptions and costs in pediatric patients with acute upper respiratory infection (AURI) is important for the regulation of outpatient care and reimbursement policy. This study aims to provide evidence on these issues that was in short supply. Methods We conducted a retrospective cross-sectional study based on data from 138 hospitals across the country. All pediatric patients aged 0-14 years diagnosed with uncomplicated AURI visiting hospital ambulatory departments from 1 January 2015 to 31 December 2017 were included. We reported characteristics of pediatric patients diagnosed with AURI, the average number of medications prescribed per encounter, the categories of medication used and their percentages, the cost per visit and prescription costs of drugs. For these measurements, discrepancies among diverse groups of age, regions, insurance types, and AURI categories were compared. Kruskal-Wallis nonparametric test and Student-Newman-Keuls test were performed to test differences among subgroups. Results A total of 1,002,687 clinical records with 2,682,118 prescriptions were collected and analyzed. The average number of drugs prescribed per encounter was 2.8. The most frequently prescribed medication was Chinese traditional patent medicines (CTPM) (36.5% of overall prescriptions) followed by antibiotics (18.1%). It showed a preference of CPTM over western drugs. The median cost per visit was 119.97 CNY. The median drug cost per visit was 92.70 CNY. The expenditures of antibiotics and CTPM per visit (40.54CNY and 39.35CNY) were among the three highest categories of drugs. The percentage of out-of-pocket patients reached 65.9%. Disparities have been showed among subgroups of different ages, regions, and insurance types. Conclusions The high volume of CPTM usage is the typical feature in outpatient care of AURI pediatric patients in China. The rational and cost-effective use of CPTM and antibiotics still faces challenges. The reimbursement for child AURI cases needs to be enhanced.
Assessing the risk factors of preterm births in Kurdistan, Iran: a case-control study
Authors: Hemmatpour Siros , Mansori Majid , Moradi Ghobad , Sheikhahmadi Shobo , Bagheri Batoul
Published: February 2020

Background: Preterm birth is one of the most common causes of mortality in infants. Despite advances in health care and better access to health services in many countries, preterm birth has increased over the past two decades. Methods: This case control study was conducted on two groups with 100 participants including 100 preterm infants (case) and 100 term infants (control) with gender match in Kurdistan Province-Iran in 2018. The required information was collected from medical files and interviewing the mothers as to demographical information, midwifery specifications, background diseases, disease over pregnancy term, and infants’ information. Conditional logistic regression test was used to estimate the final model and compute the risk ratio. Results: Multivariate regression analysis showed that the risk of preterm birth in individual with AB blood type was higher (OR=5.04; 95%; CI 1.40-18.08). In addition, the risk of preterm birth was higher in the mothers with a history of stillbirth (OR=13.63; 95% CI 1.39-133.5). Preterm birth was significantly related to the history of birth diseases, history of pregnancy diseases, and using medicine for specific diseases during pregnancy. Conclusions: Blood type of mother, history of still birth, history of birth disease, history of pregnancy diseases, using medicines for specific diseases, and history of preterm birth were the risk factors of preterm birth. These factors need to be taken into account before and during pregnancy. Paying more attention to these factors attenuates the rate of preterm birth and premature infants and in turn the mortality rate of infants and mothers.
Egyptian Patients’/guardians’ experiences and perception about clinical informed consent and its purpose: Cross Sectional Study
Authors: metwally ammal , Amer Hala Abdalla , Salama Hend , Hady Safaa Abd El , Alam Raefa , Aboulghate Ahmed , Mohamed Hanan , Badran Hanan , Eltokhy Hanan , SaadAllah Amal , Eldali Abdelmoneim , El-Sonbaty Marwa , Eltahlawy Eman , Saad Walaa , Deeb Sherif El , Fathy Asmaa , Mohsen Amira , Abdel-Latif Ghada , Elmosalami Dalia , Saleh Rehan , Rabah Thanaa , Naga Mai , Hassanain Amal
Published: February 2020

Background: Informed consent (IC) is a healthcare standard emphasizing the meaning of human dignity as clarified in The Universal Declaration of Human Rights. Data about IC practices in Egypt is insufficient. This study aimed to describe the Egyptian patients ‘or guardians ‘experience about IC and their expectations about its meaning in general and according to type of healthcare facility. Methods: Self-administered questionnaire to 1092 participants who had undergone or were scheduled to a procedure requiring an IC at three types of Egyptian health care facilities. Ten statements were ranked twice by the participants to reflect their perception of IC purpose as per what is currently practiced then as per what they believe should be practiced. Results: Informed consent implementation varies across the different levels of health care facilities in Egypt; being implemented the most at the non-governmental health facilities (in 85.9 % of procedures) followed by the governmental health care facilities (77.8 %) and the least at the university hospitals (63.8 %). Current practice was perceived to: “Help patient/guardian decide”, “Document patient’s/guardian’s decision”, and “Have shared decision” (ranked 1–5 by 64.9%, 59.3 %, and 57.3% of respondents, respectively). The perceived purpose of IC was to: “Inform the patient/guardian”, “Make sure patient/guardian understand” and “Document patient’s/guardian’s decision” (ranked 1–5 by 68.4%, 65.3 %, and 65.1% of respondents, respectively). Conclusion: The use of IC is common in Egyptian medical practice but varies across healthcare facilities. Participants believe that the current purpose of IC is to help in decision making, and its main purpose should be information disclosure. There is consensus agreement that both documenting the patient’s/guardian’s decision and informing the patient /guardian is considered as important current as well as preferred practices. IC should be an integral part of any procedure with more emphasis on seeking assent children whenever appropriate. Keywords: Informed consent, Arab Culture, Norm perception, Current practice.
Anlotinib can overcome acquired resistance to EGFR-TKIs via FGFR1 signalling in non-small cell lung cancer without harboring EGFR T790M mutation
Authors: Lian Zengzhi , Du Wenwen , Zhang Yang , Fu Yulong , Liu Ting , Wang Anqi , Cai Tingting , Zhu Jianjie , Zeng Yuanyuan , Liu Zeyi , Huang Jian-an
Published: February 2020

Background Although many studies have defined mechanisms of resistance to EGFR-TKIs, acquired resistance remains the major limitation of monotherapy with EGFR-TKIs. Therefore, there is an urgent need to develop effective therapeutic interventions to overcome acquired resistance. Methods Cell viability was analysed using CCK‐8 assay. EGFR T790M mutation was sequenced on a HiSeq 4000 platform. mRNA from HCC827 and HCC827 gefitinib-resistant (GR) cells was analysed by genome analyser-based deep sequencing. The effect of anlotinib on apoptosis and cell cycle arrest of HCC827 GR was detected by fluorescence-activated cell sorting (FACS) analysis. A mouse xenograft model was used to assess the killing effect of anlotinib on HCC827 GR cells. Results Here we found the T790M mutation in the PC-9 gefitinib-resistant (GR) cell line but not in the HCC827 GR cell line. Interestingly, anlotinib could suppress the growth of HCC827 GR cells by inhibiting FGFR1 in vitro and in a mouse xenograft model. Moreover, FGFR1 was overexpressed in HCC827 GR cells, and the knockdown of FGFR1 reversed gefitinib resistance in HCC827 GR cells. Furthermore, anlotinib induced apoptosis and cell cycle arrest in HCC827 GR cells by increasing the activity of Caspase-3 and decreasing the expression of Cyclin D1. Conclusion FGFR1 overexpression is one of the mechanisms of EGFR-TKI acquired resistance and anlotinib can suppresses the growth of EGFR-TKI-resistant NSCLC cells without T790M mutation.
circRNA-UBAP2 promotes the proliferation and inhibits apoptosis of ovarian cancer though miR-382-5p/PRPF8 axis
Authors: Xu Qin , Deng Bo , Li Manlin , Chen Yang , Zhuan Li
Published: February 2020

Objective: circular RNAs (circRNAs) have been reported to be essential regulators of multiple malignant cancers. However, the functions of circRNAs in ovarian cancer need to be further explored. The aim of our study is to explore the role of circRNA-UBAP2 in ovarian cancer and its mechanism. Results: circRNA-UBAP2 was upregulated in ovarian cancer tissues and cell lines. Knockdown of circRNA-UBAP2 inhibited cell proliferation and promoted cell apoptosis, but circRNA-UBAP2 overexpressed got opposite results. In addition, circRNA-UBAP2 targeted miR-382-5p and downregulated its expression, PRPF8 was a target gene of miR-382-5p. Furthemore, circRNA-UBAP2/miR-382-5p/PRPF8 axis affected the proliferation, apoptosis and cell cycle of ovarian cancer through the mechanism of competing endogenous RNAs (ceRNA). Conclusion: circRNA-UBAP2 acted as a ceRNA to sponged miR-382-5p, increased the expression level of PRPF8, and prompted proliferation and inhibited apoptosis in ovarian cancer cells.
Economic Evaluation of Carbetocin as Prophylaxis for Postpartum Hemorrhage in the Philippines
Authors: Briones Jamaica Roanne , Talungchit Pattarawalai , Thavorncharoensap Montarat , Chaikledkaew Usa
Published: February 2020

Background: Cost-effectiveness and budget impact of carbetocin was evaluated as an alternative to oxytocin for postpartum hemorrhage (PPH) prophylaxis in the Philippines.Methods: A model-based economic evaluation was employed to assess cost-effectiveness of carbetocin compared to oxytocin for PPH. Population of interest were women undergoing either vaginal delivery (VD) or cesarean section (CS) in a public hospital setting with costs and outcomes evaluated in six weeks. Cost-utility was analyzed using a government and societal perspectives while the budget impact was determined using a third party payer’s perspective. Incremental Cost Effectiveness Ratio (ICER) was evaluated using the set threshold in the country of 150,000 PhP per QALY gained.Results: Carbetocin was not cost-effective in the Philippines. Deterministic results in a government perspective for CS was at 724,081 PhP while for VD was over 2 million PhP. Deterministic and probabilistic results in the societal perspective for CS and VD were near these respective ICER values and did not also favor carbetocin use. Moreover, the treatment effects of carbetocin in reference to oxytocin were identified as the most sensitive parameter used. On budget impact, if 50% of deliveries would switch to carbetocin for the fiscal years assessed, additional incremental cumulative costs of 1.08 billion PhP for VD and 1.86 billion PhP for CS would be needed.Conclusion: The incremental benefit of carbetocin does not justify the additional costs incurred from purchasing the drug given a Philippine context. Price reduction of carbetocin is recommended if the drug would be publicly reimbursed in the country.
Early hemoglobin status is predictive of outcomes and long-term mortality of sepsis
Authors: Qi Desheng , Peng Milin
Published: February 2020

Background: Hemoglobin change plays a critical role in progress of sepsis. However, the contribution of hemoglobin change to outcomes of patients with sepsis is still unknown. The aim of our study is to investigate the effect of early hemoglobin level within 48h after admission to Intensive Care Unit (ICU) on long term prognosis for sepsis. Methods: In this single centered, cohort study, we included patients from different ICU departments of Xiangya hospital from 2016 to 2018. Out of 1800 ICU patients, 199 patients with sepsis matched inclusion criteria. All 199 patients were divided into three groups according to 70, 80, and 90 g/L hemoglobin statuses, respectively. Results: Our study showed seventy-nine patients (39.7%) with ≤90g/L hemoglobin, forty-seven patients (23.6%) with hemoglobin ≤80g/L, and twenty-five (12.6%) with hemoglobin ≤70g/L at 48h after admission. Compared to survival group, there were higher rates of patients with hemoglobin ≤80g/L (33.7% vs. 15.1%, P=0.003), hemoglobin ≤70g/L (18.5% vs. 7.5%, P=0.031) in non-survival group, but similar rate of hemoglobin ≤90g/L patients (46.7% vs. 34.0%, P=0.081). Kaplan-Meier survival analysis showed that significant difference occurred among all three groups with total one-year survival rates. Furthermore, multivariate cox proportional hazards regression analysis showed that serum hemoglobin concentration ≤ 80g/L at 48h admission (Hazard Ratio HR 1.736, 95% CI 1.131-2.665, P=0.012), the occurrence of ARDS (HR 1.814, 95% CI 1.184-2.778, P=0.006), the use of CRRT (HR 1.569, 95% CI 1.030-2.390, P=0.036), and septic shock (HR 1.776, 95% CI 1.124-2.804, P=0.014) were independent risk predictors for one-year mortality in septic patients. Whereas the infection site from abdomen (HR 0.281, 95% CI 0.113-0.697, P=0.006) was the only independent protective factor for mortality in septic patients. Conclusion: ≤80 g/L hemoglobin within 48h after admission to ICU was the independent risk factor for mortality for patients with sepsis. Attention should be raised up to target early hemoglobin level in course of sepsis to achieve better outcomes of sepsis. Future larger researches and randomized controlled trials are needed to validate our results.