bluuebunny/crossref_metadata_2025 huggingface dataset:
MDR1 Polymorphisms and Modulation of ARV Drug Induced Hepatotoxicity
Authors: SINGH HARI OM , Samani Dharmesh
Published: November 2021

Background

Antiretroviral (ARV) regimen is used to manage the progression of HIV infection. MDR1 Polymorphism is associated with the treatment outcome. Ethnic disparities have been observed in the distribution of MDR1 genotypes. Hence we analyzed the association of MDR1 polymorphism with the modulation of ARV associated hepatotoxicity.MDR1 polymorphisms (1236 C/T, 3435 C/T) was genotyped in a total 165 HIV-infected individuals (34 ARV drug induced hepatotoxicity were labeled as cases, 131 those without hepatotoxicity were controls) and 155 healthy individuals by utilization of PCR-RFLP.
Results

Individuals with haplotype TC of MDR1 were at greater risk for hepatotoxicity severity (OR=1.96, P=0.06). Haplotypes TT and CC were associated with a reduced risk of hepatotoxicity severity (OR= 0.16, P=0.006; OR= 0.46, P=0.06). MDR1 1236TT genotype was seen higher among ARV drug induced hepatotoxicity cases who consumed alcohol than non-users (28.6% versus 14.8%, OR=1.50). There was an increased prevalence of MDR1 1236TT genotype in ARV drug induced hepatotoxicity cases on nevirapine in contrast with efavirenz (21.7% versus 9.1%, OR=2.11). The incidence of MDR1 1236CT, 1236TT genotypes was found to be more in individuals those without hepatotoxicity on nevirapine as compared to efavirenz (43.7% versus 33.3%, OR=1.66; 12.6% versus 8.3%, OR=1.96). MDR1 1236TT genotype in presence of nevirapine and who consumed alcohol showed risk for severity of hepatotoxicity (40.0% versus 16.67%, OR=2.21).
Conclusion

Haplotype TC was associated with hepatotoxicity severity. MDR1 1236TT and 3435CT genotypes in presence of nevirapine and who consume alcohol showed higher risk for acquisition and severity of ARV associated hepatotoxicity.
Italian Survey on Perception of Obesity and Bariatric and Metabolic surgery: a comparison between general practitioners and obese patients
Authors: Tassinari Daniele , Giassi Cecilia Lucia Andrea , Giovanelli Alessandro , De Santis Emanuela , Boveri Sara , Asteria Carmela
Published: November 2021

Purpose Obesity is a pandemic, chronic and relapsing disease with several treatment options. The aim of this work was to investigate the level of awareness that people with obesity (PwO) have of their own condition and the level of knowledge regarding possible treatments available. To compare and contrast collected data on PwO with data obtained from general practitioners (GPs). Methods Data for this cross-sectional, non-interventional, descriptive study was collected via an online survey (CAWI methodology). 521 people were interviewed: 320 PwO and 201 GPs. Survey data were summarised in percentages and a 95% Confidence Interval (CI 95%). Results There is a lack of awareness of obesity as a disease among PwO. Firstly, most PwO (60%, 95% CI: 54%-65%) consider obesity to be an aesthetic problem and secondly a health problem (59%, 95% CI: 54%-65%). Conversely, 80% (95% CI: 74%-85%) of GPs consider obesity as a disease. The survey focus on the knowledge of bariatric and metabolic surgery (BMS) as a possible treatment option showed that only 12% of PwO (95% CI: 8%-16%) declared they had never heard about it, while 88% (95% CI: 84%-91%) declared they knew about it. Similarly, 95% (95% CI: 91%-98%) of GPs claim to know about BMS, but they recommended it only to 5% (95% CI:2%-9%) of their patients. In treating obesity GPs considered BMS less efficient than diet and physical activity (83% (95% CI: 77%-88%) vs 90% (95% CI: 84%-93%)) and to be indicated mainly for patients with comorbidities which cannot be controlled otherwise. Conclusions Our results indicate that implementing awareness campaigns for patients and GPs is currently as essential as providing structured programmes for obesity treatment. Moreover, it is still necessary to sensitize GPs on BMS which should be considered a standard obesity treatment option in selected cases. Level of evidence: Level V, cross-sectional, descriptive study.
Too Much of a Good Thing? Inorganic Nitrogen (N) Inhibits Moss-Associated N2 Fixation But Organic N Can Promote It
Authors: Wang Yinliu , Lett Signe , Rousk Kathrin
Published: November 2021

Moss-associated nitrogen (N2) fixation is one of the main inputs of new N in pristine ecosystems that receive low amounts of atmospheric N deposition. Previous studies have shown that N2 fixation is inhibited by inorganic N (IN) inputs, but if N2 fixation in mosses is similarly affected by organic N (ON) remains unknown. Here, we assessed N2 fixation in two dominant mosses in boreal forests (Pleurozium schreberi and Sphagnum capillifolium) in response to different levels of N, simulating realistic (up to 4 kg N ha−1 yr−1) and extreme N deposition rates in pristine ecosystems (up to 20 kg N ha−1 yr−1) of IN (NH4NO3) and ON (alanine and urea). We also assessed if N2 fixation can recover from the N additions. In the realistic scenario, N2 fixation was inhibited by increasing NH4NO3 additions in P. schreberi but not in S. capillifolium, and alanine and urea stimulated N2 fixation in both moss species. In contrast, in the extreme N additions, increasing N inputs inhibited N2 fixation in both moss species and all N forms. Nitrogen fixation was more sensitive to N inputs in P. schreberi than in S. capillifolium and was higher in the recovery phase after the realistic compared to the extreme N additions. These results demonstrate that N2 fixation in mosses is less sensitive to organic than inorganic N inputs and highlight the importance of considering different N forms and species-specific responses when estimating the impact of N inputs on ecosystem functions such as moss-associated N2 fixation.
Correlation Between Maternal Weight Gain in Each Trimester and Fetal Growth According to Pre-pregnancy Maternal Body Mass Index in Twin Pregnancies
Authors: Kim Mi Ju , Kim Hyun Mi , Cha Hyun Hwa , Seong Won Joon
Published: November 2021

Background: This study aimed to determine the correlation between maternal weight gain in each trimester and fetal growth according to pre-pregnancy maternal body mass index in twin pregnancies.Methods: We conducted a retrospective review of the medical records of 500 twin pregnancies delivered at 28 weeks’ gestation or greater at a single tertiary center between January 2011 and December 2020. We measured the height, pre-pregnant body weight, and maternal body weight of women with twin pregnancies and evaluated the relationship between the maternal weight gain at each trimester and fetal growth restriction according to pre-pregnancy body mass index.Results: The overweight pregnant women were older than the normal or underweight pregnant women, and the risk of gestational diabetes was high. The underweight pregnant women were younger, and the incidences of preterm labor and short cervical length during pregnancy was high. Especially in normal weight pregnant women, the heavier the weight of the newborn babies as the second trimester of pregnancy weight gain, the less significant the weight gain in the first trimester of pregnancy and fetal growth. The most predictive single factor for the prediction of small neonates was weight gain during 24-28 weeks and 15-18 weeks, and the cutoff value was 6.2 kg. (area under the curve 0.592, p < 0.001).Conclusions: In twin pregnancy, regardless of the pre-pregnant body mass index, maternal weight gain affected fetal growth. Furthermore, weight gain in the second trimester of pregnancy is considered a powerful indicator of fetal growth, especially in normal weight pregnancies.
Treatment for right-sided intrathoracic kidney with congenital diaphragmatic hernia by combined thoracoscopic and laparoscopic approach: a case report and literature review
Authors: Yu Mingming , Chen Fang , Wei Sisi , Xie Hua
Published: November 2021

BackgroundIntrathoracic kidney (ITK) associated with congenital diaphragmatic hernia (CDH) is rare congenital anomaly and usually requires surgery. The surgical methods and approaches are diverse.Case presentationWe reported a case of a 5-year-old boy who was diagnosed as right-sided ITK with CDH. Surgical treatment was performed by combined thoracoscopic and laparoscopic approach. Anatomical reposition of the right kidney and nephropexy were carried out under laparoscopy, and repair of the hernia was performed under thoracoscopy. The postoperative recovery was uneventful and long-term follow-up demonstrated normal function and development of the kidney.ConclusionCombined thoracoscopic and laparoscopic approach is minimally invasive and effective for treatment of ITK associated with CDH. It provides better visualization of the diaphragmatic foramen and the hernia sac, and can achieve anatomical reposition and fixation of the ectopic kidney.
The Role of Procalcitonin in Predicting Risk of Mechanical Ventilation and Mortality among moderate to Severe COVID-19 Patients
Authors: Twe Cher Wei , Khoo Delton , Law Kian Boon , Nordin Nur Sabreena Ahmad , Sathasivan Subashini , Lim Kah Chuan , Atikah Sharifah Khairul , Badaruddin Syarifah Nurul Ain Syed , Chidambaram Suresh Kumar
Published: November 2021

BackgroundSerum procalcitonin (PCT) has become an emerging prognostic biomarker of disease progression in patients with COVID-19. This study aims to determine the optimal cut-off value of PCT with regards to important clinical outcomes, especially for mechanical ventilation and all-cause mortality among moderate to severe COVID-19 patients in Malaysia.MethodsA total of 319 moderate to severe COVID-19 patients hospitalized at the National Referral Hospital in December 2020 were included in the study retrospectively. Demographics, comorbidities, the severity of COVID-19 infection, laboratory and imaging findings, and treatment given were collected from the hospital information system for analysis. The optimal cut-point values for PCT were estimated in two levels. The first level involved 276 patients who had their PCT measured within 5 days following their admission. The second level involved 237 patients who had their PCT measured within 3 days following their admission. Further, a propensity score matching analysis was performed to determine the adjusted relative risk of patients with regards to various clinical outcomes according to the selected cut-point among 237 patients who had their PCT measured within 3 days. ResultsThe results showed that a PCT level of 0.2 ng/mL was the optimal cut-point for prognosis especially for mortality outcome and the need for mechanical ventilation. Before matching, patients with PCT ≥ 0.2ng/mL were associated with significantly higher odds in all investigated outcomes. After matching, patients with PCT > 0.2 ng/mL were associated with higher odds in all-cause mortality (OR: 4.629, 95% CI: 1.387 – 15.449, p = 0.0127) and non-invasive ventilation (OR: 2.667, 95% CI: 1.039 – 6.847, p = 0.0415). Furthermore, patients with higher PCT were associated with significantly longer days of mechanical ventilation (p = 0.0213). There was however no association between higher PCT level and the need for mechanical ventilation (OR: 2.010, 95% CI: 0.828 - 4.878, p = 0.1229).ConclusionOur study indicates that a rise in PCT above 0.2ng/ml is associated with an elevated risk in all-cause mortality, the need for non-invasive ventilation, and a longer duration of mechanical ventilation. The study offers concrete evidence for PCT to be used as a prognostication marker among moderate to severe COVID-19 patients.
A Novel Long Non-Coding RNA Regulates The Integrin, ITGA2 in Breast Cancer
Authors: Verhoeff Tristan J , Holloway Adele F , Dickinson Joanne L
Published: November 2021

Purpose
ITGA2 encodes the integrin, a2 which mediates metastatic progression, and is a predictor of poor prognosis and chemoresistance in breast cancer. Decreased ITGA2 promoter methylation is implicated as a driver of increased gene expression in aggressive prostate and pancreatic tumours, however the contribution of altered methylation to ITGA2 expression changes in breast tumours has not been examined.
Methods
ITGA2 gene methylation and gene expression was examined in publicly available breast cancer datasets, and ITGA2 promoter methylation was mapped by targeted bisulphite sequencing analysis in breast tumour cell lines. The expression of a putative regulatory long noncoding RNA (lncRNA) was examined by qPCR and its’ functionality was investigated using gene knockdown (antisense oligonucleotides) and over expression analysis in breast cancer cell lines.
Results
In breast tumours and breast cancer cell lines the ITGA2 promoter is largely unmethylated, with gene expression variable in tumour subtypes, irrespective of promoter methylation. A novel lncRNA (AC025180.1;ENSG00000249899), named herein I2ALR, was identified at the ITGA2 gene locus, and was variably expressed in breast tumours and breast cancer cell subtypes. I2LAR knockdown resulted in upregulation of ITGA2 gene expression, whilst over-expression of I2ALR resulted in downregulation of ITGA2 mRNA. Further, examination of two downstream targets of ITGA2 associated with breast tumor stemness and metastasis (CCND1 and ACLY), revealed concomitant gene expression changes in response to I2ALR modulation.
Conclusion
I2ALR represents a novel regulatory molecule targeting ITGA2 expression in breast tumours; a finding of significant and topical interest to the development of therapeutics targeting this integrin.
Functional and Mechanistic Characterization of an Enzyme Family Combining Bioinformatics and High-Throughput Microfluidics
Authors: Vasina Michal , Vanacek Pavel , Hon Jiri , Kovar David , Faldynova Hanka , Kunka Antonin , Badenhorst Christoffer , Buryska Tomas , Mazurenko Stanislav , Bednar David , Stavros Stavros , Bornscheuer Uwe , deMello Andrew , Damborsky Jiri , Prokop Zbynek
Published: November 2021

Next-generation sequencing doubles genomic databases every 2.5 years. The accumulation of sequence data raises the need to speed up functional analysis. Herein, we present a pipeline integrating bioinformatics and microfluidics and its application for high-throughput mining of novel haloalkane dehalogenases. We employed bioinformatics to identify 2,905 putative dehalogenases and selected 45 representative enzymes, of which 24 were produced in soluble form. Droplet-based microfluidics accelerates subsequent experimental testing up to 20,000 reactions per day while achieving 1,000-fold lower protein consumption. This resulted in doubling the dehalogenation “toolbox" characterized over three decades, yielding biocatalysts surpassing the efficiency of currently available enzymes. Combining microfluidics with modern global data analysis provided precious mechanistic information related to the high catalytic efficiency of new variants. This pipeline applied to other enzyme families can accelerate the identification of biocatalysts for industrial applications as well as the collection of high-quality data for machine learning.
Antibiotic Use and Appropriateness in the Treatment of Acute Respiratory Tract Infections in Tunisian Primary Care and Emergency Departments (Barometer Study): a Multicenter Cross-sectional Observational Clinical Study
Authors: Ali Khaoula Bel Haj , Sekma Adel , Messous Selma , Trabelsi Imen , Youssef Jalel Ben , Maghraoui Hamida , Razgallah Rabie , walha Adel , Grissa Mohamed Habib , Beltaief Kaouthar , Mezgar Zied , Coubantini Ahmed , Bouida Wahid , Msolli Mohamed Amine , Boukef Riadh , Boubaker Hamdi , Nouira Semir
Published: November 2021

BackgroundLittle is known about the pattern and appropriateness of antibiotic prescriptions in patients with acute respiratory tract infections (ARTIs).Objective Describe the antibiotics used to treat ARTIs in Tunisian primary care offices and emergency departments (EDs), and assess the appropriateness of their use.MethodsIt was a multicenter cross-sectional observational clinical study conducted at 63 primary care offices and 6 EDS during a period of 8 months. Appropriateness of antibiotic prescription was evaluated by trained physicians using the medication appropriateness index (MAI). The MAI ratings generated a weighted score of 0 to 18 with higher scores indicating low appropriateness. The study was conducted in accordance with the Declaration of Helsinki and national and institutional standards. The study was approved by the Ethics committee of Monastir Medical Faculty.ResultsFrom the 12880 patients screened we included 9886 patients. The mean age was 47.4, and 55.4% were men. The most frequent diagnosis of ARTI was were acute bronchitis (45.3%), COPD exacerbation (16.3%), tonsillitis (14.6%), rhinopharyngitis (12.2%) and sinusitis (11.5%). The most prescribed classes of antibiotics were penicillins (58.3%), fluoroquinolones (17.6%), and macrolides (16.9%). Antibiotic therapy was inappropriate in 75.5% of patients of whom 65.2% had bronchitis. 65% of patients had one or more antibiotic prescribing inappropriateness criteria as assessed by the MAI. The most frequently rated criteria were with expensiveness (75.8%) and indication (40%). Amoxicillin-clavulanic acid and levofloxacin were the most inappropriately prescribed antibiotics. History of cardiac ischemia ([OR] 3.66; 95% [CI] 2.17-10.26; p<0.001), asthma ([OR] 3.29, 95% [CI] 1.77-6.13; p<0.001), diabetes ([OR] 2.09, 95% [CI] 1.54-2.97; p=0.003), history of COPD ([OR] 1.75, 95% [CI] 1.43-2.15; p<0.001) and age >65 years (Odds Ratio [OR] 1.35, 95% confidence interval [CI] 1.16-1.58; p<0.001) were associated with a higher likelihood of inappropriate prescribing.ConclusionOur findings indicate a high inappropriate use of antibiotics in ARTIs treated in in primary care and EDs. This was mostly related to antibiotic prescription in acute bronchitis and overuse of expensive broad spectrum antibiotics. Future interventions to improve antibiotic prescribing in primary care and EDs is needed.Trial registrationthe trial is registered at Clinicaltrials.gov registry (NCT04482231)
Association Between Annual Change in FEV1 and Comorbidities or Impulse Oscillometry in Chronic Obstructive Pulmonary Disease.
Authors: Sugawara Hiroyuki , Saito Atsushi , Yokoyama Saori , Tsunematsu Kazunori , Chiba Hirofumi
Published: November 2021

Background:Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation. The decline in forced expiratory volume in one second (FEV1) is considered to be one of the most important outcome measures for evaluating disease progression. However, the only intervention proven to improve COPD prognosis is smoking cessation. This study therefore investigated the factors associated with annual FEV1 decline in COPD.Methods:This retrospective study followed up 65 patients treated for COPD for 5 years: 13 current smokers and 52 former smokers, 25 with pneumonia, 24 with asthma, 18 with cancer, and 17 with cardiovascular disease. The patients were divided into groups based on clinical cut-off parameters of the impulse oscillometry system (IOS): 11 high and 54 low R5, 8 high and 57 low R20, 21 high and 44 low R5–R20, 26 high and 39 low X5, 38 high and 27 low Fres, and 36 high and 29 low AX. We investigated whether the decline in FEV1 was associated with comorbidities and IOS parameters.Results:The annual change in FEV1 over 5 years was significantly affected by smoking status (current −66.2 mL/year vs former −5.7 mL/year, p < 0.01), pneumonia (with −31.5 mL/year vs without −8.9 mL/year, p < 0.05), asthma (with −30.2 mL/year vs −10.8 mL/year, p < 0.01), but not by cancer and cardiovascular disease. In the groups defined by IOS results, only the high AX group had significantly more annual decline in FEV1 and %FEV1 than the low AX group (−22.1 vs −12.8, p < 0.05 and −0.20 vs 0.40, p < 0.05, respectively).Conclusions:Smoking cessation, prevention of pneumonia, and asthma control could reduce FEV1 decline in COPD. AX might be a suitable parameter to predict the prognosis of COPD patients.
Interactions Between Remimazolam and Propofol in Combination With Sufentanil for Anesthesia During Gastroscopy
Authors: Lyu Song , Deng Qingchun , Lin Weixin , Wu Xiaofang
Published: November 2021

Background

This study was conducted to determine how remimazolam and propofol interact when given with sufentanil.
Methods

In this single-arm study, patients were assigned to one of five groups. The sample size was not determined in advance. When the median effective dose(ED50) and 95% confidence intervals were calculated, participants were stopped. The study included 159 patients who were scheduled for a gastrointestinal endoscopic examination and had an American Society of Anesthesiologists physical status of I/II. Patients were intravenously administered sufentanil (0.1 µg/kg), along with different doses of remimazolam and propofol depending on the group to which they were assigned. The endpoint for an effective response was the disappearance of the bilateral eyelash reflex. The up-and-down method was used to determine the ED50 within each treatment group. The ED50 deviations from the additive line were analyzed using isoradiometric analysis. The interaction coefficients were calculated by algebraic analysis. Interval estimation is used in statistical inference.
Results

In combination with sufentanil, the ED50 of remimazolam and propofol was determined to be 0.065 (0.057-0.074) mg/kg and 0.657 (0.590-0.724) mg/kg, respectively. After sufentanil administered, when 0.25, 0.5, and 0.75 ED50 remimazolam were given in combination with propofol, the interaction coefficients were 1.03,1.2and 1.08, respectively.
Conclusions

The dose of propofol with remimazolam may need to be reduced regardless of the additive or synergistic effect. There was a strong synergistic effect when the dose ratio of the two drugs was about 6:1 in mg/kg.
Trial registration:

The project was retrospectively registered on October 26, 2021 in Chinese clinical trial center with the registration number of ChiCTR2100052425.
Albumin and CRP, Which is the Best Biomarker for Postoperative Complications on Colorectal Surgery? Prospective Cohort Study
Authors: Cunha Miguel Fernandes , Mendes Beatriz , Mendanha Pedro , Miguel Ines , Rachadell Juan , Amorim Edgar , Castelo-Branco Pedro
Published: November 2021

Aim Our purpose was to investigate the potential role of albumin variation in comparison to C-reactive protein (CRP) variation as a predictive marker for postoperative complications in colorectal surgery. Methods An prospective cohort study was conducted. Adult patients who underwent elective colorectal surgery between January 2019 and December 2020 were eligible. Serum levels of albumin and CRP were measured preoperatively and on the first 4 postoperative days. Univariate analysis were performed to assess the association of albumin (Alb) and CRP with postoperative complications. Serum albumin variation (ΔAlb) and CRP variation (ΔCRP) were calculated. Receiver operating characteristic curve analysis and the Youden test were used to determine acuity and predictive cut-off values. Results Ninety-three patients were included. A CRP cut-off of 83.4 mg/dL on postoperative day (POD) 4 was the best predictor of postoperative global complications (p<0.001; AUC 0.83, 70% sensitivity, 91% specificity). Major complications were best correlated with ΔAlb on POD 2, 3 and 4 (p<0.001), with a ΔAlb cut-off of 27.4% on POD 2 showing the strongest association with this outcome (AUC 0.834, 83% sensitivity, 90% specificity). Regarding anastomotic leak, CRP on POD 3 showed better predictive values (p=0.037; AUC 0.792) with a cut-off value of 88.7 mg/dL (100% sensitivity, 52% specificity). Discussion Herein, the authors demonstrate there is a role for albumin variation, as an earlier and sensitive marker, to predict major postoperative complications in colorectal surgery. This analysis may be further applied to aid in the early identification of significant causes of re-operation and long-term morbimortality.
CircStrn3 Targeting microRNA-9-5p Is Involved in the Regulation of Cartilage Degeneration and Subchondral Bone Remodeling in Osteoarthritis
Authors: Li Bin , Ding Tao , Chen Haoyi , Li Changwei , Chen Bo , Xu Xing , Huang Ping , Hu Fangqiong , Guo Lei
Published: November 2021

Background: Osteoarthritis (OA) is the most frequent chronic degenerative joint disease, which is a “whole joint” disease including the pathological changes in the cartilage, subchondral bone and the synovium. Mechanical instability is the initiation of the development of OA. Methods: Minus RNA sequencing, fluorescence in situ hybridization and quantitative real-time PCR were used to detect the expression of circStrn3 in human and mouse OA cartilage tissues and chondrocytes. Stimulate chondrocytes to secrete exosomes miR-9-5p by stretching strain. Intra-articular injection of exosomes miR-9-5p into the OA model induced by the operation of instability of the medial meniscus in mice.Results: In the present study, minus RNA sequencing data showed that tensile strain could decrease the expression of circStrn3 in chondrocytes. The results of fluorescence in situ hybridization and quantitative Real-time PCR showed that circStrn3 expression was significantly decreased in human and mouse OA cartilage tissues and chondrocytes. CircStrn3 could inhibit matrix metabolism of chondrocytes through competitively 'sponging' miRNA-9-5p targeting kruppel-like factor 5 (KLF5), indicating that the decreasing of circStrn3 might be a protective factor in mechanical instability-induced OA. Further studies showed that the tensile strain stimulated chondrocytes to secrete exosomes miR-9-5p. Exosomes with high miR-9-5p expression from chondrocytes could inhibit osteoblasts differentiation by targeting KLF5. In addition, intra-articular injection of exosomal miR-9-5p obviously alleviated the progression of OA induced by destabilized medial meniscus surgery in mice. Conclusions: Taken together, these results demonstrated that the reduction of circStrn3 caused the increasing of miR-9-5p, which acted as a protective factor in mechanical instability-induced OA and provided a novel mechanism of communication among joint components and a potential application for the treatment of OA.
High Triglyceride-Glucose Index (TyG) is Associated With Adverse Cardiovascular Events in Patients With Type 2 Diabetes Mellitus (T2DM) and Chronic Total Occlusion (CTO) After Percutaneous Coronary Intervention (PCI)
Authors: Lin Xiao Long , Sun Hao Xuan , Zhao Jin Yang , Li Fan Qi , Zhao Dong Hui , Ma Qin , Liu Jing Hua , Fan Qian
Published: November 2021

Background: The triglyceride-glucose index (TyG index) is a reliable surrogate marker of insulin resistance, which is associated with cardiovascular disease morbidity and prognosis. However, the predictive value of the TyG index for cardiovascular events in patients with type 2 diabetes mellitus (T2DM) and chronic total occlusion (CTO) after percutaneous coronary intervention (PCI) has not been specifically studied. Method: The study retrospectively enrolled 687 patients with T2DM and CTO after PCI in the final analysis. Patients were divided into three groups according to the TyG index tertiles. The TyG index was calculated as ln [ fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2 ]. The primary observational endpoint was the composite of overall death, non-fatal stroke, non-fatal myocardial infarction (MI), or unplanned revascularization.Results: During a median follow-up of 22.0 months, 159 patients (23.14%) experienced primary endpoint events. Multivariate Cox hazards regression analysis showed that the TyG index was significantly correlated with the primary endpoint [HR 2.827, 95% CI (1.877-4.529), P＜0.001]. Kaplan–Meier curves for the primary endpoint showed a significant difference between the lower and higher TyG index group was mainly driven by the increased incidence of unplanned revascularization (Log-rank P＜0.001).Conclusion: The TyG index may be a remarkable predictor of adverse cardiovascular events, especially unplanned revascularization in patients with T2DM and CTO who are treated by PCI.
Prevalence and Determinants of Depression, Anxiety and Stress Among Psychiatric Nurses in Ghana: a Cross Sectional Study
Authors: Agyemang Sampson Opoku , Ninnoni Jerry Paul , Enyan Nancy Innocentia Ebu
Published: November 2021

Background: The job demands and stress associated with the nursing profession put nurses on an escalating risk to exhibit psychiatric morbidity such as anxiety and depression. This study assessed the prevalence and risk factors of depression, anxiety and stress among nurses working in public psychiatric hospitals in Ghana. Methods: A cross-sectional design was used for this study. Proportionate and simple random sampling method were used to select 311 respondents for the study. Data was collected using a questionnaire which comprised Beck’s Depression Inventory, Beck’s Anxiety Inventory and Perceived Stress Scale. Data was analysed using descriptive statistics and a multinomial logistic regression. Results: The results showed that 92% and 96.5% of mental health nurses experienced minimal depression and low anxiety respectively. In addition, 56.6% and 42.8% experienced low and moderate stress respectively. There was a positive association between educational level and depression whereas, a negative association existed between educational level and anxiety and stress. Also, mental health nurses who work at the OPD and Administration were more likely to experience anxiety and stress. Conclusion: The findings of this study suggest that, higher level of educational opportunities for mental health nurses leads to decreases anxiety among nurses. Also, the work environment needs to be made conducive to promote the psychological wellbeing of nurses. Additionally, interventions on the management of depression, anxiety and stress by nurses in mental health hospitals need to be instituted, thereby, improving the health of nurses working in mental health hospitals.
Postoperative complication of the index surgery is a risk factors for postoperative ileus after diverting loop ileostomy closure: a retrospective study
Authors: Nakao Toshihiro , Shimada Mitsuo , Yoshikawa Kozo , Tokunaga Takuya , Nishi Masaaki , Kashihara Hideya , Takasu Chie , Wada Yuma , Yoshimoto Toshiaki , Yamashita Syoko , Iwakawa Yosuke
Published: November 2021

Background: Postoperative ileus is one of the most common complications after diverting loop ileostomy closure. Some reports have investigated the risk factors for postoperative complications or ileus after ileostomy closure; however, these studies did not evaluate the index surgery sufficiently. In this study, we evaluated the risk factors, including the details of the index surgery, for ileus after diverting ileostomy closure.Methods: This was a retrospective study of patients who underwent ileostomy closure following index surgery for rectal cancer. Patients who developed postoperative ileus (POI (+)) and patients who did not (POI (−)) after ileostomy closure were compared.Results: Fifty-nine patients were evaluated and were divided into two groups: POI (+) (n=9) and POI (−) (n=50), and the groups were compared. There were no significant differences in the details of the index surgery, operative procedure, transanal total mesorectal excision, lateral lymph node dissection, operating time, or blood loss. The incidence of Clavien–Dindo grade ≥ III complications after the index surgery was significantly higher in the POI (+) group. Conclusions: The incidence of Clavien–Dindo grade ≥ III complications after the index surgery may increase the risk of postoperative ileus after ileostomy closure.
Engrafted glial progenitor cells yield long-term integration and sensory improvement in aged mice
Authors: Yang Zhiqi , Gong Mingyue , Jian Tingliang , Li Jin , Yang Chuanyan , Ma Qinlong , Deng Ping , Wang Yuxia , Huang Mingzhu , Wang Haoyu , Yang Shaofan , Chen Xiaowei , Yu Zhengping , Wang Manxia , Chen Chunhai , Zhang Kuan
Published: November 2021

Aging causes astrocyte morphological degeneration and functional deficiency, which impairs neuronal functions. Until now, whether age-induced neuronal deficiency could be alleviated by engraftment of glial progenitor cell (GPC) derived astrocytes remained unknown. In the current study, GPCs were generated from embryonic cortical neural stem cells in vitro and transplanted into the brains of aged mice. Their integration and intervention effects in the aged brain were examined 12 months after transplantation. Results indicated that these in-vitro-generated GPC-derived astrocytes possessed normal functional properties. After transplantation they could migrate, differentiate, achieve long-term integration, and maintain much younger morphology in the aged brain. Additionally, these GPC-derived astrocytes established endfeet expressing aquaporin-4 (AQP4) and ameliorate AQP4 polarization in the aged neocortex. More importantly, age-dependent sensory response degeneration was reversed by GPC transplantation. This work demonstrates that rejuvenation of the astrocyte niche is a promising treatment to prevent age-induced degradation of neuronal and behavioral functions.
Partial Cystectomy Could Be a Better Option of Bladder Preservation in T1 High-Grade Bladder Cancer Patients: A Propensity Score Matching Study
Authors: Zhan Xiangpeng , Fu Bin
Published: November 2021

Purpose: Partial cystectomy was investigated as a method of bladder preservation with better disease outcomes than transurethral bladder tumor resection in T1 high-grade bladder cancer patients.Method and materials: The national Surveillance, Epidemiology, and End Results database（SEER） (2004-2015) was used to obtain patients diagnosed with T1 high-grade bladder cancer, and finally, 25263 patients were enrolled in our study. The Kaplan-Meier method with the log-rank test was performed to analyze the outcome of overall survival (OS) and cancer-specific survival (CSS) between patients undergoing PC, TURBT, or RC. Moreover, the propensity score matching (PSM) and multivariable Cox proportional hazard model were also utilized in the study.Results: Ultimately, 24635 patients were undergoing TURBT, while 190 and 438 patients were respectively assigned to PC and RC groups. Compared with patients with TURBT, a tendency of a higher proportion of higher older and male patients was observed in the PC group. When matching with RC patients, patients in the PC group were common older and had bigger tumor sizes and single tumor. (All P<0.05). After 1:1 PSM, 190 patients with TURBT and 160 patients receiving RC were selected. In survival analysis, the patients in the PC group had a higher survival probability of both OS and CSS before and after PSM compared with those in the TURBT group. Meanwhile, no significant differences were observed between the RC and PC groups in OS and CSS analysis. Moreover, multivariable cox regression showed that PC was a protective factor for overall mortality (OM) and cancer-specific mortality (CSM) compared with TURBT in T1 high-grade patients. (All P<0.05)Conclusion: Patients undergoing partial cystectomy were shown to have a better outcome compared to those with transurethral bladder tumor resection in T1 high-grade bladder cancer patients. Partial cystectomy was a worthwhile alternative for T1 high-grade bladder cancer.
Impact of Keratoconus Stage on Outcome After Corneal Crosslinking
Authors: Gassel Caroline Julia , Röck Daniel , Konrad Eva-Maria , Blumenstock Gunnar , Bartz-Schmidt Karl Ulrich , Röck Tobias
Published: November 2021

Background: This study aimed to analyze if the outcome after corneal crosslinking (CXL) in progressive keratoconus patients depends on the stage in which the procedure is performed. This knowledge would help to improve success of CXL and facilitate defining surgery indications in those patients.Methods: In this retrospective study, 124 consecutive eyes of 100 patients with progressive keratoconus undergoing corneal CXL at the University Eye Hospital Tübingen were included. The eyes were graded according to modified Krumeich stages depending on induced myopia or astigmatism, corneal radii, minimum corneal thickness, and morphological changes. The observation period took place from November 2008 to September 2018. Preoperatively, 12 and 24 months after CXL, the best corrected visual acuity (BCVA) was determined and astigmatism as well as keratometric parameters (Kmax, Kmin, central corneal thickness (CCT), minimum corneal thickness (MCT)) were measured by means of a Scheimpflug camera system.Results: BCVA results showed significant differences between the modified Krumeich stages 12 months (p=0.014) and 24 months postoperatively (p=0.032). Also, astigmatism differed significantly among the stages 24 months after CXL (p=0.023); however, after 12 months, no significant differences between the groups were detectable. In terms of Kmax, Kmin, CCT, and MCT, no significant differences between the Krumeich stages were observed.Conclusions: BCVA showed a significantly higher improvement after CXL in the early stage of keratoconus compared to a higher stage. However, the postinterventional keratometric values did not differ significantly between the different modified Krumeich stages. The significantly higher improvement in BCVA after CXL in the early stage might indicate that earlier intervention provides a higher subjective benefit to the individual. Further studies with larger sample sizes are needed to confirm these findings.
Effects of Dietary Palmitoleic Acid on Vascular Function in Aorta of Diabetic Mice
Authors: Takenouchi Yasuhiro , Seki Yoshie , Shiba Sachiko , Ohtake Kazuo , Nobe Koji , Kasono Keizo
Published: November 2021

BackgroundChronic hyperglycemia in diabetes causes atherosclerosis and progresses to diabetic macroangiopathy, and can lead to coronary heart disease, myocardial infarction and cerebrovascular disease. Palmitoleic acid (POA) is a product of endogenous lipogenesis and is present in fish and vegetable oil. In human and animal studies, POA is reported as a beneficial fatty acid related to insulin sensitivity and glucose tolerance. However, few studies have reported its effects on aortic function in diabetes. Here, we investigated the effects of POA administration on vascular function in KKAy mice, a model of type 2 diabetes.MethodsMale KKAy and C57BL/6J mice at the age of 14 weeks were used in the present study. For each mouse strain, one group was fed with normal diet and the other group was fed POA-containing diet for 2 weeks. Then, the vascular reactivities of prepared aortic rings were measured in an organ bath to determine if POA administration changed vascular function in these mice.ResultsKKAy mice treated with POA exhibited decreased plasma glucose levels compared with mice treated with normal diet. However, endothelium-dependent vasorelaxant responses to acetylcholine and protease-activated receptor 2 activating protein, which are attenuated in the aorta of KKAy mice compared to control C57BL/6J mice under a normal diet, were not affected by a 2-week POA treatment. In addition, assessment of vasoconstriction revealed that the phenylephrine-induced vasoconstrictive response was enhanced in KKAy mice compared to control mice under a normal diet, but no effect was observed in KKAy mice fed a POA-containing diet. In contrast, there was an increase in vasoconstriction in control mice fed the POA-containing diet compared to mice fed a normal diet. Furthermore, the vasoconstriction in aorta in both control and KKAy mice fed a POA-containing diet were further enhanced under hyperglycemic conditions compared to normal glucose conditions in vitro. In the hyperinsulinemic, and hyperinsulinemic combined with hyperglycemic conditions, vasoconstriction was increased in KKAy mice fed with POA.ConclusionThese results suggest that POA intake enhances vasoconstriction under hyperglycemic and hyperinsulinemic conditions, which are characteristics of type 2 diabetes, and may contribute to increased vascular complications in diabetes.
Protection offered by COVID-19 vaccines in reducing SARS-CoV-2 infection frequency; severity and mortality, among Indian Healthcare Workers: Multicenter, pan-Fortis study
Authors: Acharya Subrat , Mahindra Gaurav
Published: November 2021

During COVID-19 pandemic, Healthcare Workers (HCWs) were at increased risk for exposure to SARS-CoV-2 virus and prioritized for early administration of COVID-19 vaccines in India. Real-life scenario information among vaccinated HCWs acquiring COVID-19 infection, is scarce. We retrospectively analyzed COVID-19 infection frequency, severity, and associated mortality among healthcare workers, immunized with either Covishield or Covaxin vaccines at 27 Fortis Hospitals across 11 Indian states. Positive cases were identified based on RT-PCR or rapid antigen tests for SARS-CoV-2 between 16th January 2021 till 15th May 2021. 20034 HCWs received vaccination. 3971 received 1 dose, 16063 received 2 doses. Post-vaccination, 1139 HCWs acquired COVID-19 infection, 180 (4.53%) and 959 (5.97%) among partially and fully vaccinated category, respectively. Breakthrough infection occurred among 913 (5.68%) HCWs. Concurrently, Case Positivity Rate was 11.9%, among general population (control). Among 1139 positive cases, mild, moderate, and severe infections were 1059 (93%), 71 (6.2%) and 9 (0.8%), respectively with Case Fatality Rate of 0.18%, compared to 0.92% among general population (p=0.0043). The Case Fatality Rate in vaccinated HCWs was found to be 80% less than that in general population (control). Hence, COVID-19 vaccines available in India seem to be effective against SARS-CoV-2 virus.
Effect of serum bisphenol A and low T3 on short-term prognosis of young patients with intracerebral hemorrhage
Authors: wang guoping , Chen Jinhua , Qiao Zhongdong , Zhao Lili , Guo Dongxing , Guo Ping , Wang Aiven , Sun Wanli , Zhang Lifang , Feng Cueiping , Lyu Jiyuan
Published: November 2021

BackgroundBisphenol A (BPA) is widely present in daily necessities, and its exposure is almost everywhere. We aimed to evaluate the relationship between serum BPA levels, biomarkers and recent mortality in young patients with intracerebral hemorrhage (YICH) and low T3 .MethodsUsing a multi-center longitudinal prospective study, the research team recruited 600 YICH patients and divided into two subgroups according to their thyroid function, of which 320 (53.3%) were in the LT3, Sub-clinical hypothyroidism (SCH) was 280 (46.6%) and control group (n = 600).All patients received serum BPA, and biomarker blood draws.ResultsCalculating the cumulative quantification of plastic bag products, BPA increased by 0.204 standard deviation unit per log unit (P<0.003). Serum BPA, thrombin and matrix metalloproteinase (MMP-9) {BPA (0.91±0.14) vs (0.765±0.13) vs. (0.535±0.11) pg/ml, thrombin (1.35±0.18) vs (0.66±) 0.15) vs (0.66 ±0.15) ng/ml, MMP-9 (104±10 vs (53±8.1) vs (53±) 8.1) pg/ml, both P<0.01}. Linear correlation analysis showed that serum BPA was positively correlated with miR-388-3p and 24hDBPCV, and negatively correlated with LT3 and miR-451. Multiple linear regression showed that BPA affected the increase of nDBP Percentage of independent risk factors (β = 0.286), P <0.01. Mortality rate showed 2 ,15 and 30 days of patients in the LT3 and the SCH of 4.7%vs 2.5%,6.25% vs 3.75%,4.68%vs 2.5%, P<0.01.ConclusionHigh BPA exposure strongly predicts the risk of ICH in young patients. The activation of NF-κB signaling pathway, secondary thyroid function, ambulatory blood pressure scores, and changes in messenger ribonucleic acid construct an inflammatory response system. There are also significant differences in recent mortality between the LT3 group and the SCH group.Trial registrationThe trial is registered at clinical .gov (www.medresman.Chi CTR1900023626)
Application of Ultrasonography in Conservative Treatment of Humeral Shaft Fracture in Children
Authors: Li Jun , Tan Xin , Li Xiang , Gou Pan , Yuan Xiaowei , Liu Tao , Shi Mingyan , Liu Xing
Published: November 2021

Purpose: Most of humeral shaft fractures in children could be treated satisfactorily by conservative treatment. This study aimed to evaluate the application value of ultrasonography in conservative treatment of humeral shaft fracture in children.Methods: We retrospectively reviewed children admitted to our hospital, for humeral shaft fracture from January 2014 to March 2018. The patients were divided into two groups: ultrasonography group and X-ray group. All patients were instructed to re-examined at 1 week, 2 weeks, 4 weeks, 12 weeks, 24 weeks and 1 year from the injury date for follow-up, and evaluated the prognosis according to the Disabilities of Arm, Shoulder and Hand (DASH) score at 12 months.Results: A total of 37 children were divided into ultrasonography group, 32 children were divided into X-ray group. There was no significant difference in prognosis between the two groups. The mean number of radiation exposures of ultrasonography group was less and ultrasonic examination found radial nerve injury, and using ultrasound reduced the chance of direct or in direct contact with infected peoples.Conclusion: Ultrasound is a non-invasive, non-radioactive test, which could decrease risk of COVID-19 infection and detect the vascular nerve injury caused by fracture. Ultrasonography may be the examination method for follow-up conservative treatment of humeral shaft fracture in children during the epidemic period.
Gut Dysbiosis and Hemodynamic Changes as Links of the Pathogenesis of Complications of Cirrhosis
Authors: Maslennikov Roman , Ivashkin Vladimir , Efremova Irina , Poluektova Elena , Shirokova Elena , Ivashkin Konstantin , Kudryavtseva Anna , Krasnov George
Published: November 2021

Background. Hemodynamic changes (hyperdynamic circulation) and gut dysbiosis are observed in cirrhosis. It was suggested that gut dysbiosis contributes to the development of hyperdynamic circulation, which aggravates the course of cirrhosis. The aim is to test this hypothesis.Methods. The cross-sectional observational study included 47 patients with cirrhosis. Stool microbiome was assessed using 16S rRNA gene sequencing. Echocardiography with a simultaneous assessment of blood pressure and heart rate was performed. Hemodynamic parameters were calculated. Results. Hyperdynamic circulation was found in 34% of patients. Patients with hyperdynamic circulation had higher incidences of clinically significant ascites (p=0.018), overt hepatic encephalopathy (p=0.042), hypoalbuminemia (p=0.011), hypoprothrombinemia (p=0.019), systemic inflammation (p=0.002), and severe hyperbilirubinemia (p=0.042) than patients without hyperdynamic circulation. The abundance of Proteobacteria (p=0.012), Enterobacteriaceae (p=0.008), Bacilli (p=0.027), Streptococcaceae (p=0.044), Lactobacillaceae (p=0.034), Enterococcaceae (p=0.046), and Fusobacteria (p=0.026) increased and the abundance of Bacteroidetes (p=0.049) and Erysipelotrichia (p=0.029) decreased in the gut microbiome of patients with hyperdynamic circulation compared to patients without hyperdynamic circulation. The systemic vascular resistance value negatively correlated with the abundance of Proteobacteria (r=-0.423; p=0.003), Enterobacteriaceae (r=-0.417; p=0.004), and Fusobacteria (r=-0.401; p=0.005). Heart rate was negatively correlated with the abundance of Bacteroidetes (r=-0.453; p=0.001). The cardiac output value was positively correlated with the abundance of Proteobacteria (r=0.402; p=0.003), Enterobacteriaceae (r=0.424; p=0.003), Fusobacteria (r=0.281; p=0.049), and Bacilli (r=0.314; p=0.031), and negatively correlated with the abundance of Bacteroidetes (r=-0.313; p=0.032) and Erysipelotrichia (r=-0.329; p=0.024). Conclusion. Gut dysbiosis is associated with hyperdynamic circulation, which is associated with a number of complications of cirrhosis.