bluuebunny/crossref_metadata_2025 huggingface dataset:
Adults Living With a Retro-auricular Left Ventricular Assist Device as Destination Therapy
Authors: Luciani Michela , Trenta Alessia Martina , Jack Susan Michelle , Moro Massimo , Patella Sara , Di Mauro Stefania , Ausili Davide
Published: February 2020

Background

Increasingly, there is a trend toward the use of left ventricular assist devices (LVADs) for treating advanced heart failure, as both bridge-to-transplant therapy and destination therapy. Living with an LVAD profoundly influences patients' lives. Only a few study authors investigated the experience of people with abdominal LVADs, and nothing is known about the unique experience of those with retro-auricular LVADs.

Objective

The aim of this study was to explore and describe experiences and lifestyle adjustments in adults with retro-auricular LVADs implanted as destination therapy.

Methods

Interpretive description methodology was used to explore the experiences of a purposeful sample of 10 individuals with retro-auricular LVADs implanted as destination therapy. Data were collected using in-depth semistructured interviews. Data collection and analysis were simultaneous. Triangulation, journaling, and the “thoughtful clinician test” were used to increase trustworthiness of the findings.

Results

Three primary themes describing the experience of people with retro-auricular LVADs were developed: “a new life,” “self-care,” and “resilience”; in addition, a crosscutting theme was identified: “support system.” This article focuses on the theme “a new life,” described as a continuum of events. Individuals with advanced heart failure struggle with symptom burden and consider the implantation of the device as the final option to delay death; then, they wait for the surgery that represents a turning point, after which they begin to recover through a process of adjustment until they reach a new normality.

Conclusions

Living with a retro-auricular LVAD impacts every aspect of people's lives. Knowing their experiences can help clinicians to develop targeted interventions and offer tailored support.
Examining Adherence to Medication in Patients With Atrial Fibrillation
Authors: Taylor Elaina Charlotte , O'Neill Mark , Hughes Lyndsay D. , Bennett Peter , Moss-Morris Rona
Published: February 2020

Background/Objectives

This study examined whether beliefs about medicines, drug attitudes, and depression independently predicted anticoagulant and antiarrhythmic adherence (focusing on the implementation phase of nonadherence) in patients with atrial fibrillation (AF).

Methods

This cross-sectional study was part of a larger longitudinal study. Patients with AF (N = 118) completed the Patient Health Questionnaire-8. The Beliefs about Medicines Questionnaire, Drug Attitude Inventory, and Morisky-Green-Levine Medication Adherence Scale (self-report adherence measure), related to anticoagulants and antiarrhythmics, were also completed. Correlation and multiple logistic regression analyses were conducted.

Results

There were no significant differences in nonadherence to anticoagulants or antiarrhythmics. Greater concerns (r= 0.23,P= .01) were significantly, positively associated with anticoagulant nonadherence only. Depression and drug attitudes were not significantly associated with anticoagulant/antiarrhythmic adherence. Predictors reliably distinguished adherers and nonadherers to anticoagulant medication in the regression model, explaining 14% of the variance, but only concern beliefs (odds ratio, 1.20) made a significant independent contribution to prediction (χ2= 11.40,P= .02, withdf= 4). When entered independently into a regression model, concerns (odds ratio, 1.24) significantly explained 10.3% of the variance (χ2= 7.97,P= .01, withdf= 1). Regressions were not significant for antiarrhythmic medication (P= .30).

Conclusions

Specifying medication type is important when examining nonadherence in chronic conditions. Concerns about anticoagulants, rather than depression, were significantly associated with nonadherence to anticoagulants but not antiarrhythmics. Anticoagulant concerns should be targeted at AF clinics, with an aim to reduce nonadherence and potentially modifiable adverse outcomes such as stroke.
How Healthcare Professionals in Cardiac Care Address Depressive Symptoms
Authors: Westas Mats , Lundgren Johan , Mourad Ghassan , Neher Margit , Johansson Peter
Published: February 2020

Background

Depressive symptoms are common in patients with cardiovascular disease (CVD) and are associated with a poorer quality of life and prognosis. Despite the high prevalence and negative consequences, the recognition of depressive symptoms is low. More knowledge about patients' perceptions of how depressive symptoms are addressed by healthcare professionals is therefore needed.

Objectives

The aim of this study was to explore the experiences of patients with CVD of how healthcare professionals address and manage depressive symptoms in clinical cardiac care encounters.

Methods

A qualitative, semistructured interview study was performed. Data were analyzed using inductive thematic analysis.

Results

In total, 20 patients with CVD previously treated for depressive symptoms were included (mean age, 62 [range, 34–79] years; 45% women). Three main themes emerged: (1) “not being seen as a whole person,” (2) “denying depressive symptoms,” and (3) “being provided with help.” The patients perceived that healthcare professionals mainly focused on somatic symptoms and disregarded their need for help for depressive symptoms when patients raised the issue. Some patients stated that they received help for depressive symptoms, but this depended on the patients' own ability to communicate their needs and/or having social support that could alert them to the importance of doing so. Patients also described that they downplayed the burden of depressive symptoms and/or did not recognize themselves as having depressive symptoms.

Conclusion

Depressive symptoms were overlooked in patients with CVD, and psychological needs had not been met. A good ability to address needs and having good social support were useful for receiving help with depressive symptoms.
How does Organizational Climate Motivate Employee Safe and Healthy Behavior in Small Business?
Authors: Schwatka Natalie V. , Sinclair Robert R. , Fan Wenyi , Dally Miranda , Shore Erin , Brown Carol E. , Tenney Liliana , Newman Lee S.
Published: February 2020

Objective:

This study evaluates the motivational processes between employee occupational safety and health climates and behaviors using the Theory of Self-Determination in a sample of diverse small businesses.

Methods:

We used cross-sectional data to assess whether employee safety/health intrinsic, identified, and external motives mediate the relationship between safety/health climate and behavior.

Results:

All three types of motivation mediated the relationship between safety and health climates and behaviors.

Conclusion:

Small businesses seeking to engage employees in Total Worker Health efforts should build strong safety and health climates because of their influence on employees’ motivation to participate in health promoting and health protective programs.
Evaluation of a Functional Brace in ACL-Deficient Subjects Measuring Ground Reaction Forces and Contact Pressure: A Pilot Study
Authors: Ghadikolaee Mehran Shirian , Sharifmoradi Keyvan , Karimi Mohammad Taghi , Tafti Nahid
Published: February 2020

Introduction

An ideal functional brace for anterior cruciate ligament-deficient (ACLD) patients should control anterior movement of the tibia and simultaneously decrease the effects of ground reaction shearing force. The current study was aimed to compare the interface pressure between the anterior shell of a functional brace and proximal of tibia in both sound and ACLD limbs, and to assess the effect of using functional brace on the symmetry of vertical and anteroposterior components of ground reaction force and impulse of ground reaction force during level walking.

Methods

Seven unilateral ACLD men participated in this study. The interface pressure between the anterior shell and proximal of the tibia and ground reaction force was recorded by means of Novel Pliance X and Kistler force platform, respectively. Wilcoxon ranked-sign test and factor analysis repeated measure analysis of variance were used to analyze data.

Results

The use of functional brace had no significant effect on interface pressure and peak points of the ground reaction force. By use of a functional brace, the valley and the impulse of the vertical component of ground reaction force on ACLD limb increased significantly (P < 0.05) and also improved limb symmetry of all parameters. The interface pressure was greater at distal contact points of the shell, which are at the middle level of the tibia crest.

Conclusions

The results suggest that functional brace could not apply force on proximal tibia especially at ACLD limb and therefore could not normalize vertical component of ground reaction force during level walking.
Mobility Analysis of AmpuTees (MAAT 6): Mobility, Satisfaction, and Quality of Life among Long-Term Dysvascular/Diabetic Prosthesis Users—Results of a Cross-Sectional Analysis
Authors: Wurdeman Shane R. , Stevens Phillip M. , Campbell James H.
Published: February 2020

Objective

The aim of this study was to establish the mobility, satisfaction, and quality of life (QoL) among prosthesis users with dysvascular/diabetic amputation at both acute and long-term phases of prosthetic rehabilitation.

Methods

This is a multisite, cross-sectional outcomes analysis. A total of 341 individuals met the inclusion/exclusion criteria. Individuals were grouped into acute phases (0–3 months [n = 24], 4–6 months [n = 72]) and chronic phases (24–36 months [n = 91], 37–48 months [n = 53], 49–60 months [n = 47], and 60–84 months [n = 54]) after amputation. Mobility was measured with the Prosthetic Limb Users Survey of Mobility (PLUS-M), whereas QoL and satisfaction (Sat) were reported using 10-point scales adapted from the Prosthesis Evaluation Questionnaire–Well-Being (PEQ-WB). Composite PEQ-WB scores were also compared.

Results

The average mobility, QoL, and Sat among prosthesis users was, respectively, 44.8 ± 10.6, 7.6 ± 2.2, and 7.6 ± 2.2. There were no observed differences in mobility (F
5,330 = 1.52, P = 0.18), QoL (F
5,333 = 0.78, P = 0.57), or PEQ-WB (F
5,335 = 1.618, P = 0.155) between any groups. For Sat, there was a group difference (F
5,334 = 2.44, P = 0.03) as individuals appear to experience an initial increase in Sat with receipt of a prosthesis (0–3 months) compared with 25 to 36 months (P = 0.005), 49 to 60 months (P = 0.008), and 61 to 84 months (P = 0.009).

Conclusions

Those individuals with amputation secondary to dysvascular disease and diabetes who continue to participate in prosthetic rehabilitation appear to experience levels of mobility, Sat, and QoL 7 years after amputation comparable to that reported in the first 6 months postamputation. There may be a modest increase in Sat with receipt of an initial prosthesis, potentially due to an increased optimism for one's situation. Notably, the mobility levels observed in the dysvascular population through a range of long-term postamputation periods remain within a single standard deviation of the population mean for individuals with a lower-limb amputation using a prosthesis for mobility.
Development of an algorithm to facilitate the clinical management of syphilis
Authors: Orser Lauren , O'Byrne Patrick , Bourgault Andrée , Scherling Nicole
Published: February 2020

Background:

Syphilis staging is important to determine treatment, post-treatment monitoring, and sexual partner follow-up. Many prescribers find syphilis staging to be challenging. Current guidelines for the management of patients diagnosed with syphilis provide little direction aside from an overview of some common symptoms and directing providers to stage cases in conjunction with experienced colleagues.

Local problem:

In Canada and the United States, the rate of infectious syphilis has increased noticeably since 2000. Given the increase in rates of syphilis, it is important for all clinicians to understand how to appropriately manage patient care to reduce rates of infection.

Methods and interventions:

A clinical algorithm was developed to stage infectious syphilis. This was tested among nurse practitioners and physicians in a sexually transmitted infection clinic. The algorithm was developed based on a review of the available United States, Canadian, and British practice guidelines.

Results:

Project results demonstrated that this resource could be a relevant practice tool for providers in multiple clinical settings to ensure that patients receive appropriate diagnosis, staging, and treatment of syphilis infection. A case study of a patient who presented to the clinic as a contact is used to review the algorithm and demonstrate the appropriate clinical management of patients.

Conclusions:

The algorithm appropriately guided practice and was useful to clinicians.
Endoscopic Management of Malleus Head Fixation in Revision Stapes Surgery
Authors: Fernandez Ignacio Javier , Botti Cecilia , Fermi Matteo , Presutti Livio
Published: February 2020

Objective:

Malleus ankylosis is an uncommon finding during stapes surgery, which can result in functional failure if undetected during primary surgery. Its management can be difficult and different approaches and solutions have been described to date, most of which require interruption of the ossicular chain. We report the management of such condition through a transcanal endoscopic technique, with preservation of ossicular chain integrity.

Patients:

The procedure was carried out in a patient affected by otosclerosis with persistent hearing loss after primary stapes surgery.

Intervention:

Surgical treatment of malleus head fixation through a totally endoscopic transcanal approach during revision stapes surgery.

Main Outcome Measure:

Pure tone audiometry, speech audiometry.

Results:

The patient experienced a complete closure of the air-bone gap. No postoperative vertigo or sensorineural hearing loss were observed.

Conclusions:

The present report describes the transcanal endoscopic management of malleus ankylosis during revision stapes surgery, which has not been previously reported in the literature. Pearls related to this approach and advantages in comparison to previously described approaches of the literature are discussed as well.
Ischemic Stroke and Intracranial Hemorrhages During Impella Cardiac Support
Authors: Hassett Catherine E. , Cho Sung-Min , Hasan Saad , Rice Cory J. , Migdady Ibrahim , Starling Randall C. , Soltesz Edward , Uchino Ken
Published: February 2020

Impella is a percutaneously placed, ventricular assist device for short-term cardiac support. We aimed to study acute neurologic complications during short-term cardiac support with Impella. We reviewed prospectively collected data of 79 consecutive persons implanted with Impella at a single tertiary center. Acute neurologic events (ANE) were defined as ischemic strokes or intracranial hemorrhages. Among those with ANE, specific causes of ischemic and hemorrhagic events were collected and discussed. Of 79 persons with Impella with median 8 days of support (range 1–33 days), six (7.5%) developed ANE at a median of 5 days from implant (range 1–8 days). There were three ischemic strokes, two intracerebral hemorrhages, and one subdural hematoma. Hemorrhagic events were attributed to anticoagulant use and thrombocytopenia at the time of the events. Two ischemic strokes were attributed to inadequate anticoagulation with one case of pump thrombosis diagnosed at the time of ischemic stroke. Only two of the six patients survived the acute cardiogenic shock period to achieve heart transplantation. In-hospital ischemic strokes and intracranial hemorrhages are not uncommon during short-term cardiac support period with Impella. Antithrombotic intensity, duration of device support time, and thrombocytopenia might contribute to the incidence of these events.
Complications of stereotactic biopsy of lesions in the sellar region, pineal gland, and brainstem
Authors: Cheng Gang , Yu Xin , Zhao Hulin , Cao Weidong , Li Hailong , Li Qinggang , Li Zhicaho , Yin Feng , Liu Rui , Zhang Jianning
Published: February 2020

Stereotactic biopsy (STB) is commonly used in the pathological diagnosis of intracranial lesions. The associated complication and mortality rates are low, but few reports with large sample sizes have assessed the complications of STB for lesions in the brain midline.

To evaluate the complications of STB of lesions in the sellar region, pineal region, and brainstem.

This was a retrospective analysis of patients who underwent STB of lesions in the sellar region, pineal region, and brainstem at the Neurosurgery Department, Sixth Medical Center, PLA General Hospital, China, between January 2015 and December 2017. The rates of and possible reasons for surgical complications (including bleeding) and mortality were analyzed.

A total of 145 patients underwent STB of midline brain lesions, including 16 (11.0%) in the sellar region, 18 (12.4%) in the pineal region, and 111 (76.6%) in the brainstem. Successful biopsy of the sellar region, pineal region, and brainstem was achieved in 16/16 (100%), 18/18 (100%), and 107/111 (96.4%) patients, respectively. There were no complications following STB of lesion in the sellar or pineal regions. Complications occurred in 17/111 patients (15.3%) during/after brainstem biopsy, three of whom died (2.7%). The main clinical manifestations were facioplegia, facial pain, changes in blood pressure and heart rate, and difficulty breathing.

STB of lesions in the sellar region, pineal region, and brainstem had a high success rate, but mortality was 2.7%. The occurrence of complications (15.3%) was closely related to the anatomical and functional characteristics of the region biopsied.
A clinical pilot study to evaluate the efficacy of oral intake of phellinus linteus (sanghuang) extract on knee joint and articular cartilage
Authors: Ku Yong Ho , Lee Hyun , Ryu Hwa Yeon , Park Hae-Jin , Shin Mi-Rae , Kang Jae Hui
Published: February 2020

Background:

Knee osteoarthritis (KOA) is the most common form of degenerative arthritis. We used Phellinus linteus (PL), which has been well-known anti-inflammatory function. In this study, we will evaluate if PL extract improves symptoms with KOA.

Methods:

This study will be an 8-week single-center randomized controlled double-blind clinical trial. Total of 24 subjects with KOA will be enrolled and they will be divided into 3 groups, PL 1,000 mg, PL 1,500 mg and placebo. Subjects will be followed up every 4 weeks with efficacy and safety at the 2nd and 3rd visits. All subjects should maintain a dosage schedule for this protocol. The primary outcome will be assessed with the Korean version of the Western Ontario and McMasters Universities. And the secondary outcomes will be measured using the visual analog scale, quality of life scale (EQ-5D-3L), ESR, C-reactive protein, and C-telopeptide of type-II collagen. Statistical analysis will be performed on the principle of full analysis set.

Discussion:

This study has inclusion and exclusion criteria and a well-controlled intervention. This clinical trial is the first step to assess the efficacy and safety of PL in patients with KOA. This study will make an important contribution to the literature and aid follow-up research into the use of PL in KOA.
Placebo response rate in patients with chronic constipation
Authors: Chen Jie , Liu Xinghuang , Bai Tao , Hou Xiaohua
Published: February 2020

Objective:

The aim of this systematic review and meta-analysis is to calculate the pooled placebo response rate in patients with chronic constipation (CC) in randomized controlled trial (RCT) and its related factors.

Method:

This systematic review and meta-analysis will be conducted under the guidance of Cochrane Handbook. The inclusive and exclusive criteria and search strategies for PubMed, Cochrane Library, and Embase will be introduced in this protocol. Data collection, extraction, and assessment of risk of bias will be conducted independently by 2 reviewers. The pooled placebo response rate and its 95% confidence interval (95%CI) will be calculated and the heterogeneity assessment, publication bias assessment, and subgroup analysis will be performed using R 3.6.0. This study has been registered on the PROSPERO platform (CRD42019121287).

Result:

The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.
Network and pathway-based analyses of genes associated with osteoporosis
Authors: Gu Huijie , Huang Zhongyue , Chen Guangnan , Zhou Kaifeng , Zhang Yiming , Chen Jiong , Xu Jun , Yin Xiaofan
Published: February 2020

Osteoporosis (OP) is a disease characterized by bone mass loss, bone microstructure damage, increased bone fragility, and easy fracture. The molecular mechanism underlying OP remains unclear.

In this study, we identified 217 genes associated with OP, and formed a gene set [OP-related genes gene set (OPgset)].

The highly enriched GOs and pathways showed OPgset genes were significantly involved in multiple biological processes (skeletal system development, ossification, and osteoblast differentiation), and several OP-related pathways (Wnt signaling pathway, osteoclast differentiation, steroid hormone biosynthesis, and adipocytokine signaling pathway). Besides, pathway crosstalk analysis indicated three major modules, with first module consisted of pathways mainly involved in bone development-related signaling pathways, second module in Wnt-related signaling pathway and third module in metabolic pathways. Further, we calculated degree centrality of a node and selected ten key genes/proteins, including TGFB1, IL6, WNT3A, TNF, PTH, TP53, WNT1, IGF1, IL10, and SERPINE1. We analyze the K-core and construct three k-core sub-networks of OPgset genes.

In summary, we for the first time explored the molecular mechanism underlying OP via network- and pathway-based methods, results from our study will improve our understanding of the pathogenesis of OP. In addition, these methods performed in this study can be used to explore pathogenesis and genes related to a specific disease.
Retrospective imaging studies of gastric cancer
Authors: Huang Zixing , Liu Dan , Chen Xinzu , Yu Pengxin , Wu Jiangfen , Song Bin , Hu Jiankun , Wu Bing
Published: February 2020

Introduction:

Peritoneal metastasis (PM) is a frequent condition in patients presenting with gastric cancer, especially in younger patients with advanced tumor stages. Computer tomography (CT) is the most common noninvasive modality for preoperative staging in gastric cancer. However, the challenges of limited CT soft tissue contrast result in poor CT depiction of small peritoneal tumors. The sensitivity for detecting PM remains low. About 16% of PM are undetected. Deep learning belongs to the category of artificial intelligence and has demonstrated amazing results in medical image analyses. So far, there has been no deep learning study based on CT images for the diagnosis of PM in gastric cancer.

We proposed a hypothesis:

CT images in the primary tumor region of gastric cancer had valuable information that could predict occult PM of gastric cancer, which could be extracted effectively through deep learning.

Objective:

To develop a deep learning model for accurate preoperative diagnosis of PM in gastric cancer.

Method:

All patients with gastric cancer were retrospectively enrolled. All patients were initially diagnosed as PM negative by CT and later confirmed as positive through surgery or laparoscopy. The dataset was randomly split into training cohort (70% of all patients) and testing cohort (30% of all patients). To develop deep convolutional neural network (DCNN) models with high generalizability, 5-fold cross-validation and model ensemble were utilized. The area under the receiver operating characteristic curve, sensitivity and specificity were used to evaluate DCNN models on the testing cohort.

Discussion:

This study will help us know whether deep learning can improve the performance of CT in diagnosing PM in gastric cancer.
Pediatric primary diffuse leptomeningeal melanomatosis
Authors: Xu Xinke , Zheng Yaqi , Li Junliang , Wang Fenghua , Li Fangcheng
Published: February 2020

Rationale:

Primary melanocytic tumors of central nerve system (CNS) are rare, primary diffuse leptomeningeal melanomatosis (PDLM), a subtype of malignant melanomas of CNS, is extremely rare,especially in pediatrics. As the clinical manifestation of PDLM is not characteristic, It is often misdiagnosed as tubercular meningitis and hemorrhage.

Patient concerns:

A 13-year-old boy was admitted to our department with symptoms of recurrent headache and vomiting twice. As the brain imaging revealed a lesion located in the left temporal lobe mimicked hemorrhage, so there was a misdiagnosis of hemorrhage in first hospitalization. He was admitted again for the recurrence of the headache and vomiting. Detailed physical examination showed multiple melanin changes in the skin of the whole body which were ignored in last hospitalization. Brain imaging showed the significantly enlarged lesion in the left temporal lobe and several smaller lesions in the left parietal lobe and cerebellum which indicated metastasis.

Diagnosis:

According to the history,physical examination and the radiological finding, the patient was diagnosed with malignant melanoma of central never system possibly.

Interventions:

The patient underwent left temporal and parietal lesions total resection with a craniotomy.

Outcomes:

The diagnosis of PDLM was established according to pathological characteristics and the negative finding of positron emission tomography (PET)-computed tomography (CT) outside CNS. The patient got no further treatment for economic reasons and experienced the progression and died 5 months after operation.

Lessons:

PDLM is extremely rare in CNS, as the clinical manifestation, radiological changes are not special, early diagnosis is difficult. The confirmed diagnosis is established by leptomeningeal biospy or surgical tissue. PET-CT can help differential diagnosis with metastastic leptomeningeal melanomas. The prognosis is dismal due to the inefficiency of chemotherapy or radiotherapy.
Focus group interview regarding the accessibility of health information for people with disabilities and means of improving this accessibility in the future
Authors: Shon Changwoo , Jeon Boyoung , Lim Jae Hee , Park So Youn , Lee Ye-Rin , Kim Young-Eun , Park Saengryeol , Lee Na-Eun , Oh In-Hwan
Published: February 2020

This study concerns the accessibility of health information for people with disabilities. More specifically, by interviewing policy elites who have backgrounds in this area, we seek to obtain their opinions regarding the type of information people with disabilities require, and people with disabilities overall awareness of such information. Based on the information obtained, we also aim to identify methods of improving this accessibility.

A focus group interview was conducted involving policy elites who had previously participated in decision-making processes for health policy. These elites were sourced from the fields of academia, medicine, and government. Content analysis was performed using NVivo 10, which is a computer-assisted/aided qualitative data-analysis software.

The focus-group participants felt that relevant information for people with disabilities is provided in a fragmentary manner through several channels that have relatively low reliability, which creates difficulties for a significant portion of the target recipients. Discussions regarding the type of health information required by people with disabilities yielded the following topic clusters: information regarding health-care providers who specialize in specific disability types and regarding health behaviors for certain lifecycles, and information that helps people with disabilities return to society. Further, the focus group recommended 2 means of providing essential health information to PWDs in the future. As short-term strategies, the participants proposed simplifying the existing, fragmented information channels and the creation of a comprehensive web-based information portal with an associated call center. As a long-term strategy, they proposed the development of smart-device-based information services that are tailored to the needs of individuals.

Efforts to reduce the disparities in health information for people with disabilities are essential for addressing the existing inequality regarding the availability of health information.
Association between ABCB1 (3435C>T) polymorphism and susceptibility of colorectal cancer
Authors: Han Li-li , Zuo Bai-le , Cai Wei-liang , Guo Zhen-ni , Tong Bing-hua , Wei Hui-lian , Zhu Zheng , Li Guo-yin
Published: February 2020

Studies on the relationship between ABCB1 3435C>T polymorphism (rs1045642) and colorectal cancer (CRC)susceptibility have yielded inconclusive results. To clarify this issue, we undertook a meta-analysis to investigate the relationship between rs1045642 and CRC risk.

Three electronic scientific publication databases (Cochrane Library, Pubmed, Embase) were screened using specific search terms. Relevant literature was identified using literature traceability methods. Selected publications were evaluated according to the inclusion and exclusion criteria. Effect size information (odds ratio and the corresponding 95% confidence interval [CI]) was obtained following quality assessment and data extraction from the included publications, and a meta-analysis conducted. Statistical analysis was performed with the Stata sofz (Version 13.0) software.

Overall, 17 case-control studies involving 7129 CRC patients and 7710 healthy control subjects satisfied the criteria for inclusion in the meta-analysis. There was no significant association between ABCB1 3435C>T polymorphism and CRC risk in any of the genetic models. In the CC versus CT model (I

2
 = 20.9%, P
heterogeneity = .276), CC versus CT + TT model (I

2
 = 45.6%, P
heterogeneity = .102) and CT versus CC + TT model (I

2
 = 17.8%, P
heterogeneity = .298) analyses, between-study heterogeneities were detected as significant in Asian populations. In the CT versus TT model (I

2
 = 24%, P
heterogeneity = .254) and CC + CT versus TT model (I

2
 = 0, P
heterogeneity = .55), between-study heterogeneities were found to be significant in groups of different populations.

The meta-analysis described here suggests that the ABCB1 3435C>T polymorphism is not related to CRC susceptibility.
The influence of blood pressure patterns on renal outcomes in patients with chronic kidney disease
Authors: Cha Ran-hui , Lee Hajeong , Lee Jung Pyo , Kim Yon Su , Kim Sung Gyun
Published: February 2020

Blood pressure (BP) control is the most established practice for preventing the progression and complications of chronic kidney disease (CKD). We examined the influence of BP patterns on target organ damage in hypertensive patients with CKD by using long-term follow-up data of the APrODiTe-2 study.

We collected 5 years of data of APrODiTe-2 study (1 year longitudinal study) participants after the enrollment on the progression of estimated glomerular filtration (eGFR), renal outcomes (doubling of serum creatinine, 50% decrease of eGFR, maintenance dialysis, and kidney transplantation), cerebro-cardiovascular (CCV) accidents, and all-cause mortality (n=378) to evaluate the long-term influence of BP patterns on target organ damages.

Initially, more than 2/3 of patients showed masked (50.0%) and sustained uncontrolled (30.6%) BP control states as well as non- (31.3%) and reverse-dipping (35.0%) states. Only 18.8% and 20.8% of participants showed a better change in BP control patterns and a dipping pattern change to dippers over 1 year, respectively. Composite of new CCV accidents occurred in 43 patients (11.4%), and no BP patterns were associated with the occurrence of new CCV accidents. A worse change in BP control categories over 1 year was associated with increased occurrence of composites of renal outcomes after adjustment for age, sex, and the cause of CKD (HR 5.997 [1.454–24.742], P = .013 and HR 4.331 [1.347–13.927], P = .014, respectively). Patients with a worse initial BP control category, a worse change in BP control categories over 1 year, and higher clinic systolic BP and pulse pressure (PP) (> median level) were more likely to have faster eGFR progression (absolute eGFR and eGFR ratio).

Higher BP burden (a worse change in BP control categories, higher initial clinic systolic BP and PP) was associated with faster eGFR progression and increased occurrence of renal outcomes.
Maternal HIV infection and risk of adverse pregnancy outcomes in Hunan province, China
Authors: Li Huixia , Liu Jiahui , Tan Danfeng , Huang Guangwen , Zheng Jianfei , Xiao Juan , Wang Hua , Huang Qun , Feng Na , Zhang Guoqiang
Published: February 2020

This study described the prevalence of adverse pregnancy outcomes (APOs) in Chinese HIV-infected pregnant women, and examined the relationship between maternal HIV infection /HIV-related factors and APOs.

This prospective cohort study was carried out among 483 HIV-infected pregnant women and 966 HIV-uninfected pregnant women. The HIV-infected and HIV-uninfected women were enrolled from midwifery hospitals in Hunan province between October 2014 and September 2017. All data were extracted in a standard structured form, including maternal characteristics, HIV infection status, HIV-related factors and their pregnancy outcomes. APOs were assessed by maternal HIV infection status and HIV-related factors using logistic regression analysis.

The incidences of stillbirth (3.9% vs 1.1%), preterm birth (PTB) (8.9% vs 3.7%), low birth weight (LBW) (12.2% vs 3.1%) and small for gestational age (SGA) (21.3% vs 7.0%) were higher in HIV-infected women than HIV-uninfected women, with adjusted ORs of 2.77 (95%CI: 1.24–6.17), 2.37 (95%CI: 1.44–3.89), 4.20 (95%CI: 2.59–6.82) and 3.26 (95%CI: 3.26–4.64), respectively. No differences were found in neonatal asphyxia or birth defects between HIV-infected and HIV-uninfected groups, with adjusted ORs of 1.12 (95%CI: 0.37–3.43) and 1.10 (95%CI: 0.51–2.39), respectively. Among HIV-infected pregnant women, different antiretroviral (ARV) regimens were significantly associated with stillbirths, but not PTB, LBW or SGA. Compared with untreated HIV infection (10.1%), both mono/dual therapy and HAART were associated with a reduced risk of stillbirths (2.0% and 3.2%, respectively), with an AOR of 0.19 (95%CI: 0.04–0.92) and 0.31 (95%CI: 0.11–0.85), respectively. Initial time of ARV drugs use and HIV infection status of the sexual partner were not associated with maternal APOs.

The findings of this study indicated that maternal HIV infection was associated with significantly increased risks of stillbirth, PTB, LBW and SGA, but not neonatal asphyxia or birth defects. On the condition that most HIV-infected pregnant women started ARV therapy in or after the second trimester, both mono/dual therapy and HAART had a protective effect on stillbirth compared with untreated HIV infection. As some important confounders were not effectively controlled and the specific regimens of HAART were not analyzed, the above findings may have certain bias.
Expressionof langerhans cell and plasmacytoid dendritic cell markers, and toll-like receptor 7/9 signaling pathway proteins in verruca vulgaris lesions
Authors: Tang Yi , Zhu Xiaoxia , Han Rui , Zhou Qiang , Cheng Hao
Published: February 2020

Langerhans cells (LCs) and plasmacytoid dendritic cells (pDCs) play an important role in the cutaneous immune response to viral infection. Verruca vulgaris (VV) is a chronic benign disease caused by human papillomavirus (HPV) infection.

To investigate the possible roles of LCs, pDCs and toll-like receptor (TLR)7/9 signaling pathways in the pathogenesis of VV, we detected the expression of CD1a, CD2AP, CD123, TLR7/9, IFN regulatory factor 7 (IRF7), and interleukin-1 receptor-associated kinase 1 (IRAK1) in VV lesions.

The expression of CD1a, CD2AP, CD123, TLR7/9, IRF7, and IRAK1 in 20 VV lesions was tested by immunohistochemistry. The density and number of stained cells were compared between VV lesions and the perilesional normal skin.

The density and number of CD1a-, CD2AP-, CD123-, TLR9-, and IRAK1-positive cells in the papillary layer of VV lesions were significantly higher than those in the perilesional normal skin (P < .05). There were no significant differences in the density and positive rate of CD1a+ cells in the epidermis and of TLR7+and IRF7+cells in the dermis between VV lesions and the perilesional normal skin at the edge (P > .05).

In VV, the number of LCs increases only in the dermis, indicating that LC's antigen-presenting function might not be inhibited. The increased number of pDCs in VV lesions suggests that HPV infection may recruit the pDCs to the virus-infected epithelium. We speculate that the TLR7/9 downstream signaling pathway is not fully activated in VV, leading to difficulty of HPV removal and the relapse of HPV-infected lesions.
Anxiety among caregivers of children with epilepsy from western China
Authors: Yang Chunsong , Kang BingYao , Mao Yifei , Xu Qunfen , Yu Dan , Zhang Lingli
Published: February 2020

The current study aimed to evaluate the status of anxiety among caregivers of children with epilepsy and examine the associated factors.

A cross-sectional study was conducted in western China, which consecutively recruited children with epilepsy in 2018. The self-rating anxiety scale (SAS) was used to assess the status of anxiety among caregivers of children with epilepsy. We collected information about aspects of sociodemographic data, disease status, attitude of caregivers towards the disease and family conditions as independent variables, using multiple linear regression to analyze factors related to the status of anxiety among caregivers.

A total of 334 participants were included in the study with a response rate of 95.4% (334/350). The mean age of children with epilepsy was 6.05 ± 4.11 years. 7.2% (24/334) of patients were newly diagnosed and 55.4% (185/334) of patients presented with generalized epilepsy. A total of 25.7% (86/334) of caregivers among children with epilepsy presented the symptom of anxiety, with the scores of SAS 44.31 ± 10.558. SAS scores were negatively correlated with the children's age (B = −0.141; standard error = 0.135; P = .008), attitude towards seizures (B = −0.153; standard error = 1.192; P = .004) and medical expenses payment (B = −0.169; standard error = 1.703; P = .002).

Symptoms of anxiety are common among caregivers of children with epilepsy in western China. Healthcare providers should pay more attention to caregivers with younger children, difficult financial situation, and greater fear of seizures. Exploring mental health interventions for caregivers is important.
Prenatal diagnosis of 6pter-p24 deletion syndrome in a fetus from a Han Chinese family
Authors: Shi Qing-yang , Liu Yan-hong , Zhang Yong-sheng , Yu Xiao-wei
Published: February 2020

Introduction:

Chromosome 6pter-p24 deletion syndrome (OMIM #612582) is a rare genetic disorder characterized by deletion of the distal part of 6p. Human 6p deletion syndromes result in a variety of congential malformations.

Patient concerns:

The fetus was the fourth child born to healthy non-consanguineous parents with no relevant family history.

Diagnosis:

The fetus was diagnosed with 6pter-p24 deletion syndrome through prenatal ultrasound, magnetic resonance imaging, and chromosomal microarray analysis. The fetus had brain, skeletal, and heart malformations. The fetus was cytogenetically normal. Chromosomal microarray analysis detected an interstitial 7.999Mb deletion within the 6p25.1p24.3 region of chromosome 6.

Interventions:

There was no treatment for the fetus.

Outcomes:

Pregnancy was terminated.

Conclusions:

To the author's knowledge, the present case is one of the first to report the prenatal diagnosis of 6pter-p24 deletion syndrome in a fetus. No published reports have described the diagnosis of 6pter-p24 deletion syndrome using multiple technologies during the antenatal period; therefore, our findings may provide a reference for other clinicians. The clinical features and pathophysiology of this prenatal diagnosis are discussed.
Accuracy of ADC derived from DWI for differentiating high-grade from low-grade gliomas
Authors: Wang Qiang-ping , Lei De-qiang , Yuan Ye , Xiong Nan-xiang
Published: February 2020

Objective:

Quantitative apparent diffusion coefficient (ADC) values of diffusion weighted imaging (DWI) could be applied to grade gliomas. This meta-analysis was conducted to assess the accuracy of ADC analysis in differentiating high-grade (HGGs) from low-grade gliomas (LGGs).

Methods:

PubMed, Cochrane library, Science Direct, and Embase were searched to identify suitable studies up to September 1, 2018. The quality of studies was evaluated by the quality assessment of diagnostic accuracy studies (QUADAS 2). We estimated the pooled sensitivity, specificity, positive and negative likelihood ratios (LR), diagnostic accuracy ratio (DOR) with 95% confidence intervals (CI), and determined the accuracy of the data by using the summary receiver operating characteristic (SROC) and calculating the area under the curve (AUC) to identity the accuracy of ADC analysis in grading gliomas.

Results:

Eighteen studies including 1172 patients were included and analyzed. The pooled sensitivity, specificity, PLR, NLR, DOR, and AUC with 95% CIs of DWI with b values of 1000 s/mm2 for separating HGGs from LGGs were 0.81 (95% CI 0.75–0.86), 0.87 (95% CI 0.81–0.91), 6.1 (95% CI 4.2–8.9), 0.22 (95% CI 0.17–0.29), 28 (95% CI 17–45), and 0.91 (95% CI 0.88–0.93), respectively. DWI with b values of 3000 s/mm2 showed slightly higher accuracy than that of 1000 (sensitivity 0.80, specificity 0.90 and AUC 0.92). Meta-regression analyses showed that field strengths and b values had significant impacts on diagnostic efficacy. Deeks testing confirmed no significant publication bias in all studies.

Conclusions:

This meta-analysis suggested that ADC analysis of DWI have high accuracy in differentiating HGGs from LGGs. Standardized methodology is warranted to guide the use of this technique for clinical decision-making.
A pilot study on efficacy and safety of a new salt substitute with very low sodium among hypertension patients on regular treatment
Authors: Mu Lihong , Li Chenglong , Liu Ting , Xie Wuxiang , Li Ge , Wang Meixian , Wang Ruoxi , Rao Huakun , He Qin , Wang Wen , Wu Yangfeng
Published: February 2020

Objectives:

To understand the possible effect of a novel salt substitute with very low sodium in reducing blood pressure, salt intake and use of anti–hypertensive medications among patients on regular medications, to inform the future randomized trials.

Design:

Single-arm pilot trial.

Setting:

A community health service center in Chongqing, China.

Participants:

A total of 43 patients with hypertension taking anti-hypertensive medications regularly.

Intervention:

Patients received the salt substitute with 18% sodium chloride for 8 weeks.

Main outcome measures:

Patients were followed up weekly for the use of antihypertensive medications and measurements of blood pressure. We collected 24-h urine before and after the trial to measure sodium and potassium intake.

Results:

Among 39 patients who completed the 8 weeks’ intervention, 30.8% patients stopped or reduced anti-hypertensive medications during the trial. For patients that stopped or reduced medication, the mean SBP and DBP before intervention were 122.1 ± 9.6 and 68.9 ± 9.4 mm Hg and both did not increase after intervention (SBP change: 2.8 mm Hg (−5.1, 10.8), P = .48; DBP change: 1.8 mm Hg (−2.2, 5.7), P = .38). For the rest patients, the mean SBP and DBP before intervention were 141.6 ± 16.9 and 74.6 ± 6.6 mm Hg but reduced significantly after the intervention (SBP change: −16.0 mm Hg (−21.3, −10.6), P < .001; DBP change: −5.5 mm Hg (−8.1, −2.9), P < .001). The 24-h urine sodium decreased (P < .001) and potassium increased (P < .001) among all patients. No severe adverse events were reported.

Conclusions:

The novel salt substitute showed potential in reducing blood pressure and use of antihypertensive medications. Further randomized double–blind controlled trial is warranted to validate these findings.

Clinical Trial Registration—URL:http://www.clinicaltrials.gov. Unique identifier: NCT03226327.
Blood pressure control in hypertensive patients and its relation with exercise and exercise-related behaviors
Authors: Zhang Chenyun , Zhang Yanping , Lin Hao , Liu Siyang , Xie Jing , Tang Yao , Huang Huiling , Zhang Wenchang
Published: February 2020

The effects of exercise interventions on blood pressure control in hypertensive patients have received extensive attention and recognition. However, the influence of exercise-related behaviors on the effects of blood pressure control and the management factors that affect exercise behaviors remain inconclusive. Therefore, this study aimed to explore the relationships between exercise and exercise-related behaviors and blood pressure control, expecting to provide a scientific basis for further improvement of exercise intervention programs for patients with hypertension.

Long-term residents in a community in Fuzhou, Fujian Province, China who were diagnosed with hypertension at a medical facility were recruited for this study. Hypertensive patients with uncontrolled blood pressure were placed in the case group, and those with controlled blood pressure were placed in the control group. The count data were analyzed with the χ2 test based on α = 0.05. A univariate logistic regression analysis was performed to screen significant variables; independent variables were selected based on professional knowledge and were tested for co-linearity. These variables were incorporated into a non-conditional multivariate logistic regression analysis to analyze relevant factors for blood pressure control, while calculating odds ratio (ORs), 95% confidence intervals (CIs), and P values. Differences with a P < .05 were considered statistically significant.

A total of 598 patients were included in the present study. Univariate and multivariate analyses showed that exercise (OR = 0.194; 95%CI: 0.133–0.283), frequency of self-monitoring of blood pressure (OR = 2.412; 95%CI: 1.137–5.117), and regular housework (OR = 0.397, 95%CI: 0.248–0.633) were statistically significant factors for blood pressure control. In addition, there was a relationship between exercise-related behaviors and blood pressure control: walking (OR = 0.189, 95% CI: 0.065–0.551), 60 to 120 min/day of exercise time (OR = 0.317, 95% CI: 0.118–0.856). Sex (OR = 2.248, 95% CI: 1.279–3.954), health belief (OR = 0.016, 95% CI: 0.004–0.059), and company of a family member during exercise (OR = 0.048, 95% CI: 0.025–0.094) were significant factors predictive of regular exercise in hypertensive patients.

Improving exercise-related behaviors and their management can help improve the effects of exercise interventions on blood pressure control in middle-aged and elderly hypertensive patients.