bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors associated with low adherence to head-of-bed elevation during mechanical ventilation in Chinese intensive care units
Authors: LIU Jing-tao , SONG Hai-jing , WANG Yu , KANG Yan , JIANG Li , LIN Si-han , DU Bin , MA Peng-lin 
Published: January 2024

Background
Elevating the head of bed (HOB) 30°-45° has been widely supported as a means of ventilator associated pneumonia (VAP) prevention. However, it was poorly adhered in clinical practice. This observational study aimed to investigate the factors impeding this simple practice at the bedside.

Methods
This prospective study was conducted in 33 Chinese academic hospital intensive care units (ICUs). HOB angle was measured four times daily at 5l7 hour intervals. The predefined HOB elevation goal was an angle ≥30°.

Results
The overall rate of achieving the HOB goal was 27.8% of the 8647 measurements in 314 patients during 2842 ventilation days. The HOB goal of ≥3 times/d was consistently achieved only in 15.9% of the cases. Almost 60% of patients had at least one 24 hours period during which the HOB goal was never documented. This low rate of protocol compliance was not associated with acute physiology and chronic health evaluation (APACHE) II score or dependence on vasopressors. In a survey, “nurse workload” was identified as the most important factor for non-compliance with the HOB goal. In addition, the rates of compliance were significantly different (P <0.001) between physicians self-reporting that they either did or did not know the Institutes of Healthcare Improvement (IHI) ventilator bundle.

Conclusions
Low adherence to a HOB angle of L303 was found in this nationwide survey. Nursing workload and lack of knowledge on VAP prevention were important barriers to changing this practice.
Efficacy and safety of triple-antiplatelet therapy after percutaneous coronary intervention: a meta-analysis
Authors: ZHANG Yong , TANG Hai-qin , LI Jin , FU Zhao-xin 
Published: January 2024

Background
The combination of cilostazol, aspirin and clopidogrel (triple antiplatelet therapy, TAT) after a percutaneous coronary intervention has been used as an alternative therapy. We performed a meta-analysis to evaluate the efficacy and safety of TAT for patients after percutaneous coronary intervention (PCI).

Methods
We systematically searched Pubmed, Embase and Web of Science databases to identify all randomized controlled trials (RCTs) that compared dual antiplatelet therapy (DAT) with and without cilostazol after PCI. All analyses were conducted using Review Manager 5.0.

Results
The final analysis consisted of 4474 patients from ten studies. The combined results suggested that there was a lower risk of cardiac death (relative risk (RR)=0.55, 95% confidence interval (CI): 0.31-0.98, P <0.05) and major adverse cardiac events (MACEs) (RR=0.63, 95% CI: 0.54-0.74, P <0.05) in patients treated with TAT as compared to those with DAT follow-ups after six months to one year; no significant difference was observed in bleeding and non-fatal myocardial infarction (MI) (RR=1.14, 95% CI: 0.80-1.64, P >0.05; RR=0.87, 95% CI: 0.42-1.83, P >0.05). However, the rate of adverse drug reaction was higher in patients receiving TAT than in patients receiving DAT (RR=2.21, 95% CI: 1.84-2.66, P <0.05). Moreover, there was a lower risk of stent thrombosis in patients treated with TAT as compared to those treated with DAT (RR=0.44, 95% CI: 0.21-0.94, P <0.05). The TAT group had a reduced risk of target lesion revascularization (TLR) (RR=0.60, 95% CI: 0.43-0.82, P=0.001) and target vessel revascularization (TVR) than the DAT group (RR=0.56, 95% CI: 0.45-0.71, P <0.05). The number of MACEs was lower for patients in the TAT group than in the DAT group with diabetes mellitus sub-analysis (RR=0.41, 95% CI: 0.28-0.61, P <0.05). But no significant difference was observed between the two groups regarding MACEs in patients with drug-eluting stent implantations (RR=0.82, 95% CI: 0.65-1.03, P >0.05).

Conclusion
TAT could significantly reduce the rates of MACEs and cardiac death in comparison to DAT, but more attention should be paid to adverse side effects of the drugs.
Telmisartan promotes proliferation and differentiation of endothelial progenitor cells via activation of Akt
Authors: Cao Zheng , Yang Yong , Hua Xianping , Wu Ruixia , Wang Junfeng , Zhou Ming , Zhan Zhongqun , Chen Pingying 
Published: January 2024

Background
Numerous studies have demonstrated that the peroxisome proliferator-activated receptor-γ (PPARγ) plays an important role in regulating endothelial progenitor cells (EPC) function. Telmisartan, as a partial agonist of PPARγ, may have an effect on the regulation of EPC functions. The purpose of this study was to investigate the effects of telmisartan on EPC proliferation and differentiation.

Methods
Peripheral blood derived mononuclear cells containing EPC were isolated from healthy volunteers and then cultured on fibronectin-coated dishes in the presence or absence of telmisartan. The proliferative activity of EPC was determined by colony forming units (CFU) and MTT assay. The migratory activity of EPC was assessed by transwell assay. The expression of endothelial cells (EC) markers, including vascular endothelial cadherin (VE-cadherin), von Willebrand factor (vWF) and endothelial nitric oxide synthase (eNOS), were measured by Western blotting analysis.

Results
Morphological analysis revealed that telmisartan significantly increased the proliferation of EPC and the number of endothelial cell colony forming units. Telmisartan could enhance the expression of the makers of mature EC, including VE-cadherin, vWF, and eNOS, which indicated telmisartan could stimulate EPC to differentiate into mature EC. Telmisartan increased the phosphorylation of Akt in EPC. The inhibition of Akt activation significantly attenuated the effect of telmisartan on EPC functions, suggesting that Akt is involved in the stimulatory effect of telmisartan on EPC differentiation.

Conclusions
The results of this study demonstrate that telmisartan promotes EPC functions via activation of Akt.
Change in cholesterol absorption and synthesis markers in patients with coronary heart disease after combination therapy with simvastatin plus ezetimibe
Authors: ZHANG Tao , WU Wen-feng , LIU Yang , WANG Qi-hui , WANG Lü-ya , MI Shu-hua 
Published: January 2024

Background
Statins and ezetimibe have been reported to change the balance of cholesterol metabolism, but few studies have been performed on Chinese patients. The aim of this study was to evaluate changes in cholesterol metabolism markers in patients with coronary heart disease.

Methods
Forty-five patients with coronary heart disease were treated with 20 mg/d of simvastatin for four weeks. Subjects were then divided into two different therapy groups according to whether they reached the target values for total cholesterol and low density lipoprotein cholesterol level. Patients who reached the target values remained on simvastatin and those who did not reach the target values took a combination of simvastatin plus 10 mg/d ezetimibe until the 12th week. The concentrations of cholesterol synthesis markers (lathosterol and desmosterol) and absorption markers (campesterol and sitosterol) were measured on the 1st, 4th, and 12th week of the study by gas chromatography.

Results
After treatment with simvastatin for four weeks, the levels of total cholesterol and low density lipoprotein cholesterol decreased significantly compared to levels measured during the 1st week (P <0.05). On the 12th week the levels of total cholesterol and low density lipoprotein cholesterol had decreased significantly (P <0.001) compared to levels during the 4th week. By the 12th week the levels of campesterol and sitosterol in the combination group had decreased significantly (P <0.05) compared with levels measured during the 4th week.

Conclusions
Coronary heart disease patients with high cholesterol synthesis at baseline might gain a greater benefit from simvastatin treatment. Combination therapy with simvastatin plus ezetimibe in patients with low cholesterol synthesis at baseline might increase the success rate of lipid-lowering through decreasing the absorption of cholesterol.
Changes in main causes of death in Macao residents from 1986-2006
Authors: CHAN Man-si , CHEN Qing , LAM Christopher Wai-kei 
Published: January 2024

Background
Since Macao's return of sovereignty to China in December 1999, the life style of Macao residents has changed. The aim of this study was to investigate changes of death patterns in Macao residents from 1986 to 2006 in order to identify the trends and patterns of major public health problems, which could provide the guidance for developing public health policies.

Methods
A retrospective study was conducted for this investigation. Research data were collected from official websites and statistical yearbooks and classified by the International Classification of Diseases (ICD)-9.

Results
It was observed that mortality from the three major causes of (1) infectious, maternal and childhood diseases, (2) chronic non-communicable diseases, and (3) injury and poisoning were 17.7, 298.2 and 26.0 per 100 000, respectively. The largest decrease in death rate over the 21-year study-period was from infectious, maternal and childhood diseases (62.5%). The highest mortality rate was ischemic heart diseases (37.0%). The largest increase in mortality rate was lung cancer (46.9%).

Conclusions
Mortality rate of Macao residents progressively decreased, but the constituent ratio of death from chronic non-communicable diseases was increasing. The mortality rate of lung cancer was clearly ascending, so emphasis should be put on tertiary prevention in future.
Indication of lower neck irradiation in nasopharyngeal carcinoma without nodal metastasis: the potential impact of tumor volume
Authors: FU Jie , ZHOU Jia-yin , CHONG Vincent FH , Khoo James BK 
Published: January 2024

Background
Elective radiation of lower neck is controversial for nasopharyngeal carcinoma (NPC) without lymph node metastasis (NO disease). Tumor volume is an important prognostic indicator. The objective of this study is to explore the potential impact of tumor volume on the indication of the lower neck irradiation for NO-NPC, by a qualitative evaluation of the relationship between tumor volume and nodal metastasis.

Methods
Magnetic resonance (MR) images of 99 consecutive patients with NPC who underwent treatment were retrospectively reviewed. Primary tumor volumes of NPC were semi-automatically measured, nodal metastases were N-classified and neck level involvements were examined. Distributions of tumor volumes among N-category-based groups and distributions of N-categories among tumor volume-based groups were analyzed, respectively.

Results
The numbers of patients with NO to N3 disease were 12, 39, 32, and 16, respectively. The volumes of primary tumor were from 3.3 to 89.6 ml, with a median of 17.1 ml. For patients with nodal metastasis, tumor volume did not increase significantly with the advancing of N-category (P >0.05). No significant difference was found for the distribution of N1, N2, and N3 categories among tumor volume-based groups (P>0.05). Nevertheless patients with nodal metastasis had significantly larger tumor volumes than those without metastasis (P <0.05). Patients with larger tumor volumes were associated with an increased incidence of nodal metastasis.

Conclusions
Certain positive correlations existed between tumor volume and the presence of nodal metastasis. The tumor volume (>10 ml) is a potential indicator for the lower neck irradiation for NO-NPC.
Finite element analysis of neodymium: yttrium-aluminum-garnet incisions for the prevention of anterior capsule contraction syndrome
Authors: WANG Yan-ling , WANG Zhen-ze , ZHAO Lu , XIONG Shi-hong , LI Qian , WANG Ning-li , SUN An-qiang 
Published: January 2024

Background
Anterior capsular contraction syndrome is a potential complication of continuous curvilinear capsulorhexis (CCC). Three neodymium: yttrium-aluminum-garnet (Nd:YAG) laser relaxing incisions decrease anterior capsular contraction but the mechanism is unknown. The present study analyzed the biomechanical mechanism of three Nd:YAG laser relaxing incisions made to reduce anterior capsular contraction.

Methods
A three-dimensional control model and a three-dimensional Nd:YAG model of the anterior capsule with an opening diameter of 6 mm were created. Three incisions of 1 mm in length were made centrifugally at intervals of 120° around the opening circle. The stress alterations of the anterior capsule after CCC with and without Nd:YAG relaxation were numerically simulated and compared.

Results
In the control model, the stress was axially uniform in the inner area and relatively high near the inner rim of the opening. Meanwhile, in the Nd:YAG model, the stress level was very low in the inner opening areas, especially near the three incisions. The relaxing incisions in the Nd:YAG model significantly released the relatively high stress on the anterior capsule. Additionally, there was a high stress gradient near the relaxing incisions.

Conclusion
Biomechanical effects of stress release may be the preventive mechanism of Nd:YAG incision against anterior capsular contraction syndrome.
Effect of CO2 pneumoperitoneum on the expression of the chemokine receptors CXCR4 and CCR7 in colorectal carcinoma cells in vitro
Authors: YANG Chun-kang , LI Guo-dong , YING Min-gang , XU Ke 
Published: January 2024

Background
The ability of pneumoperitoneum in laparoscopic surgery to promote proliferation and metastasis of colorectal cancer has become a focus of research in the field of minimally invasive surgery. The aim of this research was to investigate the effect of CO2 pneumoperitoneum under different pressures and exposed times on the expression of chemokine receptors in colorectal carcinoma cells.

Methods
We constructed an in vitro pneumoperitoneum model. SW480 colon carcinoma cells were exposed to CO2 pneumoperitoneum under different pressures (6, 9, 12, and 15 mmHg) for 1, 2, and 4 hours. These cells were then cultivated under the same conditions as normal SW480 colon carcinoma cells without CO2 pneumoperitoneum (control group), treated at 37°C, and 5% CO2. The expression of the chemokine receptors CXC receptor 4 (CXCR4) and chemokine C receptor 7 (CCR7) was detected by immunocytochemistry and reverse transcriptase polymerase chain reaction after being cultivated for 0, 24, 48, and 72 hours.

Results
Immunocytochemistry showed that CXCR4 expression in SW480 cells was significantly decreased in the 6, 9, 12, and 15 mmHg CO2 pneumoperitoneum-treated groups for the same exposure times compared with controls (P <0.05). CCR7 expression in SW480 cells was significantly decreased in the 12 and 15 mmHg CO2 pneumoperitoneum-treated groups compared with controls (P <0.05). CXCR4 and CCR7 expression increased up to the level of the control group after 24 and 48 hours (P >0.05). If the CO2 pneumoperitoneum pressure increased, CXCR4 and CCR7 expression decreased at all exposure times. If the CO2 pneumoperitoneum exposure time prolonged, there were no significant differences in CXCR4 and CCR7 expression under the same pressure. Under all exposure times, CXCR4 and CCR7 mRNA expression was significantly decreased in the 6, 9, 12, and 15 mmHg CO2 pneumoperitoneum-treated groups (P <0.05) compared with controls, and it increased up to the level of controls after being cultivated for 48 hours (P >0.05). If the CO2 pneumoperitoneum pressure increased (with all exposure times) and exposure time prolonged (under the same pressure), there were no significant differences in CXCR4 and CCR7 expression.

Conclusions
CXCR4 and CCR7 expression is temporarily affected after continuous CO2 pneumoperitoneum treatment. The high pressure of CO2 pneumoperitoneum plays an important role in suppressing the expression of these chemokine receptors. Different lengths of time of exposure to a CO2 pneumoperitoneum-like environment do not change CXCR4 and CCR7 expression.
Expressions of CLDN1 and insulin-like growth factor 2 are associated with poor prognosis in stage N2 non-small cell lung cancer
Authors: Zhang Zhen-fa , Pei Bao-xiang , Wang An-lei , Zhang Lian-min , Sun Bing-sheng , Jiang Ri-cheng , Wang Chang-li 
Published: January 2024

Background
Patients with single station mediastinal lymph node (N2) non-small cell lung cancer (NSCLC) have a better prognosis than those with multilevel N2. The molecular factors which are involved in disease progression remain largely unknown. The purpose of this study was to investigate gene expression differences between single station and multilevel N2 NSCLC and to identify the crucial molecular factors which are associated with progress and prognosis of stage N2 NSCLC.

Methods
Gene expression analysis was performed using Agilent 4×44K Whole Human Genome Oligo Microarray on 10 freshfrozen lymph node tissue samples from single station N2 and paired multilevel N2 NSCLC patients. Real-time reverse transcription (RT)-PCR was used to validate the differential expression of 14 genes selected by cDNA microarray of which four were confirmed. Immunohistochemical staining for these validated genes was performed on formalin-fixed, paraffin-embedded tissue samples from 130 cases of stage N2 NSCLC arranged in a high-density tissue microarray.

Results
We identified a 14 gene expression signature by comparative analysis of gene expression. Expression of these genes strongly differed between single station and multilevel N2 NSCLC. Four genes (ADAM28, MUC4, CLDN1, and IGF2) correlated with the results of microarray and real-time RT-PCR analysis for the gene-expression data in samples from 56 NSCLC patients. Immunohistochemical staining for these genes in samples from 130 cases of stage N2 NSCLC demonstrated the expression of IGF2 and CLDN1 was negatively correlated with overall survival of stage N2 NSCLC.

Conclusions
Our results suggest that the expression of CLDN1 and IGF2 indicate a poor prognosis in stage N2 NSCLC. Further, CLDN1 and IGF2 may provide potential targeting opportunities in future therapies.
Retinal nerve fiber layer in primary open-angle glaucoma with high myopia determined by optical coherence tomography and scanning laser polarimetry
Authors: WANG Xiao-en , WANG Xiao-yu , GU Yang-shun , HUANG Zhu 
Published: January 2024

Background
Fundus changes associated with high myopia (HM) may mask those associated with primary open-angle glaucoma (POAG). This study aim to determine the characteristics of RNFL thickness changes in patients with both POAG and HM and compare these to changes in patients with only HM. The diagnostic capabilities of both OCT and GDxVCC in this subset of patients are also evaluated.

Methods
Twenty-two eyes with POAG and HM (spherical equivalent (SE) between −6.0 and −12.0 D) were evaluated, and 22 eyes with HM were used for comparison. Characteristic retinal nerve fiber layer (RNFL) thickness profiles in patients with POAG and HM were examined using optical coherence tomography (OCT) and scanning laser polarimetry with variable corneal compensation (GDxVCC), and the diagnostic capabilities of these imaging modalities were compared. RNFL parameters evaluated included superior average (Savg-GDx), inferior average (Iavg-GDx), temporal-superior-nasal- inferior-temporal (TSNIT) average, and nerve fiber indicator (NFI) on GDxVCC and superior average (Savg-OCT), inferior average (Iavg-OCT), nasal average (Navg-OCT), temporal average (Tavg-OCT), and average thickness (AvgThick-OCT) on OCT (fast RNFL scan). Visual field testing was performed and defects were evaluated using mean defect (MD) and pattern standard deviation (PSD).

Results
The RNFL parameters (P <0.05) significantly different between groups included Savg-GDx, Iavg-GDx, TSNIT average, NFI, Savg-OCT, Iavg-OCT, Tavg-OCT, and AvgThick-OCT. Significant correlations existed between TSNIT average and AvgThick-OCT (r=0.778), TSNIT average and MD (r=0.749), AvgThick-OCT and MD (r=0.647), TSNIT average and PSD (r=−0.756), and AvgThick-OCT and PSD (r=−0.784). The area under the receiver operating characteristic curve (AUROC) values of TSNIT average, Savg-GDx, Iavg-GDx, NFI, Savg-OCT, Iavg-OCT, Navg-OCT, Tavg-OCT, and AvgThick-OCT were 0.947, 0.962, 0.973, 0.994, 0.909, 0.917, 0.511, 0.906, and 0.913, respectively. The NFI AUROC was the highest value.

Conclusions
RNFL thickness was significantly lower in all but the nasal quadrant in patients with POAG and HM, compared to patients with only HM. Measurements with OCT and GDxVCC were well-correlated, and both modalities detected RNFL thickness changes. However, GDxVCC was better than OCT in detecting POAG in HM patients.
Comparison of the reaction time of wrist flexion and extension between patients with stroke and age-matched healthy subjects and correlation with clinical measures
Authors: BI Sheng , WAN Chun-xiao 
Published: January 2024

Background
Brain injury had an effect on reaction time (RT) and brain-injured patients were normally significantly slower than normal controls. The RT of the paretic upper limb (UL) in patients with stroke was slower than in a control group. The present study was designed to compare the RTs of the unaffected and affected sides in stroke survivors and those of normal subjects. This study also explores the relationships among wrist flexion and extension RTs in the affected side and the motor deficits of the UL as measured by clinical Composite Spasticity Index (CSI), Associated Reaction Rating Score (ARRS), and Wolf Motor Function Test (WMFT) scores.

Methods
Ninety-eight hemiparetic stroke survivors and 20 normal subjects participated in the study. Abnormal muscle tone was measured by CSI. Associated reaction was measured by ARRS. Motor function was measured by WMFT. The subject was asked to flex or extend the affected and non-affected wrists as fast as possible, following an auditory “go” signal. An electrogoniometer attached to the wrist measured wrist flexion and extension angle. RT was defined as the time from the “go” signal to a change in wrist angle denoting movement onset. Clinical assessments and RT were conducted within one day. Differences in the variables between normal subjects and the unaffected sides of the stroke patients were analyzed using analysis of variance. Correlations were assessed by computing Spearman's correlation coefficient. The significance level was set at 5%.

Results
RTs of wrist flexion and extension in the stroke survivors' affected hands were significantly longer than those in normal subjects and their unaffected hands (P <0.01 for both). The wrist flexion RT moderately correlated with CSI (ρ=0.412, P<0.001) and ARRS (ρ=0.341, P <0.001) and with WMFT functional ability (negatively; ρ=-0.531, P <0.001) and time score (ρ=0.504, P <0.001). Similarly, the wrist extension RT moderately correlated with CSI (ρ=0.429, P<0.001), ARRS (ρ=0.374, P<0.001), and with WMFT functional ability (negatively; ρ=−0.531, P <0.001) and time score (ρ=0.486, P <0.001).

Conclusions
RTs of wrist flexion and extension on the stroke survivors' affected sides were significantly longer than those on the unaffected sides and those of normal subjects. The wrist flexion and extension RTs moderately correlated with CSI and ARRS and inversely with motor functional performance of the UL in patients with stroke.