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Clinical and economic burden of wound care in the tropics: a 5‐year institutional population health review

Abstract

The aim of this study is to evaluate the clinical and economic burden of wound care in the Tropics via a 5‐year institutional population health review. Within our data analysis, wounds are broadly classified into neuro‐ischaemic ulcers (NIUs), venous leg ulcers (VLUs), pressure injuries (PIs), and surgical site infections (SSIs). Between 2013 and 2017, there were a total of 56 583 wound‐related inpatient admissions for 41 461 patients, with a 95.1% increase in wound episodes per 1000 inpatient admissions over this period (142 and 277 wound episodes per 1000 inpatient admissions in 2013 and 2017, respectively). In 2017, the average length of stay for each wound episode was 17.7 days, which was 2.4 times that of an average acute admission at our institution. The average gross charge per wound episode was USD $12 967. Among the 12 218 patients with 16 674 wound episodes in 2017, 71.5% were more than 65 years of age with an average Charlson Comorbidity Index (CCI) of 7.2. Half (51.9%) were moderately or severely frail, while 41.3% had two or more wound‐related admission episodes. In 2017, within our healthcare cluster, the gross healthcare costs for all inpatient wound episodes stand at USD $216 million within hospital care and USD $596 000 within primary care. Most NIU patients (97.2%) had diabetes and they had the most comorbidities (average CCI 8.4) and were the frailest group of patients (44.9% severely frail). The majority of the VLU disease burden was at the specialist outpatient setting, with the average 1‐year VLU recurrence rate at 52.5% and median time between healing and recurrence at 9.5 months. PI patients were the oldest (86.5% more than 65 years‐old), constituted the largest cohort of patients with 3874 patients at an incidence of 64.6 per 1000 admissions in 2017, and have a 1‐year all‐cause mortality rate of 14.3%. For SSI patients, there was a 125% increase of 14.2 SSI wound episodes per 1000 inpatient admissions in 2013 to 32.0 in 2017, and a 413% increase in wound‐related 30‐day re‐admissions, from 40 in 2013 (4.1% of all surgeries) to 205 (8.3% of all surgeries) in 2017. The estimated gross healthcare cost per patient ranges from USD $15789–17 761 across the wound categories. Similar to global data, there is a significant and rising trend in the clinical and economic burden of wound care in Tropics.

Characterization of the fungal community in the canopy air of the invasive plant <i>Ageratina adenophora</i> and its potential to cause plant diseases

by Lin Chen, Kai Fang, Xing-Fan Dong, Ai-Ling Yang, Yu-Xuan Li, Han-Bo Zhang

Airborne fungi and their ecological functions have been largely ignored in plant invasions. In this study, high-throughput sequencing technology was used to characterize the airborne fungi in the canopy air of the invasive weed Ageratina adenophora. Then, representative phytopathogenic strains were isolated from A. adenophora leaf spots and their virulence to A.adenophora as well as common native plants in the invaded range was tested. The fungal alpha diversities were not different between the sampling sites or between the high/low part of the canopy air, but fungal co-occurrences were less common in the high than in the low part of the canopy air. Interestingly, we found that the phytopathogenic Didymellaceae fungi co-occurred more frequently with themselves than with other fungi. Disease experiments indicated that all 5 Didymellaceae strains could infect A. adenophora as well as the 16 tested native plants and that there was large variation in the virulence and host range. Our data suggested that the diverse pathogens in the canopy air might be a disease infection source that weakens the competition of invasive weeds, a novel phenomenon that remains to be explored in other invasive plants.

Prognostic significance of inflammatory indices in hepatocellular carcinoma treated with transarterial chemoembolization: A systematic review and meta-analysis

by Shuangshuang Li, Xudong Feng, Guodong Cao, Qianhui Wang, Ling Wang

Objectives

To investigate the association between inflammatory indices and clinical outcomes of hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE) by performing meta-analysis.

Methods

A systematic literature search for relevant studies published up to August 2019 was performed by using PubMed, Web of Science, EMBASE, China National Knowledge Internet (CNKI) and Wanfang databases. Pooled hazard ratios (HR) or odds ratio (OR) and 95% confidence intervals (95% CI) were calculated.

Results

A total of 5280 patients from 22 studies were finally enrolled in the meta-analysis. The results demonstrated that elevated preoperative NLR, PLR, and CRP was associated with poor OS in HCC patients treated by TACE (HR = 1.81, P3 cm (OR = 2.42, P = 0.005).

Conclusions

Elevated preoperative NLR, PLR, and CRP are associated with poor prognosis in HCC patients treated with TACE. These inflammatory indices may be convenient, accessible, affordable and dependable biomarkers with prognostic potential for HCC patients treated by TACE.

Short-term associations between ambient air pollution and stroke hospitalisations: time-series study in Shenzhen, China

Por: Guo · Y. · Xie · X. · Lei · L. · Zhou · H. · Deng · S. · Xu · Y. · Liu · Z. · Bao · J. · Peng · J. · Huang · C.
Objective

To investigate the association between ambient air pollution and stroke morbidity in different subgroups and seasons.

Methods

We performed a time-series analysis based on generalised linear models to study the short-term exposure–response relationships between air pollution and stroke hospitalisations, and conducted subgroup analyses to identify possible sensitive populations.

Results

For every 10 µg/m3 increase in the concentration of air pollutants, across lag 0–3 days, the relative risk of stroke hospitalisation was 1.029 (95% CI 1.013 to 1.045) for PM2.5, 1.054 (95% CI 1.031 to 1.077) for NO2 and 1.012 (95% CI 1.002 to 1.022) for O3. Subgroup analyses showed that statistically significant associations were found in both men and women, middle-aged and older populations, and both cerebral infarction and intracerebral haemorrhage. The seasonal analyses showed that statistically significant associations were found only in the winter.

Conclusions

Our study indicates that short-term exposure to PM2.5, NO2 and O3 may induce stroke morbidity, and the government should take actions to mitigate air pollution and protect sensitive populations.

Effect of resting heart rate on the risk of all-cause death in Chinese patients with hypertension: analysis of the Kailuan follow-up study

Por: Zhao · M. X. · Zhao · Q. · Zheng · M. · Liu · T. · Li · Y. · Wang · M. · Yao · S. · Wang · C. · Chen · Y.-M. · Xue · H. · Wu · S.
Objective

Previous studies have shown that an elevated heart rate is associated with a higher risk of cardiovascular events. This study aimed to prospectively examine the relationship between resting heart rate (RHR) and all-cause mortality in Chinese patients with hypertension.

Design

An observational, prospective and population-based cohort study.

Setting

The Kailuan cohort study was conducted in Tangshan City in northern China.

Participants

We enrolled 46 561 patients who did not receive beta-blocker treatment and were diagnosed with hypertension for the first time during an employee health examination in Kailuan Group in 2006 and 2008.

Outcome

The primary outcome of this study was all-cause mortality.

Methods

The patients in this study were followed for 9.25±1.63 years. All patients were followed up face to face every 2 years. According to the distribution of RHR in the study population, RHR was categorised into five groups on the basis of quintiles: Q1: RHR ≤68 beats per minute (bpm); Q2: RHR >68 and ≤72 bpm; Q3: RHR >72 and ≤76 bpm; Q4: RHR >76 and ≤82 bpm; Q5: RHR >82 bpm. Cox proportional hazards model, which was adjusted for traditional risk factors, was used.

Results

During follow-up, 4751 deaths occurred. After adjustment for potential confounders, restricted cubic spline regression showed that the risk of all-cause mortality increased with heart rate. In multivariate Cox regression analyses adjusted for age, sex and major covariates, the HR for all-cause mortality was 1.31 (95% CI 1.27 to 1.33) in the highest quintile group (Q5) compared with the lowest quintile group (Q1).

Conclusion

An increase in RHR is a long-term risk factor of all-cause mortality in Chinese patients with hypertension.

Trial registration number

ChiCTR-TNC-11001489.

Pattern of corneal astigmatism induced by primary pterygium in patients with cataract in a secondary hospital in Southern China: a cross-sectional study

Por: Xu · G. · Qi · W. · Hu · Y.
Objectives

To review the pattern of primary pterygium-induced corneal astigmatism in patients with cataract in a southern Chinese population.

Design

Clinic-based cross-sectional retrospective study.

Setting

A secondary hospital at southern China.

Participants

A group of 1689 eyes with primary pterygium (PT group) and the other group of 4062 eyes without pterygium (NPT group) were included.

Main outcome measures

Corneal power was measured by an autokeratorefractometer. Corneal astigmatism was calculated as the difference in corneal power between the steepest and flattest meridians. Distribution of corneal astigmatism was compared between eyes with pterygium and eyes without pterygium.

Results

Distribution of corneal astigmatism was different between PT group (skewness=2.548, kurtosis=8.237) and NPT group (skewness=2.778, kurtosis=15.52). Mean corneal astigmatism was significantly higher in the PT group (1.62±1.49D) compared with the NPT group (1.17±0.89D, p1D (PT 52.3%, NPT 40.9%, p2D (PT 22.4%, NPT 10.6%, p3D (PT 10.5%, NPT 3.2%, p0, PT –0.01±0.74D, NPT 0.01±0.52D, p=0.48; J45, PT –0.03±0.82D, NPT 0.00±0.52D, p=0.54).

Conclusions

Pattern of corneal astigmatism in eyes with cataract and coexisting primary pterygium was different from eyes without pterygium. Pterygium is associated with higher magnitude but not different axis of corneal astigmatism.

Efficacy of topical silicone gel in scar management: A systematic review and meta‐analysis of randomised controlled trials

Abstract

To assess the efficacy of topical silicone gel in the management of scars, we conducted this meta‐analysis. The systematic search was performed on PubMed, Web of Science and Embase, and six randomised controlled trials with a total of 375 patients were involved. The outcome data of Vancouver Scar Scale were extracted from the studies and their effect sizes were calculated using Review Manager 5.3. As a result, topical silicone gel significantly reduced pigmentation, height, and pliability scores postoperatively compared with placebos or no treatment (Pigmentation: standard mean difference [SMD] = −0.55 [−0.83 to –0.26], P = .0002; Height: SMD = −0.73 [−1.02 to –0.44], P < .00001; Pliability: SMD = −0.49 [−0.95 to –0.03], P = .04). Topical silicone gel and silicone gel sheet were comparably effective (P > .05). The performance of topical silicone gel and other non‐silicone topical treatment was also similar (P > .05). In summary, topical silicone gel was effective in post‐operative scar prevention.

Molecular mechanism whereby paraoxonase‐2 regulates coagulation activation through endothelial tissue factor in rat haemorrhagic shock model

Abstract

We investigated the molecular mechanism of paraoxonase‐2 (PON‐2) in regulating blood coagulation activation in rats with haemorrhagic shock through endothelial tissue factor (TF). Thirty adult Sprague Dawley rats were randomly divided into three groups: healthy control group (group A), the haemorrhagic shock PON‐2 treatment group (group B), and the haemorrhagic shock group (group C). After the model was established, blood was withdrawn from the inferior vena cava of all rats. The difference in plasma thrombomodulin (TM) levels of the three groups was determined by Western blotting. The expression of transcription factors Egr‐1 and Sp1 was detected by Western blotting assays. reverse transcription‐polymerase chain Reaction (RT‐PCR) was used to determine the mRNA expression of t‐PA, PAI‐1, TM, and PON‐2 in the serum of three groups of rats. Endothelial TF was measured by enzyme linked immunosorbent assay (ELISA), and coagulation assay was used to detect the activity of coagulation factor VIII. Histopathological examination of the arteries of the rats was performed. The molecular mechanism of PON‐2 in regulating blood coagulation activation in haemorrhagic shock model rats by endothelial tissue factor was analysed. The expression of thrombin was determined by electrophoresis. Compared with the healthy control group, the expression of TM in groups B and C decreased, both 188.64 ± 12.47 and 137.48 ± 9.72, respectively, with a significant difference. The mRNA expression of TM and PON was determined by RT‐PCR. The mRNA expression of TM and PON in group B was 0.97 ± 0.07 and 1.14 ± 0.09, compared with the control group, and the mRNA expression of TM and PON in group C was 0.86 ± 0.38 and 1.12 ± 0.41, both of which increased, and there were significant differences. By measuring the expression of endothelial TF, the expression of TF in groups B and C was elevated to 12.69 ± 1.07 and 11.59 ± 0.87, with significant differences. The enzyme activities of PON‐2 in groups B and C, which were 110.34 ± 14.37 and 52.37 ± 8.06, respectively, were increased compared with the healthy control group and there were significant differences. PON‐2 regulates the activation of coagulation in rats with haemorrhagic shock by regulating the expression of endothelial tissue‐related genes such as plasma TM and endothelial TF under hypoxic and ischaemic conditions.

Acupuncture for insomnia with short sleep duration: protocol for a randomised controlled trial

Por: Wang · C. · Yang · W.-j. · Yu · X.-t. · Fu · C. · Li · J.-j. · Wang · J. · Xu · W.-l. · Zheng · Y.-x. · Chen · Y.-f.
Introduction

Insomnia with short sleep duration has a more serious negative impact on patient health. The existing literature suggests that medication therapy is more effective for this phenotype of insomnia compared with cognitive–behavioural therapy. However, the potential side effects of hypnotic medications hinder their clinical application. Acupuncture has been widely used in the treatment of insomnia, but it remains unclear whether it has therapeutic efficacy for insomnia with short sleep duration. The purpose of this trial is to evaluate the efficacy and safety of acupuncture for insomnia with short sleep duration.

Methods and analysis

This study is designed as a randomised, single-centre, single-blinded, placebo acupuncture controlled trial involving 152 participants. Eligible patients will be divided into two groups according to the objective total sleep time: insomnia with normal sleep duration group and insomnia with short sleep duration group. Then, patients in each group will be randomly assigned to two subgroups, the treatment group (acupuncture) and the control group (placebo acupuncture), in a 1:1 ratio with 38 subjects in each subgroup. The primary outcome is the Pittsburgh Sleep Quality Index and the Insomnia Severity Index. Secondary outcomes are actigraphy, the Beck Anxiety Inventory, the Beck Depression Inventory and the Fatigue Severity Scale. All adverse effects will be assessed by the Treatment Emergent Symptom Scale. Outcomes will be evaluated at baseline, post treatment, as well as at 1-week and 1-month follow-up.

Ethics and dissemination

This protocol has been approved by the ethics committee of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine (no. 2019-17). Written informed consent will be obtained from all participants. The results will be disseminated through peer-reviewed journals for publications.

Trial registration number

ChiCTR1900023473; Pre-results.

Self-Management Behaviors, Glycemic Control, and Metabolic Syndrome in Type 2 Diabetes

imageBackground Diabetes self-management and glycemic control are suboptimal among Chinese patients with Type 2 diabetes with a large proportion of patients identified with metabolic syndrome. Objectives Based on social cognitive theory, this study examines the effect of selected personal, behavioral, and environmental factors on self-management behaviors, glycemic control, metabolic syndrome and Type 2 diabetes. Methods A cross-sectional study was conducted among 207 Chinese with Type 2 diabetes living in a suburban area of Beijing, China. Regression models were applied to examine the effect of selected personal, behavioral, and environmental factors on self-management behaviors, glycemic control, and metabolic syndrome. The relationship among individual self-management behaviors, glycemic control, and metabolic syndrome was also examined. Results Self-efficacy was significantly associated with all self-management behaviors. Social support was related to overall self-management, diabetes knowledge was related to diet, and depressive symptoms was related to self-monitoring. Problem-solving and self-management behaviors related to medication adherence and diet were significant correlates of glycemic control. Health literacy and self-management behaviors related to physical activity were correlates of metabolic syndrome. Discussion Findings suggest that a multifactorial approach may be beneficial when providing care for Chinese with Type 2 diabetes. In addition, these findings provide support for developing and testing tailored interventions that address problem-solving, health literacy, and self-efficacy, among other factors, to help patients achieve optimal glycemic control and thereby reduce their risk for metabolic syndrome and related complications.

Exploring psychosocial factors associated with frailty incidence among patients undergoing maintenance hemodialysis

Abstract

Aim and objective

We investigated the correlation between the frailty status of maintenance haemodialysis (MHD) patients and psychosocial factors.

Background

Varying degrees of frailty have been reported in MHD patients, which affect their quality of life.

Design

We adopted a cross‐sectional design in this study.

Methods

Clinical data of 187 patients at our centre were collected from December 2017–June 2018 using a cross‐sectional survey. Psychosocial factors were measured using the Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale, 10‐item Connor‐Davidson Resilience Scale (CD‐RISC), Chronic Disease Self‐Efficacy Scales and Perceived Social Support Scale. Frailty status was estimated using the fatigue, resistance, ambulation, illnesses and loss of weight (FRAIL) scale. Spearman's correlation and multiple logistic regression analysis were conducted to identify the risk factors for frailty. This study complied with the STROBE checklist.

Results

Of 187 patients, 11 cases (5.9%) of frailty were identified. Patient's age, comorbidities, parathyroid hormone level, sleep quality and depression were positively correlated with frailty (p < .05), while psychological resilience and social support were negatively correlated with frailty (p < .05). Logistic regression analysis revealed four risk factors for frailty among MHD patients, including age (p = .004), comorbidities (p = .023), depression (p = .023) and sleep disorders (p = .029). Conversely, protective factors included high psychological resilience (p = .019) and social support (p = .039).

Conclusion

Among MHD patients, the risk factors for frailty included age, comorbidity, depression and sleep disturbance, whereas the protective factors included psychological resilience and social support.

Relevance to clinical practice

Frailty is not only common among older patients, but also among people of all age groups suffering from chronic diseases. Therefore, it is important to consider the health status of MHD patients and adopt targeted nursing strategies to alleviate symptoms of frailty and improve physical condition by the following ways: postpone the progress of comorbidities, improve sleep quality, control the symptoms of depression, foster psychological resilience and facilitate support from social and family.

Skin‐patch of Xin Huang Pian on relieving joint symptoms in patients with acute gouty arthritis: A Randomized, Double‐Blind, Active‐Controlled Trial

Abstract

Aims

To evaluate the effectiveness and safety of Xin Huang Pian skin‐patches for patients with acute gouty arthritis.

Background

In China, patients with acute gouty arthritis benefit from skin‐patcheses with herbal medicines. But the clinical effects of skin‐patches with Xin Huang Pian are rarely reported.

Design

A Randomized, Double‐Blind, Active‐Controlled Trial.

Methods

The trial was performed from January 2015 ‐ December 2018 at the First Affiliated Hospital of Sun Yat‐sen University in China. It was conducted with one intervention group (skin‐patches of Xin Huang Pian, N =30) and one active control group (skin patches of Diclofenac Diethylamine Emulgel, N = 31). Participants and study investigators were both blinded to the treatment assignments. The primary outcomes were the improvement of joints' symptoms. The secondary outcomes were changes in white blood cells, erythrocyte sedimentation rate and C‐reactive protein.

Results

Skin‐patches of Xin Huang Pian showed quick effect on decreasing joint pain at 3rd day of treatment. Wherever only at 7th day, Diclofenac Diethylamine Emulgel markedly lowered joint pain. Xin Huang Pian also showed superior effect than Diclofenac Diethylamine Emulgel on improving joint swelling and range of motion and decreasing the levels of C‐reactive protein and erythrocyte sedimentation rate. No adverse reactions were observed in skin‐patches of Xin Huang Pian treatment.

Conclusion

Skin‐patches of Xin Huang Pian appeared to be safe and efficacious for relieving joint symptoms in patients with acute gouty arthritis. The mechanism might be associated with the decreased levels of C‐reactive protein and erythrocyte sedimentation rate.

Impact

•Skin‐patcheses with Xin Huang Pian are more effective than Diclofenac Diethylamine Emulgel on improving joint pain, swelling and range of motion.

Xin Huang Pian treatment showed superior effects compared with Diclofenac Diethylamine Emulgel on decreasing levels of C‐reactive protein and erythrocyte sedimentation rate.

•Patients with acute gouty arthritis may benefit from skin‐patches of Xin Huang Pian for effective relief from joint pain and swelling.

Development and validation of a sensitive LC-MS/MS method for the quantitation of IMB-YH-4py5-2H, an antituberculosis candidate, and its application to the pharmacokinetic study

by Sen He, Hong-Tong Chen, Rui Zhao, Xin-Xin Hu, Tong-Ying Nie, Xin-Yi Yang, Cong-Ran Li, Xi Lu, Xiu-Kun Wang, Xue Li, Yun Lu, Guo-Qing Li, Jing Pang, Xue-Fu You

(E)-N,N-dimethyl-4-oxo-4-(4-(pyridin-4-yl)phenyl)but-2-enamide hydrochloride (IMB-YH-4py5-2H) is a novel Protein Kinase B (PknB) inhibitor with potent activity against Mycobacterium tuberculosis strains. In the present study, a sensitive and specific liquid chromatography/tandem mass spectrometry (LC-MS/MS) method was developed and validated to determine IMB-YH-4py5-2H in rat plasma. Sample pretreatment was achieved by liquid-liquid extraction with ethyl acetate, and separation was performed on an XTerra MS C18 column (2.1×50 mm, 3.5 μm) with gradient elution (methanol and 0.1% formic acid) at a flow rate of 0.3 mL/min. Detection was performed in multiple reaction monitoring (MRM) mode. Linear calibration curves were obtained over a concentration range of 1−100 ng/mL. The intra-day and inter-day precisions were lower than 8.46%, and the accuracies ranged from -8.71% to 12.36% at all quality control levels. The extraction recoveries were approximately 70%, and the matrix effects were negligible. All quality control samples were stable under different storage conditions. The validated method was successfully applied to a preclinical pharmacokinetic study in Sprague-Dawley rats. IMB-YH-4py5-2H demonstrated improved pharmacokinetic properties (higher exposure level) compared with its leading compound. IMB-YH-4py5-2H was also distributed throughout the lung pronouncedly, especially inside alveolar macrophages, indicating its effectiveness against lower respiratory infections.

Predicting value of white cell count and total bilirubin on clinical outcomes in patients with ST-elevation myocardial infarction following percutaneous coronary intervention: a cohort study

Por: Tuxun · M. · Zhao · Q. · Xiang · Y. · Liu · F. · Shan · C.-F. · Zhou · X.-R. · Song · N. · Waisiding · A. · Zhang · X.-H. · Aihemaiti · G. · Yang · Y.-N. · Li · X.-M.
Objectives

A combined equation based on white cell count (WCC) and total bilirubin (TB) was assessed for its ability to predict adverse clinical outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI).

Design

A single-centre, prospective cohort study.

Setting

The First Affiliated Hospital of Xinjiang Medical University.

Method

A total of 615 patients with STEMI postprimary PCI were enrolled. WCC and TB were collected at admission. Logistic regression was used to determine the combined equation. The primary endpoints were in-hospital mortality and major adverse cardiovascular events (MACE), which composed of cardiac death, cardiac shock, malignant arrhythmia (ventricular tachycardia, ventricular fibrillation), severe cardiac insufficiency, non-fatal myocardial infarction, angina pectoris readmission, severe cardiac insufficiency (cardiac III–IV level), stent restenosis and target vessels revascularisation during the hospitalisation and 36 months follow-up period.

Result

77 patients occurred in MACE during the hospitalisation (17 in-hospital mortality). WCC and TB were taken as an independent variables to make a category of logistic regression analysis of in-hospital MACE, the logistic regression model was: logit (P)=–8.00+0.265 WCC+0.077 TB, the combination of WCC and TB was more valuable on evaluating the in-hospital mortality (area under the curve 0.804, 95% CI 0.678 to 0.929, p

Conclusion

The combination of WCC and TB is an independent predictor for in-hospital outcomes in patients with STEMI than single detection.

Comparison of the airway complications of subtypes of laryngeal mask airway and i-gel in child patients under general anaesthesia: a protocol for systematic review and network meta-analysis of randomised control trials

Por: Liu · J. · Xu · X. · Li · M. · Cai · R. · Yang · K.
Introduction

Laryngeal mask airway (LMA), an alternative to traditional tracheal intubation, is widely used in clinical practice and is considered to be an effective device for airway management. LMA and i-gel have been widely used in anaesthesia and emergency situations in children. Some systematic reviews have evaluated the efficacy of LMA and i-gel in children, but they have not shown consistent results in clinical performance. This study aims to evaluate the airway complications of all subtypes of LMA and i-gel in child patients under general anaesthesia using a Bayesian network meta-analysis (NMA).

Methods and analysis

PubMed, EMBASE.com, the Cochrane library, Web of Science and Chinese Biomedical Literature Database will be searched from inception to January 2019. We will include prospective randomised controlled trials (RCTs) that reported the subtypes of LMA and i-gel regardless of sample size. The risk of bias assessment of the included RCTs will be conducted according to the Cochrane Handbook V.5.1.0. A Bayesian NMA will be performed using WinBUGS V.1.4.3. Grading of Recommendations Assessment, Development and Evaluation will be used to explore the quality of evidence.

Ethics and dissemination

Ethics approval and patient consent are not required as this study is an NMA based on published trials. The results of this NMA will be submitted to a peer-reviewed journal for publication.

PROSPERO registration number

CRD42019127668.

Analysis of factors related to diabetic retinopathy in patients with newly diagnosed type 2 diabetes: a cross-sectional study

Por: Hao · Z. · Huang · X. · Qin · Y. · Li · H. · Tian · F. · Xu · R. · Chang · B. · Shao · H.
Aim

To investigate the related factors of diabetic retinopathy (DR) and explore the correlation between smoking and DR in patients with newly diagnosed type 2 diabetes mellitus (T2DM).

Design

A single-centre cross-sectional study.

Setting

Tianjin 4th Central Hospital.

Participants

Patients with newly diagnosed T2DM who visited the outpatient department of the hospital from December 2018 to April 2019.

Methods

A total of 947 patients were enrolled in the study. They were divided into two groups according to whether they were diagnosed with DR (diabetic retinopathy group, DR group; non-diabetic retinopathy group, NDR group). The smoking index (SI) was calculated to assess smoking status. Factors such as sex, age, hypertension, T2DM diagnosed age, family history of diabetes, drinking history, haemoglobin A1c (HbA1c), body mass index (BMI) and smoking status were compared between the two groups. Logistic regression was used to analyse the relationship between DR and the above factors.

Results

There was no statistically significant difference between the two groups in sex, age, hypertension, DM diagnosed age, family history of diabetes, drinking history and HbA1c. BMI was significantly higher in DR patients (27.7±4.2 vs 26.7±4.4, p=0.004). Smoking status was also different between the two groups (2=6.350, p=0.042). BMI was shown to be a related factor for DR in patients with newly diagnosed diabetes (OR=0.592, p=0.004). When BMI was ≥28 kg/m2, heavy smoking was significantly associated with DR (OR=2.219, p=0.049), and there was a negative correlation between DR and the age of diagnosis of diabetes ≥60 years (OR=0.289, p=0.009).

Conclusions

Heavy smoking was an important related factor for DR in patients with newly diagnosed diabetes mellitus when BMI was ≥28 kg/m2. Delaying the age of diabetes might prevent the occurrence of DR. To elucidate the correlation, long-term cohort studies with large samples are needed.

Use of home negative pressure wound therapy in peripheral artery disease and diabetic limb salvage

Abstract

Use of negative pressure wound therapy (NPWT) in peripheral artery disease (PAD) and diabetic limb salvage (DLS) improves wound healing by providing moist wound conditions, reducing exudate, controlling wound‐bed infection, and stimulating granulation. NPWT duration may take several weeks, and home‐based NPWT allows patient to recover in the community while minimising risks of prolonged hospitalisation. The aim of this study is to review the use and outcomes of home NPWT in PAD and DLS. The methodology is the retrospective review of patients who were discharged with home NPWT after in‐patient PAD revascularisation and DLS debridement or minor amputations. The results included a total of 118 patients who received home NPWT between January 2017 and December 2017. The mean age was 62.8 years with 66% male and 34% female patients. The study population comprised 25% smokers, 98% patients with diabetics, 35% with ischemic heart disease, and 21% with end‐stage renal failure (ESRF). Of which, 56% of patients required revascularisation while 31% of patients underwent foot debridement, 48% underwent toe amputations, and 20% underwent forefoot amputations. All patients received in‐patient NPWT for a week before being discharged on home NPWT for 4 weeks. Then, 62% received targeted antibiotics regime while 36% received empirical antibiotics on discharge; 60% of patients achieved wound healing on home NPWT, with 9% requiring split‐thickness skin graft; 4% required further surgical debridement, 16% required further minor amputation while 20% required major amputation. 9% required further home NPWT extension, with a mean length of 7.1 ± 4.7 weeks' extension. Overall survival of 1 year was 89%. Risk factors that predict the failure of home NPWT includes subjects with a background of ESRF and wet gangrene on presentation. Home NPWT is a useful adjunct in the management of PAD and DLS foot wounds.

Genetic characteristics of Jiaji Duck by whole genome re-sequencing

by Lihong Gu, Feng Wang, Zhemin Lin, Tieshan Xu, Dajie Lin, Manping Xing, Shaoxiong Yang, Zhe Chao, Baoguo Ye, Peng Lin, Chunhui Hui, Lizhi Lu, Shuisheng Hou

Jiaji Duck (JJ) is a Muscovy duck species that possesses many superior characteristics, and it has become an important genetic resource in China. However, to date, its genetic characteristics and genetic relationship with other duck breeds have not been explored yet, which greatly limits the utilization of JJ. In the present study, we investigated the genome sequences of 15 individual ducks representing five different duck populations, including JJ, French Muscovy duck (FF), mallard (YD), hong duck (HD) and Beijing duck (BD). Moreover, we investigated the characteristics of JJ-specific single nucleotide polymorphisms (SNPs) and compared the genome sequences of JJ vs. YD and JJ vs. BD using integrated strategies, including mutation detection, selective screening, and Gene Ontology (GO) analysis. More than 40 Gb of clean data were obtained for each population (mean coverage of 13.46 Gb per individual). A total number of 22,481,367 SNPs and 4,156,829 small insertion-deletions (Indels) were identified for the five duck populations, which could be used as molecular markers in breeding and utilization of JJ. Moreover, we identified 1,447,932 JJ-specific SNPs, and found that genes covering at least one JJ-specific SNP mainly involved in protein phosphorylation and dephosphorylation, as well as DNA modification. Phylogenetic tree and principal components analysis (PCA) revealed that the genetic relationship of JJ was closest to FF, while it was farthest to BD. A total of 120 and 111 genes were identified as positive selection genes for JJ vs. BD and JJ vs. YD, respectively. GO and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses showed that the positive selection genes for JJ vs. BD ducks mainly involved in pigmentation, muscle contraction and stretch, gland secretion, and immunology, while the positive selection genes obtained from JJ vs. YD ducks mainly involved in embryo development, muscle contraction and stretch, and gland secretion. Taken together, our findings enabled us to better understand the characteristics of JJ and provided a molecular basis for the breeding and hybrid utilization of JJ in the future.

Effects of hospital‐family holistic care model on the health outcome of patients with permanent enterostomy based on the theory of ‘Timing It Right’

Abstract

Aims and objectives

To explore the effects of hospital‐family holistic care model based on ‘Timing It Right’ on the health outcome of patients with permanent colostomy.

Background

Colorectal cancer is a common malignant tumour of digestive system, which seriously threatens human life and health. Colostomy is one of the main treatments for colorectal cancer, which effectively improves the 5‐year survival rate of patients. However, the postoperative psychological and physiological rehabilitation nursing is still faced with great challenges due to the change of body image and defecation pathway caused by colostomy.

Methods

A randomised controlled trial was conducted, and 119 patients with permanent enterostomy were randomly divided into two groups, with 60 cases in the intervention group and 59 cases in the control group. The intervention group received routine care follow‐up and hospital‐family holistic care intervention based on ‘Timing It Right’, while the control group received routine care and follow‐up. The resilience, self‐care ability, complications and life quality of patients with permanent enterostomy were compared between two groups before intervention, at discharge, 3 months and 6 months after discharge. CONSORT checklist was applied as the reporting guideline for this study (see Appendix S1).

Results

A total of 108 patients with permanent enterostomy completed the study (90.76%). At 3 months and 6 months after discharge, the resilience and quality of life in the intervention group were significantly better than those in the control group (t = 4.158 vs. 7.406, t = 4.933 vs. 8.611, p < .05), while the complications in the intervention group were significantly lower than that in the control group (25.5% vs. 41.51%, 14.45% vs. 30.19%; p < .05). The self‐care ability of the intervention group was significantly better than that in the control group (t = 1.543 vs. 3.656 vs. 6.273, p < .05) at discharge, 3 months and 6 months after discharge. The interaction between time and grouping showed that the effect of time factor varied with the grouping. After intervention, there were significant differences in psychological resilience, self‐care ability, complications and quality of life between the two groups at different observation points (p < .01). The three evaluation indices of intervention group increased with the migration of observation time points and were significantly better than those of control group, especially the quality of life (84.35 ± 4.25 vs. 60.45 ± 8.42, p < .01).

Conclusions

The hospital‐family holistic care model based on ‘Timing It Right’ can effectively improve the psychological resilience, self‐care ability and quality of life; reduce complications; and improve the health outcomes of patients with permanent enterostomy.

Relevance to clinical practice

Patients with permanent enterostomy have different needs for nursing care at different stages of the disease, and they are dynamically changing. The hospital‐family holistic care model based on ‘Timing It Right’ can effectively improve the health outcomes of patients with permanent enterostomy, which is worthy of clinical application.

Consistency of postoperative pain assessments between nurses and patients undergoing enhanced recovery after gynaecological surgery

Abstract

Aims and objectives

To explore the consistency of pain intensity and pain location assessed by nurses and patients in gynaecology undergoing enhanced recovery after surgery pathway.

Background

Several studies have shown that clinical nurses' assessment of patients' pain is not always accurate. Little is known about the accuracy of nurses' pain assessments for gynaecological patients. Postoperative pain assessment and management is an essential part of enhanced recovery after surgery.

Design

Comparative cross‐sectional study.

Methods

A total of 160 patients were recruited and only 85 patients and 17 nurses participated. Patients and nurses recorded pain scores (using an 11‐point Numeric Rating Scale) and pain location (incision pain, surgical area pain in the abdominal cavity, other pain or no pain) on Pain Assessment Forms at 4 hr after surgery and on the first and second postoperative days. We used the STROBE guidelines to report our study.

Results

The patients' pain score was higher than that of nurses from 4 hr to second day after laparoscopic surgery at rest. The pain scores of both nurses and patients decreased over this period of time. All the intraclass correlation coefficients were between 0.214–0.296. At the three time points, surgical area pain in the abdominal cavity and abdominal incision pain were the main pain areas. All the kappa coefficients were between 0.164–0.255.

Conclusions

The consistency of postoperative pain assessment about pain score and pain location between nurses and patients was not high. We should attach importance to systematic pain assessment, and more detailed enhanced recovery after surgery pathways should be developed about pain assessment.

Relevance to clinical practice

Continuing education for nurses regarding pain assessment is necessary. Nurses should accept the patient's self‐reported pain. There should be a step that gives more time for pain assessment in enhanced recovery after surgery pathways.

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