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Effects of photoelectric therapy on proliferation and apoptosis of scar cells by regulating the expression of microRNA‐206 and its related mechanisms

Abstract

Human skin fibroblast (HSF) cells were irradiated with different energy lasers to detect cell proliferation, apoptosis, and expression of microRNA‐206 and protein, and to further summarise the therapeutic effect of laser on scar cells. Human scar cell line HSF cells were cultured in three groups. The control group was not irradiated by laser, the low‐energy group was irradiated by 10 J/cm2 laser, and the high‐energy group was irradiated by 20 J/cm2 laser. After irradiation, HSF cells were cultured for 20 hours. Cell proliferation was detected by MTT assay. Cell cycle and apoptosis were detected by flow cytometry. Transwell migration assay was used to detect cell migratory ability. Reverse transcription polymerase chain reaction (RT‐PCR) was used to detect miR‐206 and mTOR gene levels. The levels of MMP‐9, Bax, Bcl‐2, cyclin D1, and mTOR signalling pathway proteins were detected by Western blotting assays. The results showed that after laser irradiation, the proliferation of cells decreased, and the difference between the control group and the experimental group was significant (P < .05). The higher the energy was, the greater the upregulation of apoptosis was. Apoptosis and cell migration increased (P < .05). The expressions of microRNA‐206, MMP‐9, and Bax were upregulated, while the expressions of mTOR, Bcl‐2, and cyclin D1 were downregulated. To sum up, laser irradiation can significantly inhibit the proliferation of HSF cells, affect cell cycle, and increase cell apoptosis and migratory ability.

Surgical site infection following traumatic orthopaedic surgeries in geriatric patients: Incidence and prognostic risk factors

Abstract

Geriatric population is increasing rapidly worldwide, and fragility fracture and complication following orthopaedic surgery in elderly people have now become major challenges for surgeons. Further studies are required to identify potentially modifiable factors associated with surgical site infection (SSI) in geriatric patients. This retrospective, multicenter study was conducted at four level I hospitals in China. During the 31‐month study period, a total of 2341 patients (65 years or older) underwent orthopaedic surgery and complete data were recorded from September 2015 to April 2018. Demographics information, medications and additional comorbidities, surgery‐related variables, and laboratory indexes were extracted and analysed. Receiver‐operating characteristic analysis was performed to detect the optimum threshold of continuous variables. Independent risk factors of SSI were identified by univariate and multivariate analyses. Finally, 63 patients suffered from wound infection within the follow‐up period, indicating a 2.7% incidence rate of SSI. Statistical results showed that open injury (odds ratio [OR], 9.5; 95% confidence interval [CI], 5.4‐16.7), American Society of Anesthesiologists classified III‐IV score (OR, 2.2; 95% CI, 1.3‐3.8), surgical duration of >132 minutes (OR, 2.9; 95% CI, 1.1‐5.0), serum albumin (ALB) of <36.4 mg/L (OR, 2.0; 95% CI, 1.6‐3.4), and blood glucose (GLU) of >118 mg/dL (OR, 3.1; 95% CI, 1.1‐5.3) were independent risk factors of postoperative SSI. With the application of sensitive and modifiable variables such as surgical duration and the levels of ALB and GLU, more geriatric patients with sub‐high risk of postoperative SSI could be identified.

Intra‐individual variability in sleep is related to glycaemic control in adults with type 2 diabetes

Abstract

Aims

To examine whether there were significant differences in sleep during weekdays/weekends and whether the intra‐individual variability in sleep was related to glycaemic control in patients with type 2 diabetes.

Design

Correlational, longitudinal design.

Methods

Data were collected between February 2017–January 2018. In all, 56 adults with type 2 diabetes were included (60.7 years, 55.4% female). Sleep was measured using the Consensus Sleep Diary over 8 days. Intra‐individual variability of sleep was calculated as the standard deviation of sleep variables. Standard deviations of sleep duration, sleep efficiency, sleep quality, and mid‐sleep time were obtained. Glycaemic control was measured by haemoglobin A1C. Paired t test and multiple regression analysis were used.

Results

Overall, there were no differences in sleep parameters between weekdays and weekends. Participants slept 20 min more over the weekends than during weekdays. The mid‐sleep time during weekends was about 35 min later than during weekdays. Intra‐individual variability of sleep duration and mid‐sleep ranged from 27.6–167.4 min and 13–137 min, respectively. Controlling for covariates (e.g., distress, symptoms, and self‐care), larger variability in sleep duration, and mid‐sleep were significantly related to higher A1C levels.

Conclusion

Diabetes educators are recommended to include the assessment of intra‐individual variability in sleep. Maintaining a regular sleep habit (e.g., sleep duration and sleep timing) should be highlighted during patient education.

Impact

Intra‐individual variability in sleep is an alternative dimension for sleep assessment. This study examined whether intra‐individual variability in sleep was related to glycaemic control in an older sample of type 2 diabetes patients using a sleep diary across 8 days. This sample had a similar sleep pattern during weekdays and weekends. Larger intra‐individual variabilities in sleep duration and mid‐sleep time were independently related to worse glycaemic control. Diabetes patients are recommended to maintain a regular sleep routine.

Innate immune molecule surfactant protein D attenuates sepsis‐induced acute kidney injury through modulating apoptosis and NFκB‐mediated inflammation

Abstract

The objective of this study is to investigate the mechanism whereby innate immune molecule surfactant protein D (SP‐D) attenuates sepsis‐induced acute kidney injury (AKI) through modulating apoptosis and nuclear factor kappa‐B (NFκB)‐mediated inflammation. In the present study, a mouse sepsis model was established by cecal ligation and puncture in SP‐D knockout (KO) mice and wild‐type (WT) mice. A sham‐operated group was included as the control. The experimental materials were extracted 6 and 24 hours postoperatively. The plasma levels of tumour necrosis factor alpha (TNF‐α) and MCP‐1 were determined by enzyme‐linked immunosorbent assay (ELISA). Apoptosis was measured by double staining with Annexin V/propidium iodide and flow cytometry. The levels of NFκB in renal tissues were measured by ELISA and Western blotting assay. Apoptosis was detected by TUNEL assays. There were no significant differences in plasma TNF‐α levels between the WT sham group and the KO sham group at 6 and 24 hours postoperatively (P < .05), but the levels of TNF‐α in the WT sepsis and KO sepsis groups were significantly higher than those in controls (P < .05). The levels of TNF‐α in the KO sepsis group were significantly higher than those of the WT sepsis group (P < .05). TNF‐α levels in the WT sepsis group and the KO sepsis group at 24 hours postoperatively were significantly higher than those at 6 hours postoperatively (P < .05). The levels of MCP‐1 in the WT sepsis group and the KO sepsis group at 6 and 24 hours postoperatively were significantly higher than those in the control group (P < .05), and MCP‐1 levels in the KO sepsis group were significantly higher than those in the WT sepsis group (P < .05). MCP‐1 levels in the WT sepsis group and the KO sepsis group at 24 hours postoperatively were significantly higher than those at 6 hours postoperatively (P < .05). The expression of SP‐D in WT kidneys was significantly lower at 6 and 24 hours postoperatively (P < .05). The number of TUNEL‐positive cells in the kidneys from septic SP‐D KO mice was significantly higher (P < .05). The levels of NFκB in septic mice were significantly increased at 6 and 24 hours after induction of sepsis compared with the sham‐operated group compared with those of septic SP‐D KO mice and WT mice (P < .05). Innate immune molecule SP‐D significantly decreased plasma levels of inflammatory cytokines in mice and attenuated sepsis‐induced AKI by inhibiting NFκB activity and apoptosis.

The Effectiveness of Parenting Interventions on Psychosocial Adjustment in Parents of Children and Adolescents with Type 1 Diabetes: A Meta‐Analysis

Abstract

Aims

Parenting interventions in this review refer to supportive parenting training provided for parents or primary caregivers of children and adolescents with type 1 diabetes mellitus (T1DM). The review aimed to synthesize evidence about parenting interventions in parents or caregivers of children and adolescents with T1DM, and to evaluate the effect of interventions in reducing parents’ or caregivers’ psychological distress, helping them share diabetes management responsibility, seek social support, and improve their quality of life.

Methods

We searched PubMed, MEDLINE, EMBASE, CINAHL, Cochrane, and Web of Science from January 1978 to October 2018. Randomized controlled trials (RCTs) comparing an intervention group of parenting programs with a control group of usual care were included. The primary outcomes were stress, family responsibility and conflict, and social support. Secondary outcomes included other psychological index and quality of life. Pooled effect sizes of weighted mean difference (WMD) were calculated.

Results

A total of 17 RCTs with 962 participants met the inclusion criteria. Findings of the meta‐analysis showed parenting interventions could significantly reduce parents’ depression (WMD = −5.78, 95% CI: −6.23 to −5.33, I 2 = 0%) and distress (WMD = −5.28, 95% CI: −10.31 to −.25, I 2 = 0%), and help them ask for positive social support (WMD = .83, 95% CI: .03 to 1.64, I 2 = 0%). No beneficial changes of other outcomes were found.

Linking Evidence to Action

Parents of children and adolescents with T1DM need support from the multidisciplinary team in health care, especially in mental health, family management of childhood diabetes, and social support. Parenting interventions may help parents reduce psychological distress and depression and assist them to ask for social support. Future research should include well‐designed RCTs with large samples, appropriate measures with clear definitions, objective assessment, and separation of effects on mothers and fathers.

Effects of Probiotics, Prebiotics, and Synbiotics on Calcium Homeostasis and Bone Health With Aging: A Systematic Review

Abstract

Background

Calcium homeostasis and bone health are an increasing concern for middle‐aged and older adults. Many studies have explored the positive effects of probiotics, prebiotics, or synbiotics on serum calcium and bone mineral density (BMD) or other parameters related to bone health. However, the participants, the species, doses and duration of interventions, outcomes, and measurements varied among these studies.

Aims

To systematically evaluate the effect of probiotics, prebiotics, or synbiotics on maintaining calcium homeostasis and improving bone health in middle‐aged and older adults.

Methods

We identified studies in Cochrane Library, Embase, PubMed, Web of Science, CINAHL, China National Knowledge Infrastructure, and Wanfang and articles in English and Chinese published from inception up to January 10, 2019. Randomized controlled trials (RCTs) involving probiotics, prebiotics, or synbiotics for middle‐aged or older adults were employed for meta‐analysis by using RevMan 5.3, and heterogeneity and risk of bias assessment were performed.

Results

A total of eight studies, involving 564 participants, were included. Probiotics, prebiotics, or synbiotics supplementation was able to significantly elevate serum calcium levels (0.52 mg/dl, 95% CI [0.38, 0.66]), heterogeneity: p = .13, I 2 = 44%), while the results of meta‐analysis failed to support the effects of this supplementation on the parameters related to bone health in middle‐aged and older adults, including BMD, parathyroid hormone, osteocalcin, and alkaline phosphatase.

Linking Evidence to Action

Probiotics, prebiotics, or synbiotics supplementation exerts a facilitating influence on the level of serum calcium, while the present study has not yet supported the beneficial effects of such interventions on bone health. Therefore, further studies with high‐quality RCTs are required to determine the effects of probiotics, prebiotics, or synbiotics supplementation on middle‐aged and older adults.

Diagnostic performance of image technique based transurethral resection for non-muscle invasive bladder cancer: systematic review and diagnostic meta-analysis

Por: Chen · C. · Huang · H. · Zhao · Y. · Liu · H. · Sylvester · R. · Lin · T. · Huang · J.
Objective

To explore the diagnostic performance of image technique based transurethral resection for bladder cancer, with white light-guided cystoscopy (WLC) as the reference standard.

Design

Systematic review and meta-analysis.

Data sources

PubMed/MEDLINE, Web of Science, the Cochrane Library, Central Register of Controlled Trials and Embase from inception to 31 March 2018.

Methods

Included studies reported the diagnostic performance of photodynamic diagnosis (PDD) with 5-aminolevulinic acid (5-ALA), PDD with hexaminolevulinic acid (HAL) or narrow band imaging (NBI), with WLC as the reference standard at the patient or lesion level. The studies’ risk of bias (RoB) was assessed using Quality Assessment of Diagnostic Studies-2. Data were pooled using a random effect diagnostic meta-analysis, and subgroup analyses were performed.

Results

Twenty-six studies comprising a total of 3979 patients were included in this diagnostic meta-analysis. Pooled sensitivity (SSY), specificity (SPY), diagnostic OR (DOR) and area under the receiver operating characteristic curve (AUROC) values were calculated per group for NBI, HAL and 5-ALA at the lesion or patient level. NBI showed significant diagnostic superiority compared with WLC at the lesion level (SSY 0.94, 95% CI 0.82 to 0.98; SPY 0.79, 95% CI 0.73 to 0.85; DOR 40.09, 95% CI 20.08 to 80.01; AUROC 0.88, 95% CI 0.85 to 0.91). NBI presented the highest DOR (358.71, 95% CI 44.50 to 2891.71) in the patient level. Subgroup analyses were performed on studies with low to moderate RoB and at least 100 patients at the lesion level. These results were consistent with those of the overall analysis.

Conclusions

Pooled data indicated that image technique based transurethral resection (NBI, HAL and 5-ALA) showed diagnostic superiority compared with WLC. Moreover, NBI is potentially the most promising diagnostic intervention, showing the best diagnostic performance outcomes. Further prognostic outcomes of novel imaging technologies compared with those WLC should be explored in addition to current diagnostic performance analysis.

Intracytoplasmic sperm injection (ICSI) versus conventional in vitro fertilisation (IVF) in couples with non-severe male infertility (NSMI-ICSI): protocol for a multicentre randomised controlled trial

Por: Zheng · D. · Zeng · L. · Yang · R. · Lian · Y. · Zhu · Y.-M. · Liang · X. · Tang · L. · Wang · H. · Cao · Y. · Hao · G. · Liu · J. · Zhao · J. · Wang · R. · Mol · B. W. · Li · R. · Huang · H.-F. · Qiao · J.
Introduction

Intracytoplasmic sperm injection (ICSI), originally introduced as add-on to in vitro fertilisation (IVF) for couples with severe male infertility, is in current clinical practice also used in couples with mild male or even unexplained infertility. However, ICSI has involved unresolved concerns regarding the selection and damage to gametes and the health conditions of the offspring, and it is also labour intensive and therefore more expensive than conventional IVF. High-quality well-powered randomised clinical trials (RCTs) comparing ICSI and IVF are lacking.

Methods and analysis

We propose a multicentre, open-label RCT in 10 reproductive medical centres across China. We will study couples with non-severe male infertility (defined as a semen concentrate 5–15x106/mL or sperm with a progressive motility 10%–32%) scheduled for their first or second ICSI or IVF cycle, as low fertility rate after fertilisation are more frequent in this population, which could lead to controversy about ICSI or conventional IVF for fertilisation. On the day of oocyte retrieval, eligible participants are after informed consent be randomised to undergo either ICSI or conventional IVF in a 1:1 treatment ratio. Other standard assisted reproductive treatments are similar and parallel between two groups. Our primary outcome is ongoing pregnancy leading to live birth after the first cycle with embryo transfer. To demonstrate or refute a difference of 7% between ICSI and conventional IVF, we need to include 2346 women (1173 in each intervention arm). In addition, we will follow-up neonatal outcomes after delivery to identify the influence of ICSI on offspring.

Ethics and dissemination

Ethical approval was obtained from Peking University Third Hospital medical science research ethics committee. The findings will be disseminated to the public through conference presentations and peer-reviewed scientific journals.

Trial registration number

ClinicalTrials.gov registry (NCT03298633).

Prevalence of overweight and obesity and associated risk factors among adult residents of northwest China: a cross-sectional study

Por: Song · N. · Liu · F. · Han · M. · Zhao · Q. · Zhao · Q. · Zhai · H. · Li · X.-M. · Du · G.-L. · Li · X.-M. · Yang · Y.-N.
Objective

Overweight and obesity have been shown to be related to multiple chronic conditions, leading to a heavy economic burden on society throughout the world. This study aims to estimate the prevalence of overweight and obesity and determine potential influencing factors among adults in Xinjiang, northwest China.

Design

A community-based observational study.

Setting

The First Affiliated Hospital of Xinjiang Medical University.

Methods

In total, 14 618 adult participants (7799 males; 6819 females) aged over 35 years were recruited from the Cardiovascular Risk Survey conducted in 2010. Data were obtained from face-to-face interviews and physical examinations. The sample was used to estimate the prevalence of overweight (body mass index (BMI) 24–28 kg/m2) and obesity (BMI ≥28 kg/m2) in Xinjiang Province. Influencing factors were analysed based on statistical methods.

Results

In Xinjiang Province, the overall prevalence of overweight was 36.5% (male 40.1%; female 33.4%), and the prevalence of obesity was 26.5% (male 27.2%; female 25.8%). The prevalence of both overweight and obesity were higher in women than in men (p

Conclusions

This study estimated that the prevalence of overweight and obesity among adult residents of Xinjiang Province, northwest China, was high. These data suggest that efforts related to the prevention and control of overweight and obesity should be a public health priority in northwest China.

Patient experience of hospital care in China: major findings from the Chinese Patient Experience Questionnaire Survey (2016-2018)

Por: Hu · G. · Chen · Y. · Liu · Q. · Wu · S. · Guo · J. · Liu · S. · Wang · Z. · Zhao · P. · Sun · J. · Hu · L. · Zhou · H. · Luo · L. · Mao · Y. · Needleman · J. · Ma · J. · Liu · Y.
Objectives

China launched the National Healthcare Improvement Initiative (NHII) in 2015 to improve patient experiences in healthcare. This study aimed to generate evidence of hospital care quality from the patients’ perspective.

Design

This nationwide cross-sectional study interviewed participants from 31 provinces, municipalities and autonomous regions across China.

Setting

A total of 117 tertiary hospitals in mainland China.

Participants

48 422 responses from outpatients and 35 957 responses from inpatients were included in this study.

Primary outcome measure

The scores of six predefined domains in the Chinese Patient Experience Questionnaire, five of which were designed to reflect specific dimensions of care, and one of which indicated the overall rating.

Results

More than 80% of the respondents viewed their care experiences as positive. The NHII seems to have had a positive impact, as indicated by the steady, although unremarkable, increase in the patient experience scores over the 2016–2018 period. The Chinese patients generally reported a positive experience with the clinical aspects of care, but reported a less positive experience with the environmental, interpersonal and social services aspects of care. The institutional factors, including region and type of hospital, and personal factors, such as gender, age, education and occupation, were factors affecting the patient experience in China. Humanistic care was the aspect of care with the greatest association with the overall patient experience rating in both the outpatient and inpatient settings.

Conclusions

The national survey indicated an overall positive patient perspective of care in China. Older age, higher education level and formal employment status were found to be correlated with positive care experiences, as were higher levels of economic development of the region, a more generous insurance benefits package and a higher degree of coordinated care. The interpersonal-related initiatives had substantial roles in the improvement of the patient experience. In the regions where farmers and users of traditional Chinese medicine services constitute a greater proportion of the population, improvement of patient experiences for these groups deserves special policy attention.

Home childbirth among young mothers aged 15-24 years in Nigeria: a national population-based cross-sectional study

Por: Adewuyi · E. O. · Khanal · V. · Zhao · Y. · David · L. · Bamidele · O. D. · Auta · A.
Objective

To estimate the prevalence and identify factors associated with home childbirth (delivery) among young mothers aged 15–24 years in Nigeria.

Design

A secondary analysis of cross-sectional data from the 2013 Nigeria Demographic and Health Survey (NDHS).

Setting

Nigeria.

Participants

A total of 7543 young mothers aged 15–24 years.

Outcome measure

Place of delivery.

Results

The prevalence of home delivery among young mothers aged 15–24 years was 69.5% (95% CI 67.1% to 71.8%) in Nigeria—78.9% (95%CI 76.3% to 81.2%) in rural and 43.9% (95%CI 38.5% to 49.5%, p

Conclusions

Young mothers aged 15–24 years had a higher prevalence of home delivery than the national average for all women of reproductive age in Nigeria. Priority attention is required for young mothers in poor households, rural areas, North-East, North-West and South-South regions. Faith-based interventions, a youth-oriented antenatal care package, education of girls and access to health insurance coverage are recommended to speed up the reduction of home delivery among young mothers in Nigeria.

Association between fatigue and depressive symptoms among kidney transplantation recipients: The mediating role of rumination

Abstract

Aims

Depressive symptoms are common among kidney transplantation recipients. Previous studies have reported that fatigue and rumination are risk factors for depressive symptoms. To date, the underlying mechanisms of fatigue, rumination, and depressive symptoms among kidney transplantation recipients remain unclear. This study aimed to assess the prevalence of depressive symptoms and investigate whether rumination mediates the association between fatigue and depressive symptoms among kidney transplantation recipients.

Design

Cross‐sectional study.

Methods

The study of 207 kidney transplantation recipients with an average age of 44.5 years was conducted from January 2017–July 2017. Sociodemographic and clinical characteristics, fatigue, rumination, and depressive symptoms data were collected. For the descriptive analysis, Pearson correlations and mediation analysis based on the PROCESS macro were used.

Results

The prevalence of depressive symptoms among kidney transplantation recipients was 21.7%. Rumination mediated the association between fatigue and depressive symptoms and the indirect effect was 0.19 (95% confidence interval: 0.10–0.28).

Conclusion

Depressive symptoms were highly prevalent among kidney transplantation recipients. Rumination exerts a mediating role between fatigue and depressive symptoms.

Impact

This study alerts physicians and nurses for the importance of considering the mental health of these patients and contributes to the development of effective depression management interventions.

Endoscopic resection for non-polypoid dysplasia in inflammatory bowel disease: a systematic review protocol

Por: Zhang · Y. · Chen · W. · Zhao · Y. · Wu · D.
Introduction

Non-polypoid low-grade dysplasia in inflammatory bowel disease is associated with a medium increased risk of colorectal cancer, while treatment recommendations remain controversial. We aim to evaluate the efficacy and safety of endoscopic treatment for non-polypoid dysplasia in patients with inflammatory bowel disease.

Methods and analysis

Medline, Embase, Cochrane Library, Scopus, Web of Science and clinical trials registry from database inception to the search date will be used to retrieve eligible studies. Studies that report the curative resection rate or any of other secondary outcomes of endoscopic treatment in patients with non-polypoid dysplasia in inflammatory bowel disease will be included in the analysis. We will conduct quantitative synthesis if the eligible studies are homogeneous judging from clinical and methodological perspectives.

Ethics and dissemination

Ethical approval for this study was waived by the Ethics Committee of Peking Union Medical College Hospital because there are no individual data involved in the analysis and all the combined results will be retrieved from study-level data. We plan to disseminate results through peer-reviewed journals or conference abstracts.

PROSPERO registration number

CRD42019120413.

Comparative efficacy of 13 immunosuppressive agents for idiopathic membranous nephropathy in adults with nephrotic syndrome: a systematic review and network meta-analysis

Por: Zheng · Q. · Yang · H. · Liu · W. · Sun · W. · Zhao · Q. · Zhang · X. · Jin · H. · Sun · L.
Objectives

This study aimed to compare the effectiveness of 13 types of immunosuppressive agents used to treat idiopathic membranous nephropathy (IMN) in adults with nephrotic syndrome.

Design

Systematic review and network meta-analysis.

Data sources

PubMed, EMbase, Cochrane Library, Web of Science, Clinical trials, SinoMed, Chinese Biomedicine, CNKI, WanFang and Chongqing VIP Information databases were comprehensively searched until February 2018.

Eligibility criteria

Randomised clinical trials (RCTs) comparing the effects of different immunosuppressive treatments in adult patients with IMN and nephrotic syndrome were included, and all included RCTs had a study-duration of at least 6 months.

Data extraction and synthesis

Two reviewers independently screened articles, extracted data and assessed study quality. Standard pairwise meta-analysis was performed using DerSimonian-Laird random-effects model.

Results

This study ultimately included 48 RCTs with 2736 patients and 13 immunosuppressive agents. The network meta-analysis results showed that most regimens, except for leflunomide (LEF), mizoribine (MZB) and steroids (STE), showed significantly higher probabilities of total remission (TR) when compared with non-immunosuppressive therapies (the control group),with risk ratios (RRs) of 2.71 (95% CI) 1.81 to 4.06)for tacrolimus+tripterygium wilfordii (TAC+TW), 2.16 (1.27 to 3.69) foradrenocorticotropic hormone, 2.02 (1.64 to 2.49) for TAC, 2.03 (1.13 to3.64) for azathioprine (AZA), 1.91 (1.46 to 2.50) for cyclosporine (CsA), 1.86 (1.44 to2.42) for mycophenolate mofetil (MMF), 1.85 (1.52 to 2.25) for cyclophosphamide (CTX),1.81 (1.10 to 2.98) for rituximab (RIT), 1.80 (1.38 to 2.33) for TW, 1.72 (1.35 to 2.19) for chlorambucil. As for 24 hours UTP, the direct andindirect comparisons showed that AZA (standard mean difference (SMD), –1.02(95% CI –1.90 to –0.15)), CsA (SMD, –0.70 (95% CI –1.33 to –0.08)),CTX (SMD, –1.01 (95% CI –1.44 to -0.58)), MMF (SMD, –0.98 (95% CI –1.64 to –0.32)), MZB (SMD, –0.97 (95% CI –1.90 to–0.04]), TAC (SMD, –1.16 (95% CI –1.72 to –0.60)) and TAC+TW(SMD, –2.03 (95% CI –2.94 to –1.12)) could significantly superior thancontrol, except for chlorambucil, LEF, RIT and STE. Thechanges of serum creatinine (Scr) was not significantly different between eachtreatments of immunosuppressive agents and the control, except for STE whichhas the possibility of increasing Scr (SMD, 1.00 (95% CI 0.36 to 1.64)).Comparisons among all treatments of immunosuppressive agents showed nostatistical significance in the outcome of relapse. A drenocorticotropichormone (85.1%) showed the lowest probability of relapse under the cumulativeranking curve values among all immunosuppressants. Infection,gastrointestinal symptoms, and bone marrow suppression were the common adverseevents associated with most of the immunosuppressive therapies.

Conclusions

This study demonstrates that TAC+TW, TAC and CTX are superior to other immunosuppressive agents in terms of TR and 24 hours UTP. Moreover, they are all at risk of infection, gastrointestinal symptoms, and myelosuppression. Furthermore, TAC could increase the risk of glucose intolerance or new-onset diabetes mellitus. Conversely, STE alone, LEF and MZB seem to have little advantage in clinical treatment of IMN.

PROSPERO registration number

CRD42018094228.

Association between mid-upper arm circumference and cardiometabolic risk in Chinese population: a cross-sectional study

Por: Hou · Y. · Jia · X. · Xuan · L. · Zhu · W. · Deng · C. · Wang · L. · Zhao · Z. · Li · M. · Lu · J. · Xu · Y. · Chen · Y. · Wang · W. · Bi · Y. · Xu · M. · Wang · T.
Objectives

Upper body fat has been associated with an unfavourable cardiometabolic risk. We aimed to investigate the associations between mid-upper arm circumference (MUAC), a novel indicator of upper body fat, and a wide spectrum of cardiometabolic risk profiles in Chinese population.

Design and setting

Cross-sectional analyses were performed using data from a well-defined community in 2014, Shanghai, China.

Participants

A total of 6287 Chinese adults (2310 men and 3977 women) aged 40 years or older.

Outcome measures

Multivariable logistic regression model was used to examine the associations of MUAC with cardiometabolic disorders including central obesity, diabetes, hypertension, hypertriglyceridaemia, low high-density lipoprotein (HDL) cholesterol and subclinical atherosclerosis.

Results

In the overall participants, after multivariable adjustment, each 1 SD (3.13 cm) increment in MUAC was positively associated with central obesity (OR 2.05; 95% CI 1.85 to 2.28), hypertension (OR 1.10; 95% CI 1.03 to 1.19) and low HDL cholesterol (OR 1.10; 95% CI 1.01 to 1.22). Multivariable-adjusted ORs for subclinical atherosclerosis were gradually increased across increasing quartiles of MUAC with the lowest quartile as reference (quartile 2: OR 1.31; 95% CI 1.09 to 1.58; quartile 3: OR 1.33; 95% CI 1.10 to 1.62; quartile 4: OR 1.45; 95% CI 1.16 to 1.80; p for trend=0.005). Similar but more prominent associations were observed among women than men. In addition, MUAC was significantly interacted with diabetes (p for interaction=0.04) and insulin resistance (p for interaction=0.01) on subclinical atherosclerosis.

Conclusion

A greater MUAC was positively associated with higher risks of several cardiometabolic disorders and subclinical atherosclerosis in Chinese adults.

Intended place of residence in old age of internal migrants aged 15-64 years: a citywide cross-sectional study in Shanghai, China

Por: Zhao · J. · Su · Y. · Mao · Y. · Chen · A.-n. · Zhou · X.-p. · Zhou · W.-j. · Zhu · Q.-x.
Objectives

To explore the intentions of working-age internal migrants concerning their place of residence in old age and the relevant influencing factors.

Method

A cross-sectional survey was conducted in the 17 districts of Shanghai, China in 2013. Through multi-stage stratified sampling with probability proportional to size, 7968 internal migrants (aged 15–64 years) were selected and interviewed individually face to face. The primary outcome concerned the intended place of residence in old age of internal migrants living in Shanghai. Information was collected on demographic characteristics, health insurance, economic condition and participation in social activities. Multinomial logistic regression was performed to analyse the factors influencing migrants’ intentions concerning their place of residence in old age.

Results

A total of 7927 working-age migrants with complete data were analysed. Of these, 57.0% intended to live in their hometown in old age, 17.7% planned to remain in Shanghai and 25.3% were undecided. Those respondents who were male, less educated, from rural areas or Western China, living in rental houses or who had left family members behind in their hometowns were more likely to choose their hometown as their intended residence in old age (p

Conclusions

Most of the migrants expressed an intention to remigrate to their hometowns in old age. Education, economic capacity and social insurance influenced internal migrants in their decision. Relevant authorities should monitor the remigration pattern of ageing migrants, strengthen the senior care system and prepare health service resources that are more adequate, especially in the provinces or cities whence the migrants came.

Accuracy of magnetic resonance imaging texture analysis in differentiating low-grade from high-grade gliomas: systematic review and meta-analysis

Por: Wang · Q. · Lei · D. · Yuan · Y. · Zhao · H.
Objectives

Texture analysis (TA) is a method used for quantifying the spatial distributions of intensities in images using scanning software. MRI TA could be applied to grade gliomas. This meta-analysis was performed for assessing the accuracy of MRI TA in differentiating low-grade gliomas from high-grade ones.

Methods

PubMed, Cochrane Library, Science Direct and Embase were searched for identifying suitable studies from their inception to 1 September 2018. The quality of the studies was evaluated on the basis of the Quality Assessment of Diagnostic Accuracy Studies guidelines. We estimated the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic OR (DOR) using the summary receiver operating characteristic (SROC) for identifying the accuracy of MRI TA in grading gliomas. Fagan nomogram was applied for assessing the clinical utility of TA.

Results

Six studies including 440 patients were included and analysed. The pooled sensitivity, specificity, PLR, NLR and DOR with 95% CIs were 0.93 (95% CI 0.88 to 0.96), 0.86 (95% CI 0.81 to 0.89), 6.4 (95% CI 4.8 to 8.6), 0.08 (95% CI 0.05 to 0.15) and 78 (95% CI 39 to 156), respectively. The SROC curve showed an area under the curve of 0.96 (95% CI 0.93 to 0.97). Deeks test confirmed no significant publication bias in all studies. Fagan nomogram revealed that the post-test probability increased by 43% in patients with positive pre-test.

Conclusions

The findings of this meta-analysis suggested that MRI TA has high accuracy in differentiating low-grade gliomas from high-grade ones. A standardised methodology is warranted to guide the use of this technique for clinical decision-making.

Factors associated with lower‐extremity amputation in patients with diabetic foot ulcers in a Chinese tertiary care hospital

Abstract

Providing a better understanding of the risk factors for amputation in this particular region, Hunan province, in China might help patients with diabetic foot ulcers receive timely and appropriate medical care and help prevent amputation. Diabetic foot ulcer patients referred to the Third Xiangya Hospital during the period between December 2014 and September 2018 were enrolled. Participants who underwent amputations and received conservative treatments were compared using univariate and multivariate analyses to identify the independent predictors of amputation. Those who required amputation presented significantly higher levels of white blood cell counts, platelet counts, erythrocyte sedimentation rate, C‐reactive protein, and glycated haemoglobin (HbA1c) levels. However, levels of haemoglobin, postprandial plasma C‐peptide, triglyceride, high‐density lipoprotein cholesterol, albumin, and uric acid were decreased in patients with amputations. Patients with more advanced Wagner grades had much higher rates of amputation. Multivariable‐adjusted odds ratios in stepwise logistic regression model was 1.317 for HbA1c (95% CI: 1.015‐1.709), 0.255 for triglyceride (95% CI: 0.067‐0.975), and 20.947 for Wagner grades (95% CI: 4.216‐104.080). Independent risk factors for amputation in these Chinese diabetic foot ulcer patients included an elevated HbA1c level, lower triglyceride level, and higher Wagner grades.

Relationship between gay app use and HIV testing among men who have sex with men in Shenzhen, China: a serial cross-sectional study

Por: Wei · L. · Chen · L. · Zhang · H. · Yang · Z. · Liu · S. · Tan · W. · Xie · W. · Liu · L. · Zhao · J. · Cheng · J.
Objectives

To investigate the relationship between gay app use and HIV testing among men who have sex with men (MSM).

Design

Serial cross-sectional study.

Setting

A newly well-developed city in China.

Participants

4935 MSM were recruited through offline sampling methods from 2015 to 2017.

Primary and secondary outcomes

The primary outcome is the difference in HIV testing between app and non-app users.

Results

2872 (58.2%) and 2159 (43.7%) participated MSM had been tested for HIV within lifetime and the past year, respectively. Compared with non-app-using MSM, app-using MSM had a significantly higher prevalence of HIV testing within lifetime (adjusted OR (AOR): 1.48, 95% CI 1.27 to 1.72) and the past year (AOR: 1.36, 95% CI 1.18 to 1.57). App-using MSM were more likely to take an HIV test at the Centers for Disease Control and Prevention (AOR: 1.48, 95% CI 1.24 to 1.76) and community-based organisations (AOR: 1.71, 95% CI 1.44 to 2.03), but less often at gay venues (AOR: 0.49, 95% CI 0.37 to 0.63). Meanwhile, app-using MSM were more likely to take self-testing (AOR: 1.61, 95% CI 1.21 to 2.14). Predictors of HIV testing in the past year were: having an education level of college or higher (AOR: 1.29, 95% CI 1.01 to 1.65), being self-identified as a homosexual (AOR: 1.23, 95% CI 1.02 to 1.46), being recruited through clinic-based sampling (AOR: 1.30, 95% CI 1.06 to 1.60), using gay app (AOR: 1.49, 95% CI 1.21 to 1.83), engaging in group sex (AOR: 1.64, 95% CI 1.23 to 2.19), having received HIV-related service (AOR: 5.49, 95% CI 4.57 to 6.60), having a high level of HIV-related knowledge (AOR: 1.33, 95% CI 1.10 to 1.61) and high-risk perception (AOR: 2.95, 95% CI 1.40 to 6.23).

Conclusions

Gay app use was significantly associated with increased HIV testing among MSM hard to reach by traditional outreach. Therefore, it is imperative to expand HIV testing among non-app-using MSM. Continued efforts, innovative strategies and increased resource are highly needed to realise the first ‘90’ target.

Pulmonary rehabilitation for pneumoconiosis: protocol for a systematic review and meta-analysis

Por: Zhao · H. · Xie · Y. · Wang · J. · Li · X. · Li · J.
Introduction

Pneumoconiosis is characterised by diffuse fibrosis in lung tissue, and its incidence is on the rise. At present, there are limited therapeutic options for pneumoconiosis. Pulmonary rehabilitation (PR) has been widely used to treat pneumoconiosis,however, there is limited evidence concerning its efficacy. Therefore, we plan to conduct a systematic review to investigate the efficacy and safety of PR for pneumoconiosis.

Methods and analysis

The following databases will be searched from their inception to 1 April 2019: PubMed, Embase, The Cochrane Library, Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chongqing VIP and Wanfang Data. Randomised controlled trials of PR for pneumoconiosis will be included. Primary outcomes will include 6 min walk distance and St. George’s Respiratory Questionnaire. Study selection, extraction of data and assessment of study quality each will be independently undertaken. Statistical analysis will be conducted using Review Manager software.

Ethics and dissemination

This systematic review will provide up-to-date information on PR for pneumoconiosis. The review does not require ethical approval and will be disseminated electronically through a peer-reviewed publication or conference presentations.

PROSPERO registration number

CRD42018095266.

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