Maternal and neonatal outcomes in multiple pregnancy: A multicentre study in the Beijing population

ObjectiveTo compare the adverse maternal and neonatal outcomes of multiple pregnancy and singleton pregnancy from multiple medical centers in Beijing.MethodsData concerning maternal and neonatal adverse outcomes in multiple and singleton pregnancies were collected from 15 hospitals in Beijing by a systemic cluster sampling survey conducted from 20 June to 30 November 2013. The SPSS software (version 20.0) was used for data analysis. The χ² test was used for statistical analyses.ResultsThe rate of caesarean deliveries was much higher in women with multiple pregnancies (85.8%) than that in women with singleton pregnancies (42.6%, χ² = 190.8, P < 0.001). The incidences of anemia (χ² = 40.023, P < 0.001), preterm labor (χ² = 1021.172, P < 0.001), gestational diabetes mellitus (χ² = 9.311, P < 0.01), hypertensive disorders (χ² = 122.708, P < 0.001) and post-partum hemorrhage (χ² = 48.550, P < 0.001) was significantly increased with multiple pregnancy. In addition, multiple pregnancy was associated with a significantly higher rate of small-for-gestational-age infants (χ² = 92.602, P < 0.001), low birth weight (χ² = 1141.713, P < 0.001), and neonatal intensive care unit (NICU) admission (χ² = 340.129, P < 0.001).ConclusionsMultiple pregnancy is a significant risk factor for adverse maternal and neonatal outcomes in Beijing. Improving obstetric care for multiple pregnancy, particularly in reducing preterm labor, is required to reduce the risk to mothers and infants.     

National trends in insulin resistance and β-cell dysfunction among adults with prediabetes: NHANES 2001–2016

BackgroundInsulin resistance is the central abnormality and mechanism underlying the progression of cardiometabolic-based chronic diseases. This study aimed to evaluate the trends in insulin resistance and β-cell dysfunction from 2001 to 2016 among US adults with undiagnosed diabetes, prediabetes, and normal glucose regulation and to provide sex-specific information using data from National Health and Nutrition Examination Surveys (NHANES) 2001–2016.MethodsData from 14,481 participants aged over 20 years from 8 consecutive 2-year cross–sectional cycles of the NHANES from 2001 to 2016 were used. Updated homoeostasis model assessment 2 (HOMA2: HOMA2%B for β-cell function and HOMA2IR for insulin resistance) was used as a surrogate measure. We defined the upper sex-specific tertile of HOMA2IR as insulin resistance and the lower corresponding tertile of HOMA2%B as low β-cell function.ResultsIn both sexes with undiagnosed diabetes, HOMA2%B (men, P_trend = 0.118; women, P_trend = 0.184) and HOMA2IR (men, P_trend = 0.710; women, P_trend = 0.855) remained stable over time. In the prediabetes group, both sexes exhibited significant increasing trends in HOMA2%B (men, P_trend < 0.010; women, P_trend < 0.010) and HOMA2IR (men, P_trend < 0.010; women, P_trend < 0.050). Adjusting for waist circumference mildly attenuated the trend in HOMA2IR and insulin resistance in men (P_trend < 0.010), but it resulted in no significance in women (P_trend = 0.196). In regard to normal glucose regulation, both sexes presented significant decreasing trends in low β-cell function (men, P_trend < 0.050; women < 0.010) and attenuated trends in insulin resistance (men, P_trend = 0.196; women, P_trend = 0.121).ConclusionsOver 16 years, insulin resistance demonstrated an increasing trend in adult US population with prediabetes, while β-cell function showed a compensatory increasing trend. Identifying people with prediabetes early and focusing on reducing insulin resistance as the intervention core, especially controlling central obesity, might increase the opportunity for cardiovascular and diabetes risk reduction.Keyterms: Insulin resistance, β cell dysfunction, Diabetes mellitus, Prediabetes     

Clinical observation and therapeutic evaluation of intravenous pump of recombinant human endostatin combined with TP regimen in treating patients with advanced ovarian cancer

ObjectivesTo observe the curative effects and adverse reactions of recombinant human (rh)-endostatin injection combined with a TP regimen for treating patients with advanced ovarian cancer.MethodsFifty-four patients with pathologically confirmed ovarian cancer were randomly divided into a combined treatment (intravenous pump of rh-endostatin + TP regimen) group and a control (single chemotherapy) group, twenty-seven patients in each group. All patients were given a conventional CT examination. The level of vascular endothelial growth factor (VEGF), the size of tumor before treatment, after 2 cycles and after 4 cycles of treatment were determined for the comparison of curative effects and adverse reactions.ResultsThe effective rate was 37.0% (10/27) and disease control rate was 63.0% (17/27) in the combined treatment group after 2 cycles of treatment. The effective rate was 25.9% (7/27) and disease control rate was 63.0% (17/27) in the control group. The comparison between these two groups showed no significant differences (P > 0.05). The effective rate was 63.0% (17/27) and disease control rate was 92.6% (25/27) in the combined treatment group after 4 cycles of treatment. The effective rate was 29.6% (8/27) and disease control rate was 63.0% (17/27) in the control group. The effective rate and disease control rate between these two groups after 4 cycles of treatment showed significant differences (P < 0.05). The incidences of cardiovascular toxicity, myelosuppression, sore muscles and joints, alopecia and gastrointestinal reaction was not significantly different between two groups (P > 0.05).ConclusionThe pump delivery of rh-endostatin can down-regulate the expression of VEGF in ovarian cancer and has the better curative effect and slighter adverse reactions.     

Lifestyle intervention for gestational diabetes mellitus prevention: A?cluster-randomized controlled study

ObjectiveThe study was to examine whether gestational diabetes mellitus (GDM) can be prevented by early trimester lifestyle counseling in a high-risk population.MethodsFrom September 2012 to January 2013, 1664 pregnancies in the Department of Obstetrics and Gynecology of First Hospital of Peking University were enrolled in the study during their first prenatal care visit before the 8 gestational weeks visit and asked to fill out a questionnaire on GDM risk evaluation. According to the questionnaire and medical records, those with at least one risk factor of GDM were included in the intervention study and randomly allocated to two groups, intervention group and control group. Routine prenatal care was offered, while standardized two-step lifestyle intervention was provided to the intervention group during 6–8 gestational weeks, and at 12–13 gestational weeks, enforcement intervention based on maternal anthropometrics were offered. Both groups were followed until 75 g oral glucose tolerance test (OGTT) testing at 24–28 gestational weeks. The weight gain after intervention and the prevalence of GDM were used to evaluate the effect.Results(1) According to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, the positive rate of GDM for the intervention group was 17.16% (23/134), lower than the control group which was 23.91% (33/138), P = 0.168. (2) The weight gain during the first and second trimester for the intervention group was (1.38 ± 2.34) kg and (5.51 ± 2.18) kg, lower than in the control group which was (1.41 ± 2.58) kg and (5.66 ± 2.25) kg, (P = 0.905, P = 0.567). (3) Positive rate of GDM for those fasting plasma glucose (FPG) ≥5.1 mmol/L during early pregnancy was 11/36 (30.55%) for the intervention group that was lower than 17/37 (45.95%) for the control group, but the statistical difference was not significant (P = 0.076).ConclusionThe positive rate of GDM could be reduced by a certain amount lifestyle intervention from the beginning of pregnancy. More validated effective intervention should be explored in the high-risk pregnant women.     

Polymer-free versus permanent polymer drug eluting stents in coronary artery disease: A meta-analysis of 10 RCTs with 6575 patients

BackgroundPermanent polymer drug eluting stents (PP-DES) may induce inflammation of the vessel wall due to the existence of the polymer, which may delay intimal healing. Polymer-free DES (PF-DES) that eliminate the polymeric carrier may potentially lead to safer DES. However, the safety and efficacy of PF-DES remains controversial.MethodsRandomized controlled trials comparing PF-DES with PP-DES were searched in online database including MEDLINE, Excerpta Medica Database (EMBASE) and Cochrane Library. Studies reporting late lumen loss (LLL), all-cause death, myocardial infarction (MI), target lesion revascularization (TLR) and late stent thrombosis (LST) were enrolled and quantitatively analyzed.ResultsTen studies enrolling 6575 patients were included in this meta-analysis. The PF-DES showed a benefit in reducing all-cause death (OR = 0.77, 95% CI: 0.61 to 0.98, P = 0.03) and long-term LLL (weighted mean difference (WMD) −0.16 mm, 95% CI: −0.22 to −0.11 mm, P < 0.001), while no superiority was found in reducing short-term LLL (WMD 0.03 mm, 95% CI: −0.07–0.13 mm, P = 0.57), MI (OR = 1.12, 95% CI: 0.19 to 23.18, P = 0.39), TLR (OR = 1.19, 95% CI: 0.42 to 3.38, P = 0.83) and LST (OR = 0.92, 95% CI: 0.05 to 5.71, P = 0.74).ConclusionPF-DES showed benefits in reducing long-term LLL and mortality compared with PP-DES, but no superiority was found in short-term LLL, MI, TLR and LST. These findings provide a sound basis for the wide application of PF-DES in the future.     

A meta-analysis of the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis versus patients with stage IIIb/c or IV breast cancer

ObjectiveTo systematically evaluate the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis (SLNM) versus patients with stage IIIb/c or IV breast cancer, so as to provide evidence for clinical practice and research.MethodsComputer retrieval from PubMed, Cochrane Libratory, CNKI (China National Knowledge Infrastructure), CBM and Wanfang Database with the assistance of other retrieval tools. All the studies evaluating the prognosis in patients with breast cancer with ipsilateral supraclavicular lymph node metastasis versus patients with stage IIIb/c or IV breast cancer were collected. Quality assessment was performed for the included data based on the quality assessment criteria appropriate for this study. Meta-analysis was performed using RevMan 5.3 software.ResultsA total of four references (1277 patients) were included. Assessment of influences on prognosis: As compared to the stage IIIb/c group, the 5-year survival rate was slightly lower in the SLNM group (relative risk (RR) 0.79; 95% confidence interval (CI) 0.59–1.06; Z = 1.55, P = 0.12), but there was no statistical significance; in contrast, the 5-year survival rate was significantly increased in the SLNM group as compared to the stage IV group (RR = 2.70; 95%CI: 1.36–5.37; Z = 2.84, P = 0.005). As compared to the stage IIIb/c group, the 5-year disease-free survival rate was lower in the SLNM group (RR = 0.65; 95%CI: 0.40–1.05; Z = 1.75, P = 0.08); however, there was no statistical significance.ConclusionsIn patients with advanced breast cancer receiving combined therapy, the prognosis in patients with breast cancer with ipsilateral SLNM was significantly better than in those with stage IV breast cancer, and slightly worse than those with stage IIIb/c breast cancer. However, with the scarcity and poor quality of these observational studies, the long-term prognosis remains to be further verified in large-sample, high-quality studies.     

Clinical analysis of retroperitoneoscopic nephroureterectomy for renal tuberculosis

ObjectivesTo explore the feasibility and safety of retroperitoneoscopic nephroureterectomy for kidney tuberculosis.MethodsForty-eight retroperitoneoscopic nephroureterectomies and thirty-five nephroureterectomies for kidney tuberculosis procedures were performed from June 2008 to December 2014. The patients consisted of 53 males and 30 females with a mean age of 36 years (range: 26–51 years). The patients'' data were reviewed and analyzed.ResultsThe retroperitoneoscopic nephroureterectomy procedures were completed successfully in 48 cases with no conversions to open surgery. The mean operating time was 170 minutes (range: 121–258 minutes), the mean blood loss was 110 ml (range: 70–250 ml), and the mean hospital stay was 5.70 days (range: 5–14 days); these were all much less than nephroureterectomy procedures (P < 0.05). A total of five minor complications (10.4%) occurred, injury to the peritoneum was observed in three patients, and infection at the incision site was observed in two patients, there were no obvious difference between the two surgical methods (P > 0.05). Seventy-five patients were followed up, and the average follow-up time was 12.5 months (range: 6–20 months). All the patients recovered without any lesions remaining.ConclusionsThe results of this study indicate that retroperitoneoscopic nephroureterectomy is a feasible, safe, effective, and less invasive treatment modality for treating renal tuberculosis.     

Decrease with aging of the microcirculatory function of the lumbar vertebral marrow preceding the loss of bone material density and the onset of intervertebral discal degeneration: A study about the potential cause

ObjectiveUsing a dynamic computed tomographic perfusion (CTP) imaging method to explore the age-related distribution of the microcirculation perfusion function in the vertebral marrow, the bone material density (BMD), and the intervertebral discal degeneration (IDD). Further, to discuss a possible causation relationship between them.MethodsOne hundred and eighty-six people were randomly enrolled by stratified sampling and grouped by age: ≤15, 16–25, 26–35, 36–45, 46–55, 56–65, 66–75, and ≥76 years old. The average CTP and BMD of the third and fourth lumbar vertebrae marrow were measured and the IDD incidence of the third-fourth vertebrae was assessed. The temporal–spatial distribution patterns of the age-related changes of the CTP, BMD, and IDD were described, and the correlations between them were calculated.ResultsThe microcirculatory perfusion function of the vertebral marrow develops to maturity by 25 years and is maintained until age 35, then declines with aging. The BMD grew to a peak from 26 to 45 years old, then decreased yearly. The IDD showed a sudden increase after 45 years of age. The CTP [BF (r = 0.806, P = 0.000), BV (r = 0.685, P = 0.005) and PMB (r = 0.619, P = 0.001)] showed strong positive correlations and CTP [TTP (r = −0.211, P = 0.322) and MTT (r = −0.598, P = 0.002)] showed negative correlations with BMD. The CTP [BF (r = −0.815, P = 0.000), BV (r = −0.753, P = 0.000) and PMB (r = −0.690, P = 0.000)] had strong negative correlations, and CTP [TTP (r = 0.323, P = 0.126) and MTT (r = 0.628, P = 0.001)] had positive correlations with the incidence of IDD.ConclusionThe decrease with aging of the microcirculatory perfusion in the lumbar vertebral marrow preceded, and is a potential causative factor for the loss of BMD and the onset of IDD.     

Short- and long-term outcomes of kidney transplants with kidneys lavaged by retrograde perfusion technique

ObjectiveTo evaluate the clinical safety and efficacy of the retrograde perfusion technique in kidney transplantation.MethodsBetween January 2001 and June 2011, 24 cases of kidney transplantation with kidneys perfused using the retrograde perfusion technique due to renal artery variations or injury were selected as the observation group (retrograde perfussion group, RP group). Twenty-two cases of kidney transplantation via conventional perfusion were chosen as the control group (antegrade perfussion group, AP group). There were no statistically significant differences in donor data between the two groups. Cold ischemia time, warm ischemia time, renal perfusion time, amount of perfusion fluid, acute renal tubular necrosis, wound infection, urinary fistula, graft kidney function, and the 1-year, 3-year, and 5-year survival rates for the grafted kidney in both groups were observed and recorded.ResultsThe kidney perfusion time was shorter in the RP group than that in the AP group (3.14 ± 1.00 vs. 5.02 ± 1.15 min, P = 0.030). There were 10 cases of acute renal tubule necrosis in the RP group and 5 in the AP group. The length of hospital stay was 40 ± 14 d in the RP group and 25 ± 12 d in the AP group. The follow-up time was 3.5–8.5 years (mean 6.25 years). The 1-, 3-, and 5-year survival rates for the grafted kidney were 95.8%, 75.5%, and 65.5% in the RP group and 97.1%, 82.5%, and 68.4% in the AP group, respectively (P>0.05).ConclusionsThis study indicates that retrograde perfusion is safe and practicable for cadaveric kidney harvesting and can be regarded as a better alternative or remedial measure for a poorly perfused kidney due to vascular deformity or injury.     

Influence of Tirofiban maintenance duration on patients with acute myocardial infarction treated by percutaneous coronary intervention

ObjectiveTo evaluate the efficacy and short term prognosis of Tirofiban in different treatment duration in patients with acute ST segment elevation myocardial infarction (STEMI) and percutaneous coronary intervention (PCI) combined with intracoronary injection.MethodsA total of 125 patients with acute STEMI were enrolled in this study. They were randomly divided into two groups: control group (n = 61) and Tirofiban group (n = 64). The Tirofiban was used by intracoronary and intravenous administration in Tirofiban group which was randomly divided into three sub-groups according to the duration of Tirofiban by persistent intravenous injection for 12 hours, 24 hours or 36 hours. Thrombolysis in myocardial infarction flow and myocardial perfusion grades were recorded immediately after PCI. The adverse cardiac events and cardiac death within 180 days of PCI, and the adverse effects (hemorrhage and thrombocytopenia) were compared between the two groups and within Tirofiban sub-groups.ResultsGrade 3 in myocardial perfusion was significantly better in Tirofiban group than control group (85.94% vs. 72.13%, P = 0.03) after PCI. There was one cardiac death in control group in 180 days after PCI. The adverse cardiac event rates between two groups was significant difference (16 patients in control group and only 8 in Tirofiban group, P = 0.047). There was no significant difference in incidence of hemorrhage complications and platelet counts between two groups. Nevertheless, hemorrhage complications in the 12- and 24-hour subgroups were less than 36-hour subgroup (P = 0.01).ConclusionsIntravenous Tirofiban treatment reduced the adverse cardiac events and improved short term prognosis without increasing the adverse reactions of the drugs in patients undergoing PCI. The less rate of hemorrhage complication can be achieved in short-duration of Tirofiban by intravenous injection after PCI.     

Respiratory questionnaire‐based analysis of awareness of COPD in a large multicenter rural population‐based study in India

BackgroundChronic obstructive pulmonary disease (COPD) is a more prevalent chronic lung disease with a significant health burden, and the majority of these cases receive inadequate treatment.MethodsProspective, observational, interview (questionnaire) based complete workup COPD study, screened 12,000 cases with chronic respiratory symptoms with cough, sputum production, and shortness of breath. A total of 6000 COPD cases were enrolled after the spirometry test. COPD cases were assessed as disease knowledge and methods of treatment offered by applying questionnaires to patients and treating physicians.ResultsIn the present study, 3% of study cases were aware of their COPD illness, 54% were not having knowledge about the disease, and 43% cases were not accepting the COPD diagnosis (p < 0.0001). A total of 58% of cases received inhalation treatment as levosalbutamol monotherapy in 31% cases, levosalbutamol plus beclometasone in 18% cases, and formoterol plus budesonide or salmeterol plus fluticasone only in 9% of COPD cases (p < 0.0001). Total 42% cases received oral treatment as theophylline in 16% cases, salbutamol in 7% cases, oral steroids in 19% cases (p < 0.0001).Conclusion“Doctor–patient–drug trio” discordance clubbed as “difficult doctor, difficult patient, and difficult treatment” is a very crucial issue observed during diagnosis and management of COPD in peripheral settings in India.     

Screening of malnutrition using Patient‐Generated Subjective Global Assessment tool and hand muscle strength in subjects with pancreatitis

BackgroundPancreatitis patients are at an increased risk of malnutrition due to impaired digestion, absorption, and metabolism. The degree of malnutrition is dependent on the duration, viz. acute or chronic. Studies on nutritional status in patients with pancreatitis are limited. Prevalence of nutritional status, physical functioning, and muscle strength among the subjects are scarce globally. The main aim of this study was to screen the status of malnutrition using appropriate screening tools and to assess hand muscle strength among subjects.MethodA cross‐sectional study was conducted on 64 subjects (18–80 years old, 59 males and 5 females) in Mysore city, Karnataka. The patients were screened for malnutrition using a standard tool Patient‐Generated Subjective Global Assessment (PG‐SGA) and handgrip strength on both dominant and nondominant hands.ResultsThe majority of patients (n = 44) were categorized as moderately malnourished/suspected malnutrition (Stage B) according to PG‐SGA. A significant difference (p < 0.005) in handgrip strength was seen in men aged 31–40 (t = −3.287) and 41–50 (t = −5.487) years compared to healthy adults.ConclusionThis study was able to identify patients at risk of malnutrition when the PG‐SGA tool was used along with handgrip strength and other anthropometric parameters.     

Impact of elevated aspartate and alanine aminotransferase on metabolic syndrome and its components among adult people living in Ningxia,China

ObjectiveMetabolic syndrome (MS) is a combination of medical disorders that increase the risk for cardiovascular disease and diabetes mellitus. It suggests an association between an elevated serum aminotransferase level and MS. Little data show the relationship between the levels of serum aminotransferase and the incidence of MS in Ningxia, China.MethodsA total of 5415 subjects who received medical health checkups from 2007 to 2009 were enrolled in the study. The participants were interviewed by trained health workers under a structured questionnaire. MS was defined according to the modified ATPIII criteria for Asian Americans by the American Heart Association (AHA-ATP III).ResultsThe prevalence of elevated aspartate aminotransferase (AST) and ALT (>40 U/L) were 7.1% and 22.2% in males, and 2.1% and 4.8% in females respectively. The prevalence of MS was 32.1% in males and 15.4% in females. The components of MS were significantly more in the group with elevated aminotransferase levels than in the group with normal aminotransferase levels. The odds ratios (95% CI) for elevated AST were 1.90 (1.49, 2.42), 2.59 (2.01, 3.39), 1.68 (1.32, 2.15), and 1.81 (1.36, 2.42) in the adults with abdominal obesity, high serum triglycerides levels, high blood pressure, and high plasma glucose levels respectively. After adjustment for age, the odds ratios (95% CI) for elevated ALT were 3.08 (2.63, 3.61), 4.30 (3.64, 5.08), 1.26 (1.08, 1.48), 2.16 (1.93, 2.65) and 2.38 (1.96, 2.87) in adults with abdominal obesity, high serum triglycerides levels, low serum high-density lipoproteincholesterol (HDL-C), high blood pressure, and high plasma glucose levels respectively. The odds ratios (95% CI) for elevated AST were 1.67 (1.06, 2.63), 2.28 (1.46, 3.63), 2.59 (1.59, 4.21) and for elevated ALT 2.02 (1.50, 2.73), 2.68 (1.96, 3.65), 3.94 (2.86, 5.43) for the subjects with 1, 2, and ≥3 risk factors after adjustment for age, gender, and BMI.ConclusionThe serum aminotransferase levels were higher in males compared to females, and serum ALT level was more closely associated with MS than the AST level in adults in Ningxia, China. With an increasing the number of components of MS, the aminotransferase levels and the risks for elevated aminotransferase increase, whereas the AST/ALT ratios decrease.     

Changes in body composition in relation to estimated glomerular filtration rate and physical activity in predialysis chronic kidney disease

BackgroundEarly body composition changes, associated with physical inactivity and disease advancement are devastating for patient‐related outcomes in predialysis chronic kidney disease (CKD), thus warranting a detailed analysis of body composition beyond conventional measures.MethodsThe study included 40 subjects diagnosed with CKD; recruited between January to May 2021. Body composition was measured using the multifrequency analyzer, InBody 770. International Physical Activity Questionnaire‐Short Form was used to assess physical activity. Suitable statistical analyses were performed using SPSS 21.0.ResultsThe mean age of the subjects was 58.68 ± 12.24 years. Sarcopenic obesity was prevalent in 62.5% of the subjects. Body mass index under identified obesity by 15% compared to percent body fat, especially in subjects with low muscle mass. The decline in a unit of estimated glomerular filtration rate (eGFR) significantly correlated with a decrease in weight (p = 0.02), body fat mass (p = 0.05), visceral fat area (p = 0.05), and phase angle (p = 0.01) with marginal changes in waist–hip ratio and extracellular water/total body water. The effect of physical activity on skeletal muscle mass was homogeneous between low and moderate levels, but significantly different from high activity level.ConclusionChanges in fat and fluid compartment were associated with eGFR decline, whereas higher physical activity positively affected body composition.     

Comparison of circumferential pulmonary vein anatomy mapping guided by 3D mapping versus a mesh mapping catheter

ObjectiveCatheter-based pulmonary vein isolation (PVI) is an established therapy for paroxysmal atrial fibrillation. The high-density mesh mapper (HDMM) guides circumferential PV-atrium isolation without the 3D electroanatomic mapping. This study aims to compare circumferential pulmonary vein (CPV) anatomy mapping between guiding by a 3D mapping system and the HDMM.MethodsForty-four consecutive patients with paroxysmal atrial fibrillation were scheduled for a first procedure for PVI. A CPV ostial anatomy map guided by HDMM was set up in the CARTO system while the operator was blinded to the CARTO screen. Then CARTO-guided ipsilateral PV maps were obtained and PVI was performed. This established another set of CPV ostial anatomy maps. The differences between the two mapping images were compared and analyzed.ResultsAll 176 PVs in 44 patients could be mapped by both HDMM and CARTO. About 44.9% of the PV ostial anatomies were generally similar between the two different map images. The average point-to-point straight distance between the HDMM-guided map and the CARTO-guided map was 6.2 ± 1.4 mm. The area of the circumferential right PV (CRPV) in the HDMM map was larger than that in the CARTO map (P = 0.013). After a mean follow-up of 18.3 ± 4.3 months (6–24 months), 72.7% of patients (32/44) were free of atrial arrhythmia without anti-arrhythmic drugs (AADs).ConclusionCompared to the CARTO-guided CPV anatomy image, a highly similar figure could be achieved by mapping guided by the HDMM. (Clinical trial.gov number, ChiCTR-TNRC-11001390.)     

Mental health outcomes among patients from Fangcang shelter hospitals exposed to coronavirus disease 2019: An observational cross-sectional study

Background: The coronavirus disease 2019 (COVID-19) is not only attacking physical health, but it is also increasing psychological suffering. This study aimed to observe the impact of the COVID-19 pandemic on mental health outcomes among patients with mild to moderate illness in Fangcang shelter hospitals.Methods: We conducted an observational, cross-sectional study of 129 patients with mild to moderate illness from Jiangxia Fangcang shelter hospitals in Wuhan, China. The participants were assessed by quantifying their symptoms of depression, anxiety, insomnia, and stressful life events and analyzing potential risk factors associated with these symptoms. Using correlation analysis, we examined associations between exposure to COVID-19 and subsequent psychological distress in response to the outbreak.Results: In total, 49.6% of participants had depressive or anxiety symptoms. The depressive and anxiety symptoms were highly related to sleep disturbances and hypochondriasis (allr > 0.50,P < 0.01). The impact of the event was positively related to depressive symptoms, anxiety symptoms, sleep disturbances, hypochondriasis and life events (allr > 0.35,P < 0.01) but was negatively related to psychological resilience (r = -0.41,P < 0.01). The presence of the COVID-19 infection in this setting was associated with increased anxiety, depression and stress levels, and decreased sleep quality, and seriously affected patients’ quality of life as well as adversely affecting the course and prognosis of physical diseases.Conclusion: The sleep quality, anxiety, and depression of COVID-19 patients in Fangcang shelter hospitals were significantly related to the impact of the epidemic.     

Potential role of pemetrexed in metastatic breast cancer patients pre-treated with anthracycline or taxane

ObjectivesThis article reviews pharmacology, pharmacokinetic properties, clinical efficacy, and safety in metastatic breast cancer patients, as well as the predictive biomarkers for outcome of treatment with pemetrexed-based regimens.MethodsPubMed, Embase, OVID, and the Cochrane Library databases were searched from the beginning of each database without any limitations to the date of publication. Search terms were ‘‘pemetrexed’’ or ‘‘{"type":"entrez-nucleotide","attrs":{"text":"LY231514","term_id":"1257767600","term_text":"LY231514"}}LY231514’’ or “Alimta”, “metastatic breast cancer”, and “advanced breast cancer”.ResultsThere were 15 studies (n = 1002) meeting our criteria for evaluation. Eight single-agent trials (n = 551) and seven using combinations with other agents (n = 451) were identified that evaluated pemetrexed for use in patients with metastatic breast cancer. Response rates to pemetrexed as a single agent varied from 8% to 31%, and with combination therapy have been reported to be between 15.8% and 55.7%. With routine supplementation of patients with folic acid, dexamethasone, and vitamin B₁₂, the toxicity profile of these patients was mild, including dose-limiting neutropenia and thrombocytopenia, as well as lower grades of reversible hepatotoxicity and gastrointestinal toxicity. Expression of thymidylate synthase (TS) and other biomarkers are associated with the prognosis and sensitivity for pemetrexed in breast cancer.ConclusionPemetrexed has shown remarkable activity with acceptable toxicities for treatment of metastatic breast cancer patients. Translational research on pemetrexed in breast cancer identified biomarkers as well as additional genes important to its clinical activity and toxicity. Further research is needed to clarify the role of pemetrexed in breast cancer treatment in order to guide oncologists.     

Recombinant human erythropoietin accelerated the proliferation of non‐small cell lung cancer cell lines and reduced the expression of VEGF,HIF‐1α, and PD‐L1 under a simulated hypoxic environment in vitro

BackgroundAs erythropoietin (EPO) has been used to treat anemia in cancer patients, negative controversy has continued. Unfortunately, its effects on non‐small‐cell lung carcinoma (NSCLC) cell lines are uncertain and the phenomenon of inducing immune escape of tumor cells remains to be explored. This study aimed to provide an important basis for the application of exogenous EPO in the treatment of tumor‐associated anemia.MethodsCells were cultured in 1% O₂, 5% CO₂, and 94% N₂ to simulate a hypoxic environment of the tumor. A549 cell line (lower expression EPOR) and NCI‐H838 cell line (higher expression EPOR) were treated with 2 and 8 U/ml recombinant human EPO (rhEPO). CCK‐8 method was used to determine the logarithmic growth phase of the cells and to detect cell proliferation. The expression levels of VEGF, HIF‐1α, and PD‐L1 were determined by western blot. One‐way ANOVA was used for statistical analysis between groups, with p < 0.05 indicating a significant difference.ResultsHypoxia itself could decrease the survival rate of NSCLC cells. Under the hypoxic condition, rhEPO induced tumor cells proliferation, especially in the NCI‐H838 cell line, where 2 U/ml rhEPO increased the total number of surviving cells (Hypoxia + rhEPO 2 U/ml vs. Hypoxia, p < 0.05). Western blot analysis showed that hypoxia upregulated the expression of VEGF, HIF‐1α, and PD‐L1 in NSCLC cell lines (Normoxia vs. Hypoxia, p < 0.05), but may not be dependent on the expression levels of EPOR. RhEPO decreased the expression levels of VEGF and HIF‐1α. In the A549 cell line, it depended on the concentration of rhEPO and was particularly obvious in HIF‐1α (Hypoxia vs. Hypoxia + rhEPO 2 U/ml vs. Hypoxia + rhEPO 8 U/ml, p < 0.05). A low concentration of rhEPO may not reduce VEGF expression. In the NCI‐H838 cell line, the effect of rhEPO on VEGF was more obvious, but it may be independent of rhEPO concentrations. The downregulation of PD‐L1 expression by rhEPO was only presented in the A549 cell line and required higher rhEPO concentrations (Hypoxia + rhEPO 8 U/ml vs. Hypoxia&Hypoxia + rhEPO 2 U/ml, p < 0.05).ConclusionThe effect of prolonged high concentrations of rhEPO under hypoxic conditions resulted in accelerated cells proliferation of non‐small‐cell lung cancer and was independent of EPOR expression levels on the cell lines surface. Hypoxia resulted in increased expression of VEGF, HIF‐1α, and PD‐L1 on the NSCLC cell lines. Under normoxic conditions, rhEPO did not affect the expression of VEGF, HIF‐1α, and PD‐L1; but under hypoxic conditions, the application of rhEPO reduced the expression of VEGF, HIF‐1α, and PD‐L1, producing an impact on the biological behavior of tumor cells.     

Cognitive deficiency,parental relationship,and coping strategies are related with anxiety and depression among parents of children with epilepsy

BackgroundThe diagnosis of epilepsy in a child often and understandably causes psychological adjustment difficulties in the parents. To help parents of children with epilepsy cope with stress, it is important to understand how parents cope with the sickness of their child. The objective of this study was to assess factors related to the state of anxiety and depression among parents of children with epilepsy.MethodsThe present study was a cross‐sectional study, and the data were collected through an anonymous, Internet‐based survey platform between October 2018 and October 2019 from 250 participants aged 22–65 years. Participants were invited to fill questionnaires include socioeconomic questionnaire, anxiety, depression, and coping strategies scale.ResultAmong the parents of children with epilepsy, 48.8% (122/250) had depressive symptoms (Patient Health Questionnaire‐9 [PHQ‐9] score >4) and 46.4% (116/250) had anxiety symptoms (7‐item Generalized Anxiety Disorder [GAD‐7] score >5). Depression among parents of children with epilepsy was significantly associated with comorbidity (odds ratio [OR] = 0.392, 95% CI = 0.182–0.846), a poor parental relationship (OR = 0.283, 95% CI = 0.130–0.614), positive coping (OR = 0.947, 95% CI = 0.903–0.992), and negative coping (OR = 1.287, 95% CI = 1.179–1.405). Anxiety among parents of children with epilepsy was significantly associated with a poor parental relationship (OR = 0.416, 95% CI = 0.207–0.835) and negative coping (OR = 1.155, 95% CI = 1.087–1.228).ConclusionsThe present study indicates the importance of couple support and providing effective coping to make parents of children with epilepsy more resilient in the presence of negative life events, especially for parents of children with comorbidity with cognitive deficiency.