Incremental burden of cardiovascular comorbidity and psoriatic arthritis among adults with moderate-to-severe psoriasis in five European countries

BACKGROUND

Moderate-to-severe psoriasis is associated with reduced health-related quality of life (HRQoL). Individuals with psoriasis are at increased risk for other medical conditions, but little information quantifies the incremental burden of psoriasis-associated comorbidity among European adults, and data have generally been limited to clinical samples.

OBJECTIVE

To quantify the incremental burden of cardiovascular comorbidity and psoriatic arthritis among adults with moderate-to-severe psoriasis in the general population of France, Germany, Italy, Spain and the United Kingdom (EU5).

METHODS

All measures were self-reported and came from the 2010-2013 EU5 National Health and Wellness Surveys (NHWS). Moderate-to-severe psoriasis was identified by >10% body surface area affected by psoriasis and/or use of therapies for moderate-severe disease. Outcomes were SF-12v2/SF-36v2 mental and physical component summary scores (MCS and PCS, respectively), SF-6D health utility, Work Productivity and Activity Impairment (WPAI) questionnaire and healthcare use in the past 6 months. Generalized linear models compared across cardiovascular comorbidity (CV) or psoriatic arthritis (PsA) groups vs. non-CV or non-PsA groups with appropriate link functions to adjust for covariates.

RESULTS

Among moderate-to-severe psoriasis respondents (n = 957), 19.8% (n = 190) reported CV comorbidity and 12.3% (n = 118) reported PsA. After adjustment for covariates, CV comorbidity was associated with 3.0 points lower MCS, 3.4 points lower PCS and 0.05 points lower SF-6D (all P < 0.01). Likewise, they had greater mean work impairment (48% vs. 33%), more activity impairment (48% vs. 37%), and more healthcare provider visits (8.8 vs. 6.9), emergency room visits (0.65 vs. 0.31) and hospitalizations (0.61 vs. 0.22) (all P < 0.05). Compared to non-PsA respondents, PsA respondents also had worse mean MCS (2.6 points), PCS (6.3 points) and SF-6D scores (0.07 points), and more work impairment (52% vs. 34%), activity impairment (54% vs. 38%) and healthcare provider visits (10.5 vs. 6.9) (all P < 0.05).

CONCLUSION

CV comorbidity and PsA were associated with significant incremental burden among EU5 adults with moderate-to-severe psoriasis.

Rapid formation of Ni3Sn4 joints for die attachment of SiC-based high temperature power devices using ultrasound-induced transient liquid phase bonding process

High melting point Ni₃Sn₄ joints for the die attachment of SiC-based high temperature power devices was successfully achieved using an ultrasound-induced transient liquid phase (TLP) bonding process within a remarkably short bonding time of 8s. The formed intermetallic joints, which are completely composed of the refined equiaxial Ni₃Sn₄ grains with the average diameter of 2μm, perform the average shear strength of 26.7MPa. The sonochemical effects of ultrasonic waves dominate the mechanism and kinetics of the rapid formation of Ni₃Sn₄ joints.

[Analysis on the causes of unscheduled suspensions of knee and hip arthroplasty]

OBJECTIVE

To analyze and summarize the causes of unscheduled suspension of knee and hip arthroplasty and to provide the method for optimizing the patient's preoperative management and improving the efficiency of medical resources as well as the patient's satisfaction.

METHODS

The data for this report was retrospectively collected from September 2013 to August 2014 in our hospital, from cases of knee and hip arthroplasty that were suspended before the scheduled operation time. Acquisition data from the collected cases including the patients' gender, age and the surgical procedure. At the same time, the suspension reasons were recorded and analyzed. All the decisions of suspension was made by the surgeons and the anesthesiologists according to the abnormal result of preoperative examinations, after communicating with the patients and their families and obtaining their understandings.

RESULTS

In the collecting period, our department scheduled 1 146 cases of knee and hip arthroplasty, among which 1 003 were completed, 143 suspended (12.5% suspension rate). Among the causes of suspension, the top four common causes were cardiovascular disease (44/143, 31%), other infections (20/143, 14%), bacteriuria (18/143, 13%) and inappropriate surgical indication (16/143, 11%). Other causes include surgeon's reason, Blood system abnormalities, high inflammatory index, deep vein thrombosis, other diseases uncontrolled, abnormal liver function and poor diabetes mellitus control, etc. For the rate of suspension, there was no significant difference between the patients with different genders (male: 15.0%, and female: 11.7%, P=0.149), or age (≤50 years: 13.0%; 51-65 years: 11.6%; 66-80 years 13.3%; >80 years 11.1%; P=0.864). However compared with knee arthroplasty, hip arthroplasty had a higher suspension rate (knee arthroplasry 11.1%, hip arthroplasry 16.1%, P=0.021).

CONCLUSION

It is important to educate and manage the patients before their knee and hip arthroplasty. Through clear diagnosis, detailed medical history analysis careful physical examination, and targeted outpatient examinations and tests for which priority was focused on cardiovascular or other system diseases we could minimize the occurrence of operative suspension post hospitalization, therefore improving the efficiency of the use of medical resources.

[Mediator effect analysis of the trait coping style on job stress and fatigue of the military personnel stationed in plateau and high cold region]

Objective: To investigate the fatigue status of military personnel stationed in plateau and high cold region, and to analyze the mediator effect of trait coping style on job stress and fatigue. Methods: In October 2010, with the method of cluster random sampling survey, 531 military personnel stationed in plateau and high cold region were chosen as subject. The fatigue status were evaluated by the Chinese version multidimensional fatigue inventory (MFI-20) , job stress were evaluated by the Job Stress Survey (JSS) , and trait coping style were evaluated by the Trait Coping Style Questionnaire (TCSQ) . Results: According to the information of different population characteristics, mean rank of physical fatigue about the urban (town) group were higher than that of rural group (Z=-2.200, P<0.05) ; mean rank of reduced motivation about the urban (town) group were higher than that of rural group (Z=-2.781, P<0.05) ; mean rank of general fatigue scores about the urban (town) group were higher than that of rural group (Z=-3.026, P<0.05) ; mean rank of physical fatigue about the up or equal 20-years old age group were higher than that of below 20-years old age group (Z=-4.045, P<0.05) ; mean rank of reduced motivation about the up or equal 20-years old age group were higher than that of below 20-years old age group (Z=-2.182, P<0.05) ; mean rank of mental fatigue about the up or equal 20-years old age group were higher than that of below 20-years old age group (Z=-2.879, P<0.05) ; mean rank of general fatigue scores about the up or equal 20-years old age group were higher than that of below 20-years old age group (Z=-3.647, P<0.05) ; mean rank of reduced motivation were significant statistical difference among the military officers, sergeancy and soldier group (F=18.965, P<0.05) ; mean rank of general fatigue scores were significant statistical difference among the military officers, sergeancy and soldier group (F=14.711, P<0.05) . The score of negative coping style were positively correlated with the score of physical fatigue (r(s)=0.129) , reduced activity (r(s)=0.123) , reduced motivation (r(s)=0.149) and general fatigue (r(s)=0.174) respectively, the score of organizational support lack strength were positively correlated with the score of physical fatigue (r(s)=0.090) , reduced activity (r(s)=0.098) , reduced motivation (r(s)=0.099) and general fatigue (r(s)=0.130) respectively. The mediator effect of negative coping style on the job stress and fatigue was 0.013 (P<0.01) . Conclusion: The fatigue statuses of the urban (town) group and the up or equal 20-years old age group are poor, and the negative coping style plays mediator effect on the job stress and fatigue.

Hypertensive disorders of pregnancy in women with gestational diabetes mellitus on overweight status of their children

Hypertensive disorders of pregnancy (HDP) as a group of medical complications in pregnancy are believed to be associated with an increased risk of poor fetal growth, but the influence on offspring’s body composition is not clear. The aim of the present study was to evaluate the association between maternal hypertensive disorders of pregnancy and overweight status in the offspring of mothers with gestational diabetes mellitus (GDM).

A cross-sectional study among 1263 GDM mother-child pairs was performed in Tianjin, China. General linear models and logistic regression models were used to assess the associations of maternal hypertension in pregnancy with anthropometry and overweight status in the offspring from birth to 1–5 years old.

Offspring of GDM mothers who were diagnosed with hypertensive disorders during pregnancy had higher mean values of Z scores for birth weight for gestational age and birth weight for length, and higher mean values of Z scores for weight for age, weight for length/height, and body mass index for age at 1–5 years old than those of GDM mothers with normal blood pressure during pregnancy. Maternal hypertensive disorders of pregnancy were associated with increased risks of large for gestational age (OR 1.74, 95%CI 1.08–2.79) and macrosomia (OR 2.02, 95%CI 1.23–3.31) at birth and childhood overweight/obesity at 1–5 years old age (OR 1.88, 95%CI 1.16–3.04).

For offspring of mothers with GDM, maternal hypertension during pregnancy was a risk factor for macrosomia at birth and childhood overweight and obesity, and controlling the maternal hypertension may be more important for preventing large for gestational age babies and childhood obesity.

[The multicenter study on the registration and follow-up of low anticoagulation therapy for the heart valve operation in China]

OBJECTIVE

To investigate the optimal anticoagulation methods and monitoring strategy for Chinese patients undergoing heart valve replacement, which is potentially quite different from western populations.

METHODS

In this multicenter prospective cohort study, the anticoagulation and monitoring strategy data was acquired from 25 773 in-hospital patients in 35 medical centers and 20 519 patients in outpatient clinic in 11 medical centers from January 1st, 2011 to December 31th, 2015.

RESULTS

As for in-hospital patients, mean age of study population was (48.6±11.2) years old; main etiology of valve pathology was rheumatic (87.5%) origin among study cohort; 94.8% of study population received mechanical valve implantation; international normalized ratio (INR) monitoring (in all the study centers) and low-intensity anticoagulation strategy (31 hospitals chose target INR range of 1.5-2.5, and actual values of INR among 89.2% of 100 069 in-hospital monitoring samples were 1.5-2.5), with mean actual INR values of 1.84±0.53, and warfarin dosage of (2.82±0.93) mg/d were widely adopted among the study centers; strategies of in-hospital warfarin administration were similar in all the study centers; complication rates of low-intensity anticoagulation strategy were low in severe hemorrhage (0.02%), thrombosis (0.05%), and thromboembolism (0.05%) events, without anticoagulation-related death.As for 18 974 outpatient clinic patients, the follow-up rate was 92.47%, with a total of 30 012 patient-years (Pty). Anticoagulation-related morbidity and mortality rates were 0.67% and 0.15% Pty; major hemorrhage morbidity and mortality rates were 0.25% and 0.13% Pty; thromboembolism morbidity and mortality rates were 0.45% and 0.03% Pty.The mean dosage of warfarin daily dosage was (2.85±1.23) mg/d and INR value was 1.82±0.57.No significant regional difference in the intensity of anticoagulation therapy was noted during the study.

CONCLUSIONS

INR can be used as a normalized indicator for intensity of anticoagulation therapy in China.The optimal anticoagulation intensity with INR range from 1.5 to 2.5 is safe and effective for Chinese patients with heart valve replacement, and there is no significant regional difference in the intensity of anticoagulation therapy.

[Comparision for clinical efficiency of continuous adductor canal block and femoral nerve block in total knee arthroplasty]

OBJECTIVE

To compare the pain control efficiency of continuous adductor canal block (ACB) and femoral nerve block (FNB) in total knee arthroplasty.

METHODS

From April to September 2016, patients with severe knee osteoarthritis undergoing primary unilateral total knee arthroplasty (TKA) were prospectively observed, and all the patients were randomized received ultrasound-guided continuous ACB or FNB after surgery. Numeric pain rating scales(NPRS)pain scores in rest and activity 2, 6, 12, 24 and 48 h after surgery were collected, and the preoperative and postoperative quadriceps strength at 24 and 48 h were analyzed. Opioids consumption and anesthesia related adverse effects were also recorded.

RESULTS

In the study, 40 patients were enrolled, with 20 patients in each group, male:female=7:33, the age: (63.8±10.1) years, and the body mass index (BMI): (28.5±3.5) kg/m(2).The general conditions were comparable between the two groups. Though the rest pain 2 h after surgery [ACB=0.0(0,6), FNB=3.0(0,5), P=0.004] and activity pain 12 h post operation [ACB=3.0(3,0), FNB=5.5(0,10), P=0.004] were lower in ACB group compared with FNB group, there was no statistical difference in the other pain checking points between the two groups. The quadriceps strength 24 h and 48 h after surgery were(85.3±27.6) N and (80.0±30.1) N in ACB group, (69.0±29.4) N and (64.4±32.0) N in FNB group, both of them were declined by time. The exact data were higher in ACB group, however, there was no statistical difference between the two group by repeated measurements variance analysis(F=2.703, P=0.108).Four patients in ACB group and five in FNB acquired additional use of dolantin once (100 mg/per time) within 24 h. And among them, three patients acquired once dolantin in ACB, two in FNB, from 24 to 48 h postoperation. There were five patients who suffered nausea postoperation in ACB group, and one who reported xerostomia. Four patients in FNB had nausea with vomiting, and three experienced xerostomia. Deep vein thrombosis appeared in 2 patients in FNB group, but no one in ACB group.

CONCLUSION

Continuous ACB is not superior in pain control after TKA compared with FNB, and the quadriceps strength could be reserved more by this method, which performed early benefits in fast rehabilitation.

Preparation and evaluation of a self-nanoemulsifying drug delivery system loaded with Akebia saponin D-phospholipid complex

BACKGROUND

Akebia saponin D (ASD) exerts various pharmacological activities but with poor oral bioavailability. In this study, a self-nanoemulsifying drug delivery system (SNEDDS) based on the drug-phospholipid complex technique was developed to improve the oral absorption of ASD.

METHODS

ASD-phospholipid complex (APC) was prepared using a solvent-evaporation method and characterized by infrared spectroscopy, differential scanning calorimetry, morphology observation, and solubility test. Oil and cosurfactant were selected according to their ability to dissolve APC, while surfactant was chosen based on its emulsification efficiency in SNEDDS. Pseudoternary phase diagrams were constructed to determine the optimized APC-SNEDDS formulation, which was characterized by droplet size determination, zeta potential determination, and morphology observation. Robustness to dilution and thermodynamic stability of optimized formulation were also evaluated. Subsequently, pharmacokinetic parameters and oral bioavailability of ASD, APC, and APC-SNEDDS were investigated in rats.

RESULTS

The liposolubility significantly increased 11.4-fold after formation of APC, which was verified by the solubility test in n-octanol. Peceol (Glyceryl monooleate [type 40]), Cremophor^® EL (Polyoxyl 35 castor oil), and Transcutol HP (Diethylene glycol monoethyl ether) were selected as oil, surfactant, and cosurfactant, respectively. The optimal formulation was composed of Glyceryl monooleate (type 40), Polyoxyl 35 castor oil, Diethylene glycol monoethyl ether, and APC (1:4.5:4.5:1.74, w/w/w/w), which showed a particle size of 148.0±2.7 nm and a zeta potential of -13.7±0.92 mV after dilution with distilled water at a ratio of 1:100 (w/w) and good colloidal stability. Pharmacokinetic studies showed that APC-SNEDDS exhibited a significantly greater C_max1 (733.4±203.8 ng/mL) than ASD (437.2±174.2 ng/mL), and a greater C_max2 (985.8±366.6 ng/mL) than ASD (180.5±75.1 ng/mL) and APC (549.7±113.5 ng/mL). Compared with ASD, T_max1 and T_max2 were both remarkably shortened by APC-SNEDDS. The oral bioavailability in rats was enhanced significantly to 183.8% and 431.8% by APC and APC-SNEDDS, respectively.

CONCLUSION

These results indicated that APC-SNEDDS was a promising drug delivery system to enhance the oral bioavailability of ASD.

[Assessment for pain control efficiency of ultrasound guided adductor canal block in total knee arthroplasty: a report of 28 continuous cases]

Objective: To assess the pain control efficiency of continuous adductor canal block in total knee arthroplasty. Methods: From October to December 2015, patients with severe knee osteoarthritis undergoing primary unilateral TKA were observed clinically.All of the patients received ultrasound-guided continuous adductor canal block after surgery.NPRS Pain score in rest and activity at 2, 6, 12, 24, 48 h after surgery were collected, preoperative and postoperative quadriceps strength at 24, 48 h were analyzed. Opioids consumption and anesthesia related adverse effects were also recorded. Results: All of the patients were enrolled. Rest pain control was fairly good(1.8±1.5), (2.4±1.5), (2.7±1.3), (2.7±1.7), (2.3±1.4) score, but the patients were not satisfied with activity pain control(3.1±2.1), (3.1±2.1), (4.2±2.2), (4.7±2.5), (6.2±2.4) score. There were statistically differences comparing the NPRS in rest pain with the score in activity, except for the results between each other at 6 hours (P=0.252>0.05)after surgery.The results showed no significant differences comparing quadriceps strengthpreoperatively with 24, 48 h postoperatively by repeated measurements variance analysis.Eight patients acquired additional use of dolantin once (100 mg/per time) within 24 h and among them three patients acquired once dolantin during 24 to 48 h. Eleven patients complained nausea postoperatively, one reported vomiting and one experienced xerostomia. Conclusion: Ultrasound-guided continuous adductor canal block can reduce resting pain after TKA, but has a limited effect in activity pain control.Quadriceps strength had been spared after ACB, which might performearly benefits in rehabilitation. ACB-related complications need further observation to be defined.

Mutation-based selection and analysis of Komagataeibacter hansenii HDM1-3 for improvement in bacterial cellulose production

AIMS

A low yield of bacterial cellulose (BC) always results from an excessive accumulation of organic acids. Screening and the selection of bacterial mutants with a low accumulation of organic acids is an efficient approach for improving BC production.

METHODS AND RESULTS

In combination with the proton suicide method (medium containing NaBr-NaBrO₃ ), diethyl sulphate chemical mutagenesis coupled with ⁶⁰ Co-γ irradiation treatment were performed for the screening and selection of desired mutant lines with a high yield of BC. Two high-yield strains, Br-3 and Co-5, as well as a low-yield strain, Br-12, were obtained. Amplified fragment length polymorphism (AFLP) was applied to explore the differences between the mutant lines and the wild type. For the Br-12 line, three specific fragments were verified, corresponding to TonB-dependent transport (TBDT), exopolysaccharides output protein (PePr) and an unknown gene. For Co-5, two specific fragments were matched, acsD and UDP-galactose-4-epimerase. In addition, metabolic analysis for the mutant lines indicated that BC production may be limited by excessive accumulation of organic acids in the fermentation. The limitation would be resolved by the cross-talk of genes involved in BC biosynthesis.

CONCLUSIONS

Reduced organic acid by-products from glucose in bypasses were found to be responsible for the high-yield BC synthesis in Komagataeibacter hansenii mutant strains.

SIGNIFICANCE AND IMPACT OF THE STUDY

The metabolic process was varied by mutagenesis-induced gene disruption of the metabolic products. A new idea was provided for the targeted screening and characterization of mutants in the future.

[Extended inferior meatal approach by reversing inferior turbinate for maxillary sinus and adjacent lesions]

Objective:The aim of this study is to explore the feasibility and results of surgical removal of maxillary sinus and adjacent lesions via extended inferior meatal approach by reversing inferior turbinate.Method:Among these 28 cases,there were 9 cases of maxillary cysts(4 of which with oroantral fistula),2 cases of odontogenic maxillary sinusitis(1 of which with oroantral fistula),3 cases of maxillary sinus cysts,2 cases of antrochoanal polyps,5 cases of maxillary sinus inverted papilloma,1 case of maxillary sinus inverted papilloma with infiltrative squamous cell carcinoma(moderately differentiated),4 cases of inferior orbital fracture,1 case of anterior maxillary sinus wall fracture,and 1 case of infratemporal fossa cysts with fungal maxillary sinusitis.All operations were conducted via extended inferior meatal approach.Result:All patients did not have intraoperative complications,and were free of recurrence after the 3 to 36 months postoperative follow-up.Conclusion:The extended inferior meatal approach by reversing inferior turbinate can deal with all aspects of the maxillary sinus and retromaxillary lesions.This procedure has a clear vision and high successful rate.

[A cohort study on the association between fasting plasma glucose level over 5.3 mmol/L and risks of abnormal glucose metabolism and cardiovascular diseases in the elderly]

OBJECTIVE

The aim of the study was to evaluate the association of fasting plasma glucose (FPG) level over 5.3 mmol/L to the development of abnormal glucose metabolism and cardiovascular diseases (CVD).

METHODS

This was a retrospective cohort study with 1 064 non-diabetic subjects(980 males; 84 females) aged 60 or over, who carried out annual health check-up in Chinese PLA General Hospital from May, 1996 to May, 2015. Based on the average FPG level of 3 years before enrollment, the subjects were divided into four groups: <5.3 mmol/L, 5.3-<5.6 mmol/L, 5.6-<6.1 mmol/L and 6.1-<7.0 mmol/L. Glucose metabolic changes, complications and mortality were follow-up until May, 2015.

RESULTS

(1)The initial 3-year average FPG levels were (4.9±0.4) mmol/L in the total 1 064 subjects. Among them, 126 subjects developed diabetes mellitus (DM) and 144 subjects developed impaired glucose regulation (IGR) during the follow-up visits. The proportions of IGR and diabetes increased with the FPG levels (P<0.05). The risk for developing IGR was significantly higher in subjects with FPG≥5.3 mmol/L than in those with FPG <5.3 mmol/L (RR=3.08, 95%CI 2.02-4.81, P<0.01). The risk for incident DM was markedly increased in subjects with FPG ≥ 5.6 mmol/L than in those with FPG <5.6 mmol/L (RR=6.73, 95%CI 3.90-11.52, P<0.01); (2)The risk for CVD was eight folds higher in subjects with FPG ≥5.3 mmol/L than in subjects with FPG <5.3 mmol/L (RR=8.42, 95%CI 5.11-13.82, P<0.05); (3)Survival analysis showed that the risk of death was 1.47 times higher in subjects with FPG ≥5.3 mmol/L than in subjects with FPG <5.3 mmol/L after years of followed-up (RR=1.47, 95%CI 1.09-1.98, P=0.0127).

CONCLUSION

The risks for IGR, CVD and mortality are higher in the elderly with FPG≥5.3 mmol/L, which highlights the importance for the disease prevention in elder people with FPG 5.3 mmol/L or more.

β-Arrestin-2 modulates radiation-induced intestinal crypt progenitor/stem cell injury

Intestinal crypt progenitor/stem (ICPS) cell apoptosis and vascular endothelial cell apoptosis are responsible for the initiation and development of ionizing radiation (IR)-evoked gastrointestinal syndrome. The signaling mechanisms underlying IR-induced ICPS cell apoptosis remain largely unclear. Our findings provide evidence that β-arrestin-2 (βarr2)-mediated ICPS cell apoptosis is crucial for IR-stimulated intestinal injury. βArr2-deficient mice exhibited decreased ICPS cell and intestinal Lgr5⁺ (leucine-rich repeat-containing G-protein-coupled receptor 5-positive) stem cell apoptosis, promoted crypt proliferation and reproduction, and protracted survival following lethal doses of radiation. Radioprotection in the ICPS cells isolated from βarr2-deficient mice depended on prolonged nuclear factor-κB (NF-κB) activation via direct interaction of βarr2 with IκBα and subsequent inhibition of p53-upregulated modulator of apoptosis (PUMA)-mediated mitochondrial dysfunction. Unexpectedly, βarr2 deficiency had little effect on IR-induced intestinal vascular endothelial cell apoptosis in mice. Consistently, βarr2 knockdown also provided significant radioresistance by manipulating NF-κB/PUMA signaling in Lgr5⁺ cells in vitro. Collectively, these observations show that targeting the βarr2/NF-κB/PUMA novel pathway is a potential radiomitigator for limiting the damaging effect of radiotherapy on the gastrointestinal system. Significance statement: acute injury to the intestinal mucosa is a major dose-limiting complication of abdominal radiotherapy. The issue of whether the critical factor for the initiation of radiation-induced intestinal injury is intestinal stem cell apoptosis or endothelial cell apoptosis remains unresolved. βArrs have recently been found to be multifunctional adaptor of apoptosis. Here, we found that β-arrestin-2 (βarr2) deficiency was associated with decreased radiation-induced ICPS cell apoptosis, which prolonged survival in abdominally irradiated mice. Moreover, βarr2 deficiency-mediated intestinal progenitor/stem cell radioprotection relied on protracted NF-κB activation and subsequent suppression of PUMA induction. Our results suggest that ICPS cell apoptosis is the factor involved in the initiation and development of radiation-induced gastrointestinal syndrome. βArr2 is a potential target for lessening radiation-induced ICPS cell apoptosis.

[Effects of job content on psychological stress in young recruits]

OBJECTIVE

To explore the effects of job content on psychological stress in young recruits.

METHODS

In October 2014, 625 young recruits enrolled in one troop of Xinjiang Military Command in 2014 were chosen as subjects by multi-stage stratified random sampling. The Chinese version of the job content questionnaire (JCQ)and the psychological stress self evaluation test (PEST)were used to investigate the subjects. The subjects were divided into two groups with scores higher and lower than the mean score of three subscales (job requirement, degree of autonomy, and social support)of JCQ to explore the effects of job content on psychological stress in young recruits. The correlation of psychological stress with three subscales of job content was evaluated using the Pearson' s correlation analysis. Binary logistic regression analysis was used to analyze the influencing factors for psychological stress.

RESULTS

The PEST score of young recruits was 49.98±9.98. Forty-five (7.68%)out of them had scores of ≥70 points and were diagnosed with high levels of psychological stress. When the subjects were grouped based on socio-demographic characteristics, a high level of psychological stress was significantly more frequent in subjects less than 20 years of age than in those not less than 20 years of age, in smoking subjects than in non-smoking subjects, and in urban residents than in rural residents (10.42% vs 5.03%, P<0.05; 10.14% vs 5.33%, P<0.05; 10.85% vs 5.88% , P <0.05). There were no significant differences in educational level or identity before recruitment between subjects with different levels of psychological stress (P>0.05). In various job content domains that had impacts on psychological stress, subjects with a low score of social support had significantly higher PEST scores than those with a high score of social support (50.96±10.35 vs 48.49±9.22, P<0.01). The PEST score was negatively correlated with the degree of autonomy and social support (r=-0.103, P<0.05; r=-0.239, P<0.05). The results of logistic regression analysis showed that job requirement and social support were influencing factors for psychological stress (OR=0.718, 95% CI= 0.718 (0.607~0.851), P<0.05; OR=1.185, 95% CI=1.185 (1.087~1.292), P<0.05).

CONCLUSION

Psychological stress of young recruits in army is not optimistic. Psychological stress is weakly negatively correlated with social support. The low scores on job requirement subscale and social support subscale may be potential protective factor and risk factor for psychological stress, respectively.

Association Between Interleukin-2 -330 T/G Polymorphism and Acute Renal Graft Rejection: A Meta-analysis

BACKGROUND

Interleukin-2 (IL-2) -330 T/G promoter polymorphism is involved in the acute rejection (AR) risk of kidney transplantation. However, results from published studies on the association between recipient IL-2-330 T/G polymorphism and AR risk are conflicting and inconclusive.

METHODS

We searched Medline, Embase, Web of Science, and Cochrane Central Register from their inceptions through January 2015 for relevant studies. Data concerning publication information, population characteristics, and transplant information were extracted. Odds ratios (ORs) were calculated for the association between IL-2-330 T/G polymorphism and AR risk.

RESULTS

This meta-analysis included 8 case-control studies with 1,405 cases of renal transplant recipients. The pooled estimate showed that IL-2-330 T/G polymorphism was not associated with AR risk: TT vs TG+GG: OR(fixed,) 0.93; 95% confidence interval [CI], 0.72-1.21; P = .60; GG vs TG+TT: OR(fixed), 1.15; 95% CI, 0.76-1.72; P = .51; TG vs TT+GG: OR(fixed), 1.01; 95% CI, 0.78-1.31; P = .91; T vs G: OR(fixed), 0.93; 95% CI, 0.77-1.13; P = .48. None of subgroup analyses yielded significant results in the association between IL-2-330 T/G polymorphism and AR risk. Meta-regression confirmed that there was no significant correlation between the preselected trial characteristics and our study results.

CONCLUSIONS

This meta-analysis suggests that IL-2-330 T/G polymorphism may not be associated with AR risk in renal transplant recipients.

[Evaluation and analysis of the tibial coronal alignment after total knee replacement with the extramedullary tibial cutting guided by the tibial tubercle and anterior tibial tendon in Chinese patients]

OBJECTIVE

To evaluate the efficiency of the tibial coronal alignment after total knee arthroplasty with the extramedullary cutting system guided by the tibial tubercle and anterior tibial tendon, and to discuss the potential risk factors for the postoperative malalignment.

METHODS

A retrospective study of 212 primary unilateral TKA surgeries (in 188 patients) in our hospital between June to December in 2014 had been analysed. All the cases were performed by one surgical group. An extramedullary tibial cutting guide system had been used, with a landmark of one third inner-medial tibial tubercle as a proximal anatomy reference, and anterior tibial tendon as a distal marker. The mechanical axis of lower extremity in full-length X-ray was measured before surgery, and the tibial prosthetic coronal alignment was checked two weeks postoperation, evaluating the accuracy of this extramedullary cutting system guided by our method.

RESULTS

Since good alignment was defined as an angle within 3 degrees of the perpendicular to the mechanical axis, the tibial component positions were acceptable in 191 knees (90.1%), five knees were in valgus postoperative, and sixteen knees were in varus. There were seventeen(8.7%) in 179 knees with a preoperative varus presented malalignment after surgery, and four in 12 preoperative valgus kneess howed malalignment also, no statistical difference was found by Chi-square test(χ(2)=2.778,P=0.096), which cannot define the relationship between the varus or valgus deformity preoperation and the malalignmentposition in tibial prosthesis after surgery. Twenty-two knees suffered a severe preoperative deformity as a varus or valgus angle larger than 20 degrees with absolute value of mechanical axis before surgery and tibial prosthetic coronal alignment were 21.95 °(20.00°,26.90°)and 1.85°(0.10°, 7.10°), showed a significant difference (Z=2.11,P=0.035) compared with the data [10.65°(0.50°,19.80°)in preoperative mechanical axis and 1.10°(0.00°,4.60°)in the tibial prosthetic coronal alignment]of 190 knees who presented a mild deformity before surgery(less than 20 degrees), the result indicated the severe preoperative deformity might be a potential mal-alignment risk factor within this cutting system in TKA surgery.

CONCLUSION

The tibial coronal alignment after total knee arthroplasty could achieve good results with extramedullary cutting guide, by using one third inner-medial tibial tubercle and anterior tibial tendon as a proximal and distal anatomy marker. Postoperative varus might occur in this system, and tibial prosthetic malalignment appeared more often in the patients who suffered a severe deformity before surgery.

Methods of applying the 1994 case definition of chronic fatigue syndrome - impact on classification and observed illness characteristics

BACKGROUND

Multiple case definitions are in use to identify chronic fatigue syndrome (CFS). Even when using the same definition, methods used to apply definitional criteria may affect results. The Centers for Disease Control and Prevention (CDC) conducted two population-based studies estimating CFS prevalence using the 1994 case definition; one relied on direct questions for criteria of fatigue, functional impairment and symptoms (1997 Wichita; Method 1), and the other used subscale score thresholds of standardized questionnaires for criteria (2004 Georgia; Method 2). Compared to previous reports the 2004 CFS prevalence estimate was higher, raising questions about whether changes in the method of operationalizing affected this and illness characteristics.

METHODS

The follow-up of the Georgia cohort allowed direct comparison of both methods of applying the 1994 case definition. Of 1961 participants (53 % of eligible) who completed the detailed telephone interview, 919 (47 %) were eligible for and 751 (81 %) underwent clinical evaluation including medical/psychiatric evaluations. Data from the 499 individuals with complete data and without exclusionary conditions was available for this analysis.

RESULTS

A total of 86 participants were classified as CFS by one or both methods; 44 cases identified by both methods, 15 only identified by Method 1, and 27 only identified by Method 2 (Kappa 0.63; 95 % confidence interval [CI]: 0.53, 0.73 and concordance 91.59 %). The CFS group identified by both methods were more fatigued, had worse functioning, and more symptoms than those identified by only one method. Moderate to severe depression was noted in only one individual who was classified as CFS by both methods. When comparing the CFS groups identified by only one method, those only identified by Method 2 were either similar to or more severely affected in fatigue, function, and symptoms than those only identified by Method 1.

CONCLUSIONS

The two methods demonstrated substantial concordance. While Method 2 classified more participants as CFS, there was no indication that they were less severely ill or more depressed. The classification differences do not fully explain the prevalence increase noted in the 2004 Georgia study. Use of standardized instruments for the major CFS domains provides advantages for disease stratification and comparing CFS patients to other illnesses.