Videolaryngoscopy vs. flexible fibrescopy for tracheal intubation in patients with cervical spine immobilisation: a randomised controlled trial

In patients with cervical spine immobilisation, tracheal intubation devices other than a direct laryngoscope are frequently used to facilitate tracheal intubation and avoid related complications. In this randomised controlled trial, we compared videolaryngoscopic and fibrescopic tracheal intubation in patients with a cervical collar. Tracheal intubation was performed using either a videolaryngoscope with a non-channelled Macintosh blade (n = 166) or a flexible fibrescope (n = 164) in patients having elective cervical spine surgery whose neck was immobilised with a cervical collar to simulate a difficult airway. The primary outcome was the first attempt success rate of tracheal intubation. Secondary outcomes were the overall success rate of tracheal intubation; time to tracheal intubation; use of additional airway manoeuvres; and incidence and severity of tracheal intubation-related airway complications. First attempt success rate was higher in the videolaryngoscope group than in the fibrescope group (164/166 (98.8%) vs. 149/164 (90.9%), p = 0.003). Tracheal intubation was successful within three attempts in all patients. Median (IQR [range]) time to tracheal intubation was shorter (50.0 (41.0-72.0 [25.0-170.0]) s vs. 81.0 (65.0-107.0 [24.0-178.0]) s, p < 0.001) and additional airway manoeuvres were less frequent (30/166 (18.1%) vs. 91/164 (55.5%), p < 0.001) in the videolaryngoscope group compared with the fibrescope group. The incidence and severity of intubation-related airway complications were not different between the two groups. When performing tracheal intubation in patients with a cervical collar, videolaryngoscopy with a non-channelled Macintosh blade was superior to flexible fibrescopy.

Development and Evaluation of a Blended Self-Management Program for Metabolic Syndrome in Patients With Rheumatic Diseases

Rheumatic diseases are known to be associated with the development of metabolic syndrome, which increases mortality rates due to cardiovascular complications. Although a variety of self-management programs for rheumatic diseases have been developed, few have concentrated on metabolic syndrome. This study aimed to develop and verify a blended (a mixture of telephone and online interventions) metabolic syndrome self-management program. The program was developed in four stages: analysis to identify program contents, website design, website development, and validity testing. A quasi-experimental nonequivalent control group, pretest-posttest design was adopted to verify the program effectiveness in 54 patients with rheumatic disease. The program was initially implemented via telephone for 4 weeks and then self-administered via a web-based platform for 20 weeks. Indices of metabolic syndrome and self-management and quality of life scores were measured as outcome variables. Data were collected three times: before intervention, after 4 weeks of telephone interventions, and after 20 weeks of online self-interventions. The devised program had a significant overall effect on metabolic syndrome indices, metabolic syndrome-related self-management behaviors, and quality of life. Detailed analysis showed the program effectively reduced body mass index, waist circumference, systolic blood pressure, and blood glucose levels and improved metabolic syndrome self-management behaviors. Based on our findings, it can be expected that the use of this program may retard or prevent the progression of metabolic syndrome by improving some metabolic syndrome indices and metabolic syndrome-related self-management behaviors, which are key components of care in rheumatic disease patients with metabolic syndrome. This web-based program appears to be beneficial in public health care settings because it is cost-effective, readily available, and may provide long-term support.

Temporal Changes in Metabolic Syndrome Indices and Factors of Metabolic Syndrome Development in Patients With Rheumatic Disease: A Prospective Cohort Study

Patients with rheumatic disease have a high prevalence of metabolic syndrome. The purpose of this study was to investigate temporal changes in metabolic syndrome indices and to identify factors influencing metabolic syndrome development. A prospective cohort study design was adopted. The study participants were 68 outpatients with a rheumatic disease at an outpatient clinic of a university hospital. Data on demographics, health-related characteristics, steroid use, serum C-reactive protein levels, and metabolic syndrome indices were collected between December 2017 and March 2021. Temporal changes in body mass indices, serum triglyceride, and cholesterol levels were significant. Body mass indices, diastolic blood pressure, serum triglyceride, high-density lipoprotein, and fasting blood glucose levels at time of diagnosis were found to influence metabolic syndrome development. Temporal changes in serum triglyceride, cholesterol, and fasting blood glucose levels were significantly influenced by inflammatory status. The findings demonstrate the importance of controlling inflammatory activities in the context of inhibiting the progression of metabolic syndrome and rheumatic diseases.

Measurement of the ν_{e}-Nucleus Charged-Current Double-Differential Cross Section at ⟨E_{ν}⟩=2.4 GeV Using NOvA

The inclusive electron neutrino charged-current cross section is measured in the NOvA near detector using 8.02×10^{20} protons-on-target in the NuMI beam. The sample of GeV electron neutrino interactions is the largest analyzed to date and is limited by ≃17% systematic rather than the ≃7.4% statistical uncertainties. The double-differential cross section in final-state electron energy and angle is presented for the first time, together with the single-differential dependence on Q^{2} (squared four-momentum transfer) and energy, in the range 1  GeV≤E_{ν}<6  GeV. Detailed comparisons are made to the predictions of the GENIE, GiBUU, NEUT, and NuWro neutrino event generators. The data do not strongly favor a model over the others consistently across all three cross sections measured, though some models have especially good or poor agreement in the single differential cross section vs Q^{2}.

The global burden of sudden infant death syndrome from 1990 to 2019: a systematic analysis from the Global Burden of Disease study 2019

BACKGROUND

Sudden infant death syndrome (SIDS) still remains one of the leading causes of infant death worldwide, especially in high-income countries. To date, however, there is no detailed information on the global health burden of SIDS.

AIMS

To characterize the global disease burden of SIDS and its trends from 1990 to 2019 and to compare the burden of SIDS according to the socio-demographic index (SDI).

DESIGN

Systematic analysis based on the Global Burden of Disease (GBD) 2019 data.

METHODS

Epidemiological data of 204 countries from 1990 to 2019 were collected via various methods including civil registration and vital statistics in the original GBD study. Estimates for mortality and disease burden of SIDS were modeled. Crude mortality and mortality rates per 100 000 population were analyzed. Disability-adjusted life years (DALYs) and DALY rates were also assessed.

RESULTS

In 2019, mortality rate of SIDS accounted for 20.98 [95% Uncertainty Interval, 9.15-46.16] globally, which was a 51% decrease from 1990. SIDS was most prevalent in Western sub-Saharan Africa, High-income North America and Oceania in 2019. The burden of SIDS was higher in males than females consistently from 1990 to 2019. Higher SDI and income level was associated with lower burden of SIDS; furthermore, countries with higher SDI and income had greater decreases in SIDS burden from 1990 to 2019.

CONCLUSIONS

The burden of SIDS has decreased drastically from 1990 to 2019. However, the improvements have occurred disproportionately between regions and SDI levels. Focused preventive efforts in under-resourced populations are needed.

Stachydrine alleviates lipid-induced skeletal muscle insulin resistance via AMPK/HO-1-mediated suppression of inflammation and endoplasmic reticulum stress

OBJECTIVE

Insulin resistance develops due to skeletal muscle inflammation and endoplasmic reticulum (ER) stress. Stachydrine (STA), extracted from Leonurus heterophyllus, has been shown to suppress proliferation and induce apoptosis in breast cancer cells and exert anti-inflammatory properties in the brain, heart, and liver. However, the roles of STA in insulin signaling in skeletal muscle remain unclear. Herein, we examined the impacts of STA on insulin signaling in skeletal muscle under hyperlipidemic conditions and its related molecular mechanisms.

METHODS

Various protein expression levels were determined by Western blotting. Levels of mouse serum cytokines were measured by ELISA.

RESULTS

We found that STA-ameliorated inflammation and ER stress, leading to attenuation of insulin resistance in palmitate-treated C2C12 myocytes. STA dose-dependently enhanced AMPK phosphorylation and HO-1 expression. Administration of STA attenuated not only insulin resistance but also inflammation and ER stress in the skeletal muscle of high-fat diet (HFD)-fed mice. Additionally, STA-ameliorated glucose tolerance and insulin sensitivity, as well as serum TNFα and MCP-1, in mice fed a HFD. Small interfering (si) RNA-associated suppression of AMPK or HO-1 expression abolished the effects of STA in C2C12 myocytes.

CONCLUSIONS

These results suggest that STA activates AMPK/HO-1 signaling, resulting in reduced inflammation and ER stress, thereby improving skeletal muscle insulin resistance. Using STA as a natural ingredient, this research successfully treated insulin resistance and type 2 diabetes.

Factors That Influence Sleep Disturbance and the Mediating Effects of Depression on Sleep Disturbance in Patients With Rheumatoid Arthritis

Little is known about the nature of relationships between sleep disturbance and influencing factors in rheumatoid arthritis. The purpose of this study was to identify factors that influence sleep disturbance and to evaluate mediating effects of depression on sleep disturbance. A nonexperimental, descriptive, correlational study design was adopted. One hundred patients with rheumatoid arthritis were recruited. Inflammatory status and levels of pain, fatigue, functional disability, depression, and sleep disturbance were measured. The factors that directly influenced sleep disturbance were gender, rheumatoid arthritis duration, serum C-reactive protein level, fatigue, and depression. Depression was found to have mediating effects on the relationships between sleep disturbance and arthritis symptoms. Pain, fatigue, and depression were found to have significant direct or indirect impacts on sleep disturbance. Our findings may improve understanding of sleep disturbance and aid the development of effective nursing management strategies for patients with rheumatoid arthritis suffering from sleep disturbance.

Fruit and Vegetable Intake and Non-Communicable Diseases among Adults Aged ≥50 Years in Low- and Middle-Income Countries

OBJECTIVES

The relationship between consuming ≥2 servings of fruits and ≥3 servings of vegetables a day, which has been identified as optimal for health (i.e., adequate fruit/vegetable consumption), and non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) is largely unknown. Therefore, using data from six LMICs, we investigated the independent association between inadequate fruit/vegetable consumption and 12 NCDs, and estimated the prevalence of inadequate fruit/vegetable consumption among people with NCDs.

DESIGN AND SETTING

Cross-sectional, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed.

PARTICIPANTS

Data on 34129 individuals aged ≥50 years were analyzed [mean (SD) age 62.4 (16.0); maximum age 114 years; 52.1% females].

MEASUREMENTS

Information on the number of servings of fruits and vegetables consumed on a typical day was self-reported. Twelve NCDs were assessed. Multivariable logistic regression analysis was conducted.

RESULTS

Overall, 67.2% had inadequate fruit/vegetable consumption. Inadequate fruit/vegetable consumption was independently associated with significantly higher odds for chronic lung disease (OR=1.25), diabetes (OR=1.45), hearing problems (OR=1.75), and visual impairment (OR=2.50). The prevalence of inadequate fruit/vegetable consumption was particularly high among people with visual impairment (92.5%), depression (90.5%), asthma (79.8%), and hearing problems (78.4%).

CONCLUSION

Promotion of fruit and vegetable consumption (≥2 servings of fruits and ≥3 servings of vegetables a day) in LMICs may lead to prevention of some NCDs (e.g., diabetes, chronic lung disease). Furthermore, people with certain NCDs (e.g., visual impairment, depression) had particularly high prevalence of inadequate fruit/vegetable consumption, and it is thus important to target this population to increase fruit/vegetable consumption.

Search for Active-Sterile Antineutrino Mixing Using Neutral-Current Interactions with the NOvA Experiment

This Letter reports results from the first long-baseline search for sterile antineutrinos mixing in an accelerator-based antineutrino-dominated beam. The rate of neutral-current interactions in the two NOvA detectors, at distances of 1 and 810 km from the beam source, is analyzed using an exposure of 12.51×10^{20} protons-on-target from the NuMI beam at Fermilab running in antineutrino mode. A total of 121 of neutral-current candidates are observed at the far detector, compared to a prediction of 122±11(stat.)±15(syst.) assuming mixing only between three active flavors. No evidence for ν[over ¯]_{μ}→ν[over ¯]_{s} oscillation is observed. Interpreting this result within a 3+1 model, constraints are placed on the mixing angles θ_{24}<25° and θ_{34}<32° at the 90% C.L. for 0.05  eV^{2}≤Δm_{41}^{2}≤0.5  eV^{2}, the range of mass splittings that produces no significant oscillations at the near detector. These are the first 3+1 confidence limits set using long-baseline accelerator antineutrinos.

Empirical assessment of biases in cerebrospinal fluid biomarkers of Alzheimer's disease: an umbrella review and re-analysis of data from meta-analyses

OBJECTIVE

Alzheimer's disease (AD) is a leading cause of years lived with disability in older age, and several cerebrospinal fluid (CSF) markers have been proposed in individual meta-analyses to be associated with AD but field-wide evaluation and scrutiny of the literature is not available.

MATERIALS AND METHODS

We performed an umbrella review for the reported associations between CSF biomarkers and AD. Data from available meta-analyses were reanalyzed using both random and fixed effects models. We also estimated between-study heterogeneity, small-study effects, excess significance, and prediction interval.

RESULTS

A total of 38 meta-analyses on CSF markers from 11 eligible articles were identified and reanalyzed. In 14 (36%) of the meta-analyses, the summary estimate and the results of the largest study showed non-concordant results in terms of statistical significance. Large heterogeneity (I2≥75%) was observed in 73% and small-study effects under Egger's test were shown in 28% of CSF biomarkers.

CONCLUSIONS

Our results suggest that there is an excess of statistically significant results and significant biases in the literature of CSF biomarkers for AD. Therefore, the results of CSF biomarkers should be interpreted with caution.

Supraclavicular versus infraclavicular approach for ultrasound-guided right subclavian venous catheterisation: a randomised controlled non-inferiority trial

Infraclavicular and supraclavicular approaches are used for subclavian venous catheterisation. We hypothesised that the supraclavicular approach is non-inferior to the infraclavicular approach in terms of safety during ultrasound-guided right subclavian venous catheterisation. We randomly allocated 401 neurosurgical patients undergoing ultrasound-guided right subclavian venous catheterisation into supraclavicular (n = 200) and infraclavicular (n = 201) groups. We assessed catheterisation-related complications (primary outcome measure) including catheter misplacement and mechanical complications (arterial puncture, haematoma formation, pneumothorax and haemothorax). We also recorded catheterisation success rates and time required for venous puncture and catheterisation. The number (proportion) of patients with catheterisation-related complications was six (3.0%) in the supraclavicular group and 27 (13.4%) in the infraclavicular group, mean difference (95%CI) -10.4% (-15.7 to -5.1%), p < 0.001, with a significant difference also seen for catheter misplacement. Except for a shorter time (median (IQR [range]) required for venous puncture in the supraclavicular group, being 9 (6-20 [2-138]) vs. 13 (8-20 [3-99]) s, the incidence of mechanical complications and other catheterisation characteristics were similar between the two groups. We recommend the supraclavicular approach for ultrasound-guided right subclavian venous catheterisation.

Body mass index and mortality in patients with cardiovascular disease: an umbrella review of meta-analyses

OBJECTIVE

Although many previous meta-analyses of epidemiological studies have demonstrated a relationship between body mass index (BMI) and mortality, inconsistent findings among cardiovascular disease patients have been observed. Thus, we performed an umbrella review to understand the strength of evidence and validity of claimed associations between BMI and mortality in patients with cardiovascular diseases.

MATERIALS AND METHODS

We comprehensively re-analyzed the data of meta-analyses of observational studies and randomized controlled trials on associations between BMI and mortality among patients with cardiovascular diseases. We also assessed the strength of evidence of the re-analyzed outcomes, which were determined from the criteria including statistical significance of the p-value of random-effects, as well as fixed-effects meta-analyses, small-study effects, between-study heterogeneity, and a 95% prediction interval.

RESULTS

We ran comprehensive re-analysis of the data from the 21 selected studies, which contained a total of 108 meta-analyses; 23 were graded as convincing evidence and 12 were suggestive, 42 were weak, and 23 were non-significant.

CONCLUSIONS

Underweight increased mortality in acute coronary syndrome (ACS), heart failure, and after therapeutic intervention for patients with cardiovascular diseases. Overweight, on the other hand decreased mortality in patient's ACS, atrial fibrillation, and heart failure with convincing evidence.

Fermented milk with Lactobacillus curvatus SMFM2016-NK alleviates periodontal and gut inflammation, and alters oral and gut microbiota

This study aimed to analyze the effect of milk fermented with Lactobacillus curvatus SMFM2016-NK on periodontal diseases and gut health in a rat model. To improve the effect of Lb. curvatus SMFM2016-NK-fermented milk administration for relieving periodontitis, the periodontitis rat models were treated with the following for 4 wk: 10% skim milk (normal), periodontitis + 10% skim milk (negative control), periodontitis + Lactobacillus rhamnosus GG-fermented milk (positive control), and periodontitis + Lb. curvatus SMFM2016-NK-fermented milk (PD+LCFM). Transcriptional analysis of inflammatory cytokines [tumor necrosis factor α (TNF-α), IL-1β, IL-6, and IL-10] was performed via quantitative reverse-transcription PCR. The changes in the oral and gut microbiomes after administering Lb. curvatus SMFM2016-NK-fermented milk were analyzed with metagenomics sequencing using DNA extracted from the oral gingival tissues and feces from the cecum of the rat models. After treatment with Lb. curvatus SMFM2016-NK-fermented milk, the relative gene expression levels of TNFA and IL1B in the gingiva decreased in the PD+LCFM group compared with those in the negative control group. In the oral microbiome, the proportion of the phylum Proteobacteria in the PD+LCFM group was lower than that in the negative control after treatment with Lb. curvatus SMFM2016-NK-fermented milk. For the effect in the gut, the relative gene expression levels of inflammatory cytokines in the colon between the normal and negative control groups were not different; however, the expression levels of TNFA and IL1B in the PD+LCFM and positive control groups, respectively, were lower than those in the negative control group. The composition and diversity of the gut microbiome differed among normal, periodontitis, and Lb. curvatus SMFM2016-NK-fermented milk treatment groups. These results indicate that Lb. curvatus SMFM2016-NK-fermented milk could alleviate periodontal and gut inflammation and change oral and gut microbiota.

Development and Validity Testing of a Morning Stiffness Assessment Scale for Patients with Rheumatoid Arthritis

Morning stiffness is known to exert a significant impact on functional ability, quality of life, and employment status. There is an increasing need for a valid, reliable tool to comprehensively assess morning stiffness. The purpose of this study was to develop and verify a Morning Stiffness Assessment Scale. Items were developed on the basis of a framework of the conceptual attributes of morning stiffness. Validity and reliability tests were conducted on the devised scale. Eighty-five patients with rheumatoid arthritis were included to verify the devised scale. A 10-item Morning Stiffness Assessment Scale was developed. Its content and construct validities were well supported. The scale was found to have good reliability. The devised scale is simple and brief, but it provides a more comprehensive means of evaluation for morning stiffness. We believe this scale offers a clinically useful means of properly assessing morning stiffness and has potential utility for evaluating the effects of morning stiffness treatments.

Physical injury and psychotic experiences in 48 low- and middle-income countries

BACKGROUND

Psychotic experiences (PEs) may be associated with injuries, but studies focusing specifically on low- and middle-income countries (LAMICs) are scarce. Thus, the current study examined the link between injuries and PEs in a large number of LAMICs.

METHOD

Cross-sectional data were used from 242 952 individuals in 48 LAMICs that were collected during the World Health Survey in 2002-2004 to examine the association between traffic-related and other (non-traffic-related) forms of injury and PEs. Multivariable logistic regression analysis and meta-analysis were used to examine associations while controlling for a variety of covariates including depression.

RESULTS

In fully adjusted analyses, any injury [odds ratio (OR) 2.07, 95% confidence interval (CI) 1.85-2.31], traffic injury (OR 1.84, 95% CI 1.53-2.21) and other injury (OR 2.09, 95% CI 1.84-2.37) were associated with higher odds for PEs. Results from a country-wise analysis showed that any injury was associated with significantly increased odds for PEs in 39 countries with the overall pooled OR estimated by meta-analysis being 2.46 (95% CI 2.22-2.74) with a moderate level of between-country heterogeneity (I2 = 56.3%). Similar results were observed across all country income levels (low, lower-middle and upper-middle).

CONCLUSIONS

Different types of injury are associated with PEs in LAMICs. Improving mental health systems and trauma capacity in LAMICs may be important for preventing injury-related negative mental health outcomes.

Cardiosphere-derived exosomal microRNAs for cardiac repair in pediatric dilated cardiomyopathy: preclinical and safety lead-in phase 1 clinical studies

Introduction

Stem cell therapies have been shown to improve cardiac function; however, therapeutic potential of cardiosphere-derived cells (CDCs) in dilated cardiomyopathy (DCM) and the underlying mechanisms of paracrine effectors include CDC-secreted exosomes (CDCex) mediating cardiac repair remain unknown. Purpose- We aimed to evaluate the safety and therapeutic efficacy of CDCs in swine model of DCM and translate the preclinical results into children with DCM.

Methods

As a preclinical study, female Yorkshire pigs (n=15) were treated by intracoronary administration of microspheres (1.0×104 particles) to develop diffuse cardiac dysfunction and animals were randomly assigned to receive placebo or 9.0×106 CDC injection pretreated by DMSO or exosome inhibitor (EI; GW4869). CDCex-derived microRNAs (miRs) profile was assessed and ventricular ejection fraction (EF) was evaluated before and 1 month after cell infusion. In safety lead-in clinical trial, 5 patients with DCM (&lt;18 years) with reduced EF (&lt;40%) were prospectively enrolled to receive CDC infusion. The primary endpoint was to assess safety, and the secondary outcome measure was change in cardiac function over 12 months.

Results

Compared with placebo control, DMSO-treated CDC infusion resulted in improved cardiac function with decrease in myocardial fibrosis (18.2±4.1% versus; 9.5±3.6%; P&lt;0.001) and enhanced cardiomyocyte cycling (Ki67: 27.2±3.6/106 myocytes versus 43.9±6.0/106 myocytes; P=0.002) and neovascularization (von Willebrand factor: 644.8±84.3/mm2 versus 820.7±159.7/mm2; P=0.01) at 1 month. miR expression analysis showed that CDCex were highly enriched with miR-126, miR-132, miR-146a, miR-181b, miR-210, and miR-451. Inhibition of CDCex-derived miRs production by EI pretreatment did not affect CDC viability but rendered CDC ineffective in functional improvement (ΔEF: +5.4%±2.0% versus −1.0%±2.1%; P=0.002). One-year follow-up of clinical trial was completed in 5 patients with favorable profile and preliminary efficacy outcomes. Echocardiographic measurements revealed that CDC infusion increased EF from baseline to 12 months of follow up (28.5±10.7% versus 33.0±11.1%; P=0.038) in accordance with reduced native T1 mapping (1041.6±60.4 ms versus 984.8±39.3 ms; P=0.025). CDCex-derived miRs profiles from patients demonstrated that several miRs were exclusively enriched in CDCs but human cardiac fibroblasts included miR-126, miR-132, miR-146a, miR-181b, and miR-210. Notably, miR-146a expression levels were positively correlated with the reduction in myocardial fibrosis 12 months after CDC infusion (Δnative T1: r=0.896, P=0.040).

Conclusions

Intracoronary delivery of CDCs is safe and improves cardiac function through CDCex-derived miRs secretion in swine model of DCM. The safety lead-in results in patients warrant further assessment of clinical benefits and highlight miR-146a as a major paracrine mediator of CDC's antifibrotic function for clinical therapeutics.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Research Project for Practical Application of Regenerative Medicine (16bk0104052h0001, 17bk0104052h0002, 18bk0104052h0003) by the Japan Agency for Medical Research and Development

Chronic skin disease and levels of physical activity in 17 777 Spanish adults: a cross-sectional study

BACKGROUND

To date there is limited literature on the prevalence of chronic skin conditions and its association with levels of physical activity (PA) in Spain.

AIM

To determine the prevalence of chronic skin disease and to compare levels of PA between people with and without chronic skin disease in a large representative sample of Spanish adults aged 15-69 years.

METHODS

Data from the Spanish National Health Survey 2017 were analysed. Chronic skin disease was assessed using a yes/no question. PA was measured using the short form of the International Physical Activity Questionnaire. Total PA metabolic equivalent of task min/week were calculated, and PA was included in the analyses as a continuous and a five-category variable.

RESULTS

This cross-sectional study included 17 777 adult participants (52.0% women; mean ± SD age 45.8 ± 14.1 years), of whom 940 (5.3%) had chronic skin disease. After adjusting for several potential confounders, there was a negative association between chronic skin disease and PA (OR = 0.87, 95% CI 0.76-1.00, P = 0.05), which was significant for men (OR = 0.76, 95% CI 0.62-0.93, P = 0.01) but not for women (OR = 0.97, 95% CI 0.81-1.16, P = 0.72).

CONCLUSIONS

In this large representative sample of Spanish adults, the prevalence of chronic skin disease was low. Levels of PA were lower in men with than in men without chronic skin conditions, but this association was not seen in women.

P318Exosomes mediate myocardial regeneration of cardiac progenitor cells in a swine model of dilated cardiomyopathy

Introduction

Stem cell therapy has been shown to improve cardiac function. The mechanisms of therapeutic efficacy are considered the secretion of paracrine factors but the details are still unknown.

Hypothesis

Exosomes are extracellular vesicles containing bioactive substances such as proteins, messenger RNAs and micro RNAs. We hypothesized that exosomes may be the main paracrine factors to mediate therapeutic efficacy of cardiosphere-derived cells (CDCs).

Methods

Farm pigs (30 kg, n=10) were treated by intracoronary administration of 10,000 microspheres (100–300 μm) into three vessels. Two weeks later, 9.0×106 CDCs pretreated by exosome inhibitor (EI; 20μM of GW4869) or DMSO as controls were selectively infused into three coronary arteries. Evaluation of ejection fraction (EF) was performed before cell infusion and 1 month after protocol treatment.

Results

Pigs developed diffuse hypokinetic heart failure (baseline EF 37.1%±2.1%) and randomly assigned into two groups (CDCs with EI: n=5, CDCs with DMSO: n=5). No serious adverse events were found during the CDCs infusion. Significant improvement of EF was observed in CDCs with DMSO group (37.1%±2.1% to 42.5%±3.0%; P=0.01), whereas no change was found in CDCs with EI group (37.1%±2.4% to 36.2%±2.9%; P=0.58). Myocardial fibrosis stained by picrosirius red was significantly reduced in CDCs with DMSO group compared with CDCs with EI group (9.5±3.6% versus 17.3±5.3%; P<0.01).

Conclusions

We confirmed the therapeutic efficacy of CDCs and these effects were mainly mediated by exosomes.

P3651Outcomes of right ventricular outflow tract reconstruction in children: comparison between bovine jugular vein graft and expanded polytetrafluoroethylene graft

Background

Various types of conduits are available for right ventricular outflow tract reconstruction (RVOTR). The bovine jugular vein graft (BJVG) and expanded polytetrafluoroethylene graft (ePTFEG) have been descrived as an alternative to the homograft for RVOTR. Purpose- This study summarized the results to evaluate the single-center operation of RVOTR using BJVG and ePTFEG.

Methods

The valve functions of 27 patients under 20 years old who underwent primary RVOTR with BJVG and 26 patients with ePTFEG at our university hospital between 2013 and 2018 were retrospectively investigated. The valve conditions were assessed using echocardiography and cardiac catheterization.

Results

The median age at the time of operation was 1.8 years old (range, 6 days to 7.8 years old) with BJVG and 2.2 years old (range, 8 months to 9.1 years old) with ePTFEG. The median follow-up time was 3.4 years (range, 2 months to 5.2 years) with BJVG and 2.1 years (range, 1 month to 5.1 years) with ePTFEG. The peak RVOT gradient of BJVG was lower than ePTFEG (10.6±7.7 mmHg versus 18.1±16.2 mmHg, P=0.035). There were no differences in branch pulmonary stenosis defined as peak gradient up to 36mmHg (40.7% versus 50.0%, P=0.50) and pulmonary regurgitation graded worse than moderate (18.5% versus 11.5%, P=0.48) with BJVG and ePTFEG, respectively. Aneurysmal dilatation of the conduit was seen 22.2% with BJVG but none of patients with ePTFEG (P=0.01). All of patients with aneurysmal dilated BJVG had branch pulmonary stenosis. There were no differences in catheter intervention for branch pulmonary stenosis (22.2% versus 30.8%, P=0.48) and conduit replacement (11.1% versus 7.7%, log rank P=0.67) with BJVG and ePTFEG, respectively. There were no deaths during the fllow-up period in both groups.

Conclusions

The outcomes of RVOTR with BJVG and ePTFEG were clinically satisfactory. Aneurysmal dilatation was seen with BJVG and branch pulmonary stenosis was the risk factor for aneurysmal dilatation.

P11.32 Combined effects of niclosamide and temozolomide against human glioblastoma tumorspheres

BACKGROUND

Glioblastoma (GBM) is the most aggressive type of brain tumor and has poor survival outcomes, even after a combination of surgery, radiotherapy, and chemotherapy. Temozolomide is the only agent that has been shown to be effective against GBM, suggesting that combination of temozolomide with other agents may be more effective. Niclosamide, an FDA approved anthelmintic agent, has shown anti-cancer effects against human colon, breast, prostate cancers as well as GBM. However, the efficacy of the combination of niclosamide with temozolomide against GBM tumorspheres (TSs) has not been determined. We hypothesized that the combined treatment could effectively suppress GBM TSs.

MATERIAL AND METHODS

Effects of niclosamide and/or temozolomide on GBM TSs were evaluated. Viability, stemness, and invasive properties of GBM TSs were examined. In vivo anticancer efficacy was tested in a mouse orthotopic xenograft model.

RESULTS

The combination of niclsoamide and temozolomide significantly inhibited the viability, sphere formation, expression of stemness-related proteins, and invasive properties of GBM TSs. This combination significantly down-regulated the expression of epithelial mesenchymal transition-related proteins. Bioluminescence imaging further showed that compared with either agent alone, combination of niclosamide and temozolomide significantly reduced the tumor burden in orthotopic xenograft models.

CONCLUSION

The combination of niclosamide and temozolomide effectively decreased the stemness and invasive properties of GBM TSs, suggesting that this regimen may be therapeutically effective in treating patients with GBM.

Psychotic experiences and physical health conditions in the United States

AIMS

Psychotic experiences are associated with physical health conditions, though the associations have not always been consistent in the literature. The current study examines the associations between psychotic experiences and several physical health conditions across four racial groups in the United States.

METHODS

We analyzed data from the Collaborative Psychiatric Epidemiology Surveys to examine the associations between psychotic experiences and physical health conditions across four racial groups (White, Black, Asian, Latino). We used multivariable logistic regression to calculated adjusted odds ratios and 95% Confidence Intervals.

RESULTS

Psychotic experiences were significantly associated with several physical health conditions depending on the condition and the racial group being examined. Further, the number of physical health conditions was associated with increasingly greater risk for psychotic experiences in a linear fashion.

CONCLUSIONS

Psychotic experiences may serve as useful markers for physical health conditions and overall physical health status. Future studies should examine the underlying mechanisms between psychotic experiences and health, and explore the clinical utility of psychotic experiences for preventive interventions.

Azimuthal Anisotropy of Heavy-Flavor Decay Electrons in p-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

Angular correlations between heavy-flavor decay electrons and charged particles at midrapidity (|η|<0.8) are measured in p-Pb collisions at sqrt[s_{NN}]=5.02  TeV. The analysis is carried out for the 0%-20% (high) and 60%-100% (low) multiplicity ranges. The jet contribution in the correlation distribution from high-multiplicity events is removed by subtracting the distribution from low-multiplicity events. An azimuthal modulation remains after removing the jet contribution, similar to previous observations in two-particle angular correlation measurements for light-flavor hadrons. A Fourier decomposition of the modulation results in a positive second-order coefficient (v_{2}) for heavy-flavor decay electrons in the transverse momentum interval 1.5<p_{T}<4  GeV/c in high-multiplicity events, with a significance larger than 5σ. The results are compared with those of charged particles at midrapidity and those of inclusive muons at forward rapidity. The v_{2} measurement of open heavy-flavor particles at midrapidity in small collision systems could provide crucial information to help interpret the anisotropies observed in such systems.

Discrimination and suicidality among racial and ethnic minorities in the United States

BACKGROUND

Over the past decade, suicide rates have increased among certain racial/ethnic minority groups in the United States. To better understand suicide vulnerability among people of color, studies have examined the relations between social risk factors-such as discrimination-and suicidal thoughts and behaviors. However, the literature has been inconsistent, calling for more population studies.

METHODS

This study analyzed data from two surveys: (1) The National Survey of American Life; and (2) The National Latino and Asian American Survey, which taken together are representative of Black, Latino, and Asians in the United States. Multivariable logistic regression models were used to examine the association between levels of discrimination on the Everyday Discrimination Scale and suicidal thoughts and behaviors. Additional models tested for effect modification by race and by psychiatric diagnosis.

RESULTS

We found that individuals who reported the highest levels of discrimination had greater odds of reporting lifetime suicidal thoughts, plans, and attempts, when compared with people who did not report discrimination, after adjusting for socio-demographic characteristics. Notably, discrimination increased odds of reporting an unplanned suicide attempt and a suicide attempt without the intent to die. Adjusting for psychiatric diagnoses attenuated these effects. We found no evidence of effect modification by race or by psychiatric diagnosis.

LIMITATIONS

Data were cross-sectional, which did not allow for causal inferences.

CONCLUSIONS

Future translational research can explore how screening for discrimination may help identify individuals and groups of racial/ethnic minorities at risk for suicidal thoughts and behaviors.

Factors associated with dexamethasone-induced hiccups in cancer patients undergoing chemotherapy: A case control study

PURPOSE

The purpose of this study was to identify demographic, health- and cancer-related, and physiological factors associated with dexamethasone-induced intractable hiccups in cancer patients.

METHOD

This study adopted a retrospective case control design. The study subjects were 168 cancer patients admitted to a university hospital for chemotherapy between October 2011 and December 2016: 58 patients who experienced intractable hiccups while on dexamethasone (cases) and 110 matched patients who received dexamethasone but did not experience hiccups (controls). Data were collected from most recent medical records and included demographic, health- and cancer-related, and physiological factors.

RESULTS

Our findings demonstrated that the development of dexamethasone-induced hiccups was significantly associated with a male gender, a young age, overweight/obesity, the use of alkylating anticancer agents (particularly as the first anticancer drug), high levels of hemoglobin, serum creatinine, uric acid, and albumin, and an elevated body temperature.

CONCLUSIONS

Oncology nurses should be aware of influencing factors of dexamethasone-induced hiccups in cancer patients receiving chemotherapy. Our findings may provide evidence to design oncology nursing strategies that help maximize the benefits of chemotherapy in cancer patients.

Identification of symptom clusters and their synergistic effects on quality of life in rheumatoid arthritis patients

AIMS

To examine the presence of symptom clusters and synergistic effects of symptom clusters on quality of life in rheumatoid arthritis patients.

BACKGROUND

Rheumatoid arthritis patients frequently experience multiple concurrent symptoms of pain, fatigue, and depression.

DESIGN

A nonexperimental, cross-sectional correlation design.

METHODS

The study participants were 179 rheumatoid arthritis patients. Data were collected between August and December 2016. A hypothetical model was developed based on the Theory of Unpleasant Symptoms Model: physiological antecedents included disease activity and obesity; symptoms of pain, fatigue, and depression were hypothesized as being clustered, and quality of life was taken as the outcome variable.

RESULTS

Disease activity had significant direct effects on pain, fatigue, and depression and indirect effects on fatigue and depression, whereas obesity had a significant direct effect on fatigue alone. Three symptom clusters, namely, pain fatigue, fatigue depression, and pain-fatigue depression were identified and found to have significant synergistic effects on quality of life.

CONCLUSIONS

Our findings support the importance of managing clusters of symptoms simultaneously, that is, collective symptom management. Inter-cluster dynamics between symptoms should be considered when nurses develop symptom management strategies or self-management programs to improve the quality of life of rheumatoid arthritis patients.

Correlates of cognitive impairment in patients with chronic kidney failure on haemodialysis: Systematic review and meta-analysis

AIM

To review and identify correlates of cognitive impairment in patients with chronic kidney failure (CKF) on haemodialysis.

BACKGROUND

The literature is consistent with regard to the high prevalence of cognitive impairment among patients with CKF on haemodialysis and its dependence on multidimensional risk factors.

DESIGN

Systematic review and meta-analysis based on Cochrane Handbook and PRISMA.

DATA SOURCES

Electronic searches of the MEDLINE, EMBASE, Cochrane Library databases and major Korean databases were used. Only original research that assessed correlates of cognitive impairment in patients with CKF on haemodialysis and published between 2004-2016 in English or Korean were included.

REVIEW METHODS

Studies were selected according to the PICOS: Population (chronic kidney failure patients with cognitive impairment on haemodialysis); Intervention (not applicable); Comparison (healthy controls or patients with chronic kidney failure on haemodialysis without cognitive impairment); Outcome (cognitive impairment); and Study design (primarily nonexperimental correlational studies and studies with experimental, quasi-experimental, or pre-post cohort designs). Q-test and I² index were used to examine study homogeneity.

RESULTS

A total of 39 studies were finally included. Age, gender, stroke history, difficulties in activities of daily life, haemoglobin levels, pain, sleep difficulties, and depression were found to be significant correlates of cognitive impairment.

CONCLUSIONS

Nurses should be aware that the risk of cognitive impairment in patients with CKF on haemodialysis can be significantly higher for elders, women and in patients with a stroke, greater difficulties in activities of daily living, lower haemoglobin concentrations, higher pain levels, sleep difficulties, or depression.

Comparisons of the stages and psychosocial factors of smoking cessation and coping strategies for smoking cessation in college student smokers: Conventional cigarette smokers compared to dual smokers of conventional and e-cigarettes

AIM

This study was conducted to compare conventional cigarette and dual smokers (users of both conventional and e-cigarettes) with respect to the stages of smoking cessation behavior change and psychosocial factors and coping strategies for smoking cessation among college students.

METHODS

Using convenience and snowball sampling methods, 300 college student smokers were recruited. The data were collected from July to December, 2016. The data included the general characteristics of the participants, information related to smoking and smoking cessation, the stages of smoking cessation behaviors, self-efficacy in, and barriers to, smoking cessation, and adoption of coping strategies for smoking cessation.

RESULTS

The prevalence of e-cigarette use in the cohort was 19.3%. Nicotine dependence in the dual smoker group was significantly higher than that in the conventional cigarette smoker group. No significant intergroup differences were observed for the stage of smoking cessation behavior and self-efficacy in, and perceived barriers to, smoking cessation. However, the dual smokers had a significantly higher prevalence of quit attempts and were more likely to adopt smoking cessation coping strategies.

CONCLUSIONS

The findings indicated that the dual smokers had higher levels of nicotine dependence, but were more likely to attempt to quit smoking and adopt smoking cessation coping strategies. This implies that dual smokers might find it more difficult to quit smoking related to higher nicotine dependence, despite having a higher motivation for smoking cessation. These characteristics should be considered when developing smoking cessation strategies for e-cigarette smokers. In addition, different approaches to smoking cessation education should be used for e-cigarette and conventional cigarette smokers.

Utility of the laryngeal handshake method for identifying the cricothyroid membrane

BACKGROUND

The cricothyroid membrane is the most commonly accessed location for invasive surgical airway. Although the laryngeal handshake method is recommended for identifying the cricothyroid membrane, there is no clinical data regarding the utility of the laryngeal handshake method in cricothyroid membrane identification. The objective of this study was to compare the accuracy of cricothyroid membrane identification between the laryngeal handshake method and simple palpation.

METHODS

After anaesthesia induction, the otorhinolaryngology resident and anaesthesia resident identified and marked the needle insertion point for cricothyroidotomy using simple palpation and the laryngeal handshake method, respectively. The cricothyroid membrane was confirmed with ultrasonography. Identification was determined successful if the marked point was placed within the longitudinal area of the cricothyroid membrane and within 5 mm from midline transversely. The accuracy of cricothyroid membrane identification using the laryngeal handshake method and simple palpation was compared.

RESULTS

A total of 123 patients were enrolled. The cricothyroid membrane was correctly identified in 87 (70.7%, 95% confidence interval 61.8-78.6%) patients using the laryngeal handshake method compared to 78 (63.4%, 95% confidence interval 54.3-71.9%) patients using simple palpation (P = .188). The time required to identify the cricothyroid membrane was longer when using the laryngeal handshake method (15 [3-48] seconds vs 10.9 [3-55] seconds, P = .003).

CONCLUSION

The success rate of identifying the cricothyroid membrane was similar among the anesthesiologists who performed the laryngeal handshake method and also among otorhinolaryngologists who used simple palpation.

Criminal victimization and psychotic experiences: cross-sectional associations in 35 low- and middle-income countries

OBJECTIVE

Criminal victimization has been associated with elevated risk for psychotic symptoms in the United Kingdom, but has not been studied in low- and middle-income countries (LMICs). Understanding whether crime exposure may play a role in the social etiology of psychosis could help guide prevention and intervention efforts.

METHOD

We tested the hypothesis that criminal victimization would be associated with elevated odds of psychotic experiences in 35 LMICs (N = 146 999) using cross-sectional data from the World Health Organization World Health Survey. Multivariable logistic regression analyses were used to test for associations between criminal victimization and psychotic experiences.

RESULTS

Victimization was associated with greater odds of psychotic experiences, OR (95% CI) = 1.72 (1.50-1.98), and was significantly more strongly associated with psychotic experiences in non-urban, OR (95% CI) = 1.93 (1.60-2.33), compared to urban settings, OR (95% CI) = 1.48 (1.21-1.81). The association between victimization and psychosis did not change across countries with varying aggregated levels of criminal victimization.

CONCLUSIONS

In the largest ever study of victimization and psychosis, the association between criminal victimization and psychosis appears to generalize across a range of LMICs and, therefore, across nations with a broad range of crime rates, degree of urban development, average per capita income, and racial/ethnic make-up.

Chemical evidence of inter-hemispheric air mass intrusion into the Northern Hemisphere mid-latitudes

The East Asian Summer Monsoon driven by temperature and moisture gradients between the Asian continent and the Pacific Ocean, leads to approximately 50% of the annual rainfall in the region across 20–40°N. Due to its increasing scientific and social importance, there have been several previous studies on identification of moisture sources for summer monsoon rainfall over East Asia mainly using Lagrangian or Eulerian atmospheric water vapor models. The major source regions for EASM previously proposed include the North Indian Ocean, South China Sea and North western Pacific. Based on high-precision and high-frequency 6-year measurement records of hydrofluorocarbons (HFCs), here we report a direct evidence of rapid intrusion of warm and moist tropical air mass from the Southern Hemisphere (SH) reaching within a couple of days up to 33°N into East Asia. We further suggest that the combination of direct chemical tracer record and a back-trajectory model with physical meteorological variables helps pave the way to identify moisture sources for monsoon rainfall. A case study for Gosan station (33.25°N, 126.19°E) indicates that the meridional transport of precipitable water from the SH accompanying the southerly/southwesterly flow contributes most significantly to its summer rainfall.

A 2-year prospective follow-up study of temporal changes associated with post-stroke cognitive impairment

AIMS

To explore temporal patterns of change in cognitive impairments during the 2 years following stroke and to identify factors that affect these temporal changes.

BACKGROUND

Despite the prognostic importance, temporal changes in post-stroke cognitive impairment have not been systematically investigated.

DESIGN

A non-experimental, prospective, longitudinal descriptive study design.

METHODS

Fifty-two stroke patients were enrolled. Data were collected from April 2015 to September 2017. Cognitive function was evaluated at 5 different times (immediately, and at 3, 6, 12, and 24 months post-stroke).

RESULTS

Significant changes in cognitive function following stroke exhibited an "s-shaped" curve, and the most rapid changes were observed between 3 and 6 months after stroke. The incidence of post-stroke cognitive impairment ranged from 23.1% to 42.3% and was highest at 3 months and lowest at 6 months. Gender, educational level, pre-stroke cognitive and functional abilities, haematoma, and brain surgery were associated with incidence of post-stroke cognitive impairment.

CONCLUSIONS

The ongoing changes exhibited by patterns of cognitive impairment provide evidence that consistent efforts are required to achieve positive changes in post-stroke cognitive function. Our findings may be helpful to develop nursing care strategies aimed at improving cognitive ability and consequently the quality of life of stroke patients.

Temporal Patterns and Influential Factors of Blood Glucose Levels During the First 10-Day Critical Period After Brain Injury

This study was conducted to document temporal patterns of blood glucose level changes during the first 10-day critical period and to identify factors that influence stress-induced hyperglycemia development in brain injury patients. The medical records of 190 brain injury patients were retrospectively reviewed. Blood glucose levels in the poor recovery group were significantly higher than in the good recovery group, particularly during the first 72 hr (158-172 mg/dl). The poor recovery group showed persistent, fluctuating hyperglycemia, whereas the good recovery group exhibited hyperglycemic peaks during the first 3 days that subsequently reduced linearly to normal. Gender, preexisting hypertension, disease severity at admission, total calorie intake, and steroid use were found to influence stress-induced hyperglycemia development significantly. In conclusion, close monitoring and adjustment are required to maintain safe blood glucose levels and the development of protocols for safe glycemic management is essential to improve critical care in brain injury patients.

Performance of the Minto model for the target-controlled infusion of remifentanil during cardiopulmonary bypass

We studied the predictive performance of the Minto pharmacokinetic model during cardiopulmonary bypass in patients undergoing cardiac surgery. Patients received remifentanil target-controlled infusion using the Minto model during total intravenous anaesthesia with propofol. From 56 patients, 275 arterial blood samples were drawn before, during and after bypass to determine the plasma concentration of remifentanil, and the predicted concentrations were recorded at each time. For pooled data, the median prediction error and median absolute prediction error were 21.3% and 21.8%, respectively, and 22.1% and 22.3% during bypass. Both were 148.4% during hypothermic circulatory arrest and measured concentrations were more than three times greater than predicted (26.9 (17.0) vs. 7.1 (1.6) ng.ml^-1 ). The Minto model showed considerable bias but overall acceptable precision during bypass. The target concentration of remifentanil should be reduced when using the Minto model during hypothermic circulatory arrest.