Author: Nevin Manimala

J Surg Res. 2021 Feb 24;263:89-101. doi: 10.1016/j.jss.2021.01.027. Online ahead of print.

ABSTRACT

BACKGROUND: Delirium is a common complication in intensive care unit (ICU) patients, and it can significantly increase the length of hospital stay and cost. Dexamethasone is widely used in various inflammatory diseases and must be used with caution in critically ill patients. Previous studies have shown that the effect of corticosteroid use on the development of delirium in critically ill patients is still controversial, and there is inconclusive conclusion about the effect of dexamethasone on delirium in such patients. Therefore, this study aimed to confirm the effect of dexamethasone use and the dose on the incidence of delirium and patient prognosis in critically ill patients through a large cohort study.

METHODS: A retrospective cohort study was conducted using data extracted from the Medical Information Mart for Intensive Care III database, which is a large and freely available database of all 46,476 patients who visited Beth Israel Deaconess Medical Center in Boston, Massachusetts, USA and were admitted to the ICU between 2001 and 2012. The primary outcome was the development of delirium, using multivariate logistic regression analysis to reveal the relationship between dexamethasone and delirium. Secondary endpoints were in-hospital mortality, ICU mortality, total length of stay, and length of ICU stay, and the relationship between dexamethasone and prognosis was assessed with Cox proportional hazards models. Propensity score matching with 1:1 grouping was used to eliminate the effect of confounders on both cohorts. The locally weighted scatter plot smoothing technique was used to investigate the dose correlation between dexamethasone and outcomes, subgroup analysis was used to account for heterogeneity, and different correction models and propensity matching analysis were used to eliminate potential confounders.

RESULTS: Finally, 38,509 patients were included, and 2204 (5.7%) used dexamethasone. No significant statistical difference was observed in basic demographic information after propensity score matching between the two study groups. A significantly higher incidence of delirium (5.0% versus 3.4%, P < 0.001), increased in-hospital mortality (14.9% versus 10.3%, P < 0.001), ICU mortality (9.0% versus 7.5%, P = 0.008), and longer length of stay and ICU stay were observed in patients taking dexamethasone compared with those not taking dexamethasone. Multivariate logistic and Cox regression analyses confirmed that dexamethasone was significantly associated with delirium (adjusted odds ratio = 1.48, 95% confidence interval [CI] = 1.09-2.00, P = 0.012), in-hospital mortality (adjusted hazard ratio = 1.19, 95% CI = 1.02-1.40, P = 0.032), and ICU mortality (adjusted hazard ratio = 1.62, 95% CI = 1.22-2.15, P = 0.001). Compared with critically ill patients using high-dose dexamethasone, the risk of delirium was lower in the dose less than the 10 mg group, and patients using 10-14 mg may be associated with a lower risk of in-hospital death and the least ICU mortality, length of hospital stay, and ICU stay.

CONCLUSIONS: This study demonstrated that the use of dexamethasone in critically ill patients exacerbated the occurrence of delirium while increasing the risk of in-hospital death, ICU death, and length of hospital stay, with a lower risk of delirium and a shorter total length of hospital stay with low-dose dexamethasone than with larger doses.

PMID:33639374 | DOI:10.1016/j.jss.2021.01.027

J Surg Res. 2021 Feb 24;263:53-56. doi: 10.1016/j.jss.2021.01.029. Online ahead of print.

ABSTRACT

BACKGROUND: Fatigue is a common presenting symptom in primary hyperparathyroidism (PHPT). Although fatigue alone is not currently an indication for parathyroidectomy, it can have a significant detrimental effect on quality of life. The purpose of this study was to determine if there are underlying differences in demographic or disease characteristics in patients with PHPT who present with fatigue compared with those who do not.

METHODS: We reviewed a prospective database of 2197 patients undergoing parathyroidectomy for PHPT by three endocrine surgeons from 2001 to 2019. Patients were divided into two groups based on the presence or absence of fatigue as a presenting symptom. Objective measures of disease severity were then compared between groups.

RESULTS: A total of 1379 (63%) patients presented with fatigue. Patients presenting with fatigue were more likely to be female and to have a prior fracture, lower preoperative serum calcium (Ca), and normocalcemic PHPT. There were no statistically significant differences between groups in age, body mass index, history of nephrolithiasis, or preoperative serum parathyroid hormone levels. Patients presenting with fatigue were also more likely to have smaller parathyroid glands and multiglandular disease. No statistically significant differences were detected in postoperative serum Ca and parathyroid hormone levels, or cure or recurrence rates.

CONCLUSIONS: Patients with PHPT who report fatigue as a presenting symptom present with more complex disease as manifested by a higher incidence of multiglandular disease and normocalcemic PHPT. Despite this, surgical cure is equivalent to other patients. Therefore, fatigue should be a discrete indication for parathyroidectomy in PHPT.

PMID:33639369 | DOI:10.1016/j.jss.2021.01.029

Int J Med Mushrooms. 2021;23(2):29-41. doi: 10.1615/IntJMedMushrooms.2021037630.

ABSTRACT

Recent research focuses on exploring natural resources to improve the management of type 2 diabetes and to reduce the precarious health effects of synthetic drugs. This investigation aimed to appraise the antihyperglycemic potential of hydroalcoholic (70% ethanol) extracts of Inonotus pachyphloeus, Phellinus allardii, Ph. fastuosus, Ph. gilvus, Ph. sanfordii, and Ph. torulosus. Antihyperglycemic potential was screened using an in vitro inhibition of enzymatic starch digestion assay model. The amount of glucose liberation was determined using the 3,5-dinitrosalicylic acid method. Mushroom extracts showed a concentration-dependent inhibition of α-amyalse and α-glucosidase and a consequent decrease in glucose liberation. Extracts of Ph. fastuosus (half-maximal inhibitory concentration [IC50] = 27.33 ± 1.45 mg/mL) and Ph. sanfordii (IC50 = 30.33 ± 0.88 mg/mL) causing comparable inhibition of α-amyalse and α-glucosidase and decreased glucose liberation were evaluated in vivo through oral starch tolerance and oral glucose tolerance tests using Wistar albino rats. Acarbose (10 mg/kg body weight) was used as a positive control. The extracts of Ph. fastuosus and Ph. sanfordii (100, 200, and 400 mg/kg body weight) showed a dose-dependent decrease in blood glucose concentration, and this decrease was greater in starch-fed rats than in glucose-loaded rats. Ph. fastuosus and Ph. sanfordii extracts (200 and 400 mg/kg body weight) significantly reduced postprandial hyperglycemic peaks in rats challenged with excess starch and glucose. This decrease was statistically comparable to acarbose with Ph. fastuosus extract (400 mg/kg body weight). Thus, it may be concluded that the antihyperglycemic effect of Ph. fastuosus and Ph. sanfordii is mediated by inhibition of starch digestion (inhibition of α-amylase and α-glucosidase). Hence, Ph. fastuosus and Ph. sanfordii can be developed as natural antidiabetic drugs after detailed pharmacological studies.

PMID:33639079 | DOI:10.1615/IntJMedMushrooms.2021037630

Crit Rev Eukaryot Gene Expr. 2021;31(1):71-78. doi: 10.1615/CritRevEukaryotGeneExpr.2021037483.

ABSTRACT

The present study was conducted to investigate the molecular mechanism of propofol in inhibiting the proliferation of mouse cardiac fibroblasts (CFs) induced by angiotensin II (Ag II). The ventricles of SPF mice from Kunming were cultured for the second to third generation of CFs under aseptic condition. On the basis of the different adding conditions, the mice were divided into five groups: (1) control group: no drug were added; (2) Ag II group: 100 nmol/L Ag II were added; (3) 10 μmol/L propofol + 100 nmol/L Ag II group; (4) 30 μmol/L propofol + 100 nmol/L Ag II group; (5) 50 μmol/L propofol + 100 nmol/L Ag II group. The effects of propofol on the proliferation of CFs induced by Ag II, the expression of CFs ET-1, the activity of NADPH oxidase and the formation of ROS were analyzed. In addition, our study also explored the potential role of Akt-eNOS-nitric oxide pathway regarding the inhibition of proliferation of Ag II induced CFs by propofol. We found that the proliferation of CFs, the secretion of ET-1, the activity of NADPH oxidase and the level of intracellular ROS and fibronectin expression were significantly increased after CFs exposure to Ag II for 24 h. The abovementioned indexes decreased significantly in CFs after treated with propofol for 24 h (10, 30, or 50 μmol/L) with significant statistical difference (P < 0.05). Akt and eNOS siRNA transfection significantly decreased the levels of Akt and eNOS protein, respectively. Blocking pathway of Akt-eNOS-nitric oxide decreased the inhibitory effect of propofol on Ag II-induced cell proliferation of CFs. Propofol exerts effect in inhibiting ET-1 and fibronectin expression and the formation of ROS induced by Ag II. Moreover, Akt-eNOS-nitric oxide signaling pathway may be involved in the effect of propofol on the proliferation of CFs induced by Ag II.

PMID:33639057 | DOI:10.1615/CritRevEukaryotGeneExpr.2021037483

J Thromb Haemost. 2021 Feb 27. doi: 10.1111/jth.15283. Online ahead of print.

ABSTRACT

BACKGROUND: Thrombocytopenia and thrombosis are prominent in coronavirus disease 2019 (COVID-19), particularly amongst critically ill patients; however, the mechanism is unclear. Such critically ill COVID-19 patients may be suspected of heparin-induced thrombocytopenia (HIT), given similar clinical features.

OBJECTIVES: Investigate the presence of platelet-activating anti-PF4/heparin antibodies in critically ill COVID-19 patients suspected of HIT.

PATIENTS/METHODS: We tested 10 critically ill COVID-19 patients suspected of HIT for anti-PF4/heparin antibodies and functional platelet activation in the serotonin release assay (SRA). Anti-human CD32 antibody (IV.3) was added to the SRA to confirm FcγRIIA involvement. Additionally, SARS-CoV-2 antibodies were measured using an in-house ELISA. Finally, von Willebrand factor (VWF) antigen and activity were measured along with ADAMTS13 activity and the presence of anti-ADAMTS13 antibodies.

RESULTS: HIT was excluded in all samples based on anti-PF4/heparin antibody and SRA results. Notably, 6 COVID-19 patients demonstrated platelet activation by the SRA that was inhibited by FcγRIIA receptor blockade, confirming an immune complex (IC)-mediated reaction. Platelet activation was independent of heparin but inhibited by both therapeutic and high dose heparin. All 6 samples were positive for antibodies targeting the receptor binding domain (RBD) or the spike protein of the SARS-CoV-2 virus. These samples also featured significantly increased VWF antigen and activity, which was not statistically different from the 4 COVID-19 samples without platelet activation. ADAMTS13 activity was not severely reduced, and ADAMTS13 inhibitors were not present, thus ruling out a primary thrombotic microangiopathy.

CONCLUSIONS: Our study identifies platelet-activating ICs as a novel mechanism that contributes to critically ill COVID-19.

PMID:33639037 | DOI:10.1111/jth.15283

Health Soc Care Community. 2021 Feb 27. doi: 10.1111/hsc.13328. Online ahead of print.

ABSTRACT

The Adult Social Care Outcomes Toolkit four response-level interview schedule (ASCOT INT4) for service users was translated into Finnish. The aim of this paper was to investigate the construct validity and structural characteristics of the Finnish ASCOT. We used data from a face-to-face interview survey of older people receiving publicly funded home care services, which was conducted in 2016-2017 (n = 493), excluding missing values and proxy respondents (n = 334). Chi-square tests, adjusted residuals and analyses of variance were used to examine hypothesised associations between each attribute and a number of relevant variables regarding health and well-being, disabilities, living arrangements, social contact and support, experience of service use, and the nature of the locality and environment. Structural characteristics were explored using exploratory factor analysis and Cronbach’s alpha test. The EQ-5D-3L and ASCOT were moderately correlated (r = 0.429; p < 0.001). The ASCOT attributes were statistically positively related to the overall quality of life. For other tested variables, we found a high number of significant associations with the control over daily life, occupation, social participation, and personal cleanliness attributes, but fewer significant associations with the other attributes. Cronbach’s alpha was 0.697 and a single factor was extracted. This assessment provides evidence to support the construct validity of the Finnish ASCOT. The results support the introduction of the Finnish ASCOT into Finland for use in practical applications. Future research on its reliability would be useful.

PMID:33639030 | DOI:10.1111/hsc.13328

J Hum Nutr Diet. 2021 Feb 27. doi: 10.1111/jhn.12869. Online ahead of print.

ABSTRACT

BACKGROUND: Childhood overweight and obesity have become significant public health challenges worldwide. The present study aimed to investigate whether caregivers’ feeding behaviour and children’s eating behaviour were associated with the weight status of preschool children in China.

METHODS: A cross-sectional questionnaire was administered to 912 caregivers of preschool children from April to July 2016. Caregivers’ feeding behaviours were assessed by the Chinese Preschooler’s Caregiver Feeding Behaviour Scale. Children’s eating behaviours were evaluated using the Chinese Preschooler’s Eating Behaviour Questionnaire. After controlling for demographic characteristics, multiple linear regression and logistic regression analyses were performed to evaluate the relationship between caregivers’ feeding behaviour, children’s eating behaviour and children’s body mass index (BMI).

RESULTS: The results showed that weight concerns on the part of caregivers (β = 0.53) and food responsiveness on the part of children (β = 0.93) were positively correlated with children’s BMI, whereas caregivers’ responsibility for feeding (β = -0.68) and children’s external eating (β = -0.53) were negatively correlated with BMI. Among caregiver feeding behaviours, weight concerns [odds ratio (OR) =4.54, p < 0.001] and behaviour-restricted feeding (OR =0.29, p < 0.001) were positively correlated with children’s BMI. A child’s food responsiveness (OR =4.04, p < 0.001) was also positively correlated with his/her BMI, whereas the child’s satiety responsiveness (OR =0.42, p < 0.001) and emotional eating habits (OR =0.56, p < 0.001) were negatively correlated with overweight/obesity status.

CONCLUSIONS: Our study demonstrated that children’s eating behaviour and caregivers’ feeding behaviour were associated with weight status among preschool children in China. Behaviour interventions on caregivers and their children may prevent or reduce weight problems in preschool children.

PMID:33639028 | DOI:10.1111/jhn.12869

Int Nurs Rev. 2021 Feb 27. doi: 10.1111/inr.12666. Online ahead of print.

ABSTRACT

AIM: To examine the modifiable predictors and the level of workplace social capital, transformational leadership, emotional intelligence and organizational justice among registered nurses in Chinese hospitals.

BACKGROUND: Workplace social capital is a relational network developed among nurses and other healthcare professionals that provides social support, and gives value to their working lives. Internationally, cultivating high levels of social capital is critical as it can help improve nurse satisfaction and care, and address nurse turnover. However, knowledge of factors influencing nurses’ workplace social capital is limited in China.

METHODS: In this cross-sectional, descriptive predictive study, 344 registered nurses were randomly selected from three urban Chinese hospitals in Zhejiang province. Five standard instruments were applied to collect data. Descriptive statistics were used to present the level of the variables and stepwise multiple regression was performed to identify the predictors of nurses’ workplace social capital.

RESULTS: Among eight potential factors, transformational leadership and emotional intelligence positively predicted workplace social capital. Nurses perceived the overall level of workplace social capital, emotional intelligence and unit managers’ transformational leadership as high, and the overall level of organizational justice as moderate.

DISCUSSION: Enhancing unit managers’ transformational leadership and nurses’ emotional intelligence was found to positively influence the development of workplace social capital. Although it is not a predictor of workplace social capital, nurses’ organizational justice should be improved due to its importance and current unsatisfactory level.

CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nursing and health policymakers need to consider the enhancement of transformational leadership and emotional intelligence when implementing policies to improve nurses’ workplace social capital, nursing retention and job satisfaction.

PMID:33639024 | DOI:10.1111/inr.12666

J Prosthodont. 2021 Feb 27. doi: 10.1111/jopr.13350. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the buccal bone thickness of immediate implant placement with buccal bone augmentation in patients with a thin buccal plate in the esthetic zone.

MATERIALS AND METHODS: Eighteen consecutive patients requiring a single tooth replacement in the anterior maxillary zone with a thin plate (< 1 mm) were included and received immediate implant placement with narrow-diameter implants. Patients received buccal bone augmentation (both internal and external socket bone grafting) with deproteinized bovine bone mineral (DBBM) and an absorbable membrane. The final restoration was delivered after 8 months. Cone-beam CT scans were performed before surgery (CBCT0), immediately after surgery (CBCT1), at final restoration delivery (CBCT2), and at 1-year follow-up after the final restoration (CBCT3) to evaluate the buccal bone thickness and ridge width. A repeated measures ANOVA and Bonferroni correction for multiple comparisons were applied for statistical analysis of changes within different time points (α = 0.05).

RESULTS: Fifteen of the 18 enrolled patients were available for analysis at the 1-year follow-up after final restoration. The mean buccal bone thickness at 2mm apical to the implant-abutment junction (IAJ-2) were 3.59 mm (range: 3.04-4.58 mm), 2.79 mm (range: 2.25-3.78 mm), and 2.52 mm (range: 1.72-3.36 mm), respectively, at CBCT1, CBCT2, and CBCT3. A statistical significance was observed for buccal bone thickness change between CBCT1 and CBCT2 at IAJ-2 (F = 17.948, P = 0.001). The net gains of the ridge width from CBCT0 to CBCT1, CBCT1 to CBCT2, and CBCT2 to CBCT3 were 1.08 mm, -0.94 mm and -0.04 mm at 4 mm apical to the cementum-enamel junction, respectively. No statistical significance was observed for the change in ridge width from CBCT0 to CBCT3 (F = 10.518, P = 1.000).

CONCLUSIONS: Simultaneous buccal bone augmentation may maintain a predictable buccal bone thickness for immediate implant placement in the maxillary anterior sites with a thin buccal plate (< 1 mm) at 1-year follow-up after final restoration. KEY WORDS: esthetic; dental implants; cone-beam computed tomography; bone regeneration;buccal bone thickness This article is protected by copyright. All rights reserved.

PMID:33639017 | DOI:10.1111/jopr.13350

J Nurs Manag. 2021 Feb 27. doi: 10.1111/jonm.13295. Online ahead of print.

ABSTRACT

AIM: To measure nurses’ turnover intention and identify associated factors in general hospitals in China.

BACKGROUND: Understanding nurses’ turnover intention is important to retain nurses, but factors associated with turnover intention require elucidation.

METHOD: A cross-sectional survey was conducted across 23 hospitals in China to investigate nurses’ (N=12,291) turnover intention and its associated factors. Associated factors were explored by univariate and multilevel multiple logistic regression analysis.

RESULTS: The mean total score for nurses’ turnover intention was 13.97±3.63. High proactive personality score, a seriously ill family member, experience of negative workplace events, high work pressure, and high work-family conflict increased the risk for turnover intention. A low turnover intention was associated with being a non-local resident nurse, position title, high salary level, good person-organization fit and person-group fit, and high family-work facilitation.

CONCLUSION: Nurses with a proactive personality, heavy family care burden, experience of negative workplace events, no position title, and a low salary may merit special consideration.

IMPLICATIONS FOR NURSING MANAGEMENT: Nurses’ personality traits should be further focused on, and it is important to build a nurse-oriented organization atmosphere, including protecting nurses from workplace violence, establishing friendly relationships with their families, expanding career paths.

PMID:33639014 | DOI:10.1111/jonm.13295