Category: Nevin Manimala

J Dr Nurs Pract. 2021 Jun 9:JDNP-D-20-00048. doi: 10.1891/JDNP-D-20-00048. Online ahead of print.

ABSTRACT

BACKGROUND: Learning depends not only upon how teachers have designed and structured their subjects and courses but also upon how their students perceive and understand this design and structure. Understanding student’s level of perception with their clinical education forms a basis of determining the quality of nursing education.

OBJECTIVE: Assess nursing students’ perception of their learning experience with community health nursing practical modules.

METHODS: Cross-sectional descriptive study, the convenience sample included 149 students studying a community health nursing practical course at the Faculty of Nursing affiliated to [Institution MASKED]. Three tools were used; (a) interviewing questionnaire regarding demographic characteristics. (b) Undergraduate modules experience questionnaire and (c) Student evaluation of clinical education environment inventory.

RESULTS: Students’ total perception mean scores regarding the practical modules experience questionnaire was (79.82%), and different community clinical learning environment, family health centers (82.01%), schools (76. 83%), and geriatric homes (79. 29%) with statistical significance differences p ≤ .042. Furthermore, significant relationship was found between students’ academic achievement and total perception of the Undergraduate Modules Experience Questionnaire (UMEQ) and its subscales, Good Teaching, Intellectual Motivation (p ≤ .01), Clear goals and standards and Generic Skills (p ≤ .04), Appropriate Assessment and Overall Satisfaction (p ≤ .05).

CONCLUSION: Nursing students revealed a higher positive perception of community health nursing practical modules experiences. However, there was few areas are required for improving quality of the practical modules.

IMPLICATIONS FOR NURSING EDUCATION: Increasing period of students’ clinical training exposure, teaching the skills of effective time management as well as increasing number of the academic staff in the community health nursing department are recommended strategies for improving quality of community health nursing practical modules.

PMID:34108197 | DOI:10.1891/JDNP-D-20-00048

BMJ Open. 2021 Jun 9;11(6):e045353. doi: 10.1136/bmjopen-2020-045353.

ABSTRACT

OBJECTIVE: Tourniquet use in total knee replacement (TKR) is believed to improve the bone-cement interface by reducing bleeding, potentially prolonging implant survival. This study aimed to compare the risk of revision for primary cemented TKR performed with or without a tourniquet.

DESIGN: We analysed data from the National Joint Registry (NJR) for all primary cemented TKRs performed in England and Wales between April 2003 and December 2003. Kaplan-Meier plots and Cox regression were used to assess the influence of tourniquet use, age at time of surgery, sex and American Society of Anaesthesiologists (ASA) classification on risk of revision for all-causes.

RESULTS: Data were available for 16 974 cases of primary cemented TKR, of which 16 132 had surgery with a tourniquet and 842 had surgery without a tourniquet. At 10 years, 3.8% had undergone revision (95% CI 2.6% to 5.5%) in the no-tourniquet group and 3.1% in the tourniquet group (95% CI 2.8% to 3.4%). After adjusting for age at primary surgery, gender and primary ASA score, the HR for all-cause revision for cemented TKR without a tourniquet was 0.82 (95% CI 0.57 to 1.18).

CONCLUSIONS: We did not find evidence that using a tourniquet for primary cemented TKR offers a clinically important or statistically significant reduction in the risk of all-cause revision up to 13 years after surgery. Surgeons should consider this evidence when deciding whether to use a tourniquet for cemented TKR.

PMID:34108163 | DOI:10.1136/bmjopen-2020-045353

BMJ Open. 2021 Jun 9;11(6):e050919. doi: 10.1136/bmjopen-2021-050919.

ABSTRACT

INTRODUCTION: Cardiothoracic surgical outcomes are poorer in people with diabetes compared with those without diabetes. There are two important uncertainties in the management of people with diabetes undergoing major surgery: (1) how to improve diabetes management in the weeks leading up to an elective procedure and (2) whether that improved management leads to better postoperative outcomes. We previously demonstrated the feasibility of delivering the Optimising Cardiac Surgery ouTcOmes in People with diabeteS (OCTOPuS) intervention, an outpatient intervention delivered by diabetes healthcare professionals for people with suboptimally managed diabetes over 8-12 weeks before elective cardiac surgery. The present study will assess the clinical and cost-effectiveness of the intervention in cardiothoracic centres across the UK.

METHODS AND ANALYSIS: A multicentre, parallel group, single-blinded 1:1 individually randomised trial comparing time from surgery until clinically fit for discharge in adults with suboptimally managed type 1 diabetes or type 2 diabetes undergoing elective surgery between the OCTOPuS intervention and usual care (primary endpoint). Secondary endpoints will include actual time from surgery to discharge from hospital; days alive and either out of hospital or judged as clinically fit for discharge; mortality; time on intensive therapy unit (ITU)/ventilator; infections; acute myocardial infarction; change in weight; effect on postoperative renal function and incidence of acute kidney injury; change in HbA_1c; frequency and severity of self-reported hypoglycaemia; operations permanently cancelled for suboptimal glycaemic levels; cost-effectiveness; psychosocial questionnaires. The target sample size will be 426 recruited across approximately 15 sites. The primary analysis will be conducted on an intention-to-treat population. A two-sided p value of 0.05 or less will be used to declare statistical significance for all analyses and results will be presented with 95% CIs.

ETHICS AND DISSEMINATION: The trial was approved by the South Central-Hampshire A Research Ethics Committee (20/SC/0271). Results will be disseminated through conferences, scientific journals, newsletters, magazines and social media.

TRIAL REGISTRATION NUMBER: ISRCTN10170306.

PMID:34108175 | DOI:10.1136/bmjopen-2021-050919

Zhonghua Gan Zang Bing Za Zhi. 2021 May 20;29(5):462-467. doi: 10.3760/cma.j.cn501113-20190520-00176.

ABSTRACT

Objective: To investigate the effect of baicalein in improving non-alcoholic fatty liver disease caused by high fat-induced oxidative damage in mice. Methods: Male C57BL/6J mice weighing 18-20 g were randomly divided into 4 groups: normal control group (C, 10% fat for energy), high-fat group (H, 60% fat for energy), high-fat + scutellaria baicalein group (H+B, baicalein: 400 mg·kg(-1)·bw(-1)), and baicalein control group (B, baicalein: 400 mg·kg(-1)·bw(-1)). After 12 weeks, mice were sacrificed, and the tissue samples were collected. Liver pathological changes were observed by hematoxylin and eosin staining. Mitochondrial morphology was examined by ultramicropathology. Malondialdehyde (MDA), superoxide dismutase (SOD), glutathione (GSH) and mitochondrial membrane potential (MMP) changing levels in the liver were determined by kit. Sestrin2 and protein carbonylation (PCOS) levels were detected by Western blotting. Small interfering RNA (siRNA) was used to knock-down the Sestrin2 protein expression in HepG2 cells. Intramyocellular lipid changes in HepG2 cells was detected by fluorescent dye BODIPY493/503. One way ANOVA was used LSD pairwise comparison method was used to test the statistical difference. Results: Compared with the normal control group, high-fat fed caused significant fatty degeneration, decreased GSH and SOD levels (P ​​< 0.05), increased MDA and protein carbonylation levels, and increased Sestrin2 expression (P < 0.05) in mice. Mitochondrial shape changes, swelling, lack of cristae, and MMP was down-regulated by 33.3% (t = 13.456, P ​​< 0.001). Baicalein intervention had effectively inhibited hepatic steatosis and oxidative damage caused by high-fat fed, and further up-regulated Sestrin2 expression, MMP (t = 10.104, P ​​< 0.001), and significantly alleviated liver damage in mice. Sestrin2 expression knock-down had further increased the intracellular lipid deposition and PCOs expression (P ​​< 0.05), and reduced baicalein ability to antagonize lipid deposition and antioxidant capacity in Hep2 cells. Conclusion: Baicalein alleviate non-alcoholic fatty liver by regulating Sestrin2 expression and high-fat fed-induced liver oxidative damage.

PMID:34107585 | DOI:10.3760/cma.j.cn501113-20190520-00176

Zhonghua Gan Zang Bing Za Zhi. 2021 May 20;29(5):468-471. doi: 10.3760/cma.j.cn501113-20190109-00001.

ABSTRACT

42 cases with gastroesophageal varices were prospectively included. The groups were treated with endoscopic band ligation or combined with tissue adhesive. The results showed that the left gastric vein internal diameter, average blood flow velocity and blood flow volume after the treatment of band ligation combined with tissue adhesive were significantly lower than that of the treatment of band ligation alone, and the differences were statistically significant (P < 0.05). Spleen and portal vein internal diameter, blood flow and average velocity, the liver and spleen size, shear wave velocity and liver function grade of the two groups after treatment did not change significantly (P > 0.05). The effective rate of band ligation combined with tissue adhesive in the treatment of esophageal and gastric varices (66.67%, 52.38%) were higher than that of band ligation alone (42.85%, 23.81%) (P > 0.05), and the re-bleeding rate of the latter was higher (9.52% and 19.05%, P > 0.05). Hence, it is suggested that the combined therapy is safe and more effective, and has no apparent effect on liver function and portal hypertension.

PMID:34107586 | DOI:10.3760/cma.j.cn501113-20190109-00001

Zhonghua Gan Zang Bing Za Zhi. 2021 May 20;29(5):439-445. doi: 10.3760/cma.j.cn501113-20190411-00119.

ABSTRACT

Objective: To explore the regulatory role and mechanism of tribbles pseudokinase 3 (TRB3) on hepatocarcinoma (HCC) cells proliferation, apoptosis and migration. Methods: Immunohistochemistry and Western blot were used to detect TRB3 expression in cancerous and adjacent cancerous liver tissues of HCC patients. TRB3 expression was detected in vitro in HepG2 and Huh7 hepatocarcinoma cell lines. Simultaneously, CCK8 and EdU were used to detect cell proliferation after TRB3 targeted inhibition with small interfering RNA. CCK8 and EdU were used to detect cell proliferation. Flow cytometry assay was used to detect apoptosis. Transwell assay was used to evaluate migration ability. Simultaneously, Western blot was used to detect changes in apoptosis, migration-related proteins and AKT phosphorylation activity. The mean comparison between the two groups was performed by t-test, and the comparison between multiple groups was performed by one-way analysis of variance. Results: Western blot showed that the expression of TRB3 was significantly up-regulated in HCC tissues. Compared with normal liver tissues adjacent to cancer, the relative expression levels were 0.78 ± 0.12 and 0.29 ± 0.09, respectively, P < 0.01, and the difference was statistically significant. After interfering siRNA inhibited TRB3, CCK8 and EdU tests showed that the proliferation activity of HepG2 and Huh7 cells were significantly weakened (P < 0.05). Flow cytometry results showed that the apoptotic proportions of HepG2 and Huh7 cells was significantly increased (P < 0.01). Western blot also showed that the expression of apoptosis regulatory proteins BAX and BIM were significantly increased (P < 0.01). Transwell assay results showed that the migration ability of HepG2 and Huh7 cells was decreased (P < 0.05), and the expression of migration regulatory proteins MMP4 and MMP9 was also significantly down-regulated. Western blot results showed that the AKT phosphorylation level was significantly increased. Conclusion: TRB3 regulates hepatocarcinoma cells proliferation, apoptosis and migration by inhibiting the AKT phosphorylation activity. Therefore, TRB3 may be a potential target site for the liver cancer treatment.

PMID:34107581 | DOI:10.3760/cma.j.cn501113-20190411-00119

Zhonghua Gan Zang Bing Za Zhi. 2021 May 20;29(5):456-461. doi: 10.3760/cma.j.cn501113-20200427-00219.

ABSTRACT

Objective: To study the effect of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on free fatty acid (FFA)-induced hepatocyte steatosis, and to explore its autophagic role in this process. Methods: Human hepatocytes were cultured in vitro to induce NAFLD cell model. Liraglutide (LRG) concentration gradient was added to observe the effect on cell survival rate and fatty degeneration of liver cells. The relationship between liraglutide and autophagy was investigated with chloroquine inhibition and rapamycin (RAPA) activation in hepatocyte steatosis. Experimental group: control group: a certain concentration of BSA was added to cells cultured in DMEM complete medium; FFA model group: fatty degeneration of hepatocytes was induced by 1mmol/L FFA (OA : PA=2 : 1); LRG group: FFA (1 mmol/L) and LRG (100 nmol/L) were added to the cells at the same time; autophagy inhibition group: FFA (1 mmol/L), LRG (100 nmol/L), and chloroquine (20 μmol/L) were added to the cells at the same time; autophagy activated group: FFA (1 mmol/L) and RAPA (1 μmol/L) were added to the cells at the same time. Oil red O staining and fully automated biochemistry analyzer were used to observe the intracellular lipidosis condition. Western blotting was used to detect the levels of autophagy-related proteins (Beclin1, P62, and LC3B). One-way analysis of variance was used to compare the means between multiple groups. Results: Within a certain concentration range, with the increase of LRG concentration, the hepatocytes survival rate was increased and the degree of intracellular lipidosis had continued to decrease. The best effect was achieved when LRG concentration reached 100nmol/L, and the difference was statistically significant when compared with the FFA group (P < 0.01). During the exploration of the relationship between the degree of hepatic steatosis and autophagy, LRG group intracellular triglyceride content was significantly lower than FFA group (P < 0.01), and the levels of Beclin1, LC3B-II/LC3B-I were higher than FFA group. Additionally, FFA group had reduced P62 level, and enhanced autophagy. Compared with the LRG group, autophagy inhibition group intracellular triglyceride content was increased (P < 0.01), while the levels of Beclin1, LC3B-II/LC3B-I was decreased, and P62 level was increased. Autophagy activated group RAPA had significantly reduced FFA-induced intrahepatic triglyceride deposition, and the changes in autophagy-related protein levels were consistent with the effect of LRG. Conclusion: GLP-1RAs can alleviates FFA-induced lipotoxic liver cell damage, and promote autophagy to improve fatty degeneration of hepatocytes in NAFLD.

PMID:34107584 | DOI:10.3760/cma.j.cn501113-20200427-00219

J Obstet Gynaecol Res. 2021 Jun 9. doi: 10.1111/jog.14857. Online ahead of print.

ABSTRACT

OBJECTIVE: Hyperemesis gravidarum is an illness that starts in early pregnancy and manifests itself with oral intake problems, electrolyte imbalance, ketonuria, and weight loss. Inflammation is closely associated with the hyperemesis gravidarum, and inflammatory indicators have been studied to understand its pathophysiology. This study investigates the relationship of ketonuria levels with inflammatory markers platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and neutrophil-to-lymphocyte ratio (NLR) for hyperemesis gravidarum patients.

MATERIAL AND METHODS: This retrospective case control study was conducted at Kütahya Medical Sciences University Tertiary Research and Training Hospital between December 2019 and December 2020. A total of 173 pregnancies, 82 of them with hyperemesis gravidarum and 91 of them low-risk pregnancies were included in the study. The patients’ demographic profiles and laboratory parameters were recorded. The patients were divided into hyperemesis gravidarum and control groups and the groups were compared for the levels of inflammation markers. For the hyperemesis gravidarum group, the relationship between ketonuria levels and the inflammation severity was investigated.

RESULTS: MLR, NLR, PLR levels were higher in the hyperemesis gravidarum group than the control group in a statistically significant way (p < 0.001 for all of the comparisons). The hyperemesis gravidarum group was subdivided into four groups based on their ketonuria levels, and their MLR, NLR, PLR levels were compared. The differences between the groups were statistically significant (p < 0.001) and the indicators increased with the ketonuria levels. Finally, ketonuria levels had a positive and significant correlation with MLR (rho =0.67, p < 0.001), PLR (rho =0.67, p < 0.001), and NLR (rho =0.8, p < 0.001).

CONCLUSION: Hyperemesis gravidarum patients have higher levels of hematologic inflammation indicators than healthy pregnant patients. For these patients, the levels of the indicators increase with ketonuria levels.

PMID:34107554 | DOI:10.1111/jog.14857

Zhonghua Gan Zang Bing Za Zhi. 2021 May 20;29(5):403-408. doi: 10.3760/cma.j.cn501113-20201224-00676.

ABSTRACT

Objective: To understand and compare the differences between age, sex and liver diseases-related mortality risk in patients with hepatitis B virus-related liver cirrhosis. Methods: Based on the front-page inpatient medical record database and the death registration system of Beijing patients with hepatitis B-related liver cirrhosis from 2008 to 2015 were included. The survival information of all patients were traced up to the occurrence of liver disease-related mortality event or until December 31, 2019. Kaplan-Meier method was used to calculate the cumulative incidence of liver disease-related mortality in patients with liver cirrhosis. Cox regression model was used to analyze the effect of age-gender interaction on liver disease-related mortality risk. Results: A total of 16 738 patients with hepatitis B-related liver cirrhosis were included, of which 13 969 cases (83.46%) were in compensated stage and 2 769 cases (16.54%) were in decompensated stage. Liver cirrhosis complications mortality risk in patients with compensated stage cirrhosis at 3, 5, and 8 years were 10.84%, 12.70%, and 14.37%, respectively; while in decompensated stage patients, the mortality risk was 16.70%, 19.02%, and 20.73%, respectively. The 3, 5, and 8-year liver cancer mortality rates of patients with compensated stage liver cirrhosis were 5.24%, 7.49%, and 10.25%, respectively; while those with decompensated stage liver cancer mortality rates were 9.01%, 11.16%, and 13.50%, respectively. Liver disease-related mortality risk was increased with age in patients with liver cirrhosis. Liver cirrhosis complications mortality risk in female patients with liver cirrhosis at age < 60 years was lower than that of male patients. Liver cirrhosis complications mortality risk in male and female patients aged 60-69 years were similar. Liver cirrhosis complications mortality risk in female patients aged ≥70 years was higher than that of male patients. However, female patients had a lower risk of liver cancer mortality than male patients in utmost age groups. Conclusion: Age is positively correlated with liver diseases-related mortality risk in patients with hepatitis B-related liver cirrhosis. Female sex is a protective factor for liver cancer mortality in patients with liver cirrhosis, and the protective effect on liver cirrhosis complications mortality risk gradually disappears with age.

PMID:34107575 | DOI:10.3760/cma.j.cn501113-20201224-00676

Zhonghua Gan Zang Bing Za Zhi. 2021 May 20;29(5):421-426. doi: 10.3760/cma.j.cn501113-20191113-00420.

ABSTRACT

Objective: To observe the effect of tenofovir disoproxil fumarate (TDF) antiviral therapy on HBV-specific CD8(+)T cell function in peripheral blood of patients with HBeAg-positive chronic hepatitis B, and to assess its correlation with HBeAg sero-negativeness. Methods: Sixty-three cases with HLA-A02 restricted HBeAg-positive chronic hepatitis B who received TDF (300 mg/d) antiviral therapy were enrolled from October 2016 to July 2018. The peripheral blood CD8(+)T cells were separated at baseline and 48 weeks after treatment. The peripheral blood T cells count were detected by flow cytometry. The frequency of HBV-specific CD8(+)T cells secreting perforin, granzyme B, and interferon-γ (IFN-γ) were detected by enzyme-linked immunoblotting test. Direct and indirect contact co-culture system was established between HBV-specific CD8(+)T cells and HepG2.2.15 cells. HBV DNA was detected in the culture supernatant. Target cell mortality was calculated by lactate dehydrogenase level. Cytokines expression was detected by enzyme-linked immunosorbent assay. Virus-specific CD8(+)T cells cytokilling and non-cytokilling functions were evaluated. Measurement data of the two groups were compared by t-test or paired t-test. Results: Viral response, biochemical response, and HBeAg seroconversion rate at 48 weeks of TDF treatment were 100%, 90.48% (57/63), and 25.40% (16/63), respectively. There was no statistically significant difference in peripheral blood T cell count when compared with baseline and control group at 48 weeks of TDF treatment (P > 0.05). At 48 weeks of TDF treatment, the frequency of HBV-specific CD8(+)T cells secreting perforin, granzyme B, and IFN-γ in CHB patients was significantly higher than baseline (P < 0.001). Furthermore, the frequency of HBV-specific CD8(+)T cells secreting perforin, granzyme B, and IFN-γ was also significantly higher in CHB patients with HBeAg negative than that of non-negative (P < 0.05). HBV-specific CD8(+)T cells had induced significant down-regulation of HBV DNA in the supernatant of HepG2.2.15 cell culture (P < 0.001) and remarkable IFN-γ and interleukin-2 secretion (P < 0.05) at 48 weeks of TDF therapy in direct and indirect contact co-culture system. However, HepG2.2.15 cells death rate induced by virus-specific CD8(+)T cells was increased only in the direct contact co-culture system (21.7% ± 6.18% vs. 16.1% ± 4.15%, P < 0.001). Compared with HBeAg non-negative patients, HBeAg negative CHB patients with HBV-specific CD8(+)T cells had induced a strong decrease in HBV DNA (P < 0.001) and an increase in IFN-γ secretion level (P < 0.05). However, the target cell death proportion difference between HBeAg negative and non-negative patients was not statistically significant (P > 0.05). Conclusion: During TDF treatment, with the viral load reduction, virus-specific CD8(+)T cells cytokilling and non-cytokilling functions are significantly enhanced, and are closely related to HBeAg negative.

PMID:34107578 | DOI:10.3760/cma.j.cn501113-20191113-00420