Association of statin use and increase in lipoprotein(a): a real-world database research.

BACKGROUND: There is an increased concern that statins may have an unintended effect of elevated lipoprotein(a) [Lp(a)]. We conducted a large sample real-world study to test the association. METHODS: This retrospective cohort study was conducted using data from an integrated SuValue database, which includes 221 hospitals across China covering more than 200,000 of population with longitudinal follow-up to 10 years. Propensity score matching was applied to identify two comparable cohorts with statin users and non-statin users. Detailed follow-up information such as Lp(a) levels were extracted. The hazard ratio was calculated on Lp(a) changes based on the statin usage cohorts. Detailed subgroup and different characteristic cohorts' analyses were also conducted. RESULTS: After baseline propensity score matching, a total of 42,166 patients were included in a 1:1 matched ratio between statin users and non-statin users. In the case of no difference in low density lipoprotein (LDL-C), Lp(a) was increased significantly with the use of statins (adjusted HR 1.47; 95% confidence interval [CI] 1.43-1.50). Lp(a) increase was observed in various subgroup analyses and different cohorts. The dose intensity of statin was positively associated with the evaluated Lp(a) level. CONCLUSION: The use of statins was associated with an increased risk of Lp(a) elevation compared with non-statin use counterparts. The clinical relevance of these increases needs to be addressed in surrogate marker trials and/or large, cardiovascular outcomes trials.

Self-efficacy and attitudes of nurses providing oral care in geriatric care facilities: A cross-sectional study in Shanghai.

AIMS: To investigate nurses' self-efficacy and attitudes of providing oral care in geriatric care facilities (GCFs) and compare differences between individuals, facilities and countries. DESIGN: A cross-sectional and multicentre study. METHODS: Data were collected from 852 nurses in 42 GCFs using two scales, "Self-Efficacy for Providing Mouth Care" (SE-PMC) and "Attitudes for Providing Mouth Care" (A-PMC), and analysed using t-test and ANOVA. RESULTS: Totally 852 nurses (844 females, 99%) participated in this study with an effective response rate of 85.2%. Scores of SE-PMC and A-PMC of nurses varied significantly among GCFs with different sizes, types and years of establishment and differentiated among staff about the length of employment (p < .05). Nurses (N = 434) in North Carolina scored higher than nurses in Shanghai both in SE-PMC and A-PMC (p < .05). Establishment and implementation of Oral health promotion programmes were desired based on characteristics of different institutions and nurses' clinical ladder.

The Efficacy and Safety of Thrice vs Twice per Week Low-Intensity Pulsed Ultrasound Therapy for Erectile Dysfunction: A Randomized Clinical Trial.

BACKGROUND: A recent sham-controlled clinical study has shown that low-intensity pulsed ultrasound twice per week can safely and effectively treat patients with mild-to-moderate erectile dysfunction (ED). However, large-scale clinical trials are needed to verify its efficacy and safety and determine a reasonable treatment interval. AIM: To study whether low-intensity pulsed ultrasound therapy thrice per week is non-inferior to twice per week in patients with mild-to-moderate ED. METHODS: A randomized, open-label, parallel-group, non-inferiority clinical trial was conducted in 7 hospitals in China. A total of 323 patients with mild-to-moderate ED were randomized (1:1) into thrice per week (3/W) and twice per week (2/W) groups. Low-intensity pulsed ultrasound was applied on each side of the penis for 16 sessions. OUTCOMES: The primary outcome was response rate using the minimal clinically important difference in the International Index of Erectile Function (IIEF-EF) score at week 12. Secondary outcomes included Erection Hardness Score (EHS), Sexual Encounter Profile, Global Assessment Question, and Self Esteem and Relationship Questionnaire. RESULTS: Response rates in 3/W and 2/W groups were 62.0% and 62.5%, respectively. Treatment effect in the 3/W group was noninferior to that of the 2/W group, with rate difference lower bound of -0.01% [95% confidence interval -0.11 to 0.10%] within the acceptable margin (-14.0%). No significant difference was found among secondary outcomes. IIEF-EF score showed a significant increase from baseline in the 3/W group (16.8 to 20.7) and 2/W group (17.8 to 21.7), and the percentage of patients with EHS ≥3 increased in the 3/W (54.9% to 84.0%) and 2/W (59.5% to 83.5%) groups. There was no significant difference in response rate between the 2 groups after controlling for strata factors and homogeneous tests. No treatment-related adverse events were reported. CLINICAL IMPLICATIONS: Low-intensity pulsed ultrasound therapy displays similar efficacy and safety for mild-to-moderate ED when administered thrice or twice per week for 16 sessions. This study provides two options to suit patients' needs. STRENGTHS & LIMITATIONS: This is a large-sample, randomized, controlled, noninferiority trial study. Short-term follow-up and mostly younger patients are the main limitations. CONCLUSION: Low-intensity pulsed ultrasound therapy thrice and twice per week showed equivalent therapeutic effects and safety for mild-to-moderate ED in a young and generally healthy population. This therapy warrants further investigation of its potential value in rehabilitation of ED. Chen, H., Li Z., Li X., et al. The Efficacy and Safety of Thrice vs Twice per Week Low-Intensity Pulsed Ultrasound Therapy for Erectile Dysfunction: A Randomized Clinical Trial. J Sex Med 2022;19:1536-1545.

Translation, cross-cultural adaptation, and validation of the Chinese version of self-efficacy and attitudes for providing Mouth Care scale.

BACKGROUND: In recent years, oral care for older people has received extensive attention in long-term care facilities. The Self-Efficacy for Providing Mouth Care (SE-PMC) and Attitudes for Providing Mouth Care (A-PMC) scale evaluated the self-efficacy and attitude of nursing staff while providing oral care. However, whether this scale is valid and reliable for Chinese nursing staff in China remains unverified. This study aims to translate the English version of SE-PMC and A-PMC into Chinese and determine their reliability and validity. METHODS: After obtaining the author's consent, the procedure for a double-back translation and cross-cultural adaptation was conducted to develop the Chinese version of SE-PMC and A-PMC. The validity and reliability of the Chinese version of SE-PMC and A-PMC were evaluated in a cross-sectional observational study with 852 nurses from 42 Geriatric Care Facilities (GCFs). Exploratory factor analysis (EFA) (n = 427) and confirmatory factor analysis (CFA) (n = 425) were conducted to test the construct validity and quality of the factor structures. We applied the item discrimination test and homogeneity test for item analysis. Cronbach's alpha coefficient and split-half coefficient were adopted to evaluate internal consistency. RESULTS: The Chinese version of SE-PMC (11 items, 3 factors) and A-PMC (11 items, 2 factors) included 22 items, reflecting adequate construct validity and reliability. In addition, test-retest reliability was 0.809 for SE-PMC and 0.811 for A-PMC, evincing good stability. The Cronbach's α coefficient of SE-PMC was 0.831, with each factor ranging from 0.793~0.906. The Cronbach's α coefficient of the A-PMC was 0.768, with each factor ranging from 0.814~0.824. Item-Content Validity Index (I-CVI) of SE-PMC and A-PMC ranged from 0.84 ~1.00 and 0.82~1.00, respectively. CONCLUSION: The Chinese version of SE-PMC and A-PMC was validated as a reliable assessment tool to evaluate the self-efficacy and attitude of nursing staff in GCFs for providing oral care in China.

Develop a Clinical Prediction Model for Postoperative Cognitive Dysfunction after Major Noncardiac Surgery in Elderly Patients: A Protocol for a Prospective Observational Study.

Perioperative neurocognitive disorders (PNDs) refer to cognitive decline identified in the preoperative or postoperative period. It has been reported that the incidence of postoperative neurocognitive impairment after noncardiac surgery in patients older than 65 at 1 week was 25.8∼41.4%, and at 3 months 9.9∼12.7%. PNDs will last months or even develop to permanent dementia, leading to prolonged hospital stays, reduced quality of life, and increased mortality within 1 year. Despite the high incidence and poor prognosis of PNDs in the aged population, no effective clinical prediction model has been established to predict postoperative cognitive decline preoperatively. To develop a clinical prediction model for postoperative neurocognitive dysfunction, a prospective observational study (Clinical trial registration number: ChiCTR2000036304) will be performed in the Shanghai General Hospital during January 2021 to October 2022. A sample size of 675 patients aged >65 years old, male or female, and scheduled for elective major noncardiac surgery will be recruited. A battery of neuropsychological tests will be used to test the cognitive function of patients at 1 week, 1 month, and 3 months postoperatively. We will evaluate the associations of PNDs with a bunch of candidate predictors including general characteristics of patients, blood biomarkers, indices associated with anesthesia and surgery, retinal nerve-fiber layer thickness, and frailty index to develop the clinical prediction model by using multiple logistic regression analysis and least absolute shrinkage and the selection operator (LASSO) method. The k-fold cross-validation method will be utilized to validate the clinical prediction model. In conclusion, this study was aimed to develop a clinical prediction model for postoperative cognitive dysfunction of old patients. It is anticipated that the knowledge gained from this study will facilitate clinical decision-making for anesthetists and surgeons managing the aged patients undergoing noncardiac surgery.

Prognosis of severe lower respiratory tract infected patients with virus detected: a retrospective observational study.

OBJECTIVES: To compare the prognosis of severe lower respiratory tract infected patients with virus detected and patients with virus undetected by using metagenomic sequencing technology and a series of traditional serological tests. METHODS: A total of 51 consecutive lower respiratory tract infected patients were enrolled in this study and samples were obtained to perform metagenomic next-generation sequencing (mNGS) and other traditional tests for virus detection. According to the results, patients were divided into a virus-detected (VD) group and a virus-undetected (VUD) group. Meanwhile, patients' demographic information, relevant baseline indicators and outcome indicators were also collected. RESULTS: There were 27 patients in the VD group and 24 patients in the VUD group. Patients in the VD group had a longer mechanical ventilation (MV) supporting time [528.0 h (216.0, 997.0) vs 235.5 h (119.3, 421.3), p = .003], a higher tracheotomy rate [(63.0 vs. 29.2%), p = .016] and red blood cell (RBC) transfusion rate [(66.7 vs. 33.3%), p = .017] compared to the VUD group. The two groups had no significant difference in mortality rate, hospital length of stay (HLOS) or ICU length of stay (ICULOS). CONCLUSIONS: Virus detected in patients with severe lower respiratory tract infection (LRTI) was not related to a poorer prognosis, but patients in the VD group did need more clinical resources, such as more MV support and RBC transfusion.

Oral health matters in cognitive impaired aged residents in geriatric care facilities: A cross-sectional survey.

AIMS: To investigate the oral health status of aged residents and explore the possible factors associated with oral health and the effect of cognitive impairment (CI) on it in geriatric care facilities (GCF) using oral health assessment tool (OHAT) in Shanghai, China. BACKGROUND: Oral health is closely associated with overall health. Problems like missing teeth, dental caries, dental pain, periodontal diseases, oral infections and dysphagia are common in GCFs. Furthermore, residents in GCFs with CI are becoming a dominant group and this prevalence increases with age. Detection of oral problems earlier and taking oral care actions is required for these special populations. METHODS: The study was an observational cross-sectional study conducted in 42 GCFs. Data were collected from 657 subjects, including oral health assessment (OHAT), cognitive impairment (Mini-Mental State Examination, MMSE) and respondents' characteristics. The subjects were divided into CI group and non-CI group based on MMSE. Oral health conditions were compared between the two groups. RESULTS: Oral health status in the CI group was significantly worse than that in the non-CI group (p < .001) with four OHAT dimensions (tongue (p = .0007), saliva (p = .0011), natural teeth (p = .0155) and oral cleanliness (p < .001)). The worst dimension was natural teeth. Debris and plaque index (p < .001), oral odour (p < .001), chewing function (p = .0151) and swallowing function (p = .0405) were worse in CI group than those in non-CI group. In the CI group, providing oral care was a protective factor in oral health (OR = 0.600 95CI% (0.39-0.92)) and wearing dentures was a risk factor (OR = 2.09, 95CI% (1.31-3.32)), while the similar effects were not found in non-CI group. CONCLUSIONS: Oral health status among aged residents in GCFs in China was worse among individuals with CI. Caregivers in GCFs should focus more on seniors' oral health with CI. RELEVANCE TO CLINICAL PRACTICE: Residents who are suffering from CI are more vulnerable to have oral problems. Regular and proper oral health check-ups in daily nursing work to define oral problems of residents are significant. Nursing staff should pay more attention to oral assessment and effective intervention.

Short-term prognosis and influencing factors of patients with acute kidney injury treated with prolonged intermittent renal replacement therapy.

BACKGROUND: Studies assessing prognosis after prolonged intermittent renal replacement therapy (PIRRT) for acute kidney injury (AKI) are scarce. AIM: To assess the impact of PIRRT on AKI and factors associated with short-term prognosis. METHODS: In this retrospective nested case-control study, AKI patients administered PIRRT in Shanghai General Hospital from 01/2012 to 10/2018 were assigned to the 30-day survivor and death groups. Surviving patients were further divided into the kidney recovery and non-recovery groups at 30 and 90 days post-discharge, respectively. Propensity score matching was performed. RESULTS: Totally 576 patients were included in the non-matched study population, mortality and kidney recovery rates were 51.7% and 33.4%, respectively. After propensity score matching, there were 250 patients in each of the death and survival groups. Low PIRRT frequency (OR = 2.165, 95% CI = 1.178-3.978), infection (OR = 0.447, 95% CI = 0.251-0.795), number of damaged vital organs (OR = 0.478, 95% CI = 0.346-0.661), sodium (OR = 0.958, 95% CI = 0.928-0.988), total protein (OR = 1.047, 95% CI = 1.022-1.072), pre-dialysis thrombin time (TT; OR = 0.959, 95% CI = 0.936-0.983), pre-discharge glomerular filtration rate (GFR; OR = 1.024, 95% CI = 1.017-1.031) and admission ward [reference: renal ward; intensive care unit (OR = 0.042, 95% CI = 0.008-0.211); surgery (OR = 0.092, 95% CI = 0.018-0.465); medical (OR = 0.049, 95% C% CI = 0.009-0.259); other (OR = 0.097, 95% CI = 0.016-0.572)] independently predicted 30-day mortality. Peripherally inserted central catheter (OR = 13.970, 95% CI = 1.439-135.589), urea nitrogen (OR = 0.961, 95% CI = 0.933-0.990) and pre-discharge GFR (OR = 1.102, 95% CI = 1.067-1.137) independently predicted 30-day kidney recovery. Pre-dialysis Scr (OR = 0.997, 95% CI = 0.995-0.999), urea nitrogen (OR = 0.948, 95% CI = 0.912-0.986) and pre-discharge GFR (OR = 1.137 95% CI = 1.088-1.189) independently predicted 90-day kidney recovery. CONCLUSIONS: PIRRT improves survival and kidney function recovery in AKI patients. In patients with previous GFR ≥ 30 mL/(min-1.73 m2 ) and no prior maintenance dialysis, PIRRT at 3-5 sessions/week might be appropriate.

The association between social support and mental health among vulnerable adolescents in five cities: findings from the study of the well-being of adolescents in vulnerable environments.

PURPOSE: Globally, adolescents are at risk of depression, traumatic stress, and suicide, especially those living in vulnerable environments. This article examines the mental health of 15- to 19-year-old youth in five cities and identifies the social support correlates of mental health. METHODS: A total of 2,393 adolescents aged 15-19 years in economically distressed neighborhoods in Baltimore, MD; New Delhi, India; Ibadan, Nigeria; Johannesburg, South Africa; and Shanghai, China were recruited in 2013 via respondent-driven sampling to participate in a survey using an audio computer-assisted self-interview. Weighted logistic regression and general linear models were used to explore the associations between mental health and social supports. RESULTS: The highest levels of depression and posttraumatic stress symptoms were displayed in Johannesburg among females (44.6% and 67.0%, respectively), whereas the lowest were among New Delhi females and males (13.0% and 16.3%, respectively). The prevalence of suicidal ideation ranged from 7.9% (New Delhi female adolescents) to 39.6% (Johannesburg female adolescents); the 12-month prevalence of suicide attempts ranged from 1.8% (New Delhi females) to 18.3% (Ibadan males). Elevated perceptions of having a caring female adult in the home and feeling connected to their neighborhoods were positively associated with adolescents' levels of hope across the sites while negatively associated with depression and posttraumatic stress symptoms with some variation across sites and gender. CONCLUSIONS: Adolescents living in the very economically distressed areas studied register high levels of depression and posttraumatic stress. Improving social supports in families and neighborhoods may alleviate distress and foster hope. In particular, strengthening supports from female caretakers to their adolescents at home may improve the outlooks of their daughters.

Haplotyping a single triploid individual based on genetic algorithm.

The minimum error correction model is an important combinatorial model for haplotyping a single individual. In this article, triploid individual haplotype reconstruction problem is studied by using the model. A genetic algorithm based method GTIHR is presented for reconstructing the triploid individual haplotype. A novel coding method and an effectual hill-climbing operator are introduced for the GTIHR algorithm. This relatively short chromosome code can lead to a smaller solution space, which plays a positive role in speeding up the convergence process. The hill-climbing operator ensures algorithm GTIHR converge at a good solution quickly, and prevents premature convergence simultaneously. The experimental results prove that algorithm GTIHR can be implemented efficiently, and can get higher reconstruction rate than previous algorithms.