Assessment of postoperative risk factors for EEG abnormalities in routine clinical management after paediatric cardiopulmonary bypass.

OBJECTIVES: The postoperative risk factors for electroencephalogram(EEG) abnormalities after paediatric cardiopulmonary bypass (CPB) remain to be identified. We investigated the characteristics of EEG abnormalities and risk factors in routine clinical management post-CPB. METHODS: EEG and cerebral oxygen saturation (ScO2) were monitored in 96 patients (aged 3 days, 37 months, median 5 months) for 72 h post-CPB. Clinical measurements included 4-hourly arterial and central venous pressure, arterial blood gases, doses of inotropic and vasoactive drugs, daily C-reactive protein (CRP) and NT-proB-type Natriuretic Peptide (NT-proBNP). Demographics, STAT categories and outcomes (duration of mechanical ventilation,CICU stay) were recorded. Un. RESULTS: Seizures occurred in 20 patients (20.8%) beginning at 0-48 hand lasting 10 min-31 h; background abnormalities occurred in 67 (69.8%) beginning at 0-8 h and lasting 4-48 h. Patients with EEG abnormalities had worse outcomes. In univariable regression, seizures positively correlated with STAT categories, CPB time, temperature, blood pressure, central venous pressure, NT-proBNP, CRP, lactate and epinephrine, negatively with ScO2 and PaCO2 (P < 0.001 for lactate and epinephrine, P < 0.1 for the remaining). The degree of background abnormalities positively correlated with STAT categories, CPB time, operative time, central venous pressure, milrinone, negatively with blood pressure (P = 0.0003-0.087); it negatively correlated with lower dose of epinephrine (P < 0.001) and positively with higher dose (P = 0.03l). In multivariable regression, seizures positively correlated with epinephrine, lactate and temperature; the background abnormality correlations remain significant except for milrinone and operative time (P < 0.001 for epinephrine, P < 0.05 for the remaining). CONCLUSIONS: Numerous perioperative risk factors are associated with EEG abnormalities post-CPB. The most significant and consistent risk factor is epinephrine.

A comprehensive assessment of single nucleotide polymorphisms associated with pancreatic cancer risk: A protocol for systematic review and network meta-analysis.

BACKGROUND: Single nucleotide polymorphisms (SNPs) have been inconsistently associated with pancreatic cancer (PC) risk. This meta-analysis aimed to synthesize relevant data on SNPs associated with PC. METHODS: Databases were searched to identify association studies of SNPs and PC published through January 2020 from the databases of PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, the Chinese Science and Technology Periodical Database (VIP) and Wanfang databases. Network meta-analysis and Thakkinstian algorithm were used to select the most appropriate genetic model, along with false positive report probability (FPRP) for noteworthy associations. The methodological quality of data was assessed based on the STREGA statement Stata 14.0 will be used for systematic review and meta-analysis. RESULTS: This study will provide a high-quality evidence to find the SNP most associated with pancreatic cancer susceptibility and the best genetic model. CONCLUSIONS: This study will explore which SNP is most associated with pancreatic cancer susceptibility.Registration: INPLASY202040023.

[General integral medicine: the strategic direction for complex health interventions].

Nowadays, the simple combination of Western medicine (WM) and complementary and alternative medicine (CAM) cannot resolve all the health problems and various requirements. This article proposed the general integral medicine (GIM) theoretical model, which declares the disease causes analysis, clinical intervention and outcomes assessment should be recognized, managed and evaluated both from physiological, psychological, and spiritual status, and all the four dimensions: orthodox medicine (WM, Chinese medicine, etc.), individual inherent characteristics (emotion, attitude, psychology, etc.), cultural influences (doctors, caregivers, groups care, etc.), and natural environment and social systems (economic status, social security system, environmental pollution, etc). As for health outcomes assessment, a more comprehensive system including biological, doctors, patients, health intimate, social and environmental evaluations were required. The GIM model has individualized, dynamic, standardized, objective, systematic inherent characteristics, and opening and compatible external characteristics. It aims to provide the new theoretical guidance and strategic development direction for complex health interventions, and solve various medical related psychological and social problems.

[Characteristic of elements in PM2.5 and health risk assessment of heavy metals during heating season in Taiyuan].

The fine particulate matter (PM2.5) sampled during heating season in Taiyuan city and nineteen samples were used to investigate elemental concentrations and its source potential ecological risks of heavy metals, and to assess human exposure and health risk. The result indicated that main elements were Si, Ca, Al, Na, Mg, K, Fe in PM2.5. The main sources of elements in PM2.5 were divided into five categories including soil dust (43.46%), coal burning (15.69%), vehicle emission (13.41%), industrial dust (9.89%) and the construction cement dust (9.03%). Moreover, the order of potential ecological risk index of heavy metals in PM2.5 was Cd > Ni > Hg > Pb > Cu > Zn > As > Co > Cr > Mn, and the ecological hazards were high. The main exposure of heavy metals in atmosphere was respiratory inhalation . The exposure quantity for children was significantly higher than that for adult. The hazard index values suggested a potential non-carcinogenic risk in PM2.5.

Advising on Preferred Reporting Items for patient-reported outcome instrument development: the PRIPROID.

OBJECTIVE: The reporting of patient-reported outcomes (PRO) instrument development is vital for both researchers and clinicians to determine its validity, thus, we propose the Preferred Reporting Items for PRO Instrument Development (PRIPROID) to improve the quality of reports. METHODS: Abiding by the guidance published by the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) Network, we had performed 6 steps for items development: identified the need for a guideline, performed a literature review, obtained funding for the guideline initiative, identified participants, conducted a Delphi exercise and generated a list of PRIPROID items for consideration at the face-to-face meeting. RESULTS: Twenty three items subheadings under 7 topics were included: title and structured abstract, rationale, objectives, intention, eligibility criteria, conceptual framework, items generation, response options, scoring, times, administrative modes, burden assessment, properties assessment, statistical methods, participants, main results, and additional analysis, summary of evidence, limitations, clinical attentions, and conclusions, item pools or final form, and funding. CONCLUSIONS: The PRIPROID contains many elements of the PRO research, and this assists researchers to report their results more accurately and to a certain degree use this instrument to evaluate the quality of the research methods.

[On the necessity of developing quality of life instruments in traditional Chinese medicine].

The development of health-related quality of life (HRQL) instrument in traditional Chinese medicine (TCM) is increasing rapidly in China, but few studies focus on their necessity. This study explores the necessity of the development of TCM instruments from both theoretical and practice perspectives, and aims to explain whether the adoption of the cross-medical style is valid. Through theoretical analysis, both TCM and Western medicine instruments show the same objectives, whereas TCM instruments are more suitable for the Chinese social behavior, customs and expectations. In practical analysis, 47 TCM instruments were identified, among which 17 had 18 corresponding Western medical instruments. In the domains layer, except for physiological, psychological and social factors, TCM instruments focus more on the harmony between body and spirit, humanity and nature or human and society and the constitution, etc. In the facts layer, TCM instruments focus on the emotions, initiative social intercourse, TCM symptoms, diet, sleep, taste, feces and urine, etc. In addition, significant differences existed in the methods of information selection. There is no need to modify cross-medical style research except when TCM characteristic terms exist, but attention must be paid to the influence of culture in different areas. Therefore, the TCM instruments can resolve the limitations of the application of Western medical instruments to the Chinese setting, while also having remarkable abilities of information coverage and detection. Both forms of instruments have the capacity and requirement to inter-communicate with each other in order to serve the whole Chinese cultural system. Generally speaking, there is no need to modify the instruments in cross-medical style research. But this point requires further demonstration in the rigorous designed clinical trials.

[Ultrasonographic fetal nasal bone assessment in prenatal screening for Down syndrome].

OBJECTIVE: To investigate the clinic value of ultrasonographic fetal nasal bone examination as a screening marker for Down syndrome (DS). METHODS: The study was conducted in the First Affiliated Hospital of Sun Yat-sen University from Oct 2004 to Mar 2007. Two-dimensional ultrasound was used to assess the fetal nasal bone of 1863 normal pregnancies (normal group) and 25 cases with DS fetus (study group) during their second and third trimesters. The incidence of nasal bone absence or short nasal bone in two groups was determined. The fetal nasal bone absence should be confirmed in three orthogonal planes of the fetal face, and the short nasal bone included the cases that the fetal nasal bone was shorter than the 2.5th percentile of normal according to the gestational week. The diagnostic test index was used for assessing the value of fetal nasal bone abnormality as a marker in prenatal screening for DS. RESULTS: (1) 1761 fetuses of normal group were successfully examined for the nasal bone and the detection rate was 94.5% (1761/1863). 102 fetuses failed examination because of inconvenient intra-uterine position. (2) The nasal bone length grew in a linear fashion throughout pregnancy and the growth pattern correlated well with gestational age (r = 0.605, P < 0.05) in normal group. The nasal bone was absent in 3 normal fetuses (0.2%, 3/1761) and short nasal bone was found in 44 normal fetuses (2.5%, 44/1761). (3) The nasal bone was absent in 7 DS fetuses (28.0%, 7/25) and short nasal bone was found in 15 DS fetuses (60.0%, 15/25). (4) When the absence of nasal bone was used as a cut-off, the sensitivity for DS was 28.0%, the specificity was 99.8%, the positive likelihood ratio was 164.45 (95% CI: 45.11-599.60), and the negative likelihood ratio was 0.72 (95% CI: 0.57-0.92). When short nasal bone was used as a cut-off, the sensitivity was 60.0%, specificity was 97.5%, the positive likelihood ratio was 24.03 (95% CI: 7.15-80.71), and the negative likelihood ratio was 0.41 (95% CI: 0.29-0.59). CONCLUSION: Fetal nasal bone hypoplasia at the second and third trimester scan is associated with a high risk for Down syndrome and it can be used as a screen marker for this chromosomal abnormality.