The association of stress perception on anxiety, depression and sleep quality in parents of children with burns: The moderating effect of social support.

OBJECTIVE: Few studies have explored the mental health status of parents of children with burns and the moderating effect of social support on them. METHODS: A survey was performed with parents of 112 burn-injured children at a burn center in China. Their perceived stress, anxiety, depression, sleep quality, and social support were measured by the Chinese Perceived Stress Scale, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and Perceived Social Support Scale. RESULTS: ➀ The prevalence of anxiety (46.43%), depression (52.67%) and poor sleep quality (43.75%) of parents indicated that they experienced emotional and sleep disorders;➁ The perceived stress was positively correlated with sleep quality, anxiety and depression（P＜0.01), and negatively correlated with perceived social support (p＜0.05); ➂ Social support had a significant moderating effect on their perceived stress and anxiety, depression, but not on their sleep quality. With high social support, parental perceived stress had a significant positive association on anxiety and depression, while with low perceived social support, parental perceived stress had no significant association on anxiety and depression. CONCLUSION: Parents of burned children had increased stress, obvious symptoms of anxiety and depression, and poor sleep quality. Social support had a significant buffering effect on them under low pressure, and high pressure will hinder the buffering effect of social support on stress. Therefore, the ideal services to improve mental health should be provided for them to face different levels of stress.

Filter Lifespan, Treatment Effect, and Influencing Factors of Continuous Renal Replacement Therapy for Severe Burn Patients.

Continuous renal replacement therapy (CRRT) is often disrupted due to various factors, such as patient-related issues, vascular access complications, treatment plans, and medical staff factors. This unexpected interruption is referred to as non-selective filter stoppage and can result in additional treatment expenses. This study conducted a retrospectively analyzed 501 CRRT filters used in 62 patients with severe burns, lifespan and therapeutic effect of all filters were mainly analyzed, used logistic regression analysis was performed to identify risk factors associated with non-selective cessation filters. Out of 493 filters, 279 cases received heparin (56.60%), the median lifespan of the filter was 14.08 h (25th, 75th quantile: 7.30, 21.50); 128 cases were treated with nafamostat mesylate (26.00%), and the median lifespan of the filter was 16.42 h (10.49, 22.76); 86 cases were treated with sodium citrate (17.40%), and the median lifespan of the filter was 31.06 h (19.25, 48.75). In addition, significant differences were observed in the electrolyte index, renal function index, and procalcitonin levels before and after treatment with a single filter (P < .001). Multivariate logistic regression showed that the risk of non-selective cessation of sodium citrate anticoagulants was lower than that of heparin anticoagulation. Overall, CRRT is progressively becoming more prevalent in the treatment of patients with severe burns. The lifespan of individual filters and total patient treatment duration showed a consistent upward trend. The filter's lifespan was notably greater during sodium citrate anticoagulation when compared to nafamostat mesylate and heparin, meanwhile notably reducing the risk of non-selective cessation. Therefore, we recommend sodium citrate for anticoagulation in patients without any contraindications.

Development and validation of a simple-to-use nomogram for self-screening the risk of dyslipidemia.

This study aimed to help healthy adults achieve self-screening by analyzing the quantitative relationship between body composition index measurements (BMI, waist-to-hip ratio, etc.) and dyslipidemia and establishing a logical risk prediction model for dyslipidemia. We performed a cross-sectional study and collected relevant data from 1115 adults between November 2019 and August 2020. The least absolute shrinkage selection operator (LASSO) regression analysis was performed to select the best predictor variables, and multivariate logistic regression analysis was used to construct the prediction model. In this study, a graphic tool including 10 predictor variables (a "nomogram," see the precise definition in the text) was constructed to predict the risk of dyslipidemia in healthy adults. A calibration diagram, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) were used to verify the model's utility. Our proposed dyslipidemia nomogram showed good discriminative ability with a C-index of 0.737 (95% confidence interval, 0.70-0.773). In the internal validation, a high C-index value of 0.718 was achieved. DCA showed a dyslipidemia threshold probability of 2-45%, proving the value of the nomogram for clinical application for dyslipidemia. This nomogram may be useful for self-screening the risk of dyslipidemia in healthy adults.

Epidemiological and clinical characteristics of older adults with burns: a 15-year retrospective analysis of 2554 cases in Wuhan Institute of Burns.

BACKGROUND: With the increase of geriatric burns, it's urgent to summarize its characteristics. The aim of this study was to analyze the epidemiological and clinical characteristics of older adults with burns in a large center, and to provide suggestions for the prevention and treatment of geriatric burns. METHODS: This retrospective study was conducted at Wuhan Institute of Burns which is the largest burn center in central China between 2004 to 2018. Demographic and clinical data of the 60 years or above older burn inpatients were collected from medical records, analyzed and compared among groups. RESULTS: This study analyzed 2554 elderly burns, which included 50.9% in young geriatric group (60-69 years old), 32.9% in middle geriatric group (70-79 years old) and 16.2% in the oldest geriatric group (80 years old or above). The most common causes of elderly burns were flames (1081, 42.3%) and scalding (1041, 40.8%). Elderly burns with total body surface area (TBSA) of 0-9% accounted for 60.6% and the larger TBSA, the fewer number of patients. The majority of patients (70.5%) injured at home.The median of time interval from injury to admission was 7 h and the oldest geriatric group (24 h) was highest. One hundred and twenty-one cases (8.5%) were treated by cooling treatment, and 72.7% of these patients were treated less than 10 min. The median number of pre-injury diseases was one. Ninety patients (6.3%) had inhalation injury.The median length of stay (LOS) was 14 days.The median hospital cost was 10,410 CNY or 2137 CNY per % TBSA, which was correlated with TBSA, LOS, surgery, inhalation injury, number of pre-injury diseases and etiology. The mortality rate was 3.0% and correlated with TBSA, inhalation injury, pulmonary disease and Alzheimer's disease. The lethal area 50% (LA50) for total admitted elderly burns was 78.3% TBSA (95% confidence interval [CI] = 69.8 ~ 89.9% TBSA). CONCLUSION: Geriatric burns was still common and even increasing in central China, with flame burns and scalds the most common causes, majority of whom injured at home and often had problems such as few cooling treatment, improper emergency management and delayed admission. TBSA, etiology, pre-injury diseases and inhalation injury were the risk factors of length of stay, hospital cost and treatment outcomes.

Family sports interventions for the treatment of obesity in childhood: a meta-analysis.

BACKGROUND: Obesity in children has become one of the key concerns of the World Health Organization, and the incidence of related non-communicable diseases is also rising. This study evaluates the effect of family sports participation on the treatment and prevention of obesity in children aged 0-14 years by systematic analysis. METHOD: A literature review from 2000 to 2020 was conducted. According to PRISMA-IPD (Preferred Reporting Items for MetaAnalyses of individual participant data) guidelines. The two researchers independently assessed the risk and bias of the articles, obtained a comprehensive, high-quality result, and extracted the data based on the Cochrane intervention system review manual. Randomized controlled trials (RCTs) were selected from the searches that used family sports interventions or family sports combined with dietary adjustments and behavioral habits change. Only studies targeting overweight or obese children aged 0-14 years were included. RESULTS: The search resulted in a total of 16 studies. Across all 16 studies, there were a total of 1680 participants in the experimental groups and 1701 participants in the control groups. The results are as follows: body mass index (BMI) (SMD-RE = - 4.10, 95% CI (- 0.84 to 0.02), Z = 1.88, p = 0.06); Body weight (SMD-RE = - 0.77, 95% CI (- 1.53 to - 0.01), Z = 2.00, p = 0.05); Waist circumference (SMD-RE = - 0.45, 95% CI (- 1.36 to 0.47), Z = 0.96, p = 0.34); and Body fat rate (SMD-FE = - 0.06, 95% CI (- 0.22 to 0.11), Z = 0.69, p = 0.49). Hence, through family sports intervention among obese children, juvenile and obese body composition-BMI, body weight, waist circumference, and body fat rate-are all reduced. But only body weight was statistically significant. CONCLUSIONS: Compared with the samples without family sports, the weight of obese children participating in family sports decreased, but there were no significant differences in other relevant physical indicators. Follow-up research should examine large-scale clinical trials with family sports as a single factor intervention, which are needed to provide stronger evidence of the intervention effect. However, family activities can help obese children grow and develop by improving their exercise capacity, enhancing their lifestyles, and facilitating communication and relationships with their parents. In the future, long-term sports training plans for children with obesity should be implemented.

Analysis of 12,661 pediatric burns in Wuhan institute of burns: A retrospective study of fifteen years.

BACKGROUND: By analyzing the epidemic characteristics of pediatric burns in a burn center serving large areas of Hubei Provence and partly surrounding provinces around Wuhan City, the aim of this study is to provide better strategies for the prevention and care for pediatric burns. METHODS: Pediatric burn patients who were younger than 13 years old in Wuhan Third Hospital from 2004 to 2018 were included. Demographic and clinical data were collected, analyzed and compared among groups. RESULTS: 12,661 pediatric burns, mean aged 2.37 ± 2.30 y, were admitted during the 15 years, with 7973 boys (62.97%) and 4688 girls (37.03%). By age groups, infant (<3y), preschool (>3-6y) and school children (>6-13y) accounted for 81.12% (10,270 cases), 12.08% (1530 cases) and 6.80% (861 cases) respectively. The most cause of injury was scalds (11,232, 88.71%), followed by flame burns (917, 7.24%), electric burns (201, 1.59%), contact burns (127, 1.00%), firework or firecracker (124, 0.98%), chemical burns (40, 0.32%) and hot crush injury (20, 0.16%). The mean age of firework or firecracker burns was 6.19 ± 2.83y, electric burns 5.18 ± 3.31y, flame burns 4.73 ± 3.53y, hot crush injury 3.85 ± 2.37 y, contact burns 3.66 ± 3.35y, chemical burns 3.03 ± 2.50y, and scald 2.06 ± 1.91y. Over half cases (57.34%) were small burns less than 10% total burn surface area (TBSA) and the larger TBSA, the fewer number of patients. The mortality rate was 0.11% and correlated with TBSA, age and etiology. The mean length of stay (LOS) was 12.63 ± 11.91 days and highly correlated with etiology and TBSA. The mean hospital cost was 11210.76 ± 21248.87 RMB (about 1600 USD) or 1626.91 ± 3957.59 RMB (about 230 USD) per % TBSA, which was correlated with depth of burn, TBSA, etiology, LOS and age. CONCLUSION: Pediatric burns in central China was still common and even increasing. Majority of the pediatric burn victims were boys under three years old, while the mean ages of different etiologies varied from about 2-6 years old. Education and prevention aiming the high risks are the key point to decrease pediatric burns.

Impact of comorbidities on clinical prognosis in 1280 patients with different types of COVID-19.

The study aimed to compare the clinical characteristics and outcomes of patients with different types (ordinary, severe, and critical) of COVID-19. A total of 1280 patients diagnosed with COVID-19 were retrospectively studied, including 793 ordinary patients, 363 severe patients and 124 critical patients. The impact of comorbidities on prognosis in ordinary, severe, and critical patients were compared and analyzed. The most common comorbidities were hypertension (33.0%), followed by diabetes (14.4%). The length of hospital stay and time from the onset to discharge were significantly longer in ordinary patients with comorbidities compared with those without comorbidities. Critical patients with comorbidities had significantly lower cure rate (19.3% vs 38.9%, p<0.05) and significantly higher mortality rate (53.4% vs 33.3%, p<0.05) compared with those without comorbidities. The time from onset to discharge was significantly longer in ordinary patients with hypertension compared with those without hypertension. The mortality rate of critical patients with diabetes was higher than that of patients without diabetes (71.4% vs 42.7%, p<0.05). Men had a significantly increased risk of death than women (OR=4.395, 95% CI 1.896 to 10.185, p<0.05); patients with diabetes had higher risk of death (OR=3.542, 95% CI 1.167 to 10.750, p<0.05). Comorbidities prolonged treatment time in ordinary patients, increased the mortality rate and reduced the cure rate of critical patients; hypertension and diabetes may be important factors affecting the clinical course and prognosis of ordinary and critical patients, respectively.

Resveratrol accelerates wound healing by attenuating oxidative stress-induced impairment of cell proliferation and migration.

BACKGROUND: Impaired wound healing, which is due to various external and internal factors that are involved in wound pathophysiology, leads to high rates of morbidity and mortality worldwide. Oxidative stress injury is an important factor that affects wound healing by changing the whole healing process. So, resveratrol, a dietary fruits polyphenol, which is known for its antioxidant properties, maybe the candidate to accelerate the wound-healing process. METHODS: The Human Umbilical Vein Endothelial Cells (HUVECs) was used for in vitro experiments to evaluate the effect of resveratrol on hyperglycemia-induced gene expression, oxidative stress and cell proliferation. The diabetic rat model was used to evaluate the effect of resveratrol on cutaneous burn injury healing process. RESULTS: Increases in H2O2 decreased cell viability with the 0-800 µM concentration range, and resveratrol could protect HUVECs against H2O2-induced injury. The scratched wound closed rate in H2O2 group was significantly smaller than the Control group (p < 0.05) and Resveratrol + H2O2 group (p < 0.05). The fluorescence intensity of ROS was lower in Control and Resveratrol + H2O2 groups than H2O2 group. Correspondingly, compared to H2O2 group, the expressions of Mn-SOD and nuclear Nrf2 (N-Nrf2) was up-regulated in Resveratrol + H2O2 group (p < 0.05). In vivo, compared with the saline group, using resveratrol could significantly accelerate wound healing of rats on Day 14 (p < 0.05) and make the regenerated skin structure more complete and inflammatory response lower. Moreover, the expressions of Mn-SOD was significantly up-regulated after using resveratrol. CONCLUSIONS: Resveratrol has the positive effects on promoting the acceleration and quality of skin wound healing, which maybe at least in part caused by the up-regulation of nuclear Nrf2 and Mn-SOD that subsequently attenuated oxidative stress.

PIWIL2 may serve as a prognostic predictor in cancers: A systematic review and meta-analysis.

PURPOSE: PIWIL2, one of the PIWI gene subfamily, is now thought to be closely related to poor clinical outcomes in various cancers. The aim of this research was to comprehensively estimate its predictive value in the prognosis of cancer patients. METHODS: We thoroughly searched PubMed, Web of Science and Embase databases for eligible articles published until April 4th 2019, in which the association between cancer prognosis and PIWIL2 expression level was studied. Study qualities were assessed using NOS criteria. We performed analyses by Stata SE 12.0 and RevMan 5.3. The primary endpoints contained overall survival (OS), cancer-specific survival (CSS), metastasis-free survival (MFS), recurrence-free survival (RFS) and disease-free survival (DFS). RESULTS: Ten studies containing 2116 patients with 8 various solid cancers were finally included. The outcomes indicated that cancer patients with higher PIWIL2 expression level had significant shorter OS (HR:2.20, 95%CI:1.25-3.88, p=0.006), DFS/RFS/MFS (HR:2.96, 95%CI:1.68-5.23, p<0.001), CSS (HR: 2.12, 95%CI: 1.40-3.23, p<0.001) than cancer patients with lower PIWIL2 expression level. What's more, PIWIL2 over-expression was significantly correlated to more lymph node metastasis (LNM) (OR:1.61, 95%CI:1.28-2.02, p<0.001). And PIWIL2 expression was not significantly correlated with age, gender, differentiation, tumor invasion, tumor size, TNM stage and distant metastasis (DM). CONCLUSIONS: A higher expression level of PIWIL2 may predict a poorer prognosis of cancer patients. And its prognostic values are not significantly influenced by clinicopathological characters. Therefore, PIWIL2 could serve as a personalized prognostic predictor in cancers in the future.

Awareness of female condoms and failures reported with two different types in China.

OBJECTIVE: To explore knowledge and use of female condoms in China, and to compare four modes of failure between the Phoenurse female condom (PFC) and the second-generation Femidom female condom (FC2). METHODS: In a randomized, crossover trial, sexually active women aged 20-49years who attended a family planning service in Qingdao, China, were recruited between April and October, 2013. A computer-generated randomized sequence was used to assign participants (1:1) to group A (used 10 PFCs followed by 10 FC2s) or group B (used 10 FC2s followed by 10 PFCs). Study investigators and participants were masked to allocation. Participants completed questionnaires at baseline and after using the two types of FCs. They also kept coital logs. RESULTS: At baseline, 30 (10.3%) of 290 participants understood female condoms, but only 1 (0.3%) had ever used one. Total failure rates were 3.6% (420/11 578) and 2.3% (265/11 594) for PFC and FC2, respectively (P<0.001). Slippage was the most common form of failure, affecting 6.9% of PFC uses and 5.0% of FC2 uses. Breakage, misdirection, and slippage were significantly more common with the PFC than with the FC2 (P≤0.002). CONCLUSION: Understanding of female condoms is poor in China. Failure is more common with the PFC than with the FC2.

Medical abortion service in rural areas of Henan Province, China: a provider survey.

AIM: The aim of this study was to explore the knowledge, attitudes and practices on medical abortion of abortion service providers in rural areas of China. MATERIAL AND METHODS: A cross-sectional study via self-administered questionnaire was conducted among 362 abortion service providers from family planning service centers (FPSC) and hospitals in rural areas of Henan Province, China, between November 2009 and May 2010. RESULTS: Most of the providers were female (99.4%) and obstetricians/gynecologists (63.3%). The knowledge score achieved ranged from 9.4 to 78.1 points, with both the median and the mode of 56.3 points. Of the 52.2% (189/362) of providers having a preference on abortion method, 30.2% (57/189) preferred medical abortion, while 69.8% (132/189) preferred surgical abortion. In total, 50.7% (174/343) of the providers indicated the provision of medical abortion should be expanded, with the three biggest challenges in its further expansion being increased complications/failures, poor client knowledge/awareness, and problems with drug/equipment supplies. Of all the providers, 81.7% and 92.2% reported they had experience in providing medical abortion and surgical abortion, respectively. Medical abortion providers were mainly experienced in misoprostol with oral (81.8%)/vaginal (79.6%) prostaglandin (misoprostol/gemeprost). CONCLUSION: Knowledge on medical abortion of providers working in rural China was at a moderate level. Providers preferred surgical abortion to medical abortion. Providers have more experience in providing surgical abortion than medical abortion. Efforts should be made to overcome the perceived challenges in future expansion of medical abortion.

Study of knowledge and attitudes on medical abortion among Chinese health providers.

OBJECTIVE: To investigate providers' knowledge and attitudes about medical abortion (MA) and their views regarding the main challenges to expanding the use of MA in urban and rural areas in China. METHODS: A total of 658 abortion providers were surveyed from November 7, 2009, to May 29, 2010. RESULTS: The providers' knowledge about MA was relatively poor, and most thought the risks of severe complications of MA were much higher than they are. Urban nonphysician providers were the least informed about MA. Most providers thought that the main challenges to an expanded use of MA were its lesser effectiveness in comparison to surgical abortion and women's lack of knowledge about it. In rural areas many providers thought that deficiencies of clinics, such as limited bed space and inadequate toilets and washing facilities, also posed serious obstacles to expanding MA use. CONCLUSION: Abortion providers, especially urban nonphysician providers, need refresher training to strengthen their knowledge of the approved protocol for providing MA in China, and also of the indications, contraindications, and safety and efficacy of the method. Deficiencies at abortion facilities should be addressed as well, and they are more numerous in rural areas.