Does hip protector prevent falls and hip fractures? An umbrella review of meta-analyses.

BACKGROUND: Wearing hip protectors is a measure used to prevent hip fractures caused by falls. However, its protective effect has remained controversial in previous studies. This study provides a rationale for the use of hip protectors by pooling all the current meta-analysis evidence. METHODS: We conducted an umbrella review of all the current meta-analysis articles about the efficacy of hip protectors to reduce hip fractures and falls in communities and/or institutions. Major databases including EMBASE, Cochrane Library, PubMed and Web of Science, were searched up to June 2022. Two reviewers screened the studies, extracted the data, and conducted the methodological quality assessment independently. The primary outcome was the association statistic (odds ratio (OR), relative risk (RR), etc.) reported in the meta-analysis that quantified the influence of the intervention on hip fractures and falls compared to that of the control group. Narrative synthesis was also conducted. Forest plots and the AMSTAR score were used to describe the results and quality of the pooled literature, respectively. RESULTS: A total of six meta-analysis articles were included in the study. Hip protectors were effective at reducing hip fractures in older individuals who were in institutions (nursing or residential care settings) but not in communities (RR = 0.70, 95% CI 0.58 to 0.85, I2 = 42%, P < 0.001) (RR = 1.12, 95% CI 0.94 to 1.34, I2 = 0%, P = 0.20), and they did not reduce falls (RR = 1.01, 95% CI 0.90 to 1.13, I2 = 0%, P = 0.89). CONCLUSIONS: Hip protectors are effective at preventing hip fractures in institutionalized older adults but not in community-dwelling older adults. TRIAL REGISTRATION: This study has been registered in PROSPERO (PROSPERO ID: CRD42022351773).

Model-Informed Precision Dosing of Imipenem in an Obese Adolescent Patient with Augmented Renal Clearance and History of Schizophrenia.

Imipenem is a broad-spectrum antibiotic that has been used in treating severe infections and exhibits a time-dependent PK/PD profile. Its dose should be adjusted based on renal function. However, there is little experience with imipenem dosing in obese adolescent patients with augmented renal clearance (ARC) and history of schizophrenia. This case reported successful dosing of imipenem in an obese adolescent patient with ARC based on therapeutic drug monitoring (TDM) and model-informed precision dosing (MIPD). A 15-year-old male adolescent patient with history of schizophrenia was diagnosed with ventilator-associated pneumonia due to carbapenem-susceptible Klebsiella pneumoniae and received imipenem treatment (0.5 g every 8 hours with a 1-hour infusion). However, the exposure of imipenem was suboptimal due to ARC, and there is no available model for MIPD in this patient. Thus, we utilized prediction error to find a population pharmacokinetic model that fit this patient and ran Maximum a posteriori Bayesian estimation and Monte Carlo simulation based on screened models to predict changes in drug concentrations. The dose of imipenem was adjusted to 0.5 g every 6 hours with a 2-hour infusion, and subsequent TDM revealed that dosing adjustment was accurate and successful. Finally, the patient's status of infection improved. This study will be beneficial to imipenem dosing in similar cases in the future, thereby improving the safety and effectiveness of imipenem or other antibiotics.

Did the prevalence of traditional school bullying increase after COVID-19? Evidence from a two-stage cross-sectional study before and during COVID-19 pandemic.

BACKGROUND: COVID-19 has had a range of adverse effects on the behavior and mental health of adolescents globally, including bullying, anxiety and depression. However, there is a lack of comparative studies on the changes of school bullying before and during COVID-19 pandemic. OBJECTIVE: To examine the changes in traditional bullying before and during COVID-19 pandemic and reveal the related risk factors in Shantou, China. PARTICIPANTS AND SETTING: Two samples of secondary school students were collected in 2018 and 2021 in Shantou, respectively. METHODS: Bullying history and risk behaviors of students were measured in the past six months. The χ2 test was used to analyze differences in baseline information and bullying types. The binary logistic regression with Forward LR method was used to analyze factors that affect the risk of bullying victimization and perpetration before and during COVID-19. RESULTS: A total of 5782 secondary school students were included, 3071 before COVID-19 pandemic and 2711 during COVID-19. The prevalence of different types of victimization and perpetration all increased during COVID-19 (P < 0.001). Boarding, being a lower secondary school student (as opposed to upper secondary school), being male (as opposed to female), drinking, and playing violent video games were shared risk factors for bullying victimization and perpetration. Living in an urban (as opposed to rural and island) was a risk factor for perpetration. Smoking was a risk factor for perpetration. All differences were statistically significant (P < 0.05). CONCLUSIONS: We found that the prevalence of bullying victimization as well as perpetration increased during COVID-19. It suggests that we need to pay more attention to traditional school bullying prevention and control in China in the pandemic context.

Impacts of short-term air pollution exposure on appendicitis admissions: Evidence from one of the most polluted cities in mainland China.

Background: Emerging evidence indicates that air pollutants contribute to the development and progression of gastrointestinal diseases. However, there is scarce evidence of an association with appendicitis in mainland China. Methods: In this study, Linfen city, one of the most polluted cities in mainland China, was selected as the study site to explore whether air pollutants could affect appendicitis admissions and to identify susceptible populations. Daily data on appendicitis admissions and three principal air pollutants, including inhalable particulate matter (PM10), nitrogen dioxide (NO2), and sulfur dioxide (SO2) were collected in Linfen, China. The impacts of air pollutants on appendicitis were studied by using a generalized additive model (GAM) combined with the quasi-Poisson function. Stratified analyses were also performed by sex, age, and season. Results: We observed a positive association between air pollution and appendicitis admissions. For a 10 µg/m3 increase in pollutants at lag01, the corresponding relative risks (RRs) and 95% confidence intervals (95% CIs) were 1.0179 (1.0129-1.0230) for PM10, 1.0236 (1.0184-1.0288) for SO2, and 1.0979 (1.0704-1.1262) for NO2. Males and people aged 21-39 years were more susceptible to air pollutants. Regarding seasons, the effects seemed to be stronger during the cold season, but there was no statistically significant difference between the seasonal groups. Conclusions: Our findings indicated that short-term air pollution exposure was significantly correlated with appendicitis admissions, and active air pollution interventions should be implemented to reduce appendicitis hospitalizations, especially for males and people aged 21-39 years.

Development and implementation of a novel decision support tool on physical restraint use in critically ill adult patients.

AIM: To investigate whether a novel decision support tool would effectively minimize physical restraint use in critically ill adult patients. DESIGN: A nonequivalent quasi-experimental design combined with a descriptive qualitative approach was used. METHODS: A Restraint Decision Tree was developed based on a qualitative study that explored the barriers to employ the Restraint Decision Wheel. During the quasi-experimental study, patients admitted to the unit between October 2017 and March 2018 were enrolled as the control group receiving the Restraint Decision Wheel (n = 528), whereas patients between April 2018 and September 2018 were enrolled as the intervention group receiving the Restraint Decision Tree (n = 564). The physical restraint rate, accidental catheter removal rate and nurses' satisfaction were compared. RESULTS: The Restraint Decision Tree significantly decreased physical restraint use. No significant difference in the rate of accidental catheter removal was found. Nurses reported increased satisfaction with the restraint decision-making. CONCLUSIONS: The Restraint Decision Tree could minimize physical restraint use. Physicians' involvement in the restraint decision-making and nurses' competence in delirium assessment may be essential for successful implementation of the Restraint Decision Tree.

Serum iron status and the risk of breast cancer in the European population: a two-sample Mendelian randomisation study.

BACKGROUND: Previous observational studies have provided conflicting results on the association between serum iron status and the risk of breast cancer. Considering the relevance of this relationship to breast cancer prevention, its elucidation is warranted. OBJECT: We used a two-sample Mendelian randomisation (MR) study to explore the causal relationship between serum iron status and the risk of breast cancer. METHOD: To select single nucleotide polymorphisms (SNPs) that could be used as instrumental variables for iron status, we used the Genetics of Iron Status consortium, which includes 11 discovery and 8 replication cohorts, encompassing 48,972 individuals of European descent. Moreover, we used the OncoArray network to select SNPs that could be considered instrumental variables for the outcome of interest (breast cancer); this dataset included 122,977 individuals of European descent with breast cancer and 105,974 peers without breast cancer. Both conservative (SNPs associated with overall iron status markers) and liberal (SNPs associated with the levels of at least one iron status marker) approaches were used as part of the MR analysis. For the former, we used an inverse-variance weighted (IVW) method, whereas for the latter, we used the IVW, MR-Egger regression, weighted median and simple mode methods. RESULTS: When the conservative approach was used, iron status showed no significant association with the risk of breast cancer or any of its subtypes. However, when the liberal approach was used, transferrin levels were found to be positively associated with the risk of ER-negative breast cancer based on the simple mode method (OR for MR, 1.225; 95% CI, 1.064, 1.410; P = 0.030). Nevertheless, the levels of the other iron status markers showed no association with the risk of breast cancer or its subtypes (P > 0.05). CONCLUSION: In our MR study, the liberal approach suggested that changes in the concentration of transferrin could increase the risk of ER-negative breast cancer, although the levels of other iron status markers had no effect on the risk of breast cancer or its subtypes. This should be verified in future studies.

Dynamic changes of lipid profile in severe hypertriglyceridemia-induced acute pancreatitis patients under double filtration plasmapheresis: a retrospective observational study.

BACKGROUND: To investigate the dynamic change of lipid profile under double filtration plasmapheresis (DFPP) in severe hypertriglyceridemia-induced acute pancreatitis (sHTGP) patients and ascertain the association between these changes and the clinical prognosis. METHODS: sHTGP patients admitted within 72 h after disease onset were included, and all the patients received DFPP within 24 h after admission. Lipid profile were detected on admission, consecutive 4 days after DFPP and at discharge. RESULTS: There were 47 sHTGP patients enrolled in this study. At admission, all the parameters of lipid profile changed significantly except for low density lipoprotein. In the first day after DFPP, the serum level of TG, cholesterol and very low density lipoprotein declined significantly, while the high-density lipoprotein (HDL) as well as apoprotein A1 elevated obviously (P < 0.05). TG maintained the downward trend in the following three days and the other parameters kept steady. Linear regression analysis showed that HDL was negatively correlated with the duration of hospitalization among three adjusted models (P = 0.043, P = 0.029, P = 0.025 respectively). CONCLUSION: There was distinct fluctuation of the lipid profile upon the burst of sHTGP and the parameters changed significantly in the first day after DFPP. Among these parameters, HDL may serve as a biomarker for disease prognosis in patients with sHTGP.

The role of double filtration plasmapheresis in hypertriglyceridemic pancreatitis: A propensity score matching analysis.

INTRODUCTION: The role of double filtration plasmapheresis (DFPP) in hypertriglyceridemic pancreatitis (HTGP) is still not well established. Our study aimed to investigate the efficacy of DFPP in reducing triglyceride levels as well as their effects on the outcomes of HTGP. MATERIAL AND METHODS: We retrospectively evaluated the data of patients with HTGP presenting within 72 hours from symptom onset between January 2016 and February 2019. Patients with DFPP treatment were compared with those without DFPP treatment. We used a propensity score matching analysis to reduce confounding factors. RESULTS: Of the 249 patients enrolled, 88 (35.3%) were treated with DFPP. The DFPP was initiated at a median of 7.7 hours from the time of presentation. In the propensity score-matched cohort (n = 100), patients with DFPP had a significantly lower level of triglyceride (P = .034), higher triglyceride reduction (P = .005), and the proportion of triglyceride <5.65 mmol/L (P = .002) by 24 hours after admission when compared with those without DFPP. However, this efficacy did not last until 48 hours after admission. No differences were found in terms of the majority of the clinical outcomes between the two groups, including persistent organ failure (P = .098), local complications (P = .213), hospital stay (P = .657), and in-hospital mortality (P > .999). CONCLUSIONS: HTGP patients with early initiation of DFPP were associated with rapidly and efficiently reduction of triglyceride levels compared with those without DFPP. However, DFPP showed no beneficial effects on improving the clinical outcomes of HTGP.

MicroRNA-302d downregulates TGFBR2 expression and promotes hepatocellular carcinoma growth and invasion.

Hepatocellular carcinoma (HCC) is the second leading cause of cancer-associated mortality in China and the third leading cause worldwide. A number of microRNAs (miRNAs) have been implicated in cell cycle progression, growth, apoptosis, angiogenesis and metastasis in HCC. In the present study, reverse transcription-quantitative polymerase chain reaction analysis was used to detect the levels of miR-302d expression in the tissues of 30 patients with HCC. Cell cycle, growth, apoptosis and migration were analyzed using a cell counting kit, flow cytometry and a Transwell migration assay. Dual-luciferase reporter assays and western blotting were also used to analyze the expression levels of transforming growth factor beta type II receptor (TGFBR2) in HCC cells. The present study evaluated the role of miR-302d in the development and progression of HCC. Abnormally high expression of miR-302d was observed in 80% of HCC specimens. Moreover, patients with lower levels of miR-302d expression experienced a longer survival time than those with higher levels of miR-302d expression. It was demonstrated that miR-302d promoted HCC cell growth and migration, suppressed cell apoptosis and affected cell cycle distribution in vitro, and augmented tumorigenicity in vivo. Furthermore, TGFBR2, which is a tumor suppressor, was confirmed as a target of miR-302d in HCC cells. Dual-luciferase reporter assays indicated that TGFBR2 expression was negatively regulated by miR-302d. Taken together, the results of the present study suggest that miR-302d may serve as a valuable tool for predicting the prognosis of patients with HCC.

Effects of mild hypothermia therapy on the levels of glutathione in rabbit blood and cerebrospinal fluid after cardiopulmonary resuscitation.

OBJECTIVES: The aim of this study was to investigate the effects of mild hypothermia therapy on oxidative stress injury of rabbit brain tissue after cardiopulmonary resuscitation (CPR). MATERIALS AND METHODS: Rabbit models of cardiac arrest were established. After the restoration of spontaneous circulation, 50 rabbits were randomly divided into normothermia and hypothermia groups. The following five time points were selected: before CPR, immediately after CPR, 2 hr after CPR (hypothermia group reached the target temperature), 14 hr after CPR (hypothermia group before rewarming), and 24 hr after CPR (hypothermia group recovered to normal temperature). Glutathione (GSH) concentrations in both the blood and cerebrospinal fluid of the normothermia and hypothermia groups were measured. RESULTS: At 2, 14, and 24 hr after CPR, the GSH concentrations in both the blood and cerebrospinal fluid were significantly higher in the hypothermia group than in the nomorthermia group. CONCLUSION: Mild hypothermia therapy may increase GSH concentrations in rabbit blood and cerebrospinal fluid after CPR as well as promote the recovery of cerebral function.

The effect of therapeutic hypothermia after cardiopulmonary resuscitation on ICAM-1 and NSE levels in sudden cardiac arrest rabbits.

PURPOSE: To assess the effects of hypothermia and normothermia treatments for sudden cardiac arrest (SCA) on brain injury recovery in rabbit models. METHODS: Cardiopulmonary resuscitation (CPR) was implemented on apnea-induced SCA rabbit models. Fifty survived rabbits were then randomly received hypothermia (n = 25, 32-34°C) or normothermia treatment (n = 25, 39-39.5°C) for 12 hours. The expected body temperatures were achieved within the first two hours, maintained for ten hours and then rewarmed. The physiological parameters, neurologic function, and the levels of adhesion molecule ICAM-1 and neuron-specific enolase (NSE) were monitored. RESULTS: Hypothermia-treated rabbits had lower heart rate when achieving hypothermia (p < 0.0001) and higher SjvO2 after hypothermia maintenance (p = 0.038). The hypothermia group achieved better brain recovery performance according to the neurological deficit grading scale. ICAM-1 and NSE levels in both serum and CSF of the hypothermia group were lower than the normothemia group (all p < 0.0001) during hypothermia maintenance. CONCLUSION: Hypothermia treatment after CPR provides better outcome than normothermia treatment in SCA rabbits. Hypothermia can reduce the ICAM-1 and NSE levels in both serum and cerebrospinal fluid (CSF). This study supports the clinical implementation of hypothermia treatment for SCA and reveals that ICAM-1 and NSE are involved in the recovery of brain function after resuscitation.

Low Serum retinol-binding protein-4 levels in acute exacerbations of chronic obstructive pulmonary disease at intensive care unit admission is a predictor of mortality in elderly patients.

BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are thought to be associated with increased mortality in elderly patients. Low retinol-binding protein-4 (RBP4) is associated with a high risk of respiratory infections in the general population. Therefore, we hypothesized that low RBP4 levels are associated with an increased risk of AECOPD and can be used as a biomarker for AECOPD in elderly patients. METHODS: Enzyme-linked immunosorbent assays were used to assess RBP4 levels in elderly with AECOPD within the first 24 hours after intensive care unit admission. Forty-six elderly patients with stable COPD in outpatient clinics and 50 healthy elderly persons who had physical examinations as outpatients were controls. RESULTS: In AECOPD patients, RBP4 levels were lower than those in stable COPD patients and healthy controls (59.7 vs 91.2 and 113.6 mg/L, p < 0.001). RBP4 levels were decreased by 30.6% in non-survivors compared with survivors (51.5 vs 74.2 mg/L, p < 0.001). A higher Acute Physiology and Chronic Health Enquiry II (APACHE II) score and Simplified Acute Physiology score (SAPS II) were associated with lower RBP4 levels (r = -0.692, p = 0.024 and r = -0.670, p = 0.015, respectively). RBP4 was positively correlated with creatinine and body mass index, and negatively correlated with C-reactive protein and Global Initiative for Chronic Obstructive Lung Disease stage. Multivariate logistic regression showed that RBP4 was an independent mortality predictor of AECOPD (odds ratio: 0.926, p = 0.007). Analysis of the area under the receiver operating characteristic (AUC) curve showed that RBP4 showed good discrimination (AUC: 0.88; 95% confidence interval: 0.78-0.94; p = 0.008) in predicting mortality. RBP4 improved the prognostic accuracy of mortality for the APACHE II and SAPS II scores. CONCLUSIONS: Serum RBP4 levels are significantly reduced in elderly AECOPD patients. RBP4 might be a good predictive biomarker for mortality in elderly AECOPD patients in the intensive care unit.

FAT10 level in human gastric cancer and its relation with mutant p53 level, lymph node metastasis and TNM staging.

AIM: To investigate the role of FAT10 and mutant p53 in the pathogenesis, severity and prognosis of gastric cancer. METHODS: FAT10, mutant p53 mRNA and protein levels were measured by reverse transcription (RT)-PCR and immunohistochemistry in gastric cancer tissue (n = 62), tumor-adjacent tissue (n = 62) and normal gastric tissue (n = 62). Relation of FAT10 and mutant p53 expression with clinicopathological features and clinical outcomes of gastric cancer patients were analyzed. RESULTS: The FAT10, mutant p53 mRNA and protein levels were significantly higher in gastric cancer than in its adjacent and normal tissue. The FAT10 and mutant p53 levels in gastric cancer tissue were significantly correlated with lymph node metastasis and tumor, nodes, metastasis (TNM) staging. Moreover, the high FAT10 level was associated with the overall survival rate of patients. Multivariate Cox-proportional hazards model analysis showed that mRNA and protein levels of FAT10 and mutant p53, lymph node metastasis, distant metastasis and TNM stage were the independent prognostic factors for gastric cancer. CONCLUSION: FAT10 may be involved in gastric carcinogenesis, and is a potential marker for the prognosis of gastric cancer patients. FAT10 and mutant p53 may play a common role in the carcinogenesis of gastric cancer.

Relationship between matrix metalloproteinase-2 mRNA expression and clinicopathological and urokinase-type plasminogen activator system parameters and prognosis in human gastric cancer.

AIM: To investigate the relationship between matrix metalloproteinase-2 (MMP-2) mRNA expression and clinicopathologic and urokinase-type plasminogen activator (uPA) system parameter and prognosis in human gastric cancer. METHODS: Expression of MMP-2 mRNA, uPA, and uPA-R mRNA in tumor tissues and > or =5 cm adjacent normal tissues from 67 cases of gastric cancer was studied using RT-PCR and Northern blot respectively. Survival analyses were done using the Kaplan-Meier method. RESULTS: The expression rates of MMP-2 mRNA, uPA and uPA-R mRNA in tumor tissues (31%, 41%, and 51%, respectively) were significantly higher than those in > or =5 cm adjacent tissues (19%, 11%, and 9%; chi(2) = 4.59, 43.58, and 53.24 respectively, P<0.05, 0.0001, and 0.0001, respectively). Expression of MMP-2 mRNA was significantly correlated with lymph node metastasis (metastasis: 61.9%, no metastasis: 39.1%, chi(2) = 7.61, P<0.05), Lauren's classification of diffuse/mixed types: 54.2%, intestinal type: 26.3%, chi(2) = 4.25, P<0.05, expression of uPA and uPA-R mRNA (uPA+: 55.1%, uPA-: 22.2% and uPA-R+: 54.9%, uPA-R-: 18.8%, chi(2) = 5.72 and 6.40 respectively, P<0.05). Kaplan-Meier survival analysis of MMP-2 mRNA expression did not show significant difference in all 67 cases, but revealed an association of the expression of MMP-2 mRNA, uPA, and uPA-R mRNA with worse prognosis (P = 0.0083, 0.0160, and 0.0094, respectively). CONCLUSION: MMP-2 may play an important role in the development of invasion and metastasis of gastric cancer.